Are mpox cases under-reported?

The outcome of a study conducted on used condoms in 16 countries including India has got the health experts concerned as monkeypox mpox virus was found in 32 of the 1188 condoms that were tested in our country After the study was published in the journal of Lancet Infectious Diseases in August health experts are worried as the findings may be the tip of the iceberg The two persons from India who have been confirmed to have mpox are being monitored in isolationStudy covered 16 countries including IndiaDr Wiqar ShaikhDr Wiqar Shaikh professor of medicine Grant Medical College and Sir J J Group of Hospitals said that following the lifting of restrictions of pandemic and an increase in sexual interactions have fuelled the spread of the viral disease mpox beyond its known endemic regions According to Dr Shaikh the study by scientists from Japan Thailand Australia and Philippines concluded that the current global spread of mpox is marked by persontoperson transmission as well as sexual and nonsexual contactStudy of used and discarded condomsDr Shaikh said that used and discarded condoms were collected by scavengers and sanitary workers from brothels and public spaces A PCR test was done on the semen collected from each condom to determine the pathogens present It was found that 262 condoms 1337 out of a total of 20941 samples were found to be positive for mpox Among the 16 countries that were part of the study India has the highest rate 27 per cent of positive casesDr Shaikh said that semen samples were also studied for other STDs particularly HIV AIDS Dr Shaikh questioned whether the condoms could have acted as a barrier to the spread of mpox and other STDs He said it was difficult to say with certainty but it could haveMpox and other STDsDr Shaikh said that the study also suggests that people have the potential to suffer from mpox along with other serious STDs such as HIV AIDS Dr Shaikh explained that the current spread of mpox Clade II variant shows that children and people with HIV AIDS are at increased risk of not only getting mpox but are at increased risk for severe outcomes Dr Shaikh said mpox has disproportionately affected homosexualsDr Shaikh said ldquoAccording to WHO over 120 countries have confirmed more than 103000 cases of mpox since the onset of the global outbreak in 2022 In 2024 alone there were 25237 suspected and confirmed cases and 723 deaths from different outbreaks in 14 countries of the African Regionrdquo This is based on the data from September 8 2024 he saidMpox as a sexually transmitted infectionDr Subhash HiraThe correspondence letter titled ldquoCommunitybased Mpox and sexually transmitted disease surveillance using discarded condoms in the global southrdquo has been published in the journal Lancet Infectious Diseases in its August 21 2024 edition Dr Subhash Hira professor of global health at University of Washington who has critiqued the study said ldquoIt is a good scientific study designed and conducted by a multidisciplinary team of scientists doctors and researchers in 16 countries including India with a credible participation of community NGOs and social groups of LGBT The fact that the study identified mpox infection in semen of the used condoms itself indicates that those persons were established cases of mpoxrdquo Dr Hira said that study successfully identified most bacterial and viral Sexually Transmitted Infections STIs through anonymous passive surveillance methodsldquoIncidentally this study for mpox has also highlighted the importance of control of other STIs that have remained forgotten after the control of HIVAIDS The recent estimates are that over 100 million new cases of STIs occur in the world every year that cause avoidable morbidity and mortality There is a global resurgence of syphilis and its adverse outcomes on pregnancy and childrenrdquo said Dr HiraProtection by condoms is questionableDr Ketan VagholkarldquoMpox is transmitted by both nonsexual and sexual routes The study revealed a potential risk of cotransmission of mpox with wide range of other sexually transmitted diseases such as Neisseria gonorrhoeae herpes simplex virus type 1 HSV1 herpes simplex virus type 2 HSV2 HIV Chlamydia trachomatis Gardnerella vaginalis Haemophilus ducreyi Mycoplasma genitalium Mycoplasma hominis Treponema pallidum Trichomonas vaginalis Ureaplasma urealyticum human papillomavirus HPV hepatitis C virus HCV hepatitis B virus HBV MPXV has disproportionately affected homosexuals indicating amplified transmission through sexual networks The protection offered by condoms against mpox virus continues to be a topic of debate taking into consideration the results of the recent study published in the journal of Lancet Infectious Diseaserdquo said Dr Ketan Vagholkar professor of surgery at DY Patil Medical College Navi MumbaiExpert viewDr Jacob JohnDr Jacob John renowned Virologist from Vellore Tamil Nadu raised serious concerns about the study published in Lancet He said that this information by itself means that all people with Mpox are not getting diagnosed or reported or both ldquoIndia doesnrsquot have a functional public health system like in other developed countries that could monitor every disease ensure doctors diagnose and report all cases of infectious diseases and take measures to control all such diseasesrdquo He questioned our countryrsquos ability to control new diseases when we have failed to control tuberculosis typhoid malaria and cholera Dr John even cited the recent outbreak of an unknown fever that claimed lives of people including children in Gujarat ldquoThe reason why the public health system is not developed in India is because doctors hospitals medical institutions have to make more money and for that we need to have more diseases which brings in patientsrdquo said Dr JohnFirst mpox vaccine approvedMeanwhile On Friday evening WHO approved Bavarian Nordicrsquos manufactured vaccine known as Jynneos the first vaccine against mpox to control the outbreak of the disease in Africa WHO is in the process of reviewing a second vaccine to fight mpox called LC16 made by KM Biologics of Japanrdquo said Dr Sahikh32No of ve cases in India the study found out of 1188 samples16Countries that were part of the study