Public health emergency of global concern for Mpox (Monkeypox)

New Monkeypox ("mpox") Variant called "Clade 1b"

• Clade 1b is significantly more infectious and virulent than the former variants
• Affects children more than adults
• May transmit with close contact (not as dependent on sexual transmission as prior variants)
• Mortality 4% (previous strain was 1%)
• Symptoms include: high fevers, chills, arthralgia (sore joints), classic rash that closely resembles smallpox
• Clade 1b has origins in the Democratic Republic of Congo but has spread to neighbouring countries including Uganda, Burundi, Rwanda, and Kenya
• It is unknown if the vaccine (Jynneos/Imvamune/Imvanex) for the prior strain will work for this strain
• Clade 1b is likely to spread worldwide eventually
• All suspected cases should be isolated and reported to local Public Health officials

Mpox, commonly known as Monkeypox, is a viral zoonotic disease that has gained attention due to its similarities with smallpox. While it is generally less severe than smallpox, Mpox can still cause significant illness and, in some cases, serious complications. In this article, we will explore the causes, symptoms, diagnosis, treatment options, and prevention strategies for Mpox to help you stay informed and protected [1].

Causes of Mpox (Monkeypox)

Mpox is caused by the Monkeypox virus, a member of the Orthopoxvirus genus, which also includes the viruses that cause smallpox and cowpox. The virus is primarily transmitted to humans through contact with infected animals, such as rodents and primates, but human-to-human transmission can also occur [2].

The main modes of transmission include:

• Direct contact with the blood, bodily fluids, or skin lesions of infected animals or humans [3].
• Consumption of undercooked meat from infected animals [4].
• Respiratory droplets during prolonged face-to-face contact [5].
• Contaminated objects, such as bedding or clothing, that have come into contact with an infected individual [6].

The risk of transmission is higher in areas where Mpox is endemic, particularly in parts of Central and West Africa. However, global travel and trade can lead to the spread of the virus to non-endemic regions [7].

Symptoms of Mpox (Monkeypox)

The incubation period for Mpox typically ranges from 5 to 21 days. The illness begins with a prodromal phase, which includes the following symptoms [8]:

• Fever
• Headache
• Muscle aches
• Back pain
• Swollen lymph nodes
• Chills
• Exhaustion

One of the distinguishing features of Mpox is the development of a rash, which often begins on the face and then spreads to other parts of the body, including the palms of the hands and soles of the feet. The rash evolves through several stages [9]:

• Macules: Flat, red spots.
• Papules: Raised bumps.
• Vesicles: Fluid-filled blisters.
• Pustules: Pus-filled lesions.
• Scabs: Lesions that crust over and eventually fall off.

The rash typically lasts for 2 to 4 weeks. In severe cases, the lesions may coalesce, leading to large areas of skin loss. Complications of Mpox can include secondary bacterial infections, pneumonia, sepsis, and, in rare cases, death [10].

Diagnosis of Mpox (Monkeypox)

Diagnosing Mpox can be challenging, as its symptoms are similar to those of other diseases, such as chickenpox, measles, and smallpox. A thorough clinical evaluation, combined with laboratory testing, is essential for an accurate diagnosis [11].

Key diagnostic methods include:

• Polymerase Chain Reaction (PCR): The most reliable method for detecting the Monkeypox virus. PCR testing is usually performed on samples taken from skin lesions, blood, or respiratory secretions [12].
• Serology: Blood tests that detect antibodies against the Monkeypox virus. Serology is useful for determining past exposure but may not be definitive for diagnosing active infection [13].
• Virus Isolation: The virus can be isolated from clinical specimens in specialized laboratories, though this method is less commonly used due to its complexity [14].
• Electron Microscopy: This technique can be used to visualize the virus particles, but it is primarily used in research settings [15].

In endemic areas, a history of exposure to infected animals or individuals, along with the characteristic rash, may be sufficient to make a presumptive diagnosis. However, laboratory confirmation is essential in non-endemic areas to differentiate Mpox from other similar diseases [16].

Treatment of Mpox (Monkeypox)

Currently, there is no specific antiviral treatment approved for Mpox. However, supportive care and management of symptoms play a crucial role in patient recovery. The following approaches are commonly used in the treatment of Mpox [17]:

• Symptom Management: Treatment focuses on relieving symptoms such as fever, pain, and itching. This may include antipyretics, analgesics, and antihistamines [18].
• Hydration: Maintaining adequate hydration is essential, especially for patients with severe illness or those experiencing vomiting and diarrhea [19].
• Antibiotics: Secondary bacterial infections may require antibiotic treatment [20].
• Isolation: Infected individuals should be isolated to prevent the spread of the virus to others. Proper infection control measures should be implemented in healthcare settings [21].

