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Monkeypox Outbreak: All you need to know!

Jun 01 | 2:00 PM

On 6 May 2022, a monkeypox epidemic was reported, commencing with a British citizen who displayed symptoms compatible with monkeypox on 29 April 2022 after visiting Nigeria (where the disease is endemic). On 4 May, the resident returned to the United Kingdom, becoming the outbreak's index case in the country. Handling bushmeat, an animal bite or scrape, body fluids, contaminated objects, or close contact with an infected human can all spread monkeypox. Fever, headaches, muscle problems, swollen lymph nodes, and tiredness are the first symptoms. The current treatment standard is tecovirimat, an antiviral that is specifically designed to treat orthopoxvirus infections like smallpox and monkeypox. Join us live to understand all about the virus, it's symptomatology and recommended Mx!

[Music] hi dr richard welcome you all on behalf of team netflix and on 6th of may uh 2022 who reported first case of monkey pox and ever since we all are wondering if this is going to be smallpox of this century we have a lot of questions sir and we hope that uh you all you will be guiding us through this and help us to prepare uh what's coming up so uh to everyone we have dr ram gopal krishnan with us senior consultant infectious disease specialist practicing at apollo hospital chennai surrey is also acting professor and distinguished uh clinical tutor uh and at apollo hospital education and research foundation uh i welcome you sir on behalf of team and i'm glad you could join us to guide us on this important topic looking forward to learn a lot today so with this we can start okay thank you all hope all of you can see my slides and hear me we'll get started so today's today's topic is monkey pox and uh the question was asked will monkey pox be the smallpox of this century uh we will see at the end of this presentation right so so a few basics to those of you who have forgotten all your virology in your third year of mbbs but are now forced to relearn it in this kovid era fox viruses are really big viruses they are kind of like small bricks and they have a double-stranded dna genome they're kind of old viruses there are many viruses around the world which largely cause disease in animals and typically they cause a vesicular rash either in one place or all over the body and this is a classification of ox viruses you can see that the orthodox virus contains most of the viruses that are pathogenic to humans variola is the old smallpox chicken the vaccinia is your your vaccine-induced disease the vaccine itself can cause disease monkey box we'll be discussing today cowpox is a minor zoonosis the only other important virus in this family is molluscum contagiosum which can cause these umbilicated nodules in kids so it's really quite an obscure family of viruses till it hit the news recently it's been around for quite a while it was first described almost half a century ago in monkeys that's the reason for the name although currently it really has nothing to do with monkeys and roughly about 10-15 years after its discovery in in monkeys it was described in humans it is a zoonosis in most past part of the world what is the zoonosis you get it when you interfere with nature you go to places where you're not supposed to go you go you handle animals that you're not supposed to handle including many of these mammals listed here on this on this slide a gambian pouched rat for instance or a mouse etc so if it's if it's in these animals it doesn't cause any morbidity or mortality to humans if you go there and try to um to to interact with this mammal typically to consume this mammal as food in parts of rural africa that's how you pick up infection so by and large for the last 50 years this has been a zoonotic disease it's typically described in africans in rural countries in africa who go into the bush to kind of supplement their meat intake by by catching these small mammals and eating them typically if you don't cook the food you can get this infection so that's how it has been all these days if a human gets infected then yes they are infectious to others either people in their immediate family or health care workers if they if they end up in a healthcare system and transmission is not very efficient it's certainly not like covid and it's far less compared to smallpox for instance if in the smallpox era if somebody got infected 50 to 80 percent of the family members for that patient would get infected whereas for monkey pox it's only eight percent so it's not particularly infectious you have to have very close face to face contact and the transmission is through large respiratory droplets so it's certainly not like tbe or chickenpox and and and not like covert either you require much closer contact to get this particular virus so this is how the disease is transmitted it exists in nature in these cute little rats in africa humans get infected by handling these infected animals they may pass it on to family contacts and to health care workers as well and if somebody is pregnant it can go through to the fetus and once somebody is infected they develop the skin lesions which in turn are contagious to others through contact the disease is also spread to large respiratory droplets what does that mean it means if you're more than two meters away from me you can't get it the droplets drop to the floor it is not airborne doesn't fill the room like tv or chickenpox or sometimes even covet in aerosolized generating issues body fluids and contaminated materials like linen for instance are highly infectious and so it can get in through the respiratory tract through mucous