health matters newsletter mpox: a disease at our doorstep

(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)

While it has been a hectic week in the medical world the past seven days, with a number of issues hogging the limelight, it was the news of India’s first mpox case that swam right up above, to garner most attention. What with a pandemic right behind us, the natural response is to react with caution to any infectious disease that is fast spreading, for the possibility that it might be the next big thing to send nations on shutdown mode again. While the WHO has reassured the world that mpox has not yet reached that stage yet, (WHO has said that the risk of spread of current outbreak beyond Africa is moderate), the news of the first case being detected here still has the alarm bells ringing. 

Bindu Shajan Perappadan reported that while confirming the case of mpox,of the West African Clade 2, as a travel-related infection, the Centre let out no other details of the patient, except to say that the person was stable and was isolated. “The individual, a young male who recently traveled from a country experiencing ongoing Mpox transmission, is currently isolated at a designated tertiary care isolation facility. The patient remains clinically stable and is without any systemic illness or comorbidities,” noted the Ministry. 

Mpox is suspected when a patient develops fever, headache, muscle pain, back pain, weakness, and/or fatigue along with a developing skin rash that starts in the tongue and mouth before spreading to other parts of the body, especially among people who have travelled to countries with endemic Mpox, or those who have come in contact with a suspected or confirmed case of Mpox. It is also accompanied with swollen lymph nodes. High risk groups have been identified as those who are immunocompromised, children, elderly, pregnant women, and people with multiple sexual partners.

The World Health Organisation (WHO) declared Mpox a public health emergency of international concern (PHEIC) on August 14, due to the emergence of a new strain of the virus, known as Clade I. So, naturally, while assuring the public that the situation was well under control, the Centre went head and advised States to screen, test all suspect mpox cases. The Union Health Secretary, even earlier, called for the orientation of all key stakeholders with a focus on surveillance units under the Integrated Disease Surveillance Programme (IDSP) at state and district levels to re-orient them on definitions of suspect, probable, confirmed cases, contact tracing and other surveillance activities. In the letter, the Union Health secretary asked all States to make people aware of the mpox disease, its mode of spread, the need for timely reporting and taking preventive measures, besides reviewing the public health preparedness and isolation facilities for both suspect and confirmed. After all, as COVID has taught us, being prepared is half the work done during a pandemic.  

In addition, we followed up on articles that addressed the inequities of health care in Africa that have been highlighted along with the rise of the current mpox transmission. The first 100,000 doses of mpox vaccine reach Congo, three weeks after the World Health Organization declared mpox outbreaks in 12 African countries a global emergency, worse still, it’s a fraction of what is needed. In a DR Congo hospital, reports said, Mpox patients lack medicine, food. 

The other big news was something that will revolutionise TB care in the country in the future – the Union health ministry appoved new treatment for multidrug resistant TB last week. Less than years after the WHO recommended the BPaLM treatment regimen, India has adopted it too. The new BPaLM regimen consisting of four drugs — Bedaquiline, Pretomanid, Linezolid and Moxifloxacin — has proven to be a safe, more effective and quicker treatment option than previous procedures. It has the added advantage of being less toxic and having less side effects than the current regimen, besides being cost effective too. While traditional treatments can last up to 20 months with severe side effects, the BPaLM regimen can cure drug-resistant TB in just six months with high treatment success rate. India’s 75,000 drug-resistant TB patients will now be able to avail benefits of this shorter regimen. Do read The Hindu’s editorial on the subject: Taking TB seriously, welcoming the early introduction of the new regimen, and calling for leadership from India in this long-standing battle against mycobacterium tuberculosis, and drug resistance.

