New Delhi:

India on Monday reported its first confirmed case of “travel-related” Mpox, or monkeypox, in a young male who tested positive for a strain from western Africa.

The patient is in stable condition, the government has said, and is without systemic illness or comorbidities, having already been isolated over the weekend on suspicion of carrying the virus.

There is no indication of any widespread risk to the public at this time, the government said.

The government explained that testing had confirmed presence of ‘clade 2’ of the virus, and that the particular strain is “similar to 30 cases reported earlier in India, from July 2022 onwards”.

The strain of infection, however, is “not a part of the current public health emergency (declared last month by the World Health Organization), which is regarding ‘clade 1’ of the Mpox virus”.

READ | New Mpox Strain Mutating Very Rapidly. How Scientists Are Responding

A ‘clade’ refers to a biological grouping that refers to all evolutionary descendants of a common ancestor or, in this case, a particular strain of virus.

READ | India’s 1st Mpox Case? Centre Says Man Isolated, No Cause For Alarm

Earlier today the Union Health Ministry issued directives to state governments “review public health preparedness, particularly at health facility level at state and districts by senior officials”.

This should include briefing healthcare workers, “especially those working in skin/STD (sexually transmitted disease) clinics, about symptoms, differential diagnoses, and action to be taken following detection of a Mpox case”.

READ | “Prevent Undue Panic”: Centre’s Advisory To States On Mpox

But it is “crucial”, the government also said to guard against “undue panic…”

Also, to ensure information about Mpox and its common symptoms is available to the public, the government referred to the latest WHO update, which indicates that a majority of patients are men aged 18 to 44, and present with rash (systemic or genital) followed by fever.

And the most commonly reported mode of transmission, the government said, is sexual contact, followed by person-to-person non-sexual contact.

Last month the who declared Mpox a PHEIC, or Public Health Emergency of International Concern, based on the risk of spread of the current outbreak from beyond Africa, where a surge in cases has been reported from the Democratic Republic of Congo and other nations like Burundi, Kenya, Rwanda, and Uganda. There is also a new strain from the DRC, scientists said.

Five cases have been reported from Pakistan’s Peshawar, according to Geo News.

READ | Pakistan’s Peshawar Is Mpox ‘Epicentre’? Tally Reaches 5: Report

According to the WHO, so far over 120 countries have reported Mpox cases from January 2022 to August 2024. There have been over 100,000 lab-confirmed cases and around 220 deaths.

READ | Serum Institute Says Working To Develop Monkeypox Vaccine

The WHO says a vaccine can help prevent infection and can also be administered after a person has been in contact with someone who has Mpox. “In these cases, the vaccine should be given less than four days after contact (and) can be given for up to 14 days if the person has no symptoms…”

NDTV is now available on WhatsApp channels. Click on the link to get all the latest updates from NDTV on your chat.

Poxviruses have long been a cause of fear as well as curiosity for humankind. One particularly infamous poxvirus, smallpox, alone may have killed more than 500 million people in the last century.

Smallpox didn’t discriminate between rich, poor, young, old, and killed a third of the individuals whom it infected. The turning point came with evidence of the efficacy of the smallpox vaccine. Thus followed a concerted effort worldwide to administer the vaccine and eventually eradicate the dread disease. This feat has stood as a testament to the power of sustained global public health initiatives.

Mpox’s 15 minutes

Another poxvirus, mpox, was recently in the headlines after a rapidly expanding global outbreak in 2022-2023. The virus was previously called ‘monkeypox’ after a spillover event in a research facility involving monkeys in 1958; the name is considered both wrong and inappropriate today: since then, researchers have identified mpox in many sporadic outbreaks among humans. They have also found multiple mpox lineages have been circulating in humans, adapting by accumulating mutations modulated largely by the APOBEC proteins.

