By: Lebohang Maluke
MASERU
-World Health Organisation (WHO) successful and swift diagnosis of mpox hinges on the ability to accurately distinguish it from a range of other infections and conditions that may present with similar symptoms. The telltale rashes associated with mpox are not unique, and can resemble those of other diseases, including chickenpox, measles, and syphilis.
WHO elaborates that Mpox is primarily transmitted between individuals through close contact with an infected person, including those within the same household. Such close contact encompasses skin-to-skin interactions (like touching or sexual activity) as well as mouth-to-mouth or mouth-to-skin exchanges (such as kissing). Additionally, being in close proximity to an infected individual, such as during conversation or breathing near one another, can facilitate the spread of infectious respiratory particles.
National Institute For Communicable Diseases 2024 report states that the outbreak has affected 13 African countries since 1 January 2024, reporting 18 737 cases (3 101 confirmed, 16 636 suspected) and 541 deaths [case fatality ratio (CFR): 18 737/541=2.89%], namely; Burundi, Cameroon, Central Africa Republic (CAR), Congo, Cote d’ Ivoire, DRC, Ghana, Kenya, Liberia, Nigeria, Rwanda, South Africa, and Uganda have declared an outbreak of mpox.
In addition, WHO says individuals with multiple sexual partners face an increased risk of contracting mpox. Transmission can also occur through contaminated items, including clothing or linens, as well as through needle injuries in healthcare settings or in communal environments like tattoo parlors.
The virus may be transmitted from mother to child during pregnancy or childbirth. Contracting mpox while pregnant poses significant risks to the fetus or newborn, potentially resulting in pregnancy loss, stillbirth, neonatal death, or complications for the parent.
Transmission of mpox from animals to humans can occur through bites or scratches from infected animals, or during activities such as hunting, skinning, trapping, cooking, handling carcasses, or consuming animal products. The specific animal reservoir for the monkeypox virus remains unidentified, and further research is ongoing.
As of mid-2024, the clade has also been reported in other countries. Over 120 countries have reported mpox between Jan 2022 – Aug 2024, with over 100 000 laboratory-confirmed cases reported and over 220 deaths among confirmed cases
In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks.
Diagnosis
Identifying mpox can pose challenges due to the similarities it shares with other infections and medical conditions. It is crucial to differentiate mpox from measles, bacterial skin infections, scabies, herpes, syphilis, various sexually transmitted infections, and allergies related to medications. An individual diagnosed with mpox may concurrently have another sexually transmitted infection, such as syphilis or herpes. Similarly, a child suspected of having mpox might also be experiencing chickenpox. Consequently, testing is essential for individuals to receive timely care, thereby reducing the risk of severe illness and further transmission.
The preferred laboratory method for diagnosing mpox involves the detection of viral DNA through polymerase chain reaction (PCR). The most effective diagnostic samples are obtained directly from the rash, including skin, fluid, or crusts, through vigorous swabbing. In cases where skin lesions are absent, swabs from the throat or anus can be utilized for testing. Blood testing is not advisable. Methods for detecting antibodies may prove ineffective, as they do not differentiate between various orthopoxviruses.
It is recommended that HIV testing be offered to adults diagnosed with mpox, and to children when appropriate. Additionally, diagnostic tests for other conditions, such as varicella zoster virus (VZV), syphilis, and herpes, should be considered when feasible.
The primary objective of mpox treatment is to address the rash, alleviate pain, and avert complications. Timely and supportive care is crucial for managing symptoms and preventing additional issues.
Vaccination against mpox serves as a preventive measure against infection (pre-exposure prophylaxis). It is particularly advised for individuals at elevated risk of contracting mpox, especially during periods of outbreak.
High-risk groups for mpox may include:
– Healthcare and support personnel exposed to the virus;
– Individuals residing in the same household or close community as an infected person, including children;
– Individuals with multiple sexual partners, particularly men who engage in sexual activities with men; and sex workers of any gender along with their clients.
Additionally, the vaccine can be administered following exposure to an individual with mpox (post-exposure prophylaxis). In such instances, the vaccine should be administered within four days of exposure. It remains effective for up to 14 days if the individual has not yet exhibited symptoms.
Certain antiviral medications have received emergency use authorization in various countries and are currently undergoing evaluation in clinical trials. As of now, there is no established effective antiviral treatment for mpox. It is essential to persist in the assessment of therapeutic options through comprehensive clinical trials while enhancing supportive care for affected patients.
Individuals living with HIV who also contract mpox should maintain their antiretroviral therapy (ART), which should be initiated within seven days of an HIV diagnosis.
Key Facts
Mpox, formerly referred to as monkey-pox, is a viral disease resulting from the monkey-pox virus, which belongs to the Orthopoxvirus genus. The virus is categorized into two primary clades: clade I (which includes subclades Ia and Ib) and clade II (comprising subclades IIa and IIb). A significant global outbreak of mpox, attributed to the clade IIb strain, occurred between 2022 and 2023.
Currently, mpox remains a public health concern, particularly due to a rise in cases in the Democratic Republic of the Congo and other nations linked to clades Ia and Ib. Vaccines are available for mpox, and vaccination should be integrated with other public health measures.
Typical symptoms of mpox include a skin rash or mucosal lesions lasting 2 to 4 weeks, often accompanied by fever, headaches, muscle pain, back pain, fatigue, and swollen lymph nodes. Transmission of mpox can occur through close contact with an infected individual, contaminated objects, or infected animals. Additionally, the virus can be transmitted from a pregnant individual to the fetus or to the newborn during or after delivery.
Treatment for mpox focuses on supportive care to alleviate symptoms such as pain and fever, while also emphasizing proper nutrition, hydration, skin care, prevention of secondary infections, and management of co-infections, including HIV when applicable.
Overview
Mpox is an infectious disease characterized by a painful rash, swollen lymph nodes, fever, headaches, muscle aches, back pain, and fatigue. While most individuals recover completely, some may experience severe illness.
The disease is caused by the monkeypox virus (MPXV), an enveloped double-stranded DNA virus that is part of the Orthopoxvirus genus within the Poxviridae family, which also includes variola, cowpox, vaccinia, and other related viruses.
The global outbreak of clade IIb commenced in 2022 and persists, affecting various regions, including some African countries. Additionally, there are increasing outbreaks of clades Ia and Ib in the Democratic Republic of the Congo and other African nations. As of August 2024, clade Ib has also been reported.
Mpox vaccines have been predominantly inaccessible in Africa; however, numerous affluent nations have committed to providing doses to the Democratic Republic of the Congo and other impacted African countries. The United States has proposed to supply 50,000 doses of Jynneos from its national reserves, while the European Union has placed an order for 175,000 doses, with various member states promising additional contributions. Bavarian Nordic has also contributed an extra 40,000 doses. Furthermore, Japan has extended an offer of 3.5 million doses of LC16m8, which requires only a single injection rather than two.