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Monkey fever or Kyasanur Forest Disease (KFD) has claimed two lives in Karnataka calling for urgent action and implementation of preventive measures to contain spread of the disease. The tick-borne haemorrhagic fever, usually contracted by monkeys, is caused by KFD virus which is an arbobirus of the family Flaviviridae. An 18-year-old girl and a 79-year-old man have so far succumbed to the disease, out of 49 positive cases in the state. The initial symptoms of the viral disease are sudden fever, headache, body ache, vomiting, abdominal pain, and diarrhoea. while severe disease with haemorrhagic symptoms may occur later. It is important to control tick populations in wildlife, particularly monkeys, to prevent the spread. (Also read: India on the verge of eliminating ‘black fever’ kala-azar, second deadliest parasitic disease)
What is Monkey Fever?
Kyasanur Forest Disease (KFD) commonly known as Monkey Fever is a viral haemorrhagic disease that was first identified in 1957 in the Kyasanur Forest in the Western Ghats of India. It is caused by KFD virus (KFDV) which is an arbovirus of the family Flaviviridae.
“Initially confined to the Western Ghats of Karnataka, the disease has expanded its presence over the past decade, with reported cases extending to neighbouring states along the Western Ghats, such as Kerala, Maharashtra, and Tamil Nadu. The disease’s burden is on the rise, reflecting a shift in its epidemiological profile and establishing it as an emerging tropical disease in India,” says Dr Laxman Jessani – Consultant Infectious Disease, Apollo Hospitals Navi Mumbai.
“Recently, 31 cases have been detected in Karnataka’s Uttara Kannada district with patients either being treated at home or admitted to hospitals but are reported to be stable. This indicates ongoing transmission and the need for continued surveillance and preventive measures in affected areas,” says Dr Jessani.
How does Monkey fever spread?
“Infection occurs through tick bites carrying the virus or, less commonly, contact with infected animals, primarily monkeys. Symptoms include fever with possible haemorrhagic and/or neurological features. While approximately 80% of patients recover without post-viral symptoms, around 20% may develop severe haemorrhagic or neurological issues. Estimates suggest that around 500 human KFDV infections occur annually with a case fatality rate of 3-5%. As it is life-threatening and there is lack of effective countermeasures, KFDV is classified as a Biosafety level 4 (BSL4) pathogen,” says Dr Jessani.
Symptoms of Monkey Fever
After an incubation period of 3 to a week post-tick bite, monkey fever starts abruptly with fever, chills, headache, and severe exhaustion.
“As the disease progresses, symptoms can escalate to include nausea, vomiting, stomach pain, diarrhoea, meningitis, confusion and even haemorrhagic signs like nose bleeds and bleeding gums. Without proper supportive treatment, complications like shock, dehydration, electrolyte disturbances, haemorrhage and organ failure can arise and become fatal,” says Dr Shruti Sharma, Consultant-Internal Medicine, Yatharth Super Speciality Hospital.
“The virus has a 3-8 day incubation period and manifests in two or rarely four stages. In the first phase, symptoms include sudden fever, headache, body ache, conjunctiva inflammation, vomiting, abdominal pain, and diarrhoea. Clinical examination reveals lymphadenopathy, hepato-splenomegaly, weakness, and fatigue. Haemorrhagic symptoms may occur, with most patients recovering in 10-14 days,” says Dr Jessani.
“The initial symptoms often include a sudden onset of high fever accompanied by chills. Severe headaches and muscle pain are common, making the infected person feel extremely unwell. Nausea, vomiting, and diarrhoea may occur, impacting the digestive system. In severe cases, it can lead to bleeding tendencies, which may result in a range of complications,” says Dr Manjusha Agarwal, Senior Consultant, Internal Medicine Global Hospitals, Parel, Mumbai.
The virus can cause damage to vital organs, leading to organ failure. Severe cases may progress to haemorrhagic fever, causing internal bleeding and potentially fatal outcomes. If haemorrhagic symptoms persist, the second phase may bring severe neurological complications like drowsiness, disorientation, confusion, convulsion, and loss of consciousness.
“While most patients recover with subsided fever and rare long-term complications, continuous haemorrhagic issues may lead to poor outcomes, with a 2-10% mortality rate. Non-endemic areas show higher fatalities, potentially due to lower herd immunity and delayed diagnosis. Those with weakened immune systems or advanced age face a higher risk of severe outcomes,” adds Dr Jessani.
“The virus can cause damage to vital organs, leading to organ failure. Severe cases may progress to haemorrhagic fever, causing internal bleeding and potentially fatal outcomes,” says Dr Agarwal.
Diagnosis, prevention and management tips
“Due to unclear early symptoms, monkey fever diagnosis relies on clinical suspicion and confirmatory lab tests like ELISA antibody assays and RT-PCR assays that can identify immune response to KFDV and detect viral genetic material, respectively. As there are no antiviral medications that directly target KFDV, management involves symptomatic relief, close monitoring of complications, maintenance of nutrition and organ function. Preventive measures emphasize personal protection against ticks in outbreak zones via repellents and appropriate clothing as well as spraying of acaricides to control tick population spread,” says Dr Sharma.
“Early detection is vital for effective management. Preventive measures involve avoiding tick bites through protective clothing, repellents, and caution in endemic areas. Education and awareness are crucial for at-risk populations. A vaccine for Kyasanur Forest Disease is recommended for those in or visiting endemic regions, with vaccination campaigns effectively reducing disease incidence. The current vaccine is a 0.1% formalin inactivated tissue culture vaccine, and ongoing research explores more effective options,” says Dr Jessani.
“Management involves supportive care, symptom relief, and complication treatment, as there is no specific antiviral for KFD. Severe cases may require hospitalization for complication management,” adds the expert.
Dr Agarwal shares prevention and management tips for Monkey Fever:
1. A vaccine is available in endemic areas, offering protection against KFD.2. Wearing protective clothing, using tick repellents, and avoiding tick-infested areas reduce the risk of transmission.
2. Monitoring and controlling tick populations in wildlife, particularly monkeys, can help prevent the spread of the virus.
How to take care
1. There is no specific antiviral treatment for KFD, so medical care focuses on alleviating symptoms and providing supportive measures.
2. Severe cases may require hospitalization for close monitoring and intensive care.
3. Maintaining hydration is crucial to manage fever and prevent complications.
4. Analgesics and antipyretics may be prescribed to alleviate pain and reduce fever.
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