Mpox (Monkeypox)

The Mpox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox is a rare disease that is similar to smallpox symptoms, but milder, and rarely fatal. In previous years, the case fatality ratio ranged from 0-11%, however, recently it has been from 3-6%.

There are currently no treatments specifically for the mpox virus, however since the mpox and smallpox viruses are genetically similar, which means that antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat mpox virus infections.

Antivirals, such as tecovirimat (TPOXX), may be recommended for people who are more likely to get severely ill, like patients with weakened immune systems or underlying immune deficiencies.

Recent Uptick in Cases

"WHO Director-General Dr Tedros Adhanom Ghebreyesus has determined that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR)." - WHO Website.

In 2023, known cases increased significantly, and the number of cases reported in 2024 has exceeded last year’s total. In 2024 there have been more than 15,600 cases and 537 deaths in a current hotbed for the disease, the Democratic Republic of Congo.

Signs & Symptoms

The incubation period is usually from 6-13 days, however it can range from 5-21 days.

The infection period can be split into two phases:

• The invasion phase, which lasts between 0-5 days, is characterised by:
  • Lymphadenopathy (swelling of the lymph nodes). This is a distinctive feature that may initially appear similar to chickenpox, measles, smallpox
  • Fever
  • Headache
  • Back pain
  • Myalgia (muscle aches)
  • Asthenia (lack of energy).

• The skin eruption phase, which begins within 1-3 days of the fever, is characterised by:
  
  • In common cases, a rash concentrated on the face and extremities, such as palms of the hands and soles of the feet
  • In rare cases, the oral mucous membranes, genitalia, conjunctivae and cornea may be affected.

The progression/stages of the rash:

1. Macules - lesions with a flat base
2. Papules - slightly raised firm lesions
3. Vesicles - lesions filled with clear fluid
4. Pustules - lesions filled with yellowish fluid
5. Crusts - dried lesions/skin which will eventually fall off
   

Mpox is typically a self-limiting disease, which means that it can be resolved without treatment, and symptoms can last from 2-4 weeks.

Underlying immune deficiencies could lead to worse outcomes and complications of mpox can include secondary infections, such as bronchopneumonia, sepsis, encephalitis, and infection of the cornea with ensuing loss of vision.

How it Spreads

Although Mpox primarily occurs in central and west Africa, often in proximity to tropical rainforests and transmitted to humans from animals, the recent rise in cases of infected people from outside of these countries indicates that it is now widely spread from person-to-person and the virus is spreading in the community.

The spread occurs through:

• direct contact with the infectious rash, scabs, or body fluids
  
• respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or intercourse
• touching items (such as clothing or linens) that previously touched the infectious rash or body fluids
• pregnant people can spread the virus to their fetus through the placenta

An infected person is contagious from the time symptoms start until the rash has fully healed and your skin has recovered.

How to Stay Safe

Here are some precautions to take:

• Avoid close, skin-skin contact with anyone experiencing a rash
• If you know someone that has Mpox:
  • Do not touch their rash, scabs or body fluid
  • Do not share eating utensils or cups
  • Do not handle or touch their bedding, towels or clothing