Mpox: Understanding the Disease, Transmission, and Prevention

Mpox, previously known as monkeypox, has been a public health issue in certain regions of Africa since 1970. However, it gained significant global attention in 2022, when a surge in cases worldwide led the World Health Organization to declare a global health emergency. Mpox typically causes flu-like symptoms and pus-filled lesions and can lead to severe clinical outcomes.

Mpox (monkeypox) is a zoonotic orthopoxvirus that can cause disease in humans, similar to smallpox. It is a rare virus that typically infects rodents, like rats or mice, and nonhuman primates, like monkeys, and spreads from animals to humans. There are two types of mpox virus: clade I and clade II.

• Clade I causes more severe illness and has a higher mortality rate. Some outbreaks have resulted in death rates of up to 10%, although more recent outbreaks have seen lower death rates. Clade I is endemic to Central Africa.
• Clade II is responsible for the global outbreak that began in 2022. Infections from clade II mpox tend to be less severe, with a survival rate of over 99.9%. This clade is endemic to West Africa.

Certain groups are at higher risk of developing severe illness, including:

• Individuals with severely compromised immune systems
• Children under the age of 1
• Those with a history of eczema
• Pregnant individuals

Transmission of Mpox

Mpox spreads through direct contact with the blood, bodily fluids, or skin lesions of infected animals or humans. It can also be transmitted via respiratory droplets during prolonged face-to-face contact, though this mode is less common than smallpox. Human-to-human transmission can occur, especially among close contacts such as family members or healthcare workers. Infected individuals can spread the virus from the onset of symptoms until all lesions have crusted over and new skin has formed.

The virus can also survive on surfaces and materials, such as bedding and clothing, used by an infected person, leading to indirect transmission. In areas where the disease is endemic, people can become infected by handling infected animals or consuming undercooked meat from these animals.

Symptoms and Clinical Complications

Mpox symptoms may start 3 to 17 days after the exposure and may last 2 to 4 weeks. The symptoms of mpox are similar to but milder than, those of smallpox, which include:

• Fever: A sudden onset of fever is one of the first symptoms.
• Headache: Severe headaches often accompany the fever.
• Muscle Aches and Backache: These are common and can be quite debilitating.
• Swollen Lymph Nodes: This is a distinguishing feature from smallpox, as lymphadenopathy (swelling of lymph nodes) is more pronounced in mpox.
• Fatigue: A general feeling of tiredness and weakness.

Within a few days of the onset of fever, a rash develops, often starting on the face and then spreading to other body parts, including the palms of the hands and soles of the feet. The rash progresses through several stages—from macules to papules, vesicles, pustules, and finally to scabs—before healing.

Although it is rare, mpox can sometimes be fatal. The disease can also cause complications, such as pneumonia and infections in the brain (encephalitis) or eyes, which can be life-threatening.

Diagnosis

Since mpox is uncommon, it may be initially suspected as other rash-related illnesses, such as measles or chickenpox. However, swollen lymph nodes typically differentiate mpox from other similar conditions. To diagnose mpox, a healthcare provider will take a tissue sample from an open sore (lesion) and send it to a laboratory for polymerase chain reaction (PCR) testing, which involves genetic fingerprinting. In the absence of skin lesions, testing can be done using swabs or the throat or anus. Additionally, you might be asked to provide a blood sample to detect the presence of the mpox virus or antibodies produced by your immune system.

Prevention and Treatment

There is currently no specific treatment for mpox, but the disease is self-limiting and resolves on its own without the need for treatment. Supportive care, such as hydration, pain management, and treatment of secondary bacterial infections, can help alleviate symptoms and prevent complications.

Prevention is the best approach to controlling mpox. Key preventive measures include:

1. Vaccination: The smallpox vaccine has been shown to provide cross-protection against mpox. In some countries, the smallpox vaccine is used to protect those at high risk, such as healthcare workers or close contacts of confirmed cases.
2. Avoiding Contact with Infected Animals: In endemic regions, people should avoid handling animals that may carry the virus, such as rodents and primates.
3. Practicing Good Hygiene: Regular hand washing with soap and water, using hand sanitizers, and avoiding contact with potentially contaminated surfaces can reduce the risk of infection.
4. Using Personal Protective Equipment (PPE): Healthcare workers caring for patients with suspected or confirmed mpox should use appropriate PPE to prevent exposure to the virus.

How to Take Care of Yourself If You Have mpox

If you experience mpox symptoms, there are several over-the-counter (OTC) medications and self-care measures that can help alleviate discomfort:

• If you are infected, isolate yourself from others until all lesions have formed scabs to prevent the virus from spreading.
• Medications such as ibuprofen and acetaminophen can help ease pain and reduce fever.
• Taking a warm bath with colloidal oatmeal can help soothe dry, itchy skin associated with rashes.
• Use gauze or bandages to cover individual or localized sores to reduce the risk of spreading the infection to others and the environment.
• Stay home and rest, wear a mask around others to limit transmission, and drink plenty of fluids to stay hydrated.
• To prevent spreading the virus to animals, refrain from interacting with pets while you are infected.
• Avoid popping blisters or scratching sores, as this can delay healing, spread the rash to other parts of your body, and increase the risk of infection.
• Refrain from shaving areas with sores until scabs have healed and new skin has formed underneath, as shaving can cause the rash to spread to other areas.

References:

• Centers for Disease Control and Prevention. Mpox. 2023. Available from: https://www.cdc.gov/poxvirus/mpox/index.html
• World Health Organization. Mpox [Internet]. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/mpox
• Cleveland Clinic. Monkeypox: What You Need to Know [Internet]. 2023. Available from: https://my.clevelandclinic.org/health/diseases/22371-monkeypox
• Centers for Disease Control and Prevention. About Mpox [Internet]. 2023. Available from: https://www.cdc.gov/poxvirus/mpox/about/index.html
• Mayo Clinic. Monkeypox FAQ [Internet]. 2023. Available from: https://www.mayoclinic.org/diseases-conditions/infectious-diseases/expert-answers/monkeypox-faq/faq-20533608
• NDTV. New Mpox Strain Mutating Very Rapidly: How Scientists Are Responding [Internet]. 2023. Available from: https://www.ndtv.com/world-news/new-mpox-strain-mutating-very-rapidly-how-scientists-are-responding-6426881
• McCollum AM, Damon IK. Human Monkeypox. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Elsevier; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK574519/