The world has been grappling with the rapid spread of Mpox, and now, India has reported its first case of the more virulent Clade 1B strain. A 38-year-old man from Kerala, who recently returned from the United Arab Emirates, was diagnosed with the virus on Monday, September 23rd. While India has seen a handful of Mpox cases since 2022, this is the first instance of the Clade 1B strain being detected in the country.
This development raises significant concerns about the potential spread of this particular strain within India. So, what exactly is Clade 1B, and why is it different from other strains? Mpox is categorized into two distinct clades: Clade I and Clade II. Clade I is considered the more virulent and potentially deadly version of the virus, while Clade II is the strain responsible for the global outbreak that began in 2022. Infections from Clade II Mpox are generally less severe, with a survival rate exceeding 99.9%.
The Clade 1B strain, first identified in the eastern region of the Democratic Republic of Congo, is a cause for alarm. The outbreak of this strain originated in the mining town of Kamituga, South Kivu province, and has since spread to neighboring countries like Uganda, Rwanda, Burundi, and Kenya. In August, the World Health Organization (WHO) declared Mpox a Public Health Emergency of International Concern due to the rapid transmission of Clade 1B.
Epidemiological data suggests that Clade 1B transmits more readily between people compared to previous strains. Experts believe the Clade 1B genome contains genetic mutations induced by the human immune system, indicating its presence in humans for some time. It’s reported that Clade 1 strains are associated with more severe symptoms and a higher mortality rate, reaching up to 10% among children in the Democratic Republic of Congo.
One way to differentiate between Clade 1 and Clade 2 Mpox infections is through the skin rashes. Patients with Clade 1 may experience more intense rashes with larger lesions and more pronounced lymphadenopathy. Dr. Ajay Agarwal, Senior Director of Internal Medicine at Fortis Hospital in Noida, explained, “Clade 1 usually causes more severe symptoms like high fever, severe headache, myalgia, and enlarged lymph nodes. The skin lesions are usually extensive and can often cause scarring of the affected regions, whereas Clade 2 is associated with milder symptoms.”
The spread of Clade 1B extends beyond Africa. In August, a 66-year-old European male in Thailand was diagnosed with the strain, having recently returned from an African country experiencing a major Clade 1 outbreak. Europe has also recorded a Clade 1B case in a man in Sweden. The European Centre for Disease Prevention and Control anticipates more Clade 1 cases in Europe due to frequent travel between the continent and Africa.
In response to the global Mpox alert, India has heightened its vigilance against the infection. Kerala, where the recent Clade 1B case was detected, has implemented a Standard Operating Procedure (SOP) to manage the infection and prevent its transmission. The state’s Health Minister, Veena George, has urged the public to inform health officials about any international travel and seek medical attention promptly. She also released a list of state-run hospitals equipped with treatment and isolation facilities for affected individuals.
Nationally, the Indian government has directed hospitals across the country to identify patients with rashes and prepare isolation wards. Diagnostic labs have been instructed to be equipped for timely testing of the virus. Airports and ports have been placed on high alert, and states have been asked to enhance surveillance within their jurisdictions. At Bengaluru’s Kempegowda International Airport, international travelers are undergoing thermal screening. Authorities have established an isolation zone to manage suspected cases efficiently.
The Indian government is actively taking steps to prevent the spread of Mpox and its more virulent Clade 1B strain. However, with the growing threat of the virus, vigilance and prompt action remain crucial to safeguarding public health.
