by Muhammad Nadeem
By raising awareness about mpox – its transmission, symptoms, and prevention strategies – we can empower individuals to make informed decisions about their health and the health of their communities.
Mpox, formerly known as monkeypox, is a viral illness that has gained significant attention recently, particularly due to the global outbreak in 2022-2023.
The monkeypox virus was first discovered in 1958 in Denmark, where it was found in a colony of monkeys kept for research purposes. However, it wasn’t until 1970 that the first human case of mpox was reported. This initial case involved a nine-month-old boy in the Democratic Republic of the Congo (DRC). Following the eradication of smallpox in 1980 and the subsequent cessation of global smallpox vaccination, mpox emerged more prominently in central, east, and west Africa.
Mpox is caused by the monkeypox virus (MPXV), an enveloped double-stranded DNA virus belonging to the Orthopoxvirus genus in the Poxviridae family. This family also includes other notable viruses such as variola (smallpox), cowpox, and vaccinia. Two distinct genetic clades of the monkeypox virus have been identified: clade I and clade II.
Natural Reservoir and Animal Transmission
The natural reservoir of the monkeypox virus remains unknown, but various small mammals, including squirrels and monkeys, are susceptible to infection. Animal-to-human transmission of monkeypox can occur through several means, such as bites or scratches from infected animals, hunting activities, skinning infected animals, trapping wild animals, preparing, or cooking infected meat, playing with animal carcasses, or consuming infected animals. These interactions pose a risk of transmission, highlighting the importance of caution when interacting with potentially infected animals.
The extent of viral circulation in animal populations is not fully understood, and further studies are ongoing to elucidate this aspect of the virus’s ecology.
Human-to-Human Transmission
Person-to-person transmission of mpox primarily occurs through direct contact with infectious materials, which can happen in various ways. Face-to-face contact, such as talking or breathing near an infected individual, can transmit the virus. Skin-to-skin contact, including touching an infected person or engaging in sexual activities, is another common mode of transmission. Additionally, mouth-to-mouth contact, like kissing, and mouth-to-skin contact, such as oral sex or kissing the skin of an infected individual, can also spread the virus. Finally, prolonged close contact can lead to transmission through respiratory droplets or short-range aerosols. Understanding these transmission routes is crucial for taking effective precautions to prevent the spread of mpox.
The virus enters the body through broken skin, mucosal surfaces (such as the mouth, throat, eyes, genitals, or anus), or via the respiratory tract. It is important to note that mpox can spread to other members of a household and sexual partners. Individuals with multiple sexual partners are at a higher risk of contracting the virus.
Additionally, people can contract mpox from contaminated objects such as clothing or linens. In healthcare settings, transmission can occur through sharps injuries, while in community settings, places like tattoo parlours may pose a risk if proper hygiene measures are not followed.
Signs and Symptoms
The incubation period for mpox typically ranges from 1 to 21 days, with symptoms usually appearing within a week of exposure. The duration of symptoms is generally 2-4 weeks, although it may be longer in individuals with weakened immune systems.
Common symptoms of mpox include a range of physical and systemic effects. These may include a distinctive rash, accompanied by fever, sore throat, headache, muscle aches, and back pain. Additionally, individuals may experience low energy and swollen lymph nodes. These symptoms can vary in severity and may appear in different combinations, making it essential to seek medical attention if mpox is suspected.
It is important to note that the presentation of symptoms can vary among individuals. For some, the first sign of mpox is a rash, while others may experience different symptoms initially.
Mpox Rash
The mpox rash is a distinctive characteristic of the disease, beginning as flat sores that develop into blisters filled with liquid, which can be itchy or painful. As the rash progresses, the lesions dry up, crust over, and eventually fall off. The number of skin lesions can vary greatly, ranging from one or a few to hundreds. The rash can appear anywhere on the body, including the palms of hands, soles of feet, face, mouth, throat, groin, genital areas, and anus. Some individuals may also experience painful swelling of the rectum or pain and difficulty when urinating. It is essential to note that people with mpox are infectious and can transmit the disease to others until all sores have healed and a new layer of skin has formed.
While anyone can contract mpox, certain groups are at higher risk for complications, including children, pregnant individuals, and people with weakened immune systems. These groups require special attention and care to prevent severe outcomes.
In the context of the 2022-2023 global outbreak, gay, bisexual, and other men who have sex with men were identified as a group at higher risk of exposure. However, it is essential to emphasize that the risk of mpox is not limited to any specific sexual orientation or activity. Anyone who has close contact with an infected individual is at risk, and any person with multiple sex partners faces an increased risk of exposure.
Immunocompromised individuals, particularly those with advanced HIV disease (late presentation, low CD4 count, and high HIV viral load), are at an elevated risk of developing severe mpox or dying from the infection. However, people living with HIV who achieve viral suppression through antiretroviral treatment do not appear to be at any higher risk of severe mpox than the general population.
Diagnosis
Accurate diagnosis of mpox can be challenging, as other infections and conditions may present similar symptoms. It is crucial to distinguish mpox from other diseases such as chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, and other sexually transmissible infections.
