New Pandemic MPOX virus

MPOX, formerly called monkeypox, is a rare disease similar to smallpox cause by a virus. it’s found mostly in areas of Africa, but has been seen in other regions of the world. it cause flu-like symptoms such as fever and chills, and a rash.

What is MPOX?

MPOX (previously known as monkeypox) is a rare disease caused by virus. it leads to rashes and flu-like symptoms. Like the better-known virus that causes smallpox, it’s a member of the genus Orthopoxvirus genus in the poxviridae family. Initially identified in laboratory monkeys in 1958, the virus primary circulate among rodents and other small mammals. while it has historically been confined to certain regions of central and west Africa, recent outbreaks have raised global awareness and concern.

Transmission

MPOX spreads from person to person mainly through close contact with someone who has mpox, including members of a household. Close contact includes skin-to-skin (such as touching or sex) and mouth-to-mouth or mouth-to-skin contact (such as kissing), and it can also include being face-to-face with someone who has MPOX (such as talking or breathing close to one another, which can generate infectious respiratory particles).

People with multiple sexual partners are at higher risk of acquiring MPOX.

People can also contract MPOX from contaminated objects such as clothing or linen, through needle injuries in health care, or in community settings such as tattoo Parlors .

During pregnancy or birth, the virus may be passed to the baby. Contracting MPOX during pregnancy can be dangerous for the fetus or newborn infant and can lead to loss of the pregnancy, stillbirth, death of the newborn, or complications for the parent.

Animal-to-human transmission of MPOX occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses or eating animals.

Outbreaks

The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research. The first reported human case of MPOX was a nine-month-old boy in the Democratic Republic of the Congo (1970). Following the eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa.

Since then, mpox has been reported sporadically in central and east Africa (clade I) and west Africa (clade II). In 2003, an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of cases are reported in the Democratic Republic of the Congo every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travelers to other destinations.

In May 2022, an outbreak of MPOX appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions. The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men and has spread person-to-person through sexual networks

In 2022, outbreaks of MPOX due to clade I occurred in refugee camps in the Republic of the Sudan.

Since 2022, there has also been an upsurge in MPOX cases and deaths in the Democratic Republic of the Congo. In some areas of the country, a new offshoot of clade I, called clade Ib, has been spreading person-to-person. As of mid-2024, the clade has also been reported in other countries.

Over 120 countries have reported MPOX between Jan 2022 – Aug 2024, with over 100 000 laboratory-confirmed cases reported and over 220 deaths among confirmed cases.

Signs and Symptoms

The incubation period for MPOX typically ranges from 5 to 21 days.

common symptoms of MPOX are :

rash
fever
sore throat
headache
muscle aches
back pain
low energy
swollen lymph nodes.

symptoms categorized into two phases:

1. Prodromal Phase:

This initial phase lasts 1-5 days and include nonspecific symptoms such as fever, headache, muscle-aches, back-aches, swollen lymph nodes, chills, and exhaustion.

2. Rash Phase:

Following the prodromal phase, a rash develops, often starting on the face and then spreading to other parts of the body. the rash progresses through several stage, from macules to papules, vesicles, pustules, and eventually crusts. The lesion can be painful and may leave scars after healing.

Diagnosis

Identifying mpox can be difficult because other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmitted infections, and medication-associated allergies. Someone with mpox may also have another sexually transmitted infection at the same time, such as syphilis or herpes. Alternatively, a child with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get care as early as possible and prevent severe illness and further spread.

The preferred laboratory test for mpox is detection of viral DNA by polymerase chain reaction (PCR). The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done using swabs or the throat or anus. Testing blood is not recommended. Antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.

HIV testing should be offered to adults with MPOX, and children as appropriate. Diagnostic tests for other conditions should be considered where feasible, for example, varicella zoster virus (VZV), syphilis and herpes.

Treatment

the goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.

Getting an mpox vaccine can help prevent infection (pre-exposure prophylaxis). It is recommended for people at high-risk of getting mpox, especially during an outbreak.

Groups that may be at high risk of mpox include:

health and care workers at risk of exposure;
people in the same household or close community as someone who has mpox, including children;
people who have multiple sex partners, including men who have sex with men; and
sex workers of any gender and their clients.

The vaccine can also be administered after a person has been in contact with someone who has mpox (post-exposure prophylaxis). In these cases, the vaccine should be given less than 4 days after contact with someone who has mpox. The vaccine can be given for up to 14 days if the person has not developed symptoms.

Some antivirals have received emergency use authorization in some countries and are being evaluated in clinical trials. To date, there is no proven effective antiviral treatment for mpox. It is a priority to continue evaluation of therapeutics in robust clinical trials and to focus on optimizing supportive care for patients.

Individuals with HIV and mpox should continue taking their antiretroviral therapy (ART). ART should be initiated within 7 days of diagnosis of HIV.

Self-care and prevention

Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent transmitting mpox to others:

contact your health care provider for advice;
stay at home and in your own, well-ventilated room if possible;
wash hands often with soap and water or hand sanitizer, especially before or after touching sores;
wear a mask and cover lesions when around other people until your rash heals;
keep skin dry and uncovered (unless in a room with someone else);
avoid touching items in shared spaces and disinfect shared spaces frequently;
use saltwater rinses for sores in the mouth;
take warm baths with baking soda or Epsom salts for body sores; and
take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.

Do not

pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or
shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body).

Prevention

To prevent spread of mpox to others, people with mpox should isolate at home following guidance from their health care provider, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a well-fitting mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk of getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact. If having sex, use condoms as a precaution for 12 weeks (about 3 months) after you have recovered.

Taking a break from sexual activity with new partners during periods of increased transmission can reduce the risk of getting mpox. Those who have had contact with someone with mpox should monitor for signs and symptoms for 21 days (3 weeks) and take precautions such as avoiding sexual activity during this period.

Health workers should follow infection prevention and control measures to protect themselves while caring for patients with mpox by wearing appropriate personal protective equipment (PPE) (i.e. gloves, gown, eye protection and respirator) and adhering to protocol for safely swabbing lesions for diagnostic testing and handling sharp objects such as needles.

Conclusion

MPOX is a re-emerging infectious disease that poses public health challenges both in endemic regions and globally. Ongoing surveillance, research, and community education are essential to manage outbreak effectively and prevent future transmission. As our understanding of the virus evolves, so too must our strategies for control and prevention to safeguard public health.

Resources

For general information on mpox please visit:

For live information on the case numbers for mpox in Australia, visit the National Notifiable Diseases Surveillance System (NNDSS) webpage.