As of August 2024, the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) have declared the ongoing surge of Mpox (formerly known as monkeypox) a public health emergency of international concern. This decision was driven by a significant increase in cases, particularly in the Democratic Republic of Congo (DRC), where the disease has been severe, especially among children. The DRC has reported over 14,000 cases and 511 deaths in 2024 alone.
The WHO and Africa CDC have expressed urgent concern over the spread of the virus, especially in regions with limited healthcare resources. They have called for an aggressive, coordinated response to prevent further transmission and reduce the impact on vulnerable populations, particularly children, who have been disproportionately affected in this outbreak.
Globally, while Mpox cases have decreased in other regions, the situation in Africa has worsened, prompting international health organizations to ramp up efforts in surveillance, vaccination, and treatment to control the spread.
Dr. Muzamil Sultan , Senior Registrar, Department of Critical Care Medicine, Marengo Asia Hospitals, Gurugram stated, ” Monkeypox is a viral disease caused by the monkeypox virus, which is related to the smallpox virus. Based on studies in Central and West Africa, the incubation period for Mpox is described as usually lasting from 6–13 days, but may also range from 5–21 days.”
“Human Mpox often begins with a combination of the following symptoms: fever, headache, chills, exhaustion, asthenia, lymph node swelling (lymphadenopathy), back pain, and muscle aches .In cases in endemic areas (Africa), within three days after the onset of these prodromal symptoms, a centrifugal maculopapular rash starts from the site of the primary infection. It rapidly spreads to other parts of the body and progresses to develop vesicles. Palms and soles are involved in cases of the disseminated rash, which are characteristic of the disease. The number of lesions may range from a few to thousands and an increasing number of lesions is correlated with increased disease severity,” he added.
The majority of human mpox cases experience mild to moderate symptoms typically lasting from two to four weeks, followed by complete recovery with supportive care . The disease severity may vary depending on the transmission route, host susceptibility, and the quantity of virus inoculated with invasive modes of exposure causing more severe disease while having a shorter incubation period.
Complications in endemic countries include encephalitis, secondary bacterial skin infections, dehydration, conjunctivitis, keratitis, and pneumonia.
MPXV is transmitted to humans through close contact with an infected animal or human, or contact with materials contaminated with the virus. The virus enters the body through broken skin or the mucous membranes Human-to-human transmission of Mpox occurs through close contact with infectious materials from the skin or mucosal lesions of an infected person, respiratory droplets in prolonged face-to-face contact, and fomites Sexual contact seemed to be a particular risk factor driving the Mpox outbreak in 2022. Cases were identified primarily, but not exclusively, among men who have sex with men (MSM). Particular sexual practices (e.g. having multiple and frequent anonymous sexual contacts, and receptive anal sex) may have contributed to putting people at higher risk of infection. People who closely interact with an infectious person, including healthcare workers, household members, sexual partners, and commercial sex workers are at greater risk of infection. MPXV is more often detected from skin, anal, and throat samples than from blood, urine, and semen.
Emerging evidence indicates that infected people may transmit MPXV up to four days prior to symptom onset. This evidence comes from modelling studies, studies on linked transmission pairs with known exposure times
Real-time polymerase chain reaction (real-time PCR) on skin lesion materials (e.g. swabs, exudate, or lesion crusts) is used to diagnose Mpox.
Those who are infected recommendations mainly include the following as shared by Dr Muzamil Sultan:
• Cases should remain in their own room, when at home, and use designated household items (clothes, bed linen, towels, eating utensils, plates, glasses, etc.), which should not be shared with other members of the household.
• They should avoid contact with immunocompromised persons and other persons at risk for severe disease (such as infants and pregnant women) until their rash heals completely.
• They should be monitored by public health authorities (e.g. via telephone calls or other means, according to national guidance).
• They can temporarily leave their home (e.g. for medical appointments and necessary outdoor exercise for the stability of their mental health), provided they wear a medical face mask, and their rash is covered (e.g. by wearing long sleeves and trousers).
• They should practise careful respiratory hygiene and wear a medical face mask when in contact with other people. In addition, Mpox cases and their household contacts should practise careful hand hygiene at all times.
• They should abstain from sexual activity until their rash heals completely i.e. no new lesions appear, scabs have fallen off, and new skin has formed.
• They should avoid contact with any mammalian animals (see also section on ‘Special considerations to mitigate the risk of animal-to-human and human-to-animal transmission’).
Treatment is primarily symptomatic and supportive (alleviation of fever, pruritus and pain, and hydration), including the prevention and treatment of secondary bacterial infections. Tecovirimat is the only antiviral drug with an indication
The principal mode of MPXV transmission is thought to be direct contact with Mpox lesions or objects contaminated with lesions, such as clothing and bed linen (fomites). Therefore, caregivers and members of the household should avoid touching skin lesions with their bare hands, wear disposable gloves when handling materials which were in contact with the bare skin of a patient (including clothes, bed linen and towels), and observe strict hand hygiene before and after the use of gloves.
In healthcare settings, prevention of transmission is based on standard, contact and droplet infection control precautions during the care of symptomatic, suspected and confirmed Mpox patients. Mpox infection prevention and control guidance for primary and acute care settings have been developed by ECDC.
To reduce animal-to-human transmission in areas with active MPXV circulation among wildlife, it is recommended to avoid contact with (potential) animal reservoirs as well as any materials that have been in contact with a potentially infected sick or dead animal.
At last, he added, “Similarly, human cases of Mpox should avoid close direct contact with animals including pet animals, livestock and wild animals (in captivity). Close contacts of cases should also avoid being in close direct contact with animals for 21 days after the last exposure to the virus. To mitigate the risk of wild animals getting in contact with the virus, waste, including medical waste, should be disposed of in a safe manner and should not be accessible to rodents and other scavenger animals.”
