GD Topic - Monkeypox Outbreak: A Wake-Up Call for Better Disease Surveillance

Candidates planning to pursue MBA must prepare for Group Discussion Round as it can make or take away chances of admission. Check this article for a discussion on Monkeypox outbreak. Learn about disease, its symptoms, 2022-24 outbreak and its current status.

GD Topic: Monkeypox Outbreak

Group Discussion round is as important as MBA entrance test. Besides numbers achieved in MBA entrance exams like CAT, XAT, SNAP, NMAT and MAH MBA CET, GD round evaluates candidates on essential skills such as communication, leadership, confidence, analytical thinking and time management. GD is conducted to identify individuals who can effectively collaborate, persuade and present their viewpoints. These are basic traits that every top Business school values in its future managers.

Read the below article for a discussion on one Monkeypox Outbreak.

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What is Monkeypox?

Mpox or Monkeypox is a rare viral disease caused by monkeypox virus, a member of Orthopoxvirus genus in Poxviridae family. Mpox is closely related to smallpox, but it is less severe and generally less contagious. It is a zoonotic disease, which means that disease spreads from animals to humans. But, Mpox can also spread from human to human. Monkeypox is considered an growing infectious disease and has gained global attention in recent years.

Monkeypox was first identified in 1958 in monkeys kept for research and this is how the disease got its name. But, monkeys are not primary carriers of this virus. It is primarily found in certain rodents, such as squirrels and rats, which serve as natural hosts. The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo or DRC. A child was diagnosed with monkeypox when the world was trying to eradicate smallpox. Since then, monkeypox has been endemic to certain parts of Central and West Africa, particularly in countries like Nigeria, Cameroon and the DRC.

Types of Mpox or Monkeypox

The monkeypox virus Mpox or MPXV has two primary genetic clades, Clade I and Clade II. These are divided into sub-clades. The clades are separated based on their geographic origins, severity and transmission characteristics.

1. Clade I or Central African Clade:

• Clade Ia is found in endemic areas within the Democratic Republic of Congo. Clade Ia transmits more efficiently through human to human contact compared to other clades and involves a high risk. It is due to severe disease symptoms and 6-10% mortality rates.
• Clade Ib affects non endemic regions in the DRC and neighboring countries. It is also classified as high risk. The Clade Ib caused an increase in cases due to emerging networks of transmission, including sexual contact.

2. Clade II or West African Clade

• Clade IIa: This subclade is found in endemic regions such as Nigeria and other West and Central African countries and causes milder disease symptoms compared to Clade I. The mortality rate of Clade IIa is lower, 1-3%. Also, its transmission is less efficient compared to Clade I.
• Clade IIb: This subclade is seen outside endemic regions, especially in non-endemic countries in Europe, Asia and the Americas. It is considered as moderately risky and has been seen during 2022 and 2024 outbreaks. The cause of its transmission is human to human close physical or sexual contact.

Signs and Symptoms of Monkeypox

Monkeypox symptoms usually appear within 1 to 21 days after exposure to virus. This period is known as incubation period. The illness typically lasts for 2 to 4 weeks. These symptoms can range from mild to severe. It depends on an individual’s health and strain of virus.

Common Symptoms of Mpox:

• Rash
• Fever
• Sore Throat
• Headache
• Muscle Aches
• Back Pain
• Low Energy
• Swollen Lymph Nodes

For some people, rash is the first symptom. For others, it may be fever, muscle ache, or a sore throat.

Symptoms and Prevention of Monkeypox

Mpox Rash

The mpox rash can begin on face and then spread to other parts of body, such as palms of hands, soles of feet and groin. It may even start in areas where contact occurred, such as genital areas.

It spreads in following stages.

• Flat sores or macules: Small, red spots on the skin.
• Raised bumps or papules: The sores become elevated.
• Blisters or vesicles: Fluid filled bumps that may itch or cause discomfort.
• Pus-filled lesions or pustules: The blisters become filled with yellowish pus.
• Crusting and healing: The lesions dry up, scab over and eventually fall off. This leaves a new layer of skin underneath.

The number of lesions can differ between individuals. Some people may have just a few sores, while others may develop hundreds. These lesions can appear anywhere.

• Face, mouth and throat
• Palms of hands
• Soles of feet
• Groin and genitals
• Anus

Severe Symptoms and Complications

• Painful swelling of rectum or proctitis or difficulty in urinating or dysuria.
• Bacterial skin infections may result in abscesses or permanent skin damage.
• Respiratory issues, including pneumonia or difficulty breathing.
• Eye infections, keratitis or corneal infection may result in vision loss.
• Digestive problems like vomiting and diarrhea. It causes dehydration or malnutrition.
• Serious infections, including sepsis, brain inflammation or encephalitis, heart inflammation or myocarditis and infections of urinary or genital organs.

