India reports first monkeypox death from Kerala: Should we be concerned?

India’s alarm bells rang loud on Sunday after a 22-year-old man from Kerala’s Thrissur succumbed to monkeypox.

As per reports, the man — found to be the fourth case in the southern state — had returned from United Arab Emirates a few days ago and tested positive for the zoonotic (a virus transmitted to humans from animals) disease.

Kerala health minister Veena George was quoted as saying that deceased was young, did not suffer from any other illness or health problems and therefore, the health department was looking into the cause of his death.

His death — the first of its kind in India — came on the same day that Brazil and Spain also reported their first monkeypox deaths.

With this news, should India be really concerned? Are we dealing with a ‘killer disease’?

India’s first monkeypox death

The 22-year-old man, who died on Saturday, had returned to Kerala on 21 July and was admitted to a private hospital on 27 July after he developed encephalitis and fever, besides which his lymph nodes were swollen.

Kerala health minister Veena George told News Minute that the patient did not have any rashes on his body, and the doctors saw no reason to suspect that he was suffering from a monkeypox infection.

It was revealed only after his death that he had tested positive for the monkeypox virus in Ras Al-Khaimah on 19 July, just before his return to Kerala, the minister said.

Reports state that the 22-year-old was then moved to another hospital, where he was put on life support, and where he died on Saturday afternoon.

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Can monkeypox be deadly?

Experts have observed that even though India has now recorded its first monkeypox, it isn’t a cause for concern.

In the case of the 22-year-old, authorities are now investigating if there were other causes for his death.

As per experts, it seems unlikely in the current outbreak — at least outside of Africa — for the disease to turn into a deadly disease. This is because of the type of monkeypox that’s currently circulating.

“There are two distinct genetic clades, or sub-types, of the monkeypox virus: the virus originating in Central Africa (the Congo Basin) and the virus originating from West Africa,” Professor Chloe Orkin, director of the SHARE collaborative at Queen Mary University and senior author for the largest global case series on monkeypox reported in the New England Journal of Medicine, told Newsweek.

“The clade originating in the Congo Basin has caused more severe disease and may be more transmissible. Cameroon is the only country so far where both clades have been found. The clade originating from the Congo Basin has been reported to have a case fatality rate somewhere between six and 11 per cent depending on the report.

“The clade that is driving the recent outbreak that has led to the global monkeypox outbreak is not caused by the clade originating from the Congo but by the clade originating in West Africa. Prior to this outbreak this clade has been reported to have a lower case fatality rate around one per cent or less.”

However, one must note that a low fatality rate doesn’t mean it is impossible to die from the strain.

People with underlying health conditions, such as kidney disease and certain types of immunosuppression, run a greater risk from monkeypox, according to David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.

The World Health Organization (WHO) has reported three other deaths from monkeypox, outside of Africa, since the start of the year.

A 41-year-old man in Brazil became the first fatality from the virus outside Africa. Spain announced two deaths soon afterwards — the first in Europe.

In the Brazilian’s case, the deceased had suffered from lymphoma and a weakened immune system, and “comorbidities aggravated his condition”, said health officials.

In Spain, one of the cases was a patient who suffered from encephalitis.

A global health emergency

According to the US Centers for Disease Control and Prevention (CDC), as of date there are a total of 21,148 cases of monkeypox worldwide.

Last week, the WHO had declared monkeypox a global public health emergency and called on nations to work closely with communities of men who have sex with men and adopt measures that protect the health, human rights, and dignity of affected communities.

“We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little, and which meets the criteria in the International Health Regulations... For all of these reasons, I have decided that the global monkeypox outbreak represents a public health emergency of international concern,” WHO Director-General Tedros Adhanom Ghebreyesus had said.

In New York, Governor Kathy Hochul declared a disaster emergency due to the spread of monkeypox in the state through 28 August.

The state is experiencing one of the highest rates of monkeypox transmission in the country with 1,383 reported cases as of Friday, Hochul said in the executive order. The virus was declared an imminent threat to public health by the New York State Commissioner of Health on Thursday.

I am declaring a State Disaster Emergency to strengthen our ongoing efforts to confront the monkeypox outbreak.

This Executive Order enables us to respond more swiftly, and allows health care professionals to take additional steps that will help get more New Yorkers vaccinated.

— Governor Kathy Hochul (@GovKathyHochul) July 30, 2022

San Francisco has also announced a state of emergency over the growing number of monkeypox cases. The city has 281 cases, out of about 800 in California and 4,600 nationwide, according to the San Francisco Department of Public Health.

With inputs from agencies

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