By Dr. Amit Singh
Monkeypox is a viral disease of animal origin. It occurs primarily in tropical rainforest areas of Central and West Africa and is occasionally exported to other regions. Common symptoms of mpox include a rash which may last for 2–4 weeks. This may start with, or be followed by, fever, headache, muscle aches, back pain, low energy and swollen glands (lymph nodes). The rash looks like blisters or sores, and can affect the face, palms of the hands, soles of the feet, groin, genital and/or anal regions. These lesions may also be found in the mouth, throat, anus, rectum or vagina, or on the eyes. The number of sores can range from one to several thousand. Some people develop inflammation inside the rectum (proctitis) that can cause severe pain, as well as inflammation of the genitals that may cause difficulties urinating.
In most cases, the symptoms of mpox go away on their own within a few weeks with supportive care, such as medication for pain or fever. However, in some people, the illness can be severe or lead to complications and even death. Newborn babies, children, people who are pregnant and people with underlying immune deficiencies such as from advanced HIV disease may be at higher risk of more serious mpox disease and death. Severe disease due to mpox may include larger, more widespread lesions (especially in the mouth, eyes and genitals), secondary bacterial infections of the skin or blood, and lung infections. Complications can include severe bacterial infection from skin lesions, mpox affecting the brain (encephalitis), heart (myocarditis) or lungs (pneumonia), and eye problems. People with severe mpox may require hospitalization, supportive care and antiviral medicines to reduce the severity of lesions and shorten time to recovery. According to available data, between 0.1% and 10% of people with mpox have died. It is important to note that death rates in different settings may differ due to several factors, such as access to health care and underlying immunosuppression, including because of undiagnosed HIV or advanced HIV disease.
Mpox can be transmitted from Animal to Humans as well as Human to Human. The virus enters the body through broken skin (even if not visible), respiratory tract, or the mucous membranes (eyes, nose, or mouth).
- Animal-to-human transmission may occur by bite or scratch, bush meat preparation, direct contact with body fluids or lesion material, or indirect contact with lesion material, such as through contaminated bedding.
- Human to human transmission occurs through close contact includes being face-to face (such as talking or breathing close to one another which can generate droplets or short-range aerosols); skin-to-skin (such as touching or vaginal/anal sex); mouth-to mouth (such as kissing); or mouth-to-skin contact (such as oral sex or kissing the skin). It is also possible for the Mpox virus to persist for some time on clothing, bedding, towels, objects, electronics and surfaces that have been touched by a person with Mpox. The virus can also spread during pregnancy to the fetus, during or after birth through skin-to-skin contact, or from a parent with Mpox to an infant or child during close contact.
- The clinical presentation of monkeypox resembles that of smallpox, a related orthopoxvirus infection which was declared eradicated worldwide in 1980. Monkeypox is less contagious than smallpox and causes less severe illness.
Incubation period is usually 6-13 days but can range from 5-21 days and the person is usually not contagious during this period. An infected person may transmit the disease from 1-2 days before appearance of the rash and remain contagious till all the scabs fall off.
Current Scenario:
Global: As on date, cases of Monkey pox have been reported from South Africa, Kenya, Rwanda, Uganda, Democratic Republic of Congo, Burundi, Central African Republic, Congo Brazzaville, Cameroon, Nigeria, Ivory Coast, Liberia, (imported cases in Sweden and Pakistan)
WHO declared Mpox as PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN on 14th August 2024. There are vaccines recommended by WHO for use against mpox. Many years of research have led to the development of newer and safer vaccines for an eradicated disease called smallpox. Some of these vaccines have been approved in various countries for use against mpox.At present, WHO recommends use of MVA-BN or LC16 vaccines, or the ACAM2000 vaccine when the others are not available.Only people who are at risk (for example, someone who has been a close contact of someone who has mpox, or someone who belongs to a group at high risk of exposure to mpox) should be considered for vaccination. Mass vaccination is not currently recommended. Travellers who may be at risk based on an individual risk assessment with their health care provider may wish to consider vaccination.An antiviral developed to treat smallpox (tecovirimat) was approved in January 2022 by the European Medicines Agency for the treatment of mpox under exceptional circumstances. Experience with these therapeutics in the context of an outbreak of mpox is growing but still limited.
Recommended Public health actions
- Health workers should follow infection prevention and control measures to protect themselves while caring for patients with mpox (by wearing appropriate personal protective equipment and adhering to protocol for safely swabbing lesions for diagnostic testing and handling sharps such as needles).
- International Travelers Health Desk at Airports and Ships or with Crew coming from the affected countries at Seaports or Passengers at Land Borders at port of entries to keep heightened suspicion in passengers:
- Who present with fever, profound weakness & an otherwise unexplained rash and
- Who have travelled, in the last 21 days, to a country that has recently had confirmed or suspected cases of Mpox or report and contact with a person or people with confirmed or suspected Mpox.
b). All suspected cases identified at Port of Entry to be isolated at transit isolation facilities and information to be shared immediately with the health authorities
c). All infection control practices to be followed while handling such suspect cases.
3.If you have mpox, your healthcare provider will advise you on what to do while you recover. Follow healthcare provider advice on whether you should recover at home or if you need care in a health facility.
In the meantime, it is important to avoid having close contact with others until your lesions have completely healed.
If you are advised to isolate at home, protect those you live with as much as possible by:
- asking friends and family to help you by delivering things you need;
- isolating in a separate room;
- using a separate bathroom, or cleaning any surfaces you touched after each use;
- cleaning and disinfecting frequently touched surfaces with soap and water and a household disinfectant;
- avoiding sweeping/vacuuming (this might disturb virus particles and cause others to become infected);
- using separate utensils, objects, electronics, or clean well with soap and water/disinfectant before sharing;
- not sharing towels, bedding or clothes;
- doing your own laundry (lift bedding, clothes and towels carefully without shaking them, put materials in a plastic bag before carrying it to the washing machine and wash them with hot water over 60 degrees Celsius);
- opening windows for good ventilation; and
- encouraging everyone in the house to clean their hands regularly with soap and water or an alcohol-based hand sanitizer.
The Author is the Dean of the School of Medicine at Texila American University, Zambia.