membranes or through broken skins this is the way this disease is transmitted so the first case was described in 1970 at that time they had a large smallpox elimination program and they were surprised to see fox-like lesions that is how this virus was first described and since then there have been outbreaks described in africa typically in the congo basin democratic republic of the congo central and west africa and many of these central african countries have been reporting periodic outbreaks of monkey paws fox over the years kind of flying under the radar because this never developed into a pandemic till day so these are the african countries just to to revise your geography which typically are infected most of them have locally acquired disease with some important disease in adjoining countries and this is ongoing since 2017 african countries are seeing more and more cases perhaps we are invading nature's territory more and more perhaps there is more awareness and greater clinician expertise at making this diagnosis certainly nigeria has been experiencing an outbreak cameroon also has been experiencing an outbreak and the democratic republic of the congo has periodic outbreaks including fatality the the case fatality rate most recently was about 10 so africans and african physicians are are certainly no strangers to this disease and the disease is periodically exported out of africa just like covet was exported out of out of china this disease has been exported out of africa and it's quite interesting many of these these animals which has have this virus are quite cute looking and they are in demand as pets so rich american kids like to handle these pets and and from a pet store they spread to prairie dogs which are seen in the u.s and those again caused disease about 50 odd people were infected at that time no some hospitalizations but no severe disease periodic imported infections in other parts of the world there are now two clades of this virus which have been described slightly different in that the west african clade is less severe the current outbreak is all due to the west african clade the mortality rate is much less less than one percent the more severe clade the central african clade luckily has not been reported outside africa and certainly not in this current outbreak you can see here that the central african one is much more virulent it can spread up to many more generations of persons as well so we are dealing exclusively with the west african clay so moving on to the clinical features of monkey pox this is well described there are several phases the incubation period is between 5 and 20 days so quite a long time after you move out of an endemic area you can pick this up and that is the reason for prolonged isolation prolonged quarantine etc the femoral stage is lasts for about four days then rash develops and then you get better so the disease starts with a typical non-specific febrile illness before the rash develops it's impossible to make the diagnosis but luckily a rash appears in virtually all patients later on i'll show you some photos in a minute but characteristic of this disease are is sperm and soul involvement vesicular rashes rarely involve the palms and souls so if somebody has palm and soul involvement please think of monkey pass the disease characteristically progresses through several stages i'll just show you some photos in a minute the lesions may be depressed and can be extremely itchy right and one other characteristic clinical feature of monkey pox that you don't get in other vesicular diseases like chickenpox or even smallpox or or herpes is lymphadenopathy they have prominent systemic lymphadenopathy the mucous membranes may be affected typically the mouth the genitalia as well as the conjunctiva and many ocular complications have been reported so this is the classic progression of lesions they're all in the same stage which is as opposed to chickenpox where lesions may be in multiple stages of evolution starts off as a macule and progresses to papule vesicle and finally a pustule and which finally cross over so you can see here that the lesions can be quite disfiguring and can cause a lot of social stigma these are typical early symptoms fever lymph node source rash eye irritation or redness and many complications can occur although in the modern era with better supportive care complications should be less you can have a complication like a bacterial infection of the eyes or of skin strep or staff can enter through the skin patients can have diarrhea vomiting can involve the cns can cause encephalitis and also pneumonia so if somebody has vision loss or has altered mental status respiratory distress you should be very careful and always suspect secondary bacterial sepsis through these blisters which which break down and allow bacteria to get it so this is kind of a summary of symptoms all these patients have rash fever headache and most of them have lymphadenopathy with the other symptoms being less common so very typical clinical presentation classically in endemic areas physicians should be easily able to diagnose this the main clinical differential diagnosis is between chicken pox and measles much less likely miso is a much commoner disease but it doesn't cause a vesicular rash but chicken pox can be missed chicken pox typically is a is not a centrifuge it's a centripetal it involves central areas and you can see lesions in various stages of development some may be vesicular some may be scabbed over et cetera monkey pox just like smallpox evolves you know slowly and classically all lesions are in the same stage so it's important to make this differential diagnosis between monkey pox and chickenpox