With the first case of Mpox Clade II reported in India, the virus is no longer a distant concern confined to Africa but a pressing issue at our doorstep. While Clade II has a lower fatality rate compared to its more severe counterpart, Clade I, its presence in India raises a critical question: Is mass screening required to prevent a potential outbreak?

Recent data show a troubling trend in Mpox occurrences in India, highlighting the country's potential susceptibility to the disease. The National Centre for Disease Control (NCDC) reported the detection of the first Mpox case in India on July 14, 2022, in Kollam, Kerala. The most recent case came from Kerala on March 27, 2024. To date, with the new case recently declared, India has reported 31 confirmed cases, evenly split between Kerala and Delhi. Despite this, there have been no recent reports of new instances.

However, a recent investigation of condom samples published Lancet Infectious Diseases from several nations found considerable information about Mpox virus (MPXV) prevalence. Out of the 20,941 samples analysed worldwide, 1.3% had MPXV DNA. India had the highest positive rate of 2.7% (32 out of 1,188 samples), whereas neighbouring countries Pakistan (2.3%) and Thailand (2.1%) had lower rates. This shows a significant MPXV presence in India, which is a major public health problem. 

The MPXV DNA found in Indian condom samples had many nucleotide changes in common with samples from Nepal and Pakistan. This showed patterns of transmission in that region. Furthermore, the detection of MPXV DNA often coincided with other STIs like herpes simplex virus (HSV) and HIV, underscoring the risk of co-transmission.

The efficiency of condoms in preventing the transmission of MPXV is unknown; however, the evidence suggests that they could be a beneficial indirect surveillance technique. This is crucial because MPXV can spread by a variety of channels, including semen and vaginal sores. The detection of MPXV DNA in condoms, along with other STIs, highlights the importance of comprehensive Mpox surveillance and preventive programs.

In a similar editorial comment published in the same journal, the authors noted that Mpox has a low fatality rate worldwide, particularly for clade II, which has recently become common. Young children and immunocompromised adults, such as those with HIV, are particularly vulnerable to the disease. The current worries regarding a more severe class I, mainly in the Democratic Republic of the Congo, show that the severity of Mpox varies greatly. Clade I has a greater case fatality rate; however, this is primarily due to historical and demographic reasons, such as a higher prevalence of severe cases among youngsters. 

While the case fatality rate for clade I in the Democratic Republic of the Congo has declined from over 8% to roughly 3%, indicating probable reporting biases, the disease continues to pose a major hazard in areas with high HIV prevalence and limited medical facilities. 

While the government communication and some epidemiologists suggest that there is no need to panic at the moment, studies indicate that India has a high positive rate for STIs and MPXV DNA is found in a lot of them. This means that Mpox outbreaks are more likely to happen and stronger precautions need to be taken.

The detection of Mpox DNA in multiple condom samples across India, with a positive rate of 2.7%, suggests the virus could be more widespread than currently acknowledged. Given its transmission through multiple channels, including sexual contact and co-infections with other STIs like HIV and herpes, India's susceptibility to a rapid spread seems plausible. The virulence factor of Mpox, particularly among immunocompromised individuals and young children, further underscores the urgency of preventive measures.

While government communication downplays the need for panic, the high prevalence of Mpox DNA in STI cases should not be overlooked. Mass screening could be a proactive tool, identifying carriers early and curbing the virus’s spread before it escalates. Should we wait for more cases to emerge, or is it time to act now to ensure Mpox doesn't become another widespread epidemic in India?