Among the measures that have enabled India’s progress in TB care is the provision of a nutrition package for persons who have TB and their family members. This emphasises the role that proper nutrition has to play in cure and recovery. Contextually, here is another Report that throws light on need of nutrition among childhood cancer patients in India, according to a report by Poonima Sah. In India, an estimated 76,000 children and adults between the age group of 0 to 19 years, may develop cancer annually, said a report by Cuddles Foundation, a non-profit based in India working with 40 public hospitals across 14 States. The report titled ‘Food Heals Report 2024’ was released in Mumbai in recognition of Childhood Cancer Awareness Month. The report further highlights that 65% of newly diagnosed paediatric cancer patients consume less than half of the daily calories and protein required for healthy development. Inadequate nutrition significantly reduces treatment tolerance, increases infection rates, and compromises growth and healing. 23% of children are below the age of 5 years, 36% of children between 5 and 10 years and 41% of children above 10 years. Most of the cases were haematological cancers with 60% and 40% with solid cancers. The report also estimates that childhood cancer burden accounts for 3% of boys and 1.8% of girls in the age group of 0-14 years. The gender distribution has remained unchanged for the past 4 years, aligning with the ratio of cancer diagnoses among boys at 66% and girls at 34% in India. Clearly, this should be on the list of focus areas for the health care community and the government, in India. 

Another major health decision that was taken this week, in India was the National Medical Commission withdrawing its revised medical curriculum guidelines. Earlier various groups of experts, and activists said the  New MBBS curriculum was full of errors. The new guidelines that were set to be implemented from this year’s batch of MBBS students would have taken the country several centuries behind. While they were not progressive, they were also violative of the law, and of its own guidelines set earlier. Published on August 31, the new curriculum specified that sodomy and lesbianism were “unnatural sexual offences”, including them under the category ‘sexual offences’. It also slotted transvestism or cross-dressing under the category of sexual perversion. The mandatory seven hours of disability competencies that students earlier had to undergo were excluded from the foundation course too.Thankfully, buffeted by strong criticism, the NMC withdrew the changes to the curriculum, thus sparing young students of the need to learn these erroneous assumptions. Read the edit here:  Undoing the undoing: On the Competency-Based Medical Education Curriculum guidelines 

A couple of interesting research articles on mobile phones and screen usage also came up this week. Firstly, Ken Karipidis and Sarah Loughran write that Mobile phones are not linked to brain cancer, major review of 28 years of research finds. The review was commissioned by the World Health Organization and is published today in the journal Environment International. Mobile phones are often held against the head during use. And they emit radio waves, a type of non-ionising radiation. These two factors are largely why the idea mobile phones might cause brain cancer emerged in the first place. The possibility that mobile phones might cause cancer has been a long-standing concern,in the public arena, though scientific consensus has always held that there’s no association between mobile phone radio waves and brain cancer, or health more generally. Mobile phones – and wireless tech more broadly – are a major part of our daily lives. So it’s been vital for science to address the safety of radio wave exposure from these devices. 
This is the most comprehensive review on this topic till date – it considered more than 5,000 studies, of which 63, published between 1994 and 2022, were included in the final analysis. No association between mobile phone use and brain cancer, or any other head or neck cancer, was found. There was also no association with cancer if a person used a mobile phone for ten or more years (prolonged use). How often they used it – either based on the number of calls or the time spent on the phone – also didn’t make a difference. So all of us, addicted to our phones, can take the results with confidence and with a huge sigh of relief.

Here’s the other side. Rachael Taylor argues It’s almost impossible to keep teens off their phones in bed – but new research shows it really does affect their sleep, but it comes with a nuance. 

Parents of children and teenagers have long been warned about the dangers of screen time and digital devices before bed – the worry being that screens could harm the sleep patterns of young people. But do screens really hurt the length and quality of sleep? Our new research found that using screens in bed was worse for sleep than using screens for hours before going to bed. Sleep guidelines recommend no screen use in the hour or two before bed. But we found screen time in the two hours before bed had little impact on young people’s sleep. Instead, it was screen time once in bed that caused problems. The next step to better understanding this will be to conduct experiments that can actually prove different types and timings of screen time affect sleep, says the author. Screens at night may not be the bogey man they have been made out to be. But allowing young people to have screens in bed can be detrimental to their quality of sleep. So the simple message might be to keep those devices out of the bedroom.