you can see this is the distribution of rash you can see the distribution of rash is different it's much more peripheral compared to chickenpox you can also see the vesicles which are much more superficial and smaller in chickenpox compared to monkey pox much deeper and with almost the central umbilication it can involve the eye it can be vision threatening at times so you you will have to have an ophthalmologist involved if they have any kind of eye symptoms we spoke about bacterial sepsis as well as encephalitis so quite uncommon especially with the west african clade which is much less virulent compared to the east african clay and you can see here how disfiguring this can be especially in dark skinned individuals it causes a lot of scarring a lot of hypopigmentation so um so so it often carries these long-term sequelae um and so you need good supportive care including mental health support for many of these uh survivors so that is classical chickenpox which has been sorry monkey parks which has been around for half a decade half a century or so what's new this is what is new about a couple of weeks back monkey pox has been described as a re-emerging disease and these are the two documents you can refer to which describe this in detail and the first index case was reported almost four weeks ago in the uk there was an important case of monkey pox in somebody who had come from nigeria so this typically this comes out of africa so this patient had traveled to nigeria came back to london it was confirmed on pcr testing the uk then reported two further cases who were part of the same family but different from the index case and then one more case and then they started reporting more and more cases and what they found was four subsequent cases where all in men who had sex with men and they all had a vesicular rash like illness which was in the genital area not a classical presentation of monkey pox they were all identified in std clinics and they were managed in kind of isolation centers that's what they call these high consequence id units in the uk and there were more cases described as well all where of the west african clay from 18th may other parts of europe started recording cases portugal 14 cases all were men and many of them had some ulcerative type lesions which are quite different from the classical presentation of chickenpox almost mimic genital ulcer disease like herpes simplex syphilis shankroyd etc more cases from spain and more parts of europe were involved as well germany belgium france italy etc again many of these patients had a travel history to other parts of europe which were which had disease as well other parts of europe and now 67 confirmed cases this number keeps changing by the day confirmed as well as suspected cases and outside europe as well uh all inpatients who are traveled one case in boston united states in a adult male who had traveled to canada one probable case in new york city uae israel australia all had reported cases largely those who had traveled to the uk so this is the distribution of cases in europe you can see that spain and portugal have many cases reported and other parts of the world are sporadic cases so so this is the concern that it could start like this and involve all the countries over the world can this become a pandemic that is the burning question you need to ask so we have about 92 confirmed cases roughly about one week ago and about 28 suspected cases you can see the countries that were involved but it's important for for clinicians to realize that this presence a little bit differently right even in the past sexual transmission of monkey pox has been described but compared to natural acquisition either from bushmeat or transmission from an index case it wasn't thought to be the main mode of transmission this was hypothesized but currently it's behaving like a very classical std either either because of the sexual activity or much less likely because of the close physical contact involved this just mimics shankroid syphilis gonorrhea or molluscum contagiosum so so you need to keep this disease in the back of your mind if you have somebody presenting with an ulcerative std have they traveled have they been in in contact with anybody who has traveled so there is now an interim case definition which is quite useful a confirmed case is one that has been confirmed classically by a pcr test at a reference laboratory a probable case you can make kind of a clinical diagnosis if somebody has an unexplained rash and with symptom onset in the last couple of months as well as some pointer towards an orthopox virus infection or is a risk high-risk person for instance somebody who a man who has sex with men or who has multiple sexual partners who has traveled to a monkey box endemic country etc so you are allowed to make a clinical diagnosis of a probable case using these criteria so these are these are quite useful if you are in clinical doubt as to whether you can you should diagnose this disease in somebody with any kind of ulcer or rash how do you confirm you need species specific pcr this the monkey monkey box can be cultured but pcr is now much easier to do the virus can be detected in any clinically involved specimen typically a skin lesion as well as respiratory secretions it is classified as a category 3 pathogen and should be handled only in a high secure laboratory but so far uh hospital transmission is is just never been documented so so we just like to be careful and keep it that way the indian government has put out put out an adversary as to what you need to do about this there was also a guideline released just uh earlier the earlier this week and basically suspect this in somebody who