In the latest outbreak of mpox, World Health Organization has reported 87,113 confirmed cases of Monkeypox disease, including 130 deaths in 111 countries from January 2022 to April 2023. Pakistan’s first case of Monkeypox appeared in a person traveling from Saudi Arabia on 21st April 2023. The first confirmed case of Monkeypox in Pakistan during the current outbreak of 2022-2023 has sparked concern among the populace and health officials. In this article, we will endeavor to understand the causes of Monkeypox, its transmission, the likely impact on Pakistan, and what measures Pakistan should focus on to deal with Monkeypox disease.
What causes Monkeypox?
Monkeypox is an infectious disease; the Monkeypox virus causes this fatal zoonotic viral disease. The Monkeypox virus belongs to the family of smallpox viruses; it is a double-stranded DNA virus of the Orthopoxvirus genus from the Poxiviridae family. This virus first appeared in monkeys kept in an isolated Danish research facility in 1958. Hence, the name “Monkeypox” was attributed to this disease. However, researchers have found rodents to be the primary carriers of the virus instead of monkeys. Transmission of the virus to humans from rodents or animals is considered to be the cause of Monkeypox.
Transmission! How does Monkeypox Spread?
Physical contact is the main reason for the transmission or spread of Monkeypox from humans to humans or from animals to humans. Close contact with an infected person, especially within the first week of illness, causes the spread of Monkeypox disease. Close contact includes exposure to an infected person’s breathing, skin, saliva, or respiratory droplets. Household members and sex partners are at a higher risk of infection from the Monkeypox virus.
Bites or scratches by the animals during various activities such as hunting, cooking, skinning, and trapping cause the transmission of Monkeypox disease from animals to humans.
Read here about the signs and symptoms of monkeypox.
Impact of Monkeypox in Pakistan
Since May 2022, when the World Health Organization (WHO) declared the Monkeypox virus a Public Health Emergency of International Concern, health authorities have tested 22 suspected cases of Monkeypox in Pakistan. However, there is only one confirmed case till now. The probability of a localized spread of Monkeypox in Pakistan is very low. However, a large population of non-human primates can become a reservoir for the monkeypox virus. The proximity of India and Afghanistan, two monkeypox-endemic countries, also puts Pakistan at risk of the Monkeypox outbreak.
Measures to Handle Monkeypox in Pakistan
Pakistan has been proactive in preventing the spread of the Monkeypox in Pakistan. The Special Secretary of Health presided over a high-level meeting in late April 2023. DG (Health), representatives of the National Institute of Health (NIH), and the Pakistan Institute of Medical Sciences attended the meeting to discuss the confirmation of the first case of Monkeypox in Pakistan and prioritize the response.
NCOC played a pivotal role in coordinating the response to NCOVID-19 Pandemic. The Ministry of National Health Services is using the experience and paraphernalia of NCOC at the National Institute of Health (NIH) for vigilance on the spread of Monkeypox at National and international levels.
REFERENCE: “NIH Experts Review Monkeypox Challenges.” National Institutes of Health (NIH), 25 Aug. 2022, www.nih.gov/news-events/news-releases/nih-experts-review-monkeypox-challenges.
The primary task of the setup is to ensure preparedness and a timely response against Monkeypox disease for its containment.
The strategic approach decided at the national level for the containment of Monkeypox in Pakistan focuses on the following:
- Issuance of a Health Advisory by the National Institute of Health (NIH)
- Appointing medical staff at all entry points and building their capacity
- NIH to extend technical support to provinces for facilitating PCR- based tests and diagnosis of Monkeypox
- Training and capacity building for staff for case management and contact tracing.
The National Institute of Health has issued an advisory to all Provincial Health Departments and Boarder Health Services that outlines the framework for the containment of Monkeypox in Pakistan. The framework specifies the cardinals around which all health departments have to craft or develop their response.
- Contact tracing is used to identify, manage, and follow up on contacts.
- Identifying suspected cases.
- Identifying the source and cluster of infections.
- Check transmission by isolating the case.
- Recognize risk groups.
- Protect frontline health workers.
- Control and preventive measures.
What is the response of WHO against the Monkeypox outbreak?
The World Health Organization (WHO) has developed a strategic preparedness, readiness, and response plan (SPRR) to enable countries to plan and respond to the current outbreak of Monkeypox.
REFERENCE: “Monkeypox Strategic Preparedness, Readiness, and Response Plan (SPRP).” Monkeypox Strategic Preparedness, Readiness, and Response Plan (SPRP), 5 Oct. 2022, www.who.int/publications/m/item/monkeypox-strategic-preparedness–readiness–and-response-plan-(sprp).
The SPRR has three main objectives: interrupt human-human transmission, minimize zoonotic transmission, and protect vulnerable groups at risk.
The five core components of SPRR, also called the 5Cs, are emergency coordination, collaborative surveillance, community protection, safe and scalable care, countermeasures, and research.
The emergency coordination component of SPRR rests on leadership, coordination, planning, financing, and monitoring. It fosters coordination between all stakeholders to strengthen public health services.
The collaborative surveillance component emphasizes epidemiological investigations and contacts tracing with the help of laboratories and diagnostics. This mechanism will assist in monitoring and sharing the information to understand how the Monkeypox outbreak is evolving and make informed decisions.
The third protocol of 5Cs, Community protection, is crucial to contain the spread of Monkeypox disease. The governments are responsible for implementing the cardinal guidelines of community protection as per their environment-specific context. The Community Protection protocol rests on the following pillars:-
- Risk Communication and Community Engagement (RCCE)
- Controlling points of entry (PoE), international travel and transport, mass gatherings, and population movements
The fourth protocol is Safe and scalable care that advocates quality clinical care and infection prevention. Governments should provide infrastructure for better case management and infection prevention to protect health workers and communities.
The fifth protocol, Countermeasures and Research, facilitates access to medical products and promotes research and innovation.
Monkeypox is a zoonotic viral disease that spreads through physical contact with infected humans and animals. Pakistan is taking proactive measures in the form of Health advisories, surveillance, contact tracing, and isolation measures to contain the spread of Monkeypox in Pakistan. However, the proximity of Endemic countries and the reservoir of Primary carriers pose the risk of a Monkeypox outbreak. Though Pakistan has developed a robust response mechanism against viral disease during NCOVID-19 Pandemic, the WHO response framework, Strategic Preparedness Readiness Response Plan, has potential prospects to further refine the response of Pakistan against the Monkeypox outbreak.
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