new delhi a 34yearold man from west delhi is currently admitted in the isolation ward of a staterun hospital designated for management of monkeypox cases unlike the other three cases all of them from kerala and with a history of travel to the uae the delhi patient doesnt have any history of travel to countries that have reported instances of monkeypox this has alarmed health officials about the extent of the spread of the diseasealso many health experts have pointed out how the infection is mostly being reported in gay or bisexual men in this backdrop the dghs also highlighted the need for a targeted approach towards men who have sex with men msm by the national aids control organisationthe union health ministry had issued guidelines for management of monkeypox to all states and uts to ensure preparedness to deal with any potential crisis in mayend much before the disease was declared a public health emergency of international concern by the world health organisationin its guidelines the health ministry said even one case of monkeypox is to be considered an outbreak it should trigger a detailed investigation by rapid response teams that need to be initiated through the integrated disease surveillance programme the guideline stated it directed all states and uts to report any suspected case immediately to the state and the central surveillance units which shall have to report the same to the health ministrya confirmed case is laboratory confirmed for monkeypox virus by detection of unique sequences of viral dna either by polymerase chain reaction pcr andor sequencing