Man who died in Thrissur on Saturday had tested positive for monkeypox in the United Arab Emirates before returning to India, Kerala health minister Veena George said on Sunday. The state government will confirm the infection only after getting swab results from the National Institute of Virology, the minister said.

He returned to India on July 22 and was admitted to a private hospital five days later after he developed high fever, she added.

“We will inquire how he came out of the airport and suppressed his health details like this,” she said. “We have prepared a detailed route map of the deceased and many people were already been quarantined.”

The deceased reportedly told his mother and sister about his test in the UAE only after his condition deteriorated. Initially, he was admitted to a private hospital in Chavakkad and later shifted to another hospital in Thrissur after his condition deteriorated, the relative said.

One of his relatives, who preferred not to be named, said he reached Kozhikode airport in the early hours of July 22 and three of his friends received him. The man then travelled to many places in the next three days and even played football, he said.

It was really baffling how the man evaded the screening and thermal test at the airport, a Kozhikode airport official said, seeking anonymity. After the first monkey pox case was reported in the country on July 12, who returned from the UAE to Kollam in south Kerala, the screening of passengers in all four airports in the state had been intensified. Some people, however, do take tablets to suppress body temperature, the airport official said.

Doctors who treated the deceased said his symptoms were similar to monkeypox. “There were no red marks or blisters when he got admitted. But later such symptoms started appearing on his body. Since he came from the high- risk UAE, he was admitted to an isolation ward from the day one,” a doctor who treated him said, declining to be named.

The health minister has called for an emergency meeting of health officials in Thrissur on Monday.

“Monkeypox is not a fatal disease. We have to find out how the death took place. We will also examine why there was a delay in hospitalization,” George said, adding that doctors told her that he was suffering from some other ailments as well. “The strain identified here is not that virulent, but it spreads fast. Since the infection is fast, we have to take adequate precautions,” she said.

Monkeypox virus mutates at a higher rate but it is treatable, experts said. The infection starts with fever and headache and flue. As the infection turns acute, red lesions appear on the body, which triggers itching like in chicken pox, they said. The incubation period of virus ranges from five to 21 days.

“It is not a fatal, but the only concern is that it has high mutation rate. We have to find out how this young man died,” said Dr N M Arun, internal medicine and public health expert. “Human to human infection rate is also not that high like Covid. Only those who come in close contact with the infected can be further infected.”

Isolation is key in containing the disease and all who come in contact with patients will have to take extreme caution,” said Dr K Bindu, community medicine expert at Kozhikode medical college. “In some African countries, there are reports that it spreads through animal meat, so we have to ensure that meat is cooked properly.”

Transmission happens only through close contact like touching or sharing the cloth, towel or bed sheets used by the infected, as secretion from lesions carry a high virus load, experts said. Sex with the infected will also transmit and transmission can happen till lesions heal and final stages of healing is critical for transmission like other pox diseases, they said as per the reports by Hindustan Times.

The World Health Organisation last week declared a global health emergency over a monkeypox outbreak reported from more than 75 countries.