Mpox

What is Mpox?
Mpox is an infection from animals caused by a virus closely related to the smallpox virus. Infection is usually transmitted to humans through scratches or bites from infected animals, such as rodents or monkeys. It can also spread between people.

Where is Mpox usually found?
Mpox is commonly found in central and west Africa where there are tropical rainforests and where animals that may carry the virus typically live. However, over the past few weeks an increasing number of cases of mpox have been identified within several European countries, as well as in the US, Canada and Australia.

The risk of becoming infected with Mpox is not limited to people who are sexually active or men who have sex with men. Anyone who has close physical contact with someone who is infectious is at risk. Anyone who has symptoms that could be Mpox should seek advice from their doctor immediately.

Public health authorities recommend observing safe sexual practices – avoid multiple sexual partners, avoid engaging in sexual activities with unknown partners and always use protection (e.g., condoms).

What tests are done to confirm Mpox infection?
A sample is taken from the rash lesions and sent to the laboratory for testing.  This test can only be done by specialists in infectious diseases in cases where they strongly suspect Mpox.

Do positive cases need to isolate?
Positive cases need to stay in mandatory isolation for 21 days from when the swab test was carried out.  

Do close contacts need to quarantine?
Close contacts are not required to isolate as long as they do not have any symptoms.  Should they develop symptoms, they are required to isolate at once and seek immediate medical advice.

Are there any travel restrictions in place because of Mpox?
There are currently no travel restrictions in relation Mpox cases.
If you’re travelling overseas, it is advisable to take the usual precautions regarding the prevention of infection, i.e., proper hand hygiene, avoiding crowded places and avoiding contact with individuals who appear unwell.

What are the recent developments?

• Mpox virus is categorized into two main clades: clade I and clade II.
• Each clade further divides into sub-clades: clade 1a, 1b for clade I, and 2a, 2b for clade II.
• The global Mpox outbreak of 2022 was primarily caused by clade IIb.
• Initially reported in November 2023, clade Ib has emerged in the Democratic Republic of the Congo and is spreading through sexual and close contact.
• As of now, there has been only one reported case of clade Ib in Europe.
• Clade I generally leads to more severe disease and higher mortality rates in populations where it is endemic, such as in Africa. However, the severity can vary in different populations.
• Ongoing studies are aimed at understanding the characteristics of this new strain.

What are current public health measures?

• In response to the new outbreak, the WHO has declared the Mpox outbreak a public health emergency of international concern.
• General precautions to minimize transmission include isolating oneself if symptoms develop, avoiding close contact with infected individuals, and practicing frequent hand hygiene and disinfection of potentially contaminated items.

Why is this disease called Mpox?
The disease is called mpox because it was first identified in colonies of monkeys kept for research in 1958. It was only later detected in humans in 1970.

What are the symptoms of Mpox?
Initial symptoms are fever, headache, swollen lymph nodes (glands), muscle aches, back pain, and low energy. This is followed by a rash, within one to three days of the start of the fever. The rash can be flat or slightly raised, filled with clear or yellowish fluid, and can then crust, dry up and fall off. The number of lesions on one person can range from a few to several thousand. The rash tends to be concentrated on the face, palms of the hands and soles of the feet. They can also be found on the mouth, genitals and eyes.

Symptoms typically last between 2 to 4 weeks and go away on their own without treatment.

People with mpox are infectious to others from the onset of fever until all lesions scab over and fall off.

What is the incubation period (the time period between exposure to an infection and the appearance of the first symptoms) of Mpox?
The incubation period is the duration/time between contact with the infected person and the time that the first symptoms appear. The incubation period for Mpox is between 5 and 21 days.

Can people die from Mpox?
Mpox infection is usually mild and most of those who are infected recover within a few weeks without requiring any treatment. In some individuals however, infection can lead to medical complications and even death. Newborns, children and people with underlying immune deficiencies may be at risk of more serious symptoms and death from mpox.

Complications from severe cases of mpox include skin infections, pneumonia, confusion and eye infections which can lead to loss of vision.

The strain currently affecting individuals worldwide is a strain found in West Africa, which is known to be associated with less severe disease.

How does Mpox spread from person to person?
People with Mpox are infectious while they have symptoms (normally for between two and four weeks). Although person-to-person spread is not common you can catch Mpox through close physical contact with someone who has symptoms.

The rash, bodily fluids (such as fluid, pus or blood from skin lesions) and scabs are particularly infectious. Ulcers, lesions or sores in the mouth can also be infectious, meaning the virus can spread through saliva. The virus can also spread through large respiratory droplets.

Therefore, one become infected through:

• Contact with clothing or linens (such as bedding or towels) or objects like eating utensils/dishes used by an infected person
• Direct contact with mpox skin lesions or scabs
• Coughing or sneezing of an individual with a Mpox rash

People who closely interact with someone who is infectious, including health workers, household members and sexual partners are therefore at greater risk for infection.

The virus can also spread from someone who is pregnant to the foetus from the placenta, or from an infected parent to child during or after birth through skin-to-skin contact.

It is not clear whether people who do not have symptoms can spread the disease.

Who is at risk of catching Mpox?
Anyone who has close physical contact with someone who has symptoms of Mpox, or with an infected animal are at highest risk of infection.

People who were vaccinated against smallpox are likely to have some protection against Mpox infection. However, younger people are unlikely to have been vaccinated against smallpox because smallpox vaccination stopped worldwide after smallpox became the first human disease to be eradicated in 1980. In Malta the smallpox vaccine was given until 1971. Even though people who have been vaccinated against smallpox will have some protection againstMpox, they also need to take precautions to protect themselves and others.

Newborns, children and people with underlying immune deficiencies may be at risk of more serious symptoms and death from Mpox. Health workers are also at higher risk due to longer virus exposure.

