First two cases of Monkeypox virus infection in travellers returned from UAE to India, July 2022

Abstract We report the first two confirmed cases of Monkeypox in foreign returnees from United Arab Emirates who presented with fever, myalgia, and vesicular lesions on the genital area with cervical lymphadenopathy. The oropharyngeal & nasopharyngeal swab, EDTA blood, serum, urine, lesion samples from multiple sites (lesion fluid, lesion roof and lesion base) were collected from both the cases on ninth post onset day of illness. The clinical specimens of both the cases were tested with real time PCR for Orthopoxvirus, Monkeypox virus (MPXV), West African clade specific MPXV. The specimens oropharyngeal & nasopharyngeal swab, urine, lesion samples from multiple sites (lesion fluid, lesion roof and lesion base) were tested positive for MPXV. The complete genome sequences obtained from skin lesions of case 1 and 2 showed similarity of 99.91 and 99.96% respectively with MPXV_USA_2022_FL001 West African clade. Phylogenetic analysis revealed that the two cases were infected with Monkeypox virus strain A.2 which belong to hMPXV-1A lineage of clade 3.