High Risk Groups

Individuals who are at a higher risk of illness or death from monkeypox include following.

• Children
• Pregnant Women
• People with weak Immune System. These consists of people living with uncontrolled HIV or undergoing treatments that suppress immunity.

2022-2024 Monkeypox Outbreak

The monkeypox outbreak 2022 was first large scale spread of disease. It spread from outside its usual endemic regions, Central and West Africa, to non endemic countries across Europe, North America, South America, Asia and Middle East.

The first case of 2022 outbreak was reported in the United Kingdom in May. By August 2022, over 14,000 laboratory confirmed cases were reported globally. In India, the first monkeypox case was detected on July 14, 2022. It was detected when a traveler from the UAE, who had returned to Kerala, started developing symptoms. This marked India's entry into global outbreak. The cases were found particularly among individuals with a history of international travel.

Earlier, monkeypox spread through animal to human transmission in forested areas. But, in 2022, monkeypox spread through human to human contact. People were affected through close contact with infected individuals, respiratory droplets, or contaminated objects. This was due to an increase in international travel and social events.

As cases increased worldwide, the World Health Organization declared monkeypox a Public Health Emergency of International Concern or PHEIC in July 2022. With PHEIC, WHO emphasized the urgent need for coordinated global action. The Indian government also increased its surveillance, issued guidelines for healthcare facilities and educated people about symptoms and preventive measures of monkeypox. By May 2023, when WHO saw a decline in global cases, it declared PHEIC over.

Monkeypox has been reported for more than a decade in the DRC. Also, number of reported cases has increased every year. In 2023, the number of reported cases increased significantly. By mid August 2024, the number exceeded previous year’s total cases by more than 15,600 cases and 537 deaths. Due to this emergence and rapid spread of a new virus strain, clade 1b through sexual networks in DRC and its detection in its neighboring countries, on 14 August 2024, WHO Director General declared monkeypox a Public Health Emergency of International Concern under the International Health Regulations 2005.

At time, World Health Organization was actively working to make sure equal access to vaccines for mpox, particularly in lower income countries that have not yet issued their own national regulatory approvals. Two vaccines were in use on WHO’s Strategic Advisory Group of Experts on Immunization recommendation. WHO listed national regulatory officials and individual countries also approved these vaccines.  

To speed up vaccine access, Director General of WHO also initiated Emergency Use Listing or EUL. It allowed faster approval and procurement by global partners such as Gavi and UNICEF. WHO also coordinated efforts with vaccine manufacturers and partners through interim Medical Countermeasures Network to make sure equal distribution of vaccines, therapeutics, diagnostics and other critical tools. Since then, WHO has been working with affected countries and partners to control these outbreaks.

Current Situation of Monkeypox

In November 2024, WHO conducted latest global mpox rapid risk assessment. Based on report, risk of monkeypox was assessed as follows.

• Clade Ib MPXV is affecting non endemic areas, including the Democratic Republic of Congo and neighboring countries. It is considered to pose a high risk.
• Clade Ia MPXV is primarily circulating in endemic regions within DRC. It is also categorized as high risk.
• Clade II MPXV is observed in countries such as Nigeria and other areas in West and Central Africa. It is assessed to present a moderate risk.
• Clade IIb MPXV is associated with ongoing global mpox epidemic. It is also deemed to have a moderate risk.

Monkeypox Cases Statistics

As per data reported to WHO by November 30, 2024 since January 1, 2022, 127 member states across all 6 WHO regions have reported cases of mpox to WHO. Also, 117,663 laboratory confirmed cases and 2 probable cases, including 263 deaths have been reported to WHO. The number of cases reported in November has decreased by 13.2% as compared to October cases.

The 10 most affected countries globally since January 1, 2022, till November 2024 include following.

• United States of America 34,349 cases
• Brazil 13,236 cases
• Democratic Republic of Congo 10,492 cases
• Spain 8,443 cases
• France 4,371 cases
• Colombia 4,280 cases
• Mexico 4,192 cases
• United Kingdom 4,146 cases 
• Germany 4,040 cases
• Peru 3,949 cases

These countries collectively contribute 77.8% of total cases reported globally.

Check Out Total Mpox cases by WHO region from 1 Jan 2022, as of 30 Nov 2024 at WHO’s official website.

From 2024, as of January 12, 2025, 21 countries have reported 15,094 confirmed cases, including 64 deaths to WHO. The three countries with most number of cases from 2024 include Democratic Republic of Congo with 9513 cases, Burundi with 3116 cases and Uganda with 1,830 cases.