Key Facts on Mpox

formerly referred to as monkeypox, mpox is a viral infection carried on by the monkeypox virus, that falls to the Orthopoxvirus genus. The virus has two primary clades: Clade I (subclades Ia and Ib) and Clade II (subclades IIa and IIb). The global outbreak in 2022-2023 was caused by Clade IIb, but recent surges in cases, especially in the Democratic Republic of the Congo (DRC), have been linked to Clade Ia and Ib.

Current Outbreaks and Ongoing Concerns

Monkeypox continues to pose a public health threat. Incidents have been reported from 2022 in a variety of spots, with a rising number of cases in African countries. Notably, the DRC has witnessed a surge of Clade Ia and Ib cases. By mid-2024, Clade Ib was also identified outside Africa, raising alarms for potential global spread.

Mpox Virus Overview

The Orthopoxvirus genus, which also contains the smallpox, cowpox, and vaccinia viruses, is habitat to the double-stranded DNA virus called the monkeypox virus (MPXV). Although the exact natural reservoir of the virus remains unknown, small mammals, such as squirrels and monkeys, are believed to be susceptible carriers.

Transmission of  the virus

Monkeypox primarily spreads through close contact with infected individuals, animals, or contaminated objects. Human-to-human transmission typically occurs via skin-to-skin contact, sexual activity, respiratory droplets, or contact with mucosal surfaces. Individuals who have had several sexual partners are more probable to have mpox. Additionally, contaminated items like clothing or linens can facilitate transmission.

Animal-to-human transmission can occur through bites, scratches, or activities such as hunting, skinning, or consuming infected animals. During pregnancy, an infected individual may pass the virus to their fetus, leading to severe complications or stillbirth.

Signs and Symptoms

Monkeypox typically begins with flu-like symptoms followed by a rash. Common symptoms include:

Fever
Headache
Muscle aches
Sore throat
Back pain
Low energy
Swollen lymph nodes
Rash (often the most noticeable symptom)

The rash usually starts as a flat sore, developing into fluid-filled blisters that may be itchy or painful. It often begins on the face or other body parts, spreading to the hands, feet, or genitals. Some people develop just a few lesions, while others may experience hundreds.

Complications can arise from bacterial infections, pneumonia, or encephalitis, and mpox can lead to death in some cases.

Diagnosis

Diagnosing mpox can be challenging due to its resemblance to other illnesses, such as chickenpox, measles, or bacterial skin infections. The gold standard for diagnosis is polymerase chain reaction (PCR) testing, usually conducted using samples taken from skin lesions. It is not advised to use blood testing to identify mpox.

Healthcare professionals may also recommend HIV testing for individuals diagnosed with mpox, as those with weakened immune systems are at higher risk of complications.

Treatment and Vaccination

There is no specific antiviral treatment for mpox, but supportive care plays a critical role in managing symptoms and preventing complications. Treatment involves:

Skin care and wound management
Pain treatment for sore throat, aches in the muscles, and fever
Hydration and nutrition support
Prevention of secondary infections

Vaccination is recommended for individuals at high risk of contracting mpox, including healthcare workers, people in close contact with infected individuals, and those with multiple sexual partners. Vaccines can also be used post-exposure if administered within 4-14 days after contact with an infected person.
Self-Care and Prevention

Individuals with mpox should follow specific guidelines to manage symptoms and prevent spreading the virus. These include:

Isolating at home or in a well-ventilated space until the rash heals
Washing hands frequently
Wearing a mask and covering lesions around others
Avoiding contact with shared items in common spaces
Taking over-the-counter pain relief medications, such as acetaminophen or ibuprofen
Using warm baths or saltwater rinses to alleviate body sores and oral lesions

To prevent spreading mpox, infected individuals should avoid sexual activity, particularly with new partners, during outbreaks. Health professionals should use personal protective equipment (PPE) to limit the risk of infection while treating patients.

Mpox and Vulnerable Populations

Certain populations, including children, pregnant individuals, and people with compromised immune systems, are more vulnerable to severe illness from mpox. In particular, people living with HIV who are not receiving appropriate care are at increased risk for complications, including pneumonia, vision loss, and sepsis.

Outbreak History

The monkeypox virus was first identified in monkeys in Denmark in 1958. The first recorded human case occurred in the Democratic Republic of the Congo in 1970. Since then, outbreaks have periodically taken place in West and Central Africa. In 2003, the United States experienced an outbreak linked to imported wild animals, and in 2017, Nigeria saw a resurgence of cases, which spread to travelers globally.

The global outbreak that began in 2022 primarily affected men who have sex with men, though other populations were also impacted. By mid-2024, over 120 countries had reported more than 100,000 laboratory-confirmed cases of mpox, with more than 220 deaths.

Stigma and Discrimination

Stigma and discrimination surrounding mpox can hinder public health efforts by deterring individuals from seeking care or reporting symptoms. Mpox has been particularly stigmatized in communities of gay, bisexual, and transgender individuals, as well as gender-diverse populations. Reducing stigma and promoting inclusivity in healthcare responses are essential to controlling the spread of the virus.

WHO Response

The World Health Organization (WHO) has played a pivotal role in coordinating global efforts to address mpox outbreaks. This includes facilitating research on vaccines and treatments, working to strengthen healthcare systems, and ensuring equitable access to medical resources. In May 2022 and August 2024, the World Health Organization (WHO) deemed mpox an Emergency in Public Health of International Concern (PHEIC).

Conclusion

Mpox continues to pose significant public health challenges globally. Although most people recover, it can lead to severe complications, particularly in vulnerable populations. Ongoing research, access to vaccines, and coordinated public health measures are crucial for controlling its spread. The stigma surrounding mpox must also be addressed to ensure that all affected communities feel safe in seeking the care they need.

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