Nikita Francis writes a very important story on how there is Limited access to mental healthcare despite the rising demand. The demand for mental healthcare is increasing in India thanks to shifts in attitudes over the years. However, data show that there is no commensurate rise in the number of mental health professionals. The WHOs guidelines state that there should be at least three practising psychiatrists per one lakh population. As per the latest National Mental Health Survey (NMHS), which was conducted between 2015 and 2016, India has only 0.75 psychiatrists per 1 lakh population. In its 2023 report, ‘Mental Healthcare and Its Management in Contemporary Times,’ the Parliamentary Standing Committee on Health and Family Welfare stated that there were 9,000 working psychiatrists in India at the time. If the goal is to have three psychiatrists per one lakh population, India would require 36,000, the report said. 

Incidentally, on World Suicide Prevention Day, today (Sepetember 10) Afshan Yasmeen brings us information that NIMHANS is to launch a Suicide Prevention Centre. Suicide remains a leading cause of death in India, with self-harm incidents frequently presenting in State-run general hospitals.The new centre aims to tackle this gap in health care services, by developing and implementing an integrated programme designed to improve the capacity for mental health assessments and care planning for self-harm patients in general hospitals.

An online vaccine management portal U-Win will be launched later in September to maintain a permanent digital record of vaccination and medicines of more than three crore pregnant women and almost 2.7 crore children born annually, Union Health Secretary Apurva Chandra said last Friday. This is a very significant development that has the capacity to boost immunisation, and maternal and child health in all. As of now, the U-Win platform, a replication of the COVID-19 vaccine management system Co-WIN, is being run in a pilot mode in all states and Union territories except for West Bengal and captures every vaccination event of all pregnant women and children under the Universal Immunisation Programme.

Our tail piece for the week picks itself again. Even if it is not talking about the fictional empires of Ice and Fire, Sridhar Sivasubbu and Vinod Scaria’s article is on an equally fascinating subject: The Gene of thrones: genomes of rulers reveal how empires rose and fell. The authors discus Palaeogenomics — the analysis of ancient DNA from archaeological sites — is an important way for scientists to understand the past. For example, they have investigated the genomes of individuals from the now-extinct Paleo-Eskimo, the first culture known to settle in Greenland, to reveal their migration from Siberia to the New World around 5,500 years ago. Ancient DNA from the world’s tropical regions has been a challenge to study because the skeletal remains that host them decay rapidly in the warm, wet weather. Nevertheless, advances in palaeogenomics allowed researchers to obtain and sequence the genome of a 4000-year-old strand of hair belonging to an individual from the Middle Nile Valley in eastern Africa, allowing them to unravel the history of population dispersal on the continent.

In our explainers section this week: 

Why do people catch colds and flu more often in the winter?  

Zubeda Hamid writes on the ‘Brazen’ claims triggers curiosity about an old eye condition — presbyopia. For the original story that cause a flutter earlier last week, this is the story to read: DCGI gives approval for Indian eye drops developed to reduce dependency on reading glasses  

Do More children have food allergies now? Yes, say paediatricians, reports R. Sujatha 

In the In Focus podcast, learn about What is behind the escalating violence in healthcare spaces in India 

 Puneet Kumar and Vipin M. Vashishtha explain that a new Mice study claims to have found long COVID’s ‘real’ perpetrator – fibrinogen and fibrin, two components of blood that play important roles in clotting.  

If you have a few extra moments, also read: 

Dozens of viruses detected in Chinese fur farm animals 

Second stage of Gaza polio campaign begins while war goes on in other areas,  

Employ ex-servicemen, State security forces in high-risk areas of hospitals: Health Ministry 

Polio vaccination targets surpassed for Gaza children, WHO says

Blood fats could predict if weight loss will help pre-diabetics manage sugar, study suggests

National Exit Test for Ayush to apply to students who had enrolled from 2021-2022 onwards: Minister 

Medical institutes asked to upload details of temporary registration for foreign medical practitioners 

There is a significant dengue issue in Karnataka, we will continue to follow up over the week, but in the meanwhile, this is where you can catch all the stories

Dengue cases cross the 25,000 mark, the highest ever, in Karnataka  

Karnataka notifies dengue as epidemic after unprecedented 25,589 cases this year 

Karnataka’s 2024 dengue tally crosses last year’s caseload 

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