In some cases, antiviral drugs that are effective against other orthopoxviruses, such as smallpox, may be used off-label to treat Mpox. These include:

• Cidofovir: An antiviral drug that has shown some efficacy against orthopoxviruses in animal studies [22].
• Brincidofovir: A derivative of cidofovir with a better safety profile, currently under investigation for the treatment of orthopoxvirus infections [23].
• Vaccinia Immune Globulin (VIG): A product derived from the blood of individuals vaccinated against smallpox, which may provide some benefit in severe cases [24].

Vaccination with the smallpox vaccine has been shown to provide cross-protection against Mpox, and it may be recommended for individuals at high risk of exposure, such as healthcare workers or those living in endemic areas [25].

Recovery from Mpox typically occurs within 2 to 4 weeks. However, patients with severe cases or those with compromised immune systems may require more intensive care and longer recovery times [26].

Prevention of Mpox (Monkeypox)

Preventing Mpox involves reducing the risk of virus exposure and taking proactive steps to protect oneself and others. Here are some key prevention strategies [27]:

• Avoid Contact with Infected Animals: Avoid handling animals that could carry the virus, particularly in areas where Mpox is endemic. This includes avoiding contact with rodents, monkeys, and other wildlife.
• Practice Good Hygiene: Wash your hands frequently with soap and water, especially after contact with potentially infected animals, people, or contaminated objects.
• Safe Food Practices: Cook all animal products thoroughly before consumption, particularly in regions where Mpox is known to occur.
• Limit Contact with Infected Individuals: If you know someone who is infected, avoid close contact and do not share personal items such as clothing, bedding, or utensils.
• Use Personal Protective Equipment (PPE): Healthcare workers and caregivers should use appropriate PPE, including gloves, masks, and gowns, when caring for individuals with suspected or confirmed Mpox.
• Vaccination: In some cases, vaccination with the smallpox vaccine may be recommended for those at high risk of exposure to the Monkeypox virus. Consult with a healthcare provider for more information.

By following these prevention measures, individuals can reduce their risk of contracting Mpox and help prevent its spread within communities.

References

1. Centers for Disease Control and Prevention (CDC). Mpox (Monkeypox).
2. World Health Organization (WHO). Monkeypox Fact Sheet.
3. WHO Disease Outbreak News: Monkeypox.
4. Reynolds MG, Carroll DS, Karem KL. Factors affecting the likelihood of monkeypox's emergence and spread in the post-smallpox era.
5. Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK.
6. Fine PE, Jezek Z, Grab B, Dixon H. The transmission potential of monkeypox virus in human populations.
7. Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox - a potential threat?
8. WHO Monkeypox Fact Sheet.
9. CDC: Monkeypox Symptoms.
10. Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis.
11. Petersen BW, Damon IK. Smallpox, monkeypox, and other poxvirus infections.
12. WHO Monkeypox Fact Sheet.
13. Hutin YJ, Williams RJ, Malfait P, et al. Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997.
14. Yinka-Ogunleye A, Aruna O, Dalhat M, et al. Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report.
15. Doty JB, Malekani JM, Kalemba LN, et al. Assessing monkeypox virus prevalence in small mammals at the human-animal interface in the Democratic Republic of the Congo.
16. Sklenovska N, Van Ranst M. Emergence of monkeypox as the most important orthopoxvirus infection in humans.
17. CDC: Monkeypox Treatment Information.
18. CDC: Monkeypox Treatment Information.
19. WHO Monkeypox Fact Sheet.
20. Jezek Z, Grab B, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients.
21. CDC: Monkeypox Prevention.
22. Lederman ER, Reynolds MG, Karem KL, et al. Monkeypox superinfection and the necessity for rapid evaluation of poxvirus vaccines and antiviral treatments.
23. Shchelkunov SN. Monkeypox virus: Interrelationships between clinical manifestations, epidemiology, and biology of the causative agent.
24. Chen N, Li G, Liszewski MK, et al. Virulence differences between monkeypox virus isolates from West Africa and the Congo basin.
25. CDC: Monkeypox Prevention Information.
26. WHO: Monkeypox Fact Sheet.
27. WHO: Monkeypox Prevention and Outbreak Response.