But it wasn’t until 2022 that the disease became widely known, thanks to outbreaks in more than 118 countries and the World Health Organisation (WHO) quickly declaring it a public health emergency. To date, this outbreak has infected almost 100,000 people. Based on WHO data, infections have a mortality rate of 1-10%.

The outbreak was due to one clade (strains of the virus descended from a common ancestor) — called IIb — having developed very high human-to-human transmission through close contact and spread through the sexual route. While the rate of new infections has been dropping, mpox continues to circulate among unvaccinated individuals worldwide. This increases the chance that a more virulent and transmissible strain might emerge and become endemic somewhere.

Expanding, contracting as required

Mpox, like all poxviruses, are DNA viruses. The mpox genome has about 197 kilobases (kb). The core genes are those closely conserved (i.e. preserved during evolution) by various poxviruses plus two sections about 6.4 kb long, one at each end of the genome. Researchers don’t yet know what function these sections serve but suspect they influence how well the poxviruses can infect different hosts.

The mpox genome also has a sequence of bases repeating in a pattern, which researchers believe play a role in the virus’s evolution.

The mpox family of viruses is also known to be able to evade selective evolutionary pressures. It does this by duplicating genes and/or accumulating mutations and expanding its genome significantly — or contracting its genome by deleting gene stretches or inactivating them. Such rhythmic expansions and contractions are called genomic accordions.

Find the accordion

In a study published on April 18 by Nature Communications, researchers at the Icahn School of Medicine in New York and multiple institutions in Spain extensively sequenced the genome of the mpox virus implicated in the 2022 outbreak. They used advanced genome sequencing technologies to piece together a comprehensive genome of the mpox virus from scratch.

They found that the 6.4-kb-long sections of the virus strongly influenced the virus’s human-to-human transmissibility. They also reported that variations in three genes in particular could affect the virus’s evolution. Importantly, 6.4-kb-long sections, which scientists had previously considered to be not so informative, were actually found to be the virus’s genomic accordions.

All mpox genomes can be divided into two distinct yet broad clades: I and II. Clade I is thought to have a higher mortality. Each clade has sub-clades, or lineages, defined by specific evolutionary processes. Researchers have also found evidence of significantly different mpox virulence in animal models. The new study, like others like it, further the idea that the 2022 outbreak largely involved a new lineage of the virus, clade IIb, that was even better adapted to human-to-human transmission than clades I or IIa.

The outbreak in the DRC

Between September 2023 and February 2024, health workers detected a large mpox outbreak detected in the Democratic Republic of the Congo (DRC), centred on a mining village and quickly spreading to a number of regions within the country. This outbreak was associated with a significantly larger spread as well as mortality. Researchers soon confirmed mpox clade I was responsible.

This outbreak differed from earlier ones, which were sporadic and self-contained spillover events, by spreading through human-to-human contact and affecting young adults rather than children. A preprint paper, uploaded by researchers from Belgium, Canada, the DRC, France, Ghana, Nigeria, South Africa, and the U.S., on April 14 describes the genomes of virus samples obtained from 241 individuals suspected to have been infected during the outbreak.

The genomic data suggests a distinct lineage of clade I being associated with human-to-human transmission. The researchers also found evidence — in fragments of the genome that closely resembled viruses isolated and sequenced in recent years — of the hypothesis that this lineage emerged from a very recent zoonotic spillover.

One eye on the genome

As with any viral infection, without urgent intervention, the outbreak has the potential to spread rapidly across national, and even continental, boundaries and emerge as another global outbreak.

To prevent such an outcome, genome sequences from before and during mpox outbreaks have provided well-lit glimpses of the evolutionary dynamics the virus uses to invent new ways to move between and survive in different populations of animals and people.

Thus, through rigorous genomic investigations and coordinated public health efforts, we can mitigate the threat of emerging pathogens and the world’s health security.

The authors are senior consultants at the Vishwanath Cancer Care Foundation and Adjunct Professors at Indian Institute of Technology Kanpur. All opinions expressed are personal.