Mpox, formerly known as monkeypox, has emerged as a significant global health concern, demanding attention and swift action. Originally confined to parts of West and Central Africa, Mpox witnessed a dramatic shift in its global impact starting in May 2022. To comprehend the complexities of the outbreak and the current state of the virus, Firstpost engaged in a conversation with Dr. Kari Debbink, PhD, an associate teaching professor in the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health. Dr. Debbink offers crucial insights into risk factors, diagnostic methods, treatment options, and ongoing research related to Mpox.
Dr. Debbink emphasizes the heightened vulnerability of certain groups to severe Mpox outcomes. “Children, pregnant women, and those with weakened immune systems are most at risk for severe Mpox outcomes,” she explains, highlighting the need for targeted interventions to protect these susceptible populations.
On diagnosing Mpox, Dr. Debbink underscores the importance of PCR testing. “PCR testing is the WHO recommended standard for diagnosing Mpox. This is because the PCR test is able to detect DNA that is specific to the virus, so it can’t be confused with other viruses or conditions,” she notes. This precision is paramount for accurate diagnosis and effective response.
Regarding treatment, Dr. Debbink mentions that while no specific treatments for Mpox are approved, certain antivirals and treatments for smallpox are being tested. “There are no approved treatments that are specific to Mpox at this point. However, there are some antivirals approved for smallpox that are in clinical trials to test effectiveness against Mpox including TPOXX, Tembexa, and Vistide. There is also an immunoglobulin treatment (VIGIV) for smallpox that is being tested against Mpox,” she states.
Dr. Debbink also highlights the promise of ongoing trials. “There are several ongoing trials including the STOMP trial (US) and the PALM trial (DRC),” she adds. These trials are essential for identifying effective treatments and managing the disease.
Dr. Debbink discussed the role of vaccines in controlling Mpox outbreaks. “There are a few vaccines recommended by the WHO for Mpox for those at high risk of being exposed to the virus (MVA-BN, brand names Jynneos/Imvamune/Imvanex and the LC16 vaccine). In US trials, MVA-BN showed ~86% vaccine effectiveness against Mpox in individuals who were fully vaccinated (had two vaccine doses),” she explains. This information is vital for understanding the effectiveness of vaccination efforts.
On current research, Dr. Debbink highlights the multi-pronged approach being taken. “The efforts are multi-pronged and focus not only on drug development and vaccines but on surveillance and distribution of vaccines and healthcare resources to the most affected areas. Much of the fight against Mpox relies on detection of cases and the infrastructure to prevent transmission and spread, so making sure that the areas most affected get the appropriate aid is a primary way to fight Mpox. Further research on vaccine effectiveness for different Clades and for different populations will also be important in combatting Mpox,” she concludes.
Mpox: A Deeper Look
Caused by the monkeypox virus (MPXV), related to the smallpox virus, Mpox can result in a painful rash, swollen lymph nodes, and fever. While most cases are mild, severe cases can occur and can be fatal. Historically, Mpox was confined to sporadic cases in Africa, with limited human-to-human transmission. The virus typically affected individuals with direct contact with infected animals or contaminated materials.
Initial Outbreak (May 2022 – December 2022)
In May 2022, Mpox began spreading beyond its endemic regions, leading to a significant global outbreak. The initial surge witnessed thousands of cases, primarily in Europe and North America. The majority of cases were among men who have sex with men (MSM), although Mpox is not exclusive to this group. To address the outbreak, public health interventions included enhanced surveillance, vaccination campaigns, and educational efforts. By the end of 2022, case numbers began to decline, though the virus continued to circulate in various regions.
Emergence of Clade 1b (2023 – 2024)
In early 2023, a new variant, clade 1b, emerged in Central Africa. This variant exhibited different transmission patterns and presented significant challenges for control efforts. The emergence of clade 1b emphasized the need for improved healthcare infrastructure in affected regions. The WHO declared the outbreak a public health emergency of international concern in August 2024 due to the variant’s rapid spread and difficulties in accurate tracking and reporting.
Regional Insights
From May 2022 to July 2024, the United Kingdom reported over 4,000 cases of Mpox. Most cases occurred in 2022, with a decline in subsequent years. Public health efforts in the United Kingdom focused on vaccination and education, particularly within MSM communities. In Central Africa, where clade 1b emerged, continues to face significant challenges. The region’s limited healthcare infrastructure has exacerbated the situation, leading to underreporting and delayed interventions. Efforts to improve diagnostic capabilities and provide international support are ongoing. Of late, the Mpox virus has spread to various countries in Asia like Pakistan, the Philippines, and Malaysia.
Vaccination and Public Health Response
Smallpox vaccines have been integral to the global response to Mpox. The WHO recommends vaccines like MVA-BN and LC16 for high-risk individuals. The effectiveness of these vaccines has been demonstrated in trials, with MVA-BN showing approximately 86% effectiveness. The WHO and national health agencies are working together to coordinate responses, share data, and support affected regions. Public health campaigns aim to promote safe practices and vaccination to reduce transmission.
Diagnostic and Treatment Advances
Dr. Debbink’s insight on diagnostic methods emphasizes the importance of PCR testing for accurate Mpox diagnosis. This method is crucial for differentiating Mpox from other conditions. Currently, no specific treatments for Mpox are approved, but antivirals and treatments for smallpox are under investigation. Ongoing clinical trials are exploring the effectiveness of these treatments against Mpox. Ongoing trials, such as the STOMP and PALM trials, are crucial for discovering effective therapies for Mpox. These trials aim to identify new treatment options and improve management strategies.
WHO’s Perspective
In August 2024, WHO Regional Director for Europe, Hans Kluge, emphasized that while Mpox poses serious concerns, it is manageable with the right response. He highlighted the importance of avoiding panic and ensuring a coordinated approach to control the outbreak. The WHO’s strategic framework aims to enhance prevention and control efforts for Mpox. This framework includes goals for eliminating human-to-human transmission, reducing zoonotic spillovers, and advancing research and access to countermeasures. On August 14, 2024, WHO Director-General Dr. Tedros Adhanom Ghebreyesus declared the Mpox upsurge in Africa a public health emergency of international concern (PHEIC).
Mpox remains a global health challenge with recent developments highlighting the need for sustained vigilance and international cooperation. While the situation has improved since the initial outbreak in 2022, ongoing challenges such as new variants and underreporting persist. Continued efforts in vaccination, public health education, and global coordination are essential for controlling and eventually eliminating Mpox as a public health threat.