has traveled or who has come into contact in somebody who has traveled and who has a rash you need to inform your local health authority so they can be isolated still the disease is either ruled in or ruled out and you have to follow strict infection control practices to avoid hospital transmission to healthcare workers or to the population at large the apex laboratory for confirming the diagnosis is national institute of virology pune so you can contact them through your local health officer and certainly you will have to do contact tracing in case a patient is confirmed as having as having monkey pox there have been some guidelines put out by icmr and niv pune as well regarding the type of samples they want you to send it in these are available on the internet you need all these samples in these ways it could be serum it could be blood or pharyngeal samples or or lesions on the skin you could send them in appropriate samples and send it across to them and they will confirm the disease for you obviously when you take these samples the taker is at risk so it's best to dress up like a space suit kind of what we were doing when kovid first hit us like a space suit basically and and send it off to them typically they will make the diagnosis through a specific pcr they can even do next generation sequencing if they need to so what is the risk that is the question which you as a viewer must be asking you what is the risk for my patients what is the risk for me personally so the eu has done a risk assessment and certainly they conclude that if you have high risk sexual activity multiple sexual partners including some msm then the risk is high because most of their cases in the recent outbreak have involved this epidemiological risk factor there there is some transmission either during sexual intercourse or during the close personal contact at this time so so certainly msm people with high risk high sexual risk factors should be aware that there is a potential for picking up this infection and if somebody is not smallpox vaccinated typically anybody born after 1980 would not be smallpox vaccinated then obviously they're at higher risk because they don't have any immunity if somebody is immune compromised yes you can have they are at a higher risk of disease um especially hiv so this is something you need to suspect in in these patients as well with an appropriate clinical presentation what about for the broader population the average man on the street the risk is considered to be very low this is not coveted this is not primarily a respiratory virus this does not get transmitted very efficiently through the respiratory route so the risk is considered low um as far as the general population goes however immune compromised hosts elderly pregnant perhaps there may be a higher risk we really don't know as yet however we as healthcare professionals are the ones who come into close contact and the key here is not to come into inadvertent contact if you don't know what you're doing and you go close to a patient you handle the rash etcetera then you are in trouble so it is always better to suspect the diagnosis and take appropriate personal protective equipment etc before you take samples or examine these patients so far no nosocomial infection but ever ever reported so so but it's important to keep this in mind if you have somebody in your clinic tomorrow who has just traveled to nigeria who has a rash just don't go and examine that patient just put on your ppe be very careful and notify your local health authority uh if you suspect the disease so if you wear all this whatever you used to do for code i'm sure most of you must have seen covet patients then you are protected protect your eyes protect your face protect your body then you're quite safe it's only this un if you just if you handle somebody some of these patients in op examine them or face-to-face contact then there is considered to be a risk laboratory personnel need to be very careful clearly they need to be intimated beforehand that samples may have this virus and that is why specific designated viruses sorry designated laboratories are in charge of making this diagnosis risk for unprotected laboratory personnel is assessed as high so don't order blood tests on patients in whom you suspect monkey pox without notifying your lab first so this is a nice table which assesses the risk in these patients so on the left side of your screen msm multiple sexual partners risk is considered high broader population very low so that that's a good thing health professionals clinicians who see patients if you're wearing ppe don't worry nothing is going to happen to you if you're not there is a potential risk laboratory personnel again product proper protection no risk but unprotected exposure to body fluids etc yes there may be a risk so useful way to summarize your risk of picking up this virus right so people think that this is not likely to develop into a pandemic even who assess this risk a couple of days ago they also feel that the risk of spread globally is low because it really doesn't behave like covet in terms of transmissibility and if you do have a case how do you manage these patients you you inform your medical officer in your local area your state health government and then they will tell you what to do typically these patients should be isolated um they don't recommend managing these patients in any any setup government or private without prior notification of the government because of the potential for spread and the consequence of making this diagnosis right now so far no reported cases in india the treatment per se is not very complicated most of the patients with recent disease have had