Monkeypox strain A.2 found in India’s first two cases, different from variant found in Europe outbreak: ICMR-NIV study

The study also revealed that the infection starts with a febrile illness with an average incubation of 513 days with lymphadenopathy, myalgia, and headache, followed by deep-seated umbilicated vesicular/pustular rashes.

Monkeypox strain A.2 found in India’s first two cases, different from variant found in Europe outbreak: ICMR-NIV study
The first case of monkeypox, a rare but potentially serious viral illness, was reported from Kollam district on July 14. (Representational image: Reuters)

A team of scientists led by Dr. Pragya Yadav, a senior scientist at the National Institute of Virology (NIV), analysed India’s first two monkeypox cases and revealed that the duo who returned from the UAE were infected with the virus strain A.2. The researchers who conducted the study of the Indian Council of Medical Research – National Institute of Virology (ICMR-NIV) also found that the strain is different from the one causing the outbreak in Europe.

Moreover, the genomic sequencing of the two patients showed that they were infected with monkeypox virus strain A.2. However, the variant prominent in major parts of Europe is B.1. The findings of the study have been published in the Research Square, a pre-print server, and have not been peer-reviewed.

As of now, India has reported nine cases of monkeypox and one death. According to reports, the foreign returnees from UAE presented with fever, myalgia, and vesicular lesions on the genital area with cervical lymphadenopathy. The oropharyngeal and nasopharyngeal swabs, EDTA blood, serum, urine, and lesion samples from multiple sites were collected from both cases on the ninth post-onset day of illness.

ALSO READ | Current monkeypox symptoms different from previous outbreaks: BMJ study

The clinical specimen collected from the affected patients were tested with real-time PCR for orthopoxvirus, monkeypox virus (MPXV).

“The complete genome sequences obtained from skin lesions of cases 1 and 2 showed similarity of 99.91 and 99.96 per cent respectively with MPXV_USA_2022_FL001 West African clade. Phylogenetic analysis revealed that the two cases were infected with monkeypox virus strain A.2 which belong to hMPXV-1A lineage of clade 3 (West African clade),” the study by the NIV under the ICMR stated.

According to World Health Organization (WHO), Monkeypox is a viral zoonotic disease with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe. On July 23, the World Health Organization (WHO) declared monkeypox a public health emergency of international concern considering the global outbreaks in all the six regions in multiple countries.

It is noteworthy that there are two distinct genetic clades of the monkeypox virus: the central African (Congo Basin) clade and the west African clade. The Congo Basin clade has historically caused more severe disease and was thought to be more transmissible. The geographical division between the two clades has so far been in Cameroon, the only country where both virus clades have been found. According to the lead author of the study Dr. Yadav, the West African clade is found to be circulating in the current ongoing outbreaks of 2022 in non-endemic countries. “It is which is less severe than Congo lineage reported earlier,” she said.

The study also revealed that the infection starts with a febrile illness with an average incubation of 5 to 13 days with lymphadenopathy, myalgia, and headache, followed by deep-seated umbilicated vesicular/pustular rashes. Meanwhile, the rash begins from the face, genital or perianal region, and is distributed to other parts of the body.

Meanwhile, doctors and health experts have warned that as the monkeypox cases are on the rise, people need to be aware of the symptoms and take preventive measures.

“Monkeypox cases are on the rise, and it is important that we are aware of the symptoms including rash, fever, cough, and aches and pains. Though a viral illness and in most cases, people recover well, it is important to watch out for signs such as breathlessness, altered consciousness, and vision-related problems and seek help immediately. It is important to continue to wear a mask as spread can be through respiratory droplet transmission. As it can spread through contact with lesion/rash material or through contaminated clothes etc. it is important to follow hand hygiene and physical isolation to prevent further spread,” Dr. Gowri Kulkarni, Head of Operations, MediBuddy told Financial Express.com.

According to CDC, till August 5, around 28,000 confirmed cases of monkeypox globally from 88 countries.

ALSO READ | Monkeypox spread unusual, says WHO’s Dr Soumya Swaminathan

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