Monkeypox spreads by direct contact, not just through sex; India has no access to vaccine

“Some members of the gay and bisexual community were at wrong place at wrong time during the initial spread of monkeypox in the US earlier this year,” a health expert clarified

Monkeypox spreads by direct contact, not just through sex; India has no access to vaccine

Ashlin Mathew

With the current spike in monkeypox cases in the country and the World Health Organisation having declared as a global health emergency, there are concerns about the spread of the disease. Since May 2022, more than 30,000 cases have been reported round the world, nine of them in India. However, India still doesn’t have access to a monkeypox vaccine.

The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV) identified A.2 strain of monkeypox virus in the two new cases of people who had returned from the United Arab Emirates (UAE) in July. NIV is yet to find out the transmissibility of the strain. In Europe, the variant found is mostly B.1.

Monkeypox, which comes from the same virus (Orthopoxvirus) family as smallpox, is caused by infection with the human monkeypox virus. The symptoms include fever, headache, chills, muscle aches, rashes, blisters in genital organs and lesions on the body. It spreads through close bodily contact with an infected person. Initially, a majority of the cases are transmitted from infected animals to humans by direct contact.

There are two known clades of the monkeypox virus – West African and Central Africa (Congo Basin) – of which the Congo Basin strain causes more severe illness. The genome sequence decoded at NIV-Pune showed similarities with the West African clade.

The monkeypox virus has been prevalent in Central and West Africa since 1970 and now has been reported from various non-endemic countries in 2022.

“People get exposed to the virus when they are physically very close to each other. Scabs are infectious and it can remain on beddings and clothes. It can spread through contact with beddings or clothes which have come in contact with an infected person’s blisters and bodily fluids,” said Dr Lalit Kant, former head of epidemiology and communicable diseases at ICMR.

He explained that monkeypox can affect anybody. “Some members of the gay and bisexual community were at the wrong place at the wrong time during the initial spread in the US earlier this year. They had collected together where there was a lot of bodily and skin-to-skin contact and there must have been an infected person in their midst. This allowed the virus to move around. It’s unfortunate these individuals had an infected individual amongst them,” he said.

Most people born before 1980 have had smallpox vaccination in India and it seems to be effective against monkeypox. "This is not infectious as measles, chicken pox or German measles. There has to be intimate contact. The risk of transmission is remote," added Dr Jaiprakash Muliyil, epidemiologist and member of the the National Technical Advisory Group on Immunisation (NTAGI).

World Health Organisation Director General Tedros Adhanom Ghebreyesus, who had declared monkeypox as a health emergency in July, said this stigma will “make the outbreak much harder to track and to stop”.

“It is important to note that the risk of monkeypox is not limited to men who have sex with men. Anyone who has close contact with someone who is infectious is at risk,” he had clarified.

Kant pointed out that when smallpox was detected in adults and they were vaccinated, they had shown the presence of the smallpox virus in the semen. “They were able to transmit the smallpox vaccine virus through sex. So, it is known that this virus is transmissible through sex. It’s nothing new,” he said.

A recent study in The Lancet showed that the monkeypox virus may be sexually transmissible. The study had assessed viral shedding in semen samples collected 5–19 days after symptom onset in a patient and it found that semen collected in the acute phase of infection (day 6 after onset of symptoms) may contain a replication-competent virus and represent a potential source of infection.

Monkeypox is preventable as long as people avoid direct contact with infected animals and people. Smallpox vaccination seems to have about an 85% chance of fighting the infection.

In 1980, when the WHO had declared smallpox as eradicated from the world, it had asked all the countries storing smallpox strains to destroy them or hand them over to WHO. India was one of those countries which haven’t kept any of the smallpox strains with them -- vaccine or otherwise.

“Currently, there are two vaccines which have been approved for used against monkeypox – MVA-BN smallpox vaccine, ACAM 2000. Of these, ACAM 2000 was approved recently and has registered a number of adverse events. It cannot be given to cardiac patients. MVA-BN smallpox vaccine produced by the Danish company Bavarian Nordic has been approved for use in Canada, European Union, UK and USA,” observed Kant. This vaccine is based on a strain of vaccinia virus (known generically as modified vaccinia Ankara Bavarian Nordic strain, or MVA-BN).

Dr Pragya D Yadav, senior scientist at Pune-based ICMR-NIV, has said that India currently doesn’t have a smallpox vaccine. Kant pointed out that India has just initiated a dialogue with the companies.

Globally, only 16.4 million doses are available of this vaccine, of which 1.4 million are readily available for use and 15 million doses are only available in bulk form.

Globally, countries have signed contracts with Bavarian Nordic, as a result of which the US is slated to buy 14.4 million doses; EU-Canada, UK and Germany are set to purchase 2 million doses.

Currently, the Danish-based company has stated that doses were available in Brazil, Canada Cyprus, Democratic Republic of Congo, Denmark, Europe, France, Germany, Nigeria, Portugal, Scotland, Spain, UK, Israel, and Mexico.

Additionally, the company has closed down for improving their production line for manufacturing other vaccines. At the moment no production is happening for the smallpox vaccine and production is set to start in 2023.

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