fairly localized disease they have not had the classical severe monkey pox which is which has been described in africa they get better with just supportive care analgesia hydration etc and but they need to be isolated because of the spread and the problem here is these patients are infectious for up to three weeks from the onset of symptoms or in other words still all the scabs fall off which takes a long time in chicken pox they fall off in a week but in monkey pox it goes on for about three weeks so it's a prolonged period of time for which they are infectious so you'll have to patiently isolate them throughout all their that entire period of time and clearly they need to not handle any pets because remember this first gets into humans from pets so they clearly need to avoid any contact with animals it can reverse transmit as well do we have antivirals available yes and no pseudo forward is an old drug it's been around for more than 30 years now but it's very nephrotoxic there is an oral version called brin side off over which is not approved for any indication on a general basis in any country but it does have a specific approval for for treating severe diseases like variola or monkey pox in the in the us on a specific basis brin side of our has a lot of gi side effects as well there's a second drug which is much more promising called tech very matte and human trials indicated that the drug was safe and tolerable for instance this trial in the new england journal this was not really a trial on smallpox we don't have smallpox cases anymore but it was just a tolerability and safety trial quite a safe drug when they gave it to many many volunteers so it's a safe drug to use if you have to use it for monkey pox print side of over these are the doses but a little bit more on this drug a little later pseudophobia is very nephrotoxic it is occasionally used in the treatment of cmv disease in immune compromised hosts very nephrotoxic probably not worthwhile using unless you have a very severe patient with monkey pox so taco taco very matte is the is the drug that is currently favored for use in this disease but just last week the landsat published about a case series of about seven patients in whom they tried some of these medications on a compassionate use basis in the uk and what they found was quite important print side over did not work it did not apparently confer any convincing clinical benefit this was not a randomized controlled trial there were no no placebos there was no control group etc but and it also caused a lot of lft derangement so there is a problem with print side off over takeover met only one patient got and he seemed to improve but that's just an anecdote so so we can't say it certainly is uh something that needs to be tried in more patients and i'm sure we'll have data later how do you prevent this disease well smallpox vaccine is effective smallpox vaccine is no longer used anywhere worldwide there are a couple of smallpox vaccines which are restricted to government use typically for armed forces who may be the subject of of bioterrorism with the smallpox virus so they are the only ones who actually get this vaccine but historically we know that from studies in africa that smallpox vaccine is at least 85 percent effective in preventing monkey pox so worst case scenario if we have a pandemic we already have a licensed vaccine which is 85 percent effective so a vaccine already exists for this particular disease so so however no government currently wants to get into smallpox vaccination there are no cases right now it's a difficult vaccine to get out certainly manufactured on a large scale so currently including the indian government this is just an option you need to use for a worst-case scenario and because of the long incubation period you know 5 to 21 days you can actually give post exposure prophylaxis closed contacts who have been exposed to monkey pox you can vaccinate them in kind of a ring fashion doing vaccination so this this uh imban xtm which is basically the smallpox vaccine is the only one authorized in the in the european union for this particular uh uh for smallpox as well as monkey pox so currently nobody recommends a vaccination anywhere in the country even our national group the national technical advisory group nothing they just aware that this can be used they just say monitor monitor suspect based on risk factors so far no cases reported in the country vaccinia immune globulin is just patients who have been vaccinated and then immune globulin which is purified active against vaccinia this was in use 25 30 years ago for complications of vaccinia it should work for monkey pox but commercially obviously not not available or difficult to get hold of any type of immune globulin for that matter so this is my last slide monkey pox is a re-emerging infectious disease and we're all sick and tired of these agents from covet downwards so it's important to watch this space transmission in the recent outbreak appears to be sexual or through close contact as opposed to previous outbreaks where it was a zoonosis or familial transmission after an index patient got infected you need to suspect in anyone with a rash if it's a vesicular rash index or suspicion is higher if it's a genital rash suspect the disease the key is to ask for a history of travel or contact with somebody who was travel it does not necessarily have that classical progression from fever to skin lesions all over the body it can just be a genital rash alone the transmissibility and risk for the general population is considered low luckily and it's not very infectious so contact and droplet precautions should surface but we always recommend more than