AFTER DETECTING the first case of monkeypox without international travel history on Sunday, the Indian Council of Medical Research activated 15 of its Viral Research and Diagnostic Laboratories (VRDL) to conduct preliminary test for the infection. The sample will simultaneously be tested at National Institute of Virology (NIV-Pune) for confirmation.
At present, sample of any suspected case from across the country is sent to NIV-Pune for testing. “The labs are slowly being given the responsibility of testing for monkeypox, just like it was done with Covid-19. This is the way forward for increasing testing,” said Dr Priya Abraham, director of National Institute of Virology-Pune, which will be the apex lab.
The 15 labs include AIIMS-Delhi; Kasturba Hospital for Infectious Disease, Mumbai; Bangalore Medical College and Research Institute, Bangalore; Government Medical College in Thiruvananthapuram and NIV field unit in Kerala; King Institute of Preventive Medicine and Research, Chennai; and National Institute of Cholera and Enteric Diseases, Kolkata among others. “The labs were already trained last month,” said a senior ICMR official.
The patient samples will be referred by the integrated disease surveillance teams to the VRDL along with the clinical history of the patient such as where they are from, gender, age, the symptoms or complications they have, history of travel or contact, co-morbidities. The test results are to be shared with the surveillance teams within 24 hours to ensure control measures can be initiated quickly, according to sources.
No sample that is sent by an individual or a private lab will be tested at present.
The samples sent to the VDRL will be divided into three portions – one to be tested by the laboratory itself, one to be sent to NIV-Pune for simultaneous confirmatory test, and one to be stored for future studies.
The VDRL will conduct an RT-PCR test that will look for orthopox viruses – a family of viruses including monkeypox, cowpox, buffalopox, and the eradicated smallpox. If the sample is found to be negative, they will be tested for Herpes Simplex Virus that causes contagious sores mostly around the mouth and genitals, Varicella Zoster Virus that causes chickenpox, and enteroviruses that are a group of viruses that use the intestine as the route of transmission.
NIV-Pune, on the other hand, will conduct an RT-PCR to specifically detect monkeypox virus. The institute, just like it did with Covid-19, will also isolate and sequence the virus, according to sources. RT-PCR is a method of testing that amplifies the genetic material of a pathogen and matches it against known reference portions of the virus to detect an infection in patient sample. It is readily used across the country for Covid-19 detection.
The labs have also been asked to inform ICMR when they have utilised 50% of the reagents and kits for monkeypox test.
The guidelines of the Union Health Ministry state that only “suspected cases” and contacts that are symptomatic be tested for monkeypox. The guidelines define a suspected case to be a person with unexplained acute rash and one or more of the symptoms – swollen lymph nodes, fever, headache, body aches, and profound weakness. It also states that the person must have a history of international travel in the last 21 days.
Monkeypox is a viral infection that spreads from person to person through close contact with someone who has a monkeypox rash, but now the scientists are also looking at whether the disease is sexually transmitted with cases being diagnosed among men who have sex with men.
The most common symptoms of monkeypox include fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes, along with pox rashes that last for two to three weeks. It is a self-limiting disease, but can lead to death especially in children and those with weak immune systems. Complications of the infection include pneumonia, secondary skin infections, confusion, and eye problems.