Mpox, also known as monkeypox, has thrust health agencies worldwide into a state of heightened alert. The World Health Organization (WHO) has declared mpox a Public Health Emergency of International Concern (PHEIC), marking the second such emergency alert in two years following its initial outbreak in the Democratic Republic of the Congo (DRC) and subsequent spread across Africa. The WHO has issued detailed information about mpox, its transmission, risk factors, prevention methods, and treatment options. Here’s a comprehensive guide to understanding mpox based on the WHO’s insights.
What is Mpox?
Mpox is a viral illness caused by the monkeypox virus, a member of the Orthopoxvirus genus. There are two distinct clades of the virus: clade I and clade II. Common symptoms of mpox include a skin rash or mucosal lesions lasting for 2-4 weeks, accompanied by fever, headache, muscle aches, back pain, fatigue, and swollen lymph nodes.
Transmission and Spread
Mpox can be transmitted to humans through physical contact with an infected person, contaminated materials, or infected animals.
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Person-to-Person:
Transmission occurs through direct contact with infectious skin lesions, including face-to-face interactions, skin-to-skin contact (including sexual contact), mouth-to-mouth contact (kissing), and mouth-to-skin contact (oral sex). The virus can also spread through respiratory droplets or short-range aerosols during prolonged close contact.*
Animal-to-Human:
Transmission occurs through bites or scratches from infected animals, or during activities like hunting, skinning, trapping, cooking, playing with carcasses, or eating infected animals.*
Object-to-Human:
Mpox can be spread through contact with contaminated objects such as clothing or linens.Signs and Symptoms
Mpox symptoms typically begin within a week of exposure but can appear as late as 1-21 days after contact. Symptoms typically last 2-4 weeks but may persist longer in individuals with weakened immune systems. Common symptoms include:
* Rash: Begins as flat sores that develop into fluid-filled blisters. Lesions can be itchy or painful and may appear anywhere on the body, including the palms of the hands, soles of the feet, face, mouth and throat, groin and genital areas, and anus.
* Fever
* Sore throat
* Headache
* Muscle aches
* Back pain
* Low energy
* Swollen lymph nodes
Some people may experience painful swelling of the rectum or pain and difficulty urinating. Individuals with mpox are contagious and can transmit the disease until all sores have healed, and a new layer of skin has formed.
Risk Factors and Complications
Children, pregnant women, and people with weakened immune systems are at higher risk for complications from mpox. The virus can cause skin infections, leading to abscesses or severe skin damage. Other complications include:
* Pneumonia
* Corneal infection with vision loss
* Painful swallowing
* Vomiting and diarrhea (leading to dehydration or malnutrition)
* Sepsis
* Encephalitis
* Myocarditis
* Proctitis
* Balanitis
* Urethritis
* Death
Persons with compromised immune systems due to medication or underlying medical conditions are at increased risk for serious illness and death from mpox. People living with HIV who are not receiving adequate treatment are particularly susceptible to severe disease.
Diagnosis
Differentiating mpox from other infections can be challenging as symptoms can overlap. It’s important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies.
The preferred laboratory test for mpox is polymerase chain reaction (PCR), which detects viral DNA. Samples for PCR testing should be taken from skin lesions (skin, fluid, or crusts) through vigorous swabbing. In the absence of skin lesions, oropharyngeal, anal, or rectal swabs can be used for testing. Blood testing is not recommended.
Treatment
Mpox treatment focuses on managing the rash, controlling pain, and preventing complications. Early and supportive care is crucial for symptom management and avoiding further problems.
* Vaccination: The mpox vaccine can help prevent infection. It should be administered within 4 days of contact with someone who has mpox (or up to 14 days if no symptoms are present). The vaccine is recommended for individuals at high risk of exposure, including: health workers at risk of exposure, men who have sex with men, people with multiple sex partners, and sex workers.
* Antiviral Medications: Several antiviral medications, such as tecovirimat (originally developed for smallpox), have been used to treat mpox, and further studies are underway.
Prevention
* Isolation: Individuals with mpox should isolate at home or in a hospital setting (if necessary) for the duration of the infectious period. This means staying isolated from others until all lesions have healed, and scabs have fallen off.
* Covering lesions and wearing a medical mask when around other people can help prevent spread.
* Practicing good hygiene: Wash hands frequently with soap and water or hand sanitizer, especially before and after touching sores.
* Avoid touching shared items and disinfect shared spaces frequently.
* Use condoms during sexual activity to reduce the risk of mpox transmission, but be aware that this does not prevent spread from skin-to-skin or mouth-to-skin contact.
* Stay home if you have mpox symptoms and consult a healthcare professional.
WHO Response
The global outbreak of mpox was declared a PHEIC on July 23, 2022. The WHO has published a strategic preparedness and response plan for mpox and numerous technical guidance documents. Surveillance, diagnostic testing, risk communication, and community engagement are critical components of stopping the outbreak and eliminating human-to-human transmission of mpox in all settings.
Conclusion
Mpox is a serious public health concern, and it is essential to understand the disease, its transmission, and prevention strategies. By following the WHO’s recommendations, individuals can protect themselves and others from contracting and spreading this virus.