that we have more clear evidence that this works there is one promising antiviral takeovery mat sidow forward brinsted over less useful and we already have existing smallpox vaccines which can be rolled out or manufactured to scale if you do have a pandemic heaven forbid that's all i have i'll be happy to take questions or clarifications and i'll hand this back to our host thank you sir thanks a lot for wonderful presentation you covered starting from virology to management to vaccinations so it was complete you gave us complete all that a physician needs to know right now about uh monkey pox so thank you so much thanks a lot for your time uh so i will just uh put it open for all our users if you have any questions you can interact with sir directly by raising hand or if you want to ask you can just put it in the comment section and i can just take that up uh so so i can see one question uh see dr mahdi this i say i already had smallpox vaccine in childhood how protective it is against monkeybox virus 85 so good i had smallpox vaccine in childhood too so i have 85 protection too right half of us were not even born when it got eradicated nice session thank you so much sir it was wonderful session uh so dr shish pal says uh you can see a lot of amazing comments uh so dr mohan says what is the infectious time period expected uh transmission period uh is what i guess dr mohan is trying to ask the answer is till the lesions scab over so that typically takes 21 days unlike chickenpox which is 7 days 10 days max so they are infectious for 21 days so that is a practical problem prolonged isolation is needed right thank you sir uh so dr man is asking length of isolation period required for monkey pox in friction yeah that's still lesion scab over typically 21 days so yeah three weeks dr krishna priya says very useful and informative session thank you doctor uh so i can see one raised hand by dr webb i'll just accept your request if you want to interact with sir directly please uh turn on your audio video and you will be able to interact doctor made says excellent presentation and delivery thank you so much sir till then so i will uh take another question any contraindications to particular drug during symptomatic management no basically these it's a virus which gets better on its own and it typically doesn't cause systemic features it just causes fever and bad rash so it's just supportive care just like a bad burns patient for instance it's supportive care avoid infection wait till they get better hydration fluids etc secondary bacterial infections can get into the skin so you may need antibiotics for that reason yeah but overall it is uh self-contaminating right i mean there is yeah there is a case fatality rate the western clade which is the one which is being exported all over has a case fatality rate of less than one percent uh the east african clade is up to ten percent and that also may reflect uh you know poor supportive care of medical facilities in africa in rural africa right okay uh see dr priya vartini is asking will you advise refraining from going to african countries now so uh if we uh so should we i mean just isolate that particular area right now uh how is it overall uh you can't get it by going to an african country you if you go to an african country you have to come into contact with somebody who is sick or you have to go and eat bush meat typically people go from here don't go into the african bush kill small animals and consume them straight so it's it's not likely that you will pick this up by going to africa so travel if you need to but when you come back if you have a small rash on your face acne or something else then somebody might say ah she's got chicken box or she's got monkey pox and lock you off for 21 days that's different uh so dr siddhiraj is saying uh so so you talked about uh how smallpox vaccine is uh authorized only for military purposes yeah uh it is actually the use is very authorized basically so the question is on same line in future do we need to get smallpox vaccine and if has it started i mean do we need to just start that vaccination program again how will it be so no you don't have to get it's not available you you can't get smallpox vaccine for love or money if if the government of india decides that there is an outbreak of monkey pox in the country they will get smallpox vaccine from specific high security centers which have this vaccine remember that is also a biohazard so you can't get smallpox vaccine anywhere in india right now so don't worry about getting vaccinated now right so i have one question on the theme line so uh who uh has stated in the fact sheet uh so every day it is it gets updated and there they have stated that uh smallpox vaccine uh is useful to prevent monkey pox so is it like just a theoretical statement or have they done some trials or uh what the basis yeah there is uh for studies see prior to 1980 there was both smallpox and monkeypox in africa so when they were giving smallpox vaccine they found that it had an 85 percent uh benefit in preventing monkey pox um and that is why perhaps there was less monkey pox in those days everybody was being smallpox vaccinated it is only after 1980 that we have discontinued vaccination because smallpox is eradicated so there is less immunity in people who were born after 1980 or who didn't get the vaccine so that is what can potentially fuel a pandemic that is the concern right so we have evidence for that trials have been done yes thank you sir uh says there is one question from dr desai what is the main cause of death in monkey pox what has been observed till now in monkey box typically it's a bacterial infection uh patients have had pneumonia