GLOBAL MPOX UPSURGE 2024: INFORM, EDUCATE, AND PREVENT– A CALL TO ACTION FOR PAKISTAN’S CITIZENS
On August 14, 2024, the World Health Organization declared mpox a Public Health Emergency of International Concern (PHEIC). This alert signaled the critical need for heightened public awareness and preventive measures to reduce the contagious disease transmission. In June 2024, a total of 934 new laboratory confirmed cases of mpox and four deaths were reported to WHO from 26 countries, indicating continuing transmission of mpox across the world [i]. A PHEIC was also declared for a multi-country outbreak in July 2022, which was later lifted in 2023.
Mpox, previously known as monkeypox, is a viral zoonotic disease that is caused by the monkeypox virus. [ii] This DNA virus belongs to the genus Orthopoxvirus within the Poxviridae family, which also includes the smallpox virus (variola). This disease was primarily transmitted by animals to humans but now the human-to-human transmission has become increasingly common. The virus is categorised into two types, Clade I and Clade II, with Clade I known to cause more severe illness and deaths relatively.[iii] The virus is endemic to West and Central Africa; however, during the past few years, cases have increased in non-endemic regions as well.
In the past, the smallpox vaccine offered cross-protection. However, due to smallpox eradication in 1980 and subsequent vaccine discontinuation, populations are now more susceptible to mpox. [iv]?
CURRENT SITUATION IN PAKISTAN
In Pakistan, the first recorded case of mpox was reported to WHO on 20th April 2023. As of 15th August 2024, a total of 11 confirmed cases and one death associated with mpox have been reported. Luckily, the strain in Pakistan?has been classified as clade IIb, known to cause milder symptoms relative to clade I.
In response to three additional confirmed case in Peshawar since 15th August 2024[v], authorities have increased screening and vigilance at airports and have established isolation facilities in hospitals.
Currently, the risk of disease spread in Pakistan is low. As per the guidelines issued by the Ministry of National Health Services, communication efforts will focus on major international airports and cities with high inbound travellers. Community awareness activities will include public service messages and community engagement to prevent panic and rumors. Added to this, media will be instructed to share only verified information through a designated media focal person. Lastly, NIH guidelines and public health measures will be followed nationwide for mass awareness to keep the public well-informed and safe. [vi]
TRANSMISSION
?Mpox can spread through:?
STAGES OF MPOX DISEASE
?1.???? Incubation Period: The incubation period is the time between virus exposure and onset of symptoms, which is 5 to 13 days (can reach up to 21 days).[viii] [ix]
2.???? Febrile Stage: This stage typically lasts between 1 to 4 days. Along with the presence of fever, it can include fever, lethargy, sores on the mouth, nose, throat, or digestive tract, muscle ache, flu-like symptoms, headache, and lymphadenopathy (enlarged lymph nodes) in the armpit, neck, or groin area. The classic feature of mpox is the presence of fever and lymphadenopathy with rashes.
3.???? Skin Eruption Stage: This stage is characterised by the onset of rush, followed by the presence of localised lesions along with rashes.[x] These lesions evolve through different stages as depicted in the image below:
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4.??? Recovery Stage: During recovery, lesions dry and form scabs. WHO advises strict isolation until scabs fall off and new skin forms.
DIAGNOSIS
?The suspected individual is tested for this specific virus using Polymerase Chain Reaction (PCR) laboratory test.[xi]
?PREVENTIVE AND CONTROL MEASURES
?An ounce of prevention is worth a pound of cure. There are multiple ways by which exposure to the monkeypox virus can be avoided. These include:
For suspected or confirmed mpox cases, the preventive control measures would be:
IMPLICATIONS OF CONFIRMED MPOX CASES
Apart from the immediate health deterioration, the real-life challenges of mpox can be clearly illustrated by the story of a nurse who acquired the disease while treating the mpox patients in Democratic Republic of Congo (DRC). Her challenges highlighted multiple implications which included:
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IMPORTANCE OF PUBLIC AWARENESS
?Mpox is a reemerging, contagious, and potentially fatal disease, making public awareness crucial in combating its spread. As the saying goes,?"The greatest weapon against any outbreak is knowledge and awareness. Inform, educate, and prevent."?Effective public awareness initiatives can play a pivotal role in the prevention of Mpox outbreaks, such as:
CALL TO ACTION: SAFEGUARD YOURSELF AND YOUR COMMUNITY
While the prevalence of mpox is very low in Pakistan, it is essential for all individuals to undertake the responsibility of protecting themselves and their community. You should:
?Together, we can mitigate and combat the global risk of mpox outbreak by appropriate vigilance, awareness and community actions. As Dr. Margaret Chan, Former Director-General of WHO, wisely said,?“Preventing outbreaks isn’t just about controlling disease; it’s about safeguarding communities, economies, and lives.” Let's collectively take proactive actions to help protect ourselves and those around us—act now, not later, to stop the spread before it starts.
REFERENCES
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