Dr Erfana Malik
Mpox, formerly known as monkeypox, is an emerging zoonotic disease caused by the Mpox virus, affecting both humans and animals. Initially discovered in monkeys in 1958, the virus has since been detected in various animal species. The Mpox virus belongs to the Orthopoxvirus genus and exists in two distinct clades: clade I and clade II.
The first human case of Mpox was diagnosed in 1970 in the Republic of the Congo, Central Africa. Since then, Mpox has predominantly circulated in Central and West Africa, with transmission occurring between animals—primarily primates and rodents—as well as between animals and humans, and through human-to-human contact. However, in recent years, the rapid globalization, population movement, and deepening trade networks have contributed to the international dissemination of Mpox, leading to outbreaks in various countries worldwide.
Transmission
Person-to-person transmission of Mpox occurs through direct contact with infectious skin or other lesions, such as those in the mouth or on the genitals. This includes face-to-face interactions, skin-to-skin contact (including vaginal/anal sex), mouth-to-mouth contact (kissing), and mouth-to-skin contact (oral sex or kissing the skin). Respiratory droplets or short-range aerosols from prolonged close contact can also spread the virus. The virus enters the body through broken skin, mucosal surfaces (e.g., oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other household members and sex partners, with individuals having multiple sexual partners at higher risk.
Animal-to-human transmission occurs through bites or scratches from infected animals or during activities such as hunting, skinning, trapping, cooking, or consuming infected animals. The full extent of viral circulation in animal populations remains unclear, and further studies are underway. Additionally, people can contract Mpox from contaminated objects such as clothing or linens, through sharps injuries in healthcare settings, or in community spaces such as tattoo parlors.
Signs and Symptoms
Mpox symptoms typically begin within a week of exposure but can appear anywhere from 1 to 21 days afterward. The illness usually lasts 2–4 weeks but may persist longer in individuals with weakened immune systems. Common symptoms include a rash, fever, sore throat, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
The rash, often the first sign of infection, progresses from flat sores to fluid-filled blisters that may be itchy or painful. As the rash heals, the lesions dry up, crust over, and fall off. The rash can appear anywhere on the body, including the palms of the hands, soles of the feet, face, mouth, throat, groin, genital areas, and anus. In severe cases, complications may arise, such as bacterial skin infections, pneumonia, corneal infection leading to vision loss, sepsis, encephalitis, myocarditis, and, in rare cases, death. Individuals with compromised immune systems, including those with untreated or poorly controlled HIV, are at higher risk of severe illness and death.
Diagnosis
The preferred diagnostic method for Mpox is the detection of viral DNA through polymerase chain reaction (PCR) testing. The best diagnostic samples are obtained from the rash, such as skin, fluid, or crusts collected via vigorous swabbing. In the absence of skin lesions, testing can be performed on oropharyngeal, anal, or rectal swabs. Blood testing is not recommended, and antibody detection methods may not be useful as they do not distinguish between different orthopoxviruses.
Treatment and Vaccination
The primary goal of Mpox treatment is to manage symptoms, care for the rash, and prevent complications. Early and supportive care is crucial. Vaccination against Mpox can help prevent infection, especially when administered within four days of exposure (or up to 14 days if no symptoms are present). Vaccination is recommended for high-risk groups, including healthcare workers, men who have sex with men, people with multiple sexual partners, and sex workers.
Several antivirals, such as tecovirimat, initially developed to treat smallpox, have been used to treat Mpox, and further studies are ongoing.
Self-Care and Prevention
Most people with Mpox will recover within 2–4 weeks. To aid recovery and prevent spreading the virus to others, individuals should stay home and isolate themselves, practice good hand hygiene, and cover any lesions when around others. Using over-the-counter medications can help manage pain. People with Mpox should avoid popping blisters, scratching sores, or shaving areas with sores, as this can slow healing and spread the rash to other parts of the body.
To prevent transmission, individuals with Mpox should isolate at home or in a hospital if necessary, until lesions have healed and scabs have fallen off. Covering lesions and wearing a mask around others can help reduce the risk of spreading the virus.
Outbreaks and Global Emergency
After its first emergence in 1970, Mpox cases were sporadically reported in Central and East Africa (clade I) and West Africa (clade II). However, a significant outbreak in 2003 in the United States was linked to imported wild animals. Since 2005, thousands of suspected cases have been reported annually in the Democratic Republic of the Congo (DRC). In 2017, Mpox re-emerged in Nigeria, continuing to spread both domestically and internationally.
In May 2022, a sudden outbreak of Mpox rapidly spread across Europe, the Americas, and other regions, with 110 countries reporting approximately 87,000 cases and 112 deaths. This global outbreak primarily affected gay, bisexual, and other men who have sex with men, spreading through sexual networks. Notably, an outbreak in 2022 in Sudanese refugee camps was caused by Clade I MPXV, with no zoonotic origin identified.
Given the rapid and widespread nature of the outbreak, the World Health Organization (WHO) declared Mpox a global emergency, underscoring the need for coordinated international efforts to control its spread and protect vulnerable populations.
As the world grapples with this emerging threat, it is crucial to remain vigilant, prioritize vaccination and preventive measures, and continue research to better understand and combat Mpox.