they've had bacterial sepsis getting in through the infected skin lesions rarely airway obstruction uh rarely encephalitis have been reported thank you sir uh so dr vijaya raghavan is asking uh how is the distribution of rash uh which is seen in monkey box is it similar to smallpox yeah i think i showed a picture it's quite similar to smallpox the distribution typically is centrifugal that is palms souls extremities less on the trunk less on the face as opposed to chickenpox which is typically centripetal much more central doesn't involve the palms and souls right thank you sir uh so dr depali is asking so the first question that we asked will it be a small box of this century will it be the pandemic so you talked about transmission definitely uh but what are the chances that this might get turned to a pandemic so if you i don't think we'll have a pandemic i'm pretty sure we'll see imported cases coming to india uh and if we do so it'll be in travelers it may be in people with high risk sexual activity uh there's no way there we will never have a case that's what i feel but i think the chances of general spread in the population etc are very low this is not a respiratory virus like fluor or covid which uh one cough everybody gets infected so chances are this will not cause a pandemic but we still need to be cautious just like nobody thought covert would be anything big when it started off in wuhan we need to be cautious all right thank you sir uh so dr rahul is asking what uh parameter uh what parameters guides are starting the specific antiviral treatment also patients who are symptomatic so what are the criteria what are the titles actually there's no criteria it's compassionate use if somebody gets the first index case of monkey pox in india will probably get an antiviral because we don't know how severe it's going to be but having said that most of the cases in the recent european outbreak have had mild disease they've had rash there have been no deaths there have been no severe disease so we don't think it's going to be a very severe disease but since it's a new disease perhaps if tacovarimat or brincido fever are available i am sure there will be a stock kept somewhere by the government for an emergency they will use it we need more studies we don't have data yeah right thank you sir uh so there is one interesting question so dr balari is asking how much time a person should isolate himself or herself if they are coming or they have traveled from that affected data do we need to and how long actually you don't have to you have to follow the see supposing you have to follow what the government says there's been an advisory put out at most airports saying that if you have gone to an in to an a country which has reported cases and you have symptoms like fever then they will quarantine you for 21 days until they know that you don't are not developing disease okay that's not something you need to do yourself you need to follow advice given to you when you arrive at the airport right thank you sir uh so dr prithwho you have raised hand too i'm just accepting your request you can ask sir directly your question that will be great if you wish to hello yeah i just wanted to know uh uh are there are we considering any red clock signs or uh [Music] just a bit more if you if possible okay yeah go ahead red flag science is your question your voice is breaking i'll just read the question that you have put in comment section uh so so are there any uh red flag signs to consider starting with treatment uh versus specific therapy so while starting yeah actually see if you have a suspect case your hands are tied if you are a practicing clinician whether you are practicing in the public or the private sectors you pick up the phone and call your local health authority and do what they tell you to do typically they will say transfer this patient to an eyes to a designated isolation facility and then they will take it from there because the first thing you need to do is to isolate the patient and prevent spread within the health care system or the hospital or the general population then they will do the appropriate tests etc so there is no role for empiric therapy or anything just suspect and call and then do what they say keep that patient isolated in your center they will transfer the patient to an isolation center very quickly nobody wants to be the first case of monkey pox in india right so that's one yeah heard it uh so i hope this answers your question dr prito thank you for coming on stage uh so we talked about uh how small fox vaccine uh there is evidence that it might be helpful it might prevent uh monkey pox but what about chickenpox vaccine so is this chickenpox is different family can't escape with chickenpox that's a herpes virus it's not a box virus quite different just like flu shot won't work for kovit can't use chickenpox wax right so to all the doctors if you have any more questions please start putting in the comment section i have already covered uh many so just let me go through once again so we have already answered all the questions so if anyone wants to come on stage and share their thoughts their concerns uh please feel free to uh so dr pratu has commented wonderful and nostalgic to listen to you sir excellent as always uh yeah thanks dr prito i know dr pruthu quite well so thank you he has asked one question uh with this when do we decide to start treatment if necessary in immunocomplacent immunocompromised uh patient so who is well let me put it like this uh we are taking two steps at a time if you make the diagnosis or strongly suspect the diagnosis in any host immunocompromised immune competent you should start therapy but that