In the wake of two confirmed cases of monkeypox in the country being reported from Kerala, the state government on July 20 issued standard operating procedures (SOP) for isolation, sample collection and treatment of those infected or showing signs of the disease and at the same time said there was nothing to be concerned about.

Kerala Health Minister, in a release, gave details of the SOP which is to be followed by all private and government hospitals. Later in the day, in the state assembly, the minister said that there was no need to be concerned about monkeypox, but the people should take precautionary measures like wearing masks and using sanitisers to prevent the spread of the disease.

"There is no need to be worried about monkeypox. However, precautionary measures, like masks and sanitisers, taken in connection with COVID-19 should be adopted to prevent the spread of this virus," she said in the assembly. The minister also said there needs to be cooperation between the MLAs to create awareness among the people and address their concerns.

She also told the assembly that a suspected case of monkeypox in Alappuzha tested negative for the same and family members of the person who was the first reported case of the virus also tested negative. None of the contacts of the two people who got infected is developing symptoms of the disease, she added.

In the release issued in the morning regarding the SOPs, the minister said any person who has travelled in the last 21 days to a country where monkeypox has been reported and is having red spots on the body along with one or more of the other symptoms, like fever, headache, body ache or fever, should suspect infection by the virus.

The minister, in the release, further said the risk of infection is high through close physical or direct skin-to-skin contact or sexual intercourse with an infected person or by touching their bedding or clothing. Anyone falling in these categories would come in the primary contact list, she said and added that infection is confirmed through a PCR test.

According to the Health department's SOP, as mentioned in the release, suspected and probable cases of monkeypox are to be treated separately and in isolation and the District Surveillance Officer (DSO) should be informed immediately.

Samples should be collected as per the protocols laid down for the same by the National Institute of Virology (NIV) and the DSO would be responsible for sending the same to the lab, it said.

Referrals from private hospitals to government facilities should be on patient request and only critically ill patients from state-run hospitals with isolation facilities should be referred to medical colleges, the SOPs further said.

While transporting infected persons to a hospital or from one medical institution to another, a PPE kit, N95 masks, gloves and goggles should be worn by the health professionals and the patients too should wear an N95 or triple layered mask and any wounds on their bodies should be covered, it said.

After patient delivery, the ambulance and equipment therein should be disinfected and the patient's items like clothing, should be disposed of, the Health department release said. Confirmed cases of monkeypox should be managed as per the Centre's guidelines and in case of any doubt regarding treatment, the state medical board should be consulted, it added.

As all international airports in the state have thermal scanners, the release said anyone showing signs of fever would be examined for red spots by a medical team and if such signs are found, they will be transferred to the nearest hospital with isolation facilities and the DSO would be informed about the same.

Health workers have been directed to monitor those in the primary contact list for 21 days for any symptoms by calling them over the phone and recording their temperature twice a day, it said and added that the health worker or nurse in charge of monitoring should visit the house of the contacts periodically to ensure they follow the guidelines.

In case the primary contact person has a fever, they should be immediately isolated and if red spots appear, their samples should be sent for monkeypox testing, the release said. Those in the contact list who are not showing symptoms should not donate blood, cells, tissue, organs, or semen, it added.

The Kerala government on July 19 started testing for monkeypox infection at the Alappuzha NIV with testing kits brought from NIV, Pune. India had on July 18 reported a second confirmed case of monkeypox from Kerala's Kannur district. The patient, who arrived in Kerala on July 13, is a native of Kannur in north Kerala and undergoing treatment at the Pariyaram Medical College there.

The first case of monkeypox, a rare but potentially serious viral illness, was reported in the Kollam district of south Kerala on July 14. He is currently undergoing treatment at the Government Medical College Hospital, Thiruvananthapuram. Both their samples were sent to the NIV, Pune, and they tested positive for the virus.

According to the World Health Organisation, monkeypox is a viral zoonosis (a virus transmitted to humans from animals), with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe.

With the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, monkeypox has emerged as the most important orthopoxvirus for public health.