The preferred method for laboratory confirmation of mpox is the detection of viral DNA through polymerase chain reaction (PCR) testing. The most effective diagnostic specimens are taken directly from the rash – skin, fluid, or crusts – collected by vigorous swabbing. In cases where skin lesions are absent, testing can be performed on oropharyngeal, anal, or rectal swabs. Blood testing is not recommended for mpox diagnosis.
It is worth noting that antibody detection methods may not be useful in diagnosing mpox, as they do not distinguish between different orthopoxviruses.
Treatment and Vaccination
The primary goal in treating mpox is to manage symptoms, care for the rash, alleviate pain, and prevent complications. Early and supportive care is crucial in managing the disease effectively.
Individuals diagnosed with mpox can receive supportive care to manage fever, pain, and other symptoms using over-the-counter medications like paracetamol (acetaminophen) or ibuprofen. Antiviral medications, such as tecovirimat, originally developed to treat smallpox, have been used to treat mpox, and ongoing studies are evaluating their effectiveness. Proper wound care is also essential to prevent secondary bacterial infections and promote healing.
Vaccination plays a crucial role in both prevention and post-exposure management of mpox. The mpox vaccine can help prevent infection if administered within 4 days of contact with an infected individual, and in some cases, up to 14 days after exposure if no symptoms have developed. Preventive vaccination is recommended for people at high risk of exposure, especially during outbreaks, including healthcare workers, men who have sex with men, people with multiple sex partners, and sex workers. While vaccination can significantly reduce the risk of infection, it does not provide 100 per cent protection, and vaccinated individuals should still take precautions to avoid exposure.
Self-Care and Prevention
For individuals diagnosed with mpox, several self-care measures can help manage symptoms and prevent transmission to others. These include isolating at home or in a hospital setting, practicing frequent hand hygiene, wearing a well-fitting mask, covering lesions, and avoiding touching items in shared spaces. Keeping skin dry and uncovered when alone, using saltwater rinses for mouth sores, and taking sitz baths or warm baths with baking soda or Epsom salts for body sores can also help. It’s essential to avoid popping blisters or scratching sores to prevent spread and secondary infections.
Preventing the Spread of Mpox
To prevent the spread of mpox, individuals should avoid close physical contact with those who have mpox symptoms, practice safe sex, including the use of condoms, and maintain good hygiene practices, especially in shared living spaces. Being aware of the symptoms and seeking medical attention promptly if exposure or infection is suspected is also crucial.
Pregnant Individuals
Contracting mpox during pregnancy can be dangerous for both the parent and the foetus. It may lead to pregnancy loss, stillbirth, or complications for the parent. Pregnant individuals should avoid close contact with anyone who has mpox and seek immediate medical attention if exposed or symptomatic.
Children
Children can contract mpox through close contact with infected individuals, including family members or caregivers. The mpox rash in children may initially resemble other common childhood illnesses, making prompt medical evaluation crucial for accurate diagnosis and appropriate care.
Breastfeeding
If you have confirmed or suspected mpox and are breastfeeding, consult your healthcare provider for guidance. They will assess the risks and benefits of continuing breastfeeding, considering the potential for transmission and the importance of maintaining the parent-child bond. In some cases, they may advise on measures to reduce transmission risk while continuing to breastfeed.
Global Outbreaks and Public Health Response
Mpox has been causing sporadic outbreaks in Central and East Africa (clade I) and West Africa (clade II) since 1970. Notable events include an outbreak in the United States in 2003 linked to imported wild animals (clade II), and thousands of suspected cases reported annually in the Democratic Republic of Congo since 2005. In 2017, mpox re-emerged in Nigeria, spreading within the country and to international travellers. The most recent global outbreak, occurring from 2022-2023, affected primarily (but not exclusively) gay, bisexual, and other men who have sex with men, spreading through sexual networks across 110 countries.
In response to the 2022-2023 global outbreak, the World Health Organization (WHO) declared mpox a public health emergency of international concern (PHEIC) on July 23, 2022. The WHO has since published a strategic preparedness and response plan for mpox, along with a suite of technical guidance documents. The global response focuses on key areas, including enhanced surveillance and case detection, improved diagnostics and testing capacity, risk communication and community engagement, vaccine and treatment distribution, and research into transmission dynamics and effective interventions. These efforts aim to control the spread of mpox and mitigate its impact on affected communities.
Conclusion
Mpox represents a significant public health challenge that requires a comprehensive and coordinated approach to prevention, detection, and management. While the disease has gained prominence due to recent outbreaks, it is crucial to understand that mpox is not limited to any specific group or demographic. Anyone can be affected, and everyone has a role in preventing its spread.
By raising awareness about mpox – its transmission, symptoms, and prevention strategies – we can empower individuals to make informed decisions about their health and the health of their communities. As research continues and our understanding of the virus evolves, it is essential to stay informed and follow guidance from public health authorities.
Ultimately, combating mpox requires a collective effort. Through a combination of public health measures, medical interventions, and individual responsibility, we can work towards minimizing the impact of this disease and protecting the health of populations worldwide.