How can I protect myself and others against Mpox?
Individuals can reduce their risk of infection by limiting close and direct physical contact with people who are unwell, especially if they have suspected or confirmed mpox infection.

If you do need to have physical contact with someone who has Mpox (e.g., because you live together) the infected person should self-isolate and cover any skin lesions (e.g., by wearing clothing over the rash). Try to maintain some distance but if you are physically close to them, they should wear a surgical mask, especially if they are coughing or have lesions in their mouth. You should wear one also. Avoid skin-to-skin contact whenever possible and use disposable gloves if you have any direct contact with lesions. The infected person should handle their laundry (clothes and bedding) themselves, where possible. Wear a mask when handling any clothes or bedding if the person cannot do it themselves.

It is always important to maintain good hand hygiene and regularly clean your hands with soap and water or an alcohol-based hand rub, especially after contact with someone who is infected, their clothes, bed sheets, towels and other items or surfaces they have touched or that might have come into contact with their rash or respiratory secretions (e.g., utensils, dishes).

Clothes, towels, bedsheets and eating utensils should be washed with warm water and detergent. Contaminated surfaces should be cleaned and disinfected and contaminated waste (e.g., dressings) disposed of appropriately.

Is the general public at high risk of catching mpox? Is there a risk of this becoming a larger outbreak?
The overall risk for the general public and health care providers is low at this time for various reasons:

• Transmission of Mpox requires prolonged close contact with people who are infected and have symptoms
• The symptoms of Mpox, such as fever or a rash, make it easier to recognize, and cause people to seek out medical care
• The incubation period - the time from when a person is exposed to when that person develops symptoms - is long. Therefore, public health measures can help prevent additional cases

Despite this the authorities are responding to this outbreak as a high priority to avoid further spread as much as possible

Can children get Mpox?
Children are typically more prone to have severe symptoms than adolescents and adults. The virus can also be passed to a foetus or to a new born through birth or early physical contact.

What should I do if I think I may have Mpox?
If you think you have symptoms or have been a close contact of someone with Mpox, contact your GP/health centre for proper advice and guidance. It would be sensible to call your GP/health centre ahead and let them know your concerns before going to the clinic to avoid risk of spread. One should avoid using public transportation and having direct contact with others until cleared by a medical professional.

Basic hygiene such as washing, and sanitizing hands would be beneficial to minimize spread.

Can you get vaccinated for Mpox now? Is there a vaccine available for mpox and will it be offered to the public?
There isn’t a specific vaccine for Mpox, but there is a vaccine against smallpox (MVA-BN, also known as Imvamune, Imvanex or Jynneos) that does offer some protection (at least 85% effective in preventing Mpox) if given before or within a few days of exposure. This is because the Mpox virus is closely related to the virus that causes smallpox (orthopoxvirus).

People who have been vaccinated against smallpox in the past will also have some protection against Mpox. The original smallpox vaccines are no longer available to the general public, and people below the age of 50 years are unlikely to have been vaccinated.

If required, public health authorities will guide vaccination of close contacts.For more information regarding Small Pox vaccine for Mpox click here.

What treatments are available?
Mpox symptoms often resolve on their own without the need for treatment, but newer antivirals may be used if necessary. It is important to take care of the rash by letting it dry if possible or covering with a moist dressing to protect the area if needed. Avoid touching any sores in the mouth or eyes. Mouth rinses and eye drops can be used as long as cortisone-containing products are avoided.

In the case of individuals with severe symptoms high quality medical and nursing supporting case will be provided. This may include the use of vaccinia immune globulin.

Does the chickenpox vaccine prevent Mpox?
The chickenpox virus (varicella-zoster virus (VZV)) is different to the Mpox and smallpox viruses (orthopoxvirus), and for this reason the chickenpox vaccine does not protect against mpox.

Is Mpox a sexually transmitted infection?
Mpox can spread from one person to another through close physical contact, including sexual contact. It is currently not known whether Mpox can be spread through sexual transmission routes (e.g., through semen or vaginal fluids), but direct skin-to-skin contact with lesions during sexual activities can spread the virus.

Mpox rashes are sometimes found on genitals and in the mouth, which is likely to contribute to transmission during sexual contact. Mouth-to-skin contact could thus cause transmission where skin or mouth lesions are present.

The risk of becoming infected with Mpox is not limited to people who are sexually active or men who have sex with men. Anyone who has close physical contact with someone who is infectious is at risk. Anyone who has symptoms that could be Mpox should seek advice from their doctor immediately.

As always, the public health authorities recommend observation of safe practices when one engages in sexual activity – avoid multiple sexual partners, avoid engaging in sexual activities with unknown partners and always use protection (e.g., condoms, etc).

What tests are done to confirm Mpox infection?
A sample is taken from the rash lesions and sent to the laboratory for testing. This test can only be done by specialists in infectious diseases in cases they strongly suspect may be showing symptoms of Mpox.

Do positive cases need to isolate?
Positive cases need to stay in mandatory isolation for 21 days from when the swab test was carried out.

Do close contacts need to quarantine?
Close contacts are not required to isolate as long as they do not have any symptoms. Should they develop symptoms they are required to isolate at once and seek immediate medical advice.

Are there any travel restrictions in place because of Mpox?
There are currently no travel restrictions in relation the Mpox cases.

Should you be travelling overseas it is advisable to take the usual precautions with regards to prevention of infection, i.e., proper hand hygiene, avoid crowded places and avoid contact with individuals who appear unwell.

Sources:

https://www.bradfordhospitals.nhs.uk/monkeypox-cases-confirmed-in-england-plus-faqs/

https://www.who.int/news-room/questions-and-answers/item/monkeypox

https://newsnetwork.mayoclinic.org/discussion/questions-and-answers-about-monkeypox/