Monkeypox Not A Threat Like Covid, But India Must Produce Smallpox Shots Again To Combat Outbreak: Experts

Infectious diseases experts ABP Live spoke to said India should immediately start re-manufacturing the smallpox vaccine to prevent any outbreak.

Monkeypox is a poxvirus and belongs to the same family as the now-eradicated smallpox

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New Delhi: With the spread of monkeypox in non-endemic countries triggering worldwide concern, experts feel it is inevitable that India, which has 1/6th of the population, would get its first case sooner than later. Infectious diseases experts ABP Live spoke to said India should immediately start re-manufacturing the smallpox vaccine to prevent any outbreak even though they asserted that monkeypox was not a threat like Covid-19.

Smallpox Vaccine Availability in India & Why It's Best Remedy Against Monkeypox

Infectious diseases expert Dr Ishwar Gilada, the first person to raise the alarm against AIDS in India in 1985, said the only vaccine that can work against monkeypox is that of smallpox in the absence of any effective anti-viral in India.

"India presently does not have a smallpox vaccine. India used to manufacture one of the cheapest smallpox vaccines. We have to immediately look at reviving the facility for the smallpox vaccine. Smallpox vaccination gives almost 85 per cent protection against monkeypox," Dr Gilada told ABP Live.

This is so because monkeypox is a poxvirus and belongs to the same family as the now-eradicated smallpox.

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Dr Gilada, who is part of the governing council of the International AIDS Society, said smallpox vaccine has a dual role and can both prevent and treat monkeypox.

"If someone starts developing symptoms and is given the smallpox vaccine within three to four days, it has therapeutic effect. Smallpox vaccination has both immunoprevention and immuno therapy effects," he said.

After smallpox was eradicated all over the world around 1979-80, smallpox vaccination was also stopped. In 2019, the US Food and Drug Administration approved Jyenneos, a smallpox vaccine manufactured by Danish firm Bavarian Nordic, for prevention of both smallpox and monkeypox. Another anti-viral, tecovirimat, has been approved for monkeypox, but is not yet widely available.

According to the World Health Organization (WHO), over 1,000 monkeypox cases have already been detected in nearly 30 non-endemic countries. Most of the cases have been reported from Europe.

Younger Population More At Risk From Monkeypox

However, the silver lining for India is that the elderly population are at less risk from monkeypox since most of them have already been vaccinated against smallpox, especially those born before 1978-79.

Dr Kapil Salgia of Bombay Hospital said those between 20-40 years are more at risk from monkeypox, especially gay or bisexual males.

"Don't think it is going to be a rampant epidemiological issue for India and won't be a threat like Covid-19. Moreover, unlike the West, there is only a small population in India who engage in these kind of sexual activities. They must be cautioned about having unprotected sex since it is the primary way in which it spreads," Dr Salgia told ABP Live.

What Steps Should India Take To Prevent An Outbreak?

The experts said that thermal scanning at airports and ports was an "ornamental" measure and is of little help in detecting infected people since it can be temporarily suppressed by simply taking paracetamol. Dr Gilada said the government should have a multipronged screening mechanism for international travellers.

"Just using thermal scanners is futile. In these 2.5 years of pandemic, we have not caught a single Covid-19 case through thermal scanning. We should look for four or five symptoms of monkeypox. People with monkeypox will have pockmarks or vesicles on the face, palms and soles. The palms and soles are affected in 80-90% of cases. At airports, people can be asked to show their palms and soles and their face," Dr Gilada said.

"Secondly, we can check for swelling in the neck area, which is called lymphadenopathy or lymph node enlargement. It is again a symptom in 100% of monkeypox cases. Another symptom that cannot be detected easily is Odynophagia or difficulty in swallowing. If you suspect somebody, you can ask that person to take a sip of water and see how that person swallows," he added.

Dr Salgia, however, said monkeypox was not as contagious as Covid-19 even though a few cases have been found in which it has spread through respiratory droplet infection.

"But that is only when someone comes into close contact with an infected person or is taking care of that patient. The monkeypox virus cannot linger in the air over long distances," he said.

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Monkeypox and Covid-19

The monkeypox outbreak comes at a time when the world is picking up the pieces from the devastating Covid pandemic. This has led some to speculate that the chimpanzee adenovirus vector used in AstraZeneca's (Covishield in India) Covid vaccine was behind the outbreak.

Dr Gilada said such claims, which have become a topic of intense debate on social media, were false. "Vaccines are prepared with such added care that none of the vaccines can transmit another infection. In short, vaccines can not be vector or conduit to transmit any infection," he said.

He also rubbished rumours that people infected with Covid were at a greater risk of contracting monkeypox. Dr Gilada, however, said that people infected with Covid could contract monkeypox at the same time even though chances are less practically.