won't be you that will be a designated infectious disease unit which the government will do because right now there are no cases in the country the very first case will be treated very seriously isolated given all the supportive care antivirus if needed so this is not something you need to know as a practicing clinician what you need to know is suspect and call the government if you don't suspect you will spread it to you to the entire hospital where you work etc suspect and call yeah right thank you sir uh the doctor nasir gupta is asking standard prescription for monkey pox in opd uh i'm not sure if we can trade this at opd level standard prescription is phone call to your state uh health officer right perfect thank you sir uh so doctor zhao was asking is a question uh so you talked about how fatalities i mean transmission rate then you talked about uh it is more of a bacterial uh cause for death uh so dr rao i hope this answers your question is fatal how patient dies with what complications so sir talked about bacterial infection so if you want to add more yeah that's yeah typically pneumonia skin and soft tissue infections uh airway obstruction abscesses all secondary bacterial infections it's just like bad burns the whole skin is boxed and then ulcerated and rarely causes encephalitis as well thank you so we have just heard those stories that when smallpox virus was i mean when a person gets smallpox infection uh the scabs leave the scars for really long time so is the same thing happening with monkey pox i mean yeah exactly the same it scars and it leaves uh disfiguring scars for a long time so that's unfortunately a problem with this disease it's cosmetic but still it's a major problem right so you have uh covered this in your session but this last one i'll take dr monica is asking what investigations advised for monkeybox investigations are samples from any clinically involved site patient is coughing sputum skin lesions swab for that skin in a viral transport medium a blood test and send that to niv pune there are specific containers in which you send it you need to send it in easily referable on the net your your health officer will take care of all that all the health officers right now have a very high they've all been clued in because nobody wants to report the first case of monkey pox in india right so they're all clued in and they will jump on you and test if you pick up the phone and say i have a suspected they won't neglect it they will do the need for yeah right uh so one last question if you could just uh guide us on the preparedness that is required like in just few pointers that are must to know for all physicians like you said you just make an opt call and firm so that government will do the specific precautions precautionary majors and it will be taken care of but just you point us if you could summarize uh on the preparedness that is required by all indian doctors yeah the preparedness part of it is at this point there is no disease in the country so you will if you want to be the first to diagnose monkey pox in the country you have to have a high index of suspicion if somebody comes to your op with any vesicular rash after a history of travel or any ulcerative std with a history of high risk sexual exposure or a history of close contact with somebody else in the family or work who has or sexual contact who has such lesions then you suspect the disease you isolate the patient immediately at your center and you call your government okay they will tell you what to do next move on from there so that's the stage at which we are in right now we haven't even had one case if we have more cases in the country then obviously advice will change right so gradually with respect to the data availability the advice will change thank you so much it was really really insightful uh so one last i'll just accept your request dr ponchi if you want to ask anything please turn on your mic uh so you just now talked about all the investigations but is there any confirmatory test or is it just that we need to go for all right now yeah the test they do is a pcr uh this the samples have to be sent to niv pune they will do a pcr specific for box viruses or a pcr specific for monkey box they even have pcr specific for which clade it is and they also can sequence which means if it is not this what else is the complete analysis of the genome they will sequence they have all that but the designated lab right now is niv right thank you so much sir with this uh i will wrap up the session and if to all the doctors who are still here to if you have any questions you can just reach out to us via support or social media and we'll make sure that we get your query answered by dr ram uh so thank you so much for your time it was wonderful and you have guided us on all the available uh precautions that we need to take all the majors that we need to take currently uh i hope we contaminate this uh soon and not required to have another session where it has just spread uh just fingers crossed for that uh thanks a lot for your time once again it was wonderful to have you i would love to discuss some amazing infectious with you really soon welcome you

BEING ATTENDED BY

Dr. Satyendra Dubey & 2020 others

SPEAKERS

dr. Ram Gopalakrishnan

Dr. Ram Gopalakrishnan

Senior Consultant, Infectious Diseases, Apollo Hospitals, Chennai | Adjunct Professor & Distinguished Clinical Tutor, Dr. MGR Medical University & at Apollo Hospitals Educational and Research Foundati...

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dr. Ram Gopalakrishnan

Dr. Ram Gopalakrishnan

Senior Consultant, Infectious Diseases, Apoll...

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