What is Monkey Fever? (Kyasanur Forest Disease) – History, Symptoms, Transmission, Prevention, Treatment, Globally Spreadness etc

Monkey fever, also known as Kyasanur Forest Disease (KFD), is a tick-borne viral hemorrhagic fever endemic to the Indian state of Karnataka. Caused by the Kyasanur Forest Disease Virus (KFDV), it primarily affects humans bitten by infected ticks or those in contact with infected animals like monkeys, rats, and birds. This article provides a comprehensive overview of monkey fever, including its history, symptoms, transmission, prevention, treatment, and global spread.

History and Background

Monkey fever's discovery traces back to 1957 when several monkeys died from an unknown illness in the Kyasanur Forest of Karnataka. Local woodcutters clearing the forest were also afflicted by the same mysterious disease. Medical investigation led to isolating the causative Kyasanur Forest Disease Virus (KFDV), classified as a member of the virus family Flaviviridae. It was the first time KFD virus was identified.

Since its discovery, monkey fever has been reported mainly from the native Kyasanur forest areas of Shivamogga and adjoining districts. However, due to deforestation and human migration, the disease spread to newer regions like Wayanad in Kerala and Sindhudurg, Uttara Kannada in Karnataka. Overall, over 500 cases have been reported in India, with case fatality rates ranging from 3-10%.

Symptoms Initial symptoms of monkey fever usually appear within 3-8 days of exposure and resemble many viral illnesses, making diagnosis difficult initially.

Common symptoms include:

• High fever (up to 104°F)
• Chills
• Headache
• Severe muscle/joint pain
• Gastrointestinal symptoms like vomiting, diarrhea, abdominal pain
• Cough
• Abnormal bleeding from nose, gums, or under skin

As the disease progresses, more severe complications can develop in a minority of cases:

• Neurological symptoms like severe headache, mental disturbances, tremors, vision deficits
• Bleeding from mucosal surfaces (gastrointestinal, urinary tracts)
• Low blood cell/platelet count causing anemia and spontaneous bleeding
• Kidney/liver dysfunction
• Fluid buildup in lungs (pulmonary edema)

Without prompt treatment, monkey fever can be fatal with mortality rates of 10-20% historically. However, with modern ICU care and ribavirin antiviral therapy, the case fatality rate has dropped to 3-10%.

Transmission Monkey fever primarily spreads to humans through infected ticks that parasitize/feed on wild monkeys, rodents, shrews and birds in the forest regions. The primary vector is the Haemaphysalis spinigera tick species, while Ixodes petauristae and other hard ticks may also transmit the virus.

These ticks become infected with KFD by feeding on viremic animals like black-faced langurs, red-faced bonnet macaques, and rodents like rat-tailed shrews. KFDV circulates among these forest animal populations through infected ticks and forms an enzootic cycle.

Humans who enter these tick-infested forest areas during occupational activities like farming, hunting, firewood collection or tourism may get accidental tick bites and contract the disease. The virus can also spread between monkeys, shrews and other small mammals through ticks.

Human-to-human transmission is possible but very rare. It requires direct exposure to infected blood or tissues. Healthcare workers handling infected cadavers or biological samples are theoretically at risk without proper biosafety protocols.

Prevention of Monkey Fever

As no licensed KFD vaccine exists currently, prevention focuses on avoiding tick bites in forested endemic regions through personal protective measures. These include:

• Wearing full-sleeved shirts and full-length pants tucked into socks/boots
• Using DEET-based insect repellents on exposed skin and clothes
• Inspecting skin/clothes for ticks regularly and safely removing attached ticks
• Avoiding sitting/resting under trees or shrubs in endemic areas
• Maintaining clean kitchen/living areas to deter rodent/tick infestation near humans

Controlling tick populations in forest habitats through pesticides/acaricides may help reduce viral transmission between animal hosts. Avoiding unnecessary forest entry during tick season from November to May also minimizes risk.

Healthcare workers handling patients, biological samples or conducting autopsies must use proper personal protective equipment (PPE) including double gloves, goggles/face shields and N95 respirator masks.

Treatment of Monkey Fever

Currently, no specific KFD treatment is available. Therapy focuses on managing symptoms and preventing complications. Patients usually require hospitalization and close monitoring for bleeding, organ dysfunction and other issues.

Supportive care with IV fluids, blood transfusions, maintenance of fluid and electrolyte balance, and management of low blood pressure forms the mainstay of treatment. Any underlying medical conditions like diabetes, hypertension also require control.

Ribavirin is an antiviral drug that may be used experimentally. Early administration reduces complications and mortality. However, its use remains controversial due to potential toxicity, and conclusive efficacy data is lacking.

Intensive care with ventilatory and advanced organ support becomes necessary in severe cases to prevent life-threatening complications. A multidisciplinary team effort covering physicians, nursing staff and other healthcare workers is vital.

Strict isolation protocols are required until the patient is deemed non-infectious, usually after resolution of fever and other symptoms. Contaminated articles must be disinfected through autoclaving, burning or treatment with sodium hypochlorite.

Once recovered, individuals do not require isolation and are immune to future KFD infections. Only very rare recurrences have been reported.

Global Distribution

Monkey fever is presently limited to the Indian subcontinent. Sporadic cases continue occurring during the dry season in Karnataka's Shivamogga, Uttara Kannada and Chikkamagaluru districts. Some cases also reported in Kerala's Wayanad and Malappuram.

Beyond India, KFD has not been detected in any other geographical region till date. Serological surveys found no evidence of KFDV circulation in animals or humans from other Asian or African countries.

However, the presence of the tick vectors and animal hosts like macaques across large parts of South and Southeast Asia raises concerns about the disease's potential geographic expansion under favorable ecological conditions. Climate change, globalization and increased human encroachment into forest habitats pose risks.

Long-term Solutions Experts emphasize an integrative One Health approach involving veterinary, medical and environmental disciplines is required to control KFD's spread. This entails:

Active animal surveillance and tick population control in forests

Developing effective KFD vaccines for human and animal use

Further research on antivirals, diagnostics and disease ecology

Awareness campaigns educating high-risk populations like farmers

Regulating human activity/settlements in disease-prone forested areas

Cross-border cooperation for regional disease monitoring/control

With targeted efforts, the future likely holds better medical interventions and public health strategies to minimize the impact of monkey fever. However, the dynamic virus-vector-host ecology means continued monitoring is crucial to prevent wider transmission.

To conclude that, Monkey fever or Kyasanur Forest Disease is a rare but dangerous tick-borne illness endemic to parts of India. While no specific cure exists, modern intensive care has reduced mortality rates. However, prevention through personal protective measures remains crucial until better medical countermeasures like vaccines are developed. Continued research and adopting integrated One Health strategies seem vital.