Monkeypox is a viral disease that has recently emerged from animal sources and has raised concerns because of its outbreaks and potential impact on public health. It’s important to understand the characteristics of this infection, including its symptoms, how it spreads, and the measures we can take to prevent it, in order to effectively control and reduce its transmission.

Mpox, which was previously known as monkeypox, is a disease that resembles smallpox and is caused by a virus. It can lead to flu-like symptoms, including fever and chills, along with a rash that may take several weeks to resolve. While there is no established treatment for mpox, it typically resolves on its own. Health professionals advise vaccination for those who are at a higher risk of contracting mpox.

What is Monkeypox?

Monkeypox is an infectious disease caused by the monkeypox virus, which belongs to the Orthopoxvirus genus that also includes smallpox and cowpox. The virus was first discovered in 1958 during an outbreak in research monkeys, which is how it got its name. The first recorded case in humans occurred in 1970 in the Democratic Republic of the Congo. Since then, monkeypox has mostly been reported in central and west Africa, but recent cases in areas where the disease is not typically found have raised alarms among global public health officials.

Types of Monkeypox

There are two recognized subtypes of mpox:

1. Clade I.

This subtype is primarily found in Central Africa and is known to cause more severe illness compared to clade II. However, recent outbreaks of clade I have resulted in fewer fatalities.

2. Clade II

Endemic to East Africa, clade II has been responsible for a global outbreak since 2022. It is generally less fatal than clade I.

Symptoms and Causes

Symptoms:

The incubation period for mpox usually lasts between 5 to 21 days. Early symptoms often mimic those of influenza and can include:

• Fever
• Severe headache
• Muscle aches
• Back pain
• Swollen lymph nodes
• Chills
• Fatigue

Monkeypox usually resolves on its own, but severe cases can happen, especially in those with weakened immune systems, children, and pregnant women. This can result in complications like pneumonia, sepsis, or even death. Historically, the mortality rate for monkeypox varies from 1% to 10%, depending on the virus clade and the patient’s overall health.

About 1 to 3 days after the fever starts, a rash appears, often beginning on the face and then spreading to other areas of the body, such as the palms, soles, and mucous membranes. The rash goes through several stages:

• Macules: Flat, discolored spots
• Papules: Raised, solid bumps
• Vesicles: Blisters filled with clear fluid
• Pustules: Blisters filled with yellowish fluid
• Scabs: Crusts that eventually dry out and fall off

The illness generally lasts from 2 to 4 weeks. While many cases are mild, there can be complications, including secondary infections, bronchopneumonia, sepsis, encephalitis, and corneal infection, which may result in vision loss.

Causes and Transmission:

Mpox is mainly transmitted to humans from animals, particularly rodents and primates, which are common carriers. Human-to-human transmission can happen through:

• Direct contact with bodily fluids or lesion material
• Respiratory droplets during extended face-to-face interactions
• Contact with contaminated items, like bedding or clothing

The virus can enter the body through broken skin, the respiratory tract, or mucous membranes.

Recent Updates mpox outbreaks:

As of December 2024, the World Health Organization (WHO) has been closely tracking mpox outbreaks. In September 2024, WHO prequalified the first vaccine for mpox, which has strengthened preventive efforts. Furthermore, WHO and its partners have set up a mechanism for the access and allocation of mpox vaccines, treatments, and tests to guarantee fair distribution, especially in areas with limited resources.

How do a person get mpox?

1. Close Contact with Infected Individuals

• Skin-to-skin contact: This includes touching rashes, lesions, scabs, or bodily fluids from someone who is infected.
• Prolonged face-to-face contact: Being exposed to respiratory droplets when someone coughs, sneezes, or talks nearby.
• Intimate contact: This encompasses sexual contact or kissing.

2. Contaminated Materials:

• Contact with items or surfaces that have been contaminated by the virus, such as clothing, bedding, towels, or other personal belongings used by an infected person.

3. Animal-to-Human Transmission

• Direct contact: This involves handling or being scratched or bitten by infected animals, like rodents or monkeys.
• Consumption of undercooked meat: Eating meat or animal products that are not properly cooked from infected animals.

4. Mother-to-Child Transmission

• The virus can be transmitted from a pregnant person to their fetus through the placenta or during close contact after birth.

5. Healthcare Settings

Healthcare workers face risks if proper infection control measures are not adhered to while caring for patients with mpox.

Risk Factors:

• Living in or traveling to areas where mpox is endemic.
• Close contact with infected individuals or animals.
• Engaging in activities that involve exposure to bodily fluids or contaminated materials.

Preventive Measures:

Preventing monkeypox requires a comprehensive strategy that includes raising public awareness, vaccination efforts, and effective surveillance systems. Vaccines like the Modified Vaccinia Ankara (MVA) have proven effective in providing immunity against monkeypox. Health authorities advise vaccination for high-risk groups, such as healthcare workers and those who have been in contact with infected individuals.
Moreover, educating the public is crucial to help communities recognize symptoms and understand the importance of steering clear of potential virus carriers. Maintaining good hygiene practices, such as frequent handwashing and avoiding close contact with anyone showing symptoms, can greatly lower the risk of transmission. other preventive measure are

• Avoid close contact with individuals who have mpox symptoms.
• Practice good hygiene (e.g., frequent handwashing).
• Use personal protective equipment (PPE) if caring for an infected person.
• Avoid consuming undercooked animal products.

What are the risk factors for mpox?

Mpox can affect anyone. The current global outbreak seems to be hitting men who have sex with men (MSM) the hardest. Conversely, in the clade I outbreak in the Democratic Republic of Congo, more than half of the cases are among children under 15 years old.

• You’ve had sexual contact with someone diagnosed with mpox in the last two weeks.
• You’ve visited a sex club, bathhouse, or another commercial sex venue in the past six months.
• You’ve attended an event or been in a location where mpox was spreading.
• You have a sexual partner who has been in any of the above situations.
• You’ve been diagnosed with one or more sexually transmitted infections (STIs) in the last six months, including acute HIV, gonorrhea, syphilis, chancroid, or chlamydia.
• You’ve had sexual encounters with more than one person in the past six months.

You may be at a greater risk of severe illness from mpox if you:

• Have a weakened immune system, particularly due to HIV.
• Have a history of eczema.
• Are pregnant.
• Babies under 1 year old are also at increased risk for severe illness.

What are the complications of mpox?

1. Skin Complications

• Secondary bacterial infections: Lesions can become infected, resulting in cellulitis, abscesses, or impetigo.
• Scarring: Healing lesions may leave scars, particularly if they are deep or infected.

2. Respiratory Complications

• Bronchopneumonia: This can occur if the virus impacts the lungs.
• Laryngeal edema: Swelling in the throat can lead to difficulties in breathing.

3. Neurological Complications

• Encephalitis: This is the inflammation of the brain and can be life-threatening.
• Seizures: Severe neurological involvement may lead to seizures.
• Meningitis: This involves inflammation of the protective membranes surrounding the brain and spinal cord.

4. Ocular Complications

• Conjunctivitis: This is the inflammation of the eye’s outer membrane.
• Keratitis: Involvement of the cornea can result in vision loss.

5. Severe Systemic Complications

• Sepsis: A life