Mpox (Monkeypox)
By Dr Melinda Whitfield
Overview and Current Situation
Mpox, formerly known as monkeypox, has re-emerged as a significant global health threat in 2024. The World Health Organization (WHO) has classified the outbreak in African countries a Public Health Emergency of International Concern (PHEIC), underscoring the seriousness of the situation, especially in regions where healthcare systems are already burdened by other infectious diseases.
What is Mpox?
Where did it begin and where are we now?
Mpox is a viral disease that originates from animals and can be transmitted to humans. It belongs to the same family of viruses as smallpox but typically causes milder symptoms. It has been endemic in Central Africa for decades, with rare human cases typically after contact with contaminated animals.
In 2022, the virus mutated and caused a widespread international outbreak, spreading primarily among men who have sex with men. These cases were specifically caused by the less severe strain, Clade II. The spread was somewhat controlled by public ?education, development of immunity, antivirals, and vaccines.
Now, in August 2024, the more severe Clade I strain has surged in Central and East Africa, resulting in nearly 17,000 cases and around 500 deaths. The Democratic Republic of Congo is the epicenter, accounting for over 96% of this year’s cases and fatalities, exacerbated by weak healthcare and surveillance systems. Recently, a single travel-related case has been reported in Sweden. There are subvariants of Clade I, namely 1a and 1b. Most of the current cases have been the Clade 1a subvariant, with more than 80% of these cases being children and accounting for 85% of deaths. The Clade 1b variant seems to be spreading among adults.
In South Africa, as of Sunday, 16th August 2024, we have had 24 confirmed cases of Mpox, including 3 deaths all of which have been confirmed as the less severe Clade II variants, according to an ECDC (European Centre for Disease Prevention and Control) report.
Transmission
Mpox Clade II (from the 2022 outbreak) spreads primarily through close physical contact with an infected person, such as during sexual contact. For Clade I, the at-risk population differs, and transmission occurs not only through close physical contact but also through contact with contaminated materials, such as bedding or clothing. There is a theoretical risk of respiratory transmission through prolonged face-to-face contact. In the affected African countries, experts have not observed epidemiological evidence of airborne transmission but rather cases of children hunting infected animals or close contact in crowded living conditions, such as many kids sharing one bed.
Symptoms
While epidemiological trends vary by variant or strain, it should be remembered that anyone can contract Mpox regardless of age, gender, sexual orientation, and race.
The incubation period is believed to be 7-14 days, with infected individuals only being contagious from the onset of the rash through the scabbing stage.
Common symptoms include:
Testing
Individuals who suspect that they have been exposed to Mpox or have symptoms consistent with Mpox, should isolate and contact their healthcare provider virtually for guidance. Testing is conducted by the NICD (National Institute for Communicable Diseases).
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Fatality rate
Clade I is historically the more severe strain, with a 10% mortality rate compared to less than 1 % for Clade II. However, it remains uncertain whether this high rate is due to the strain’s virulence or factors such as under-detection, poor access to treatment, lack of healthcare, and poor nutrition in these African regions.
Treatment and vaccines
As with most viral infections, the mainstay of Mpox treatment is supportive, and most infections do not require any specific treatment.
An antiviral called TPOXX is available, but its effectiveness against Clade I is still uncertain ?and its use is considered for severe cases on an individual basis.
The smallpox vaccine, which also protects against Mpox, is currently the most effective preventive measure and is being used in the United States and certain European countries for high-risk households and identified close contacts up to 14 days after exposure, as well as for gay and bisexual men with multiple sex partners. However, vaccine availability, especially in Africa, is a concern. Africa is estimated to need at least 10 million doses but only has about 200,000 due to be delivered to the continent in October. WHO and Africa CDC are advocating for global cooperation to ensure sufficient vaccine supplies and distribution.
Preventive measures to protect yourself from Mpox
Future Outlook
The global spread of Mpox is anticipated, especially with international travel. However, CDC models suggest that the Clade I outbreak will be smaller than the 2022 Mpox Clade II outbreak. Africa CDC’s alert is intended to encourage collaboration rather than restrict trade or movement across borders, urging countries to enhance vigilance, screening, education, testing and contact tracing.
Considerations for business travelers
Conclusion
The resurgence of the more virulent Clade I strain of Mpox poses a significant global health risk. Unlike COVID-19, which was a novel virus, Mpox has been known and studied for decades. We have learnt valuable lessons from COVID-19, and many processes and protocols were instituted and honed for a better worldwide response to outbreaks of this nature.
Vigilance, timely vaccination, and international cooperation are essential to contain this outbreak and prevent it from escalating further. Locally, our Department of Health is collaborating with all stakeholders to intensify surveillance, contact tracing, and health screening early detection of new cases in the country.
For the latest updates and guidance, please refer to WHO, CDC, and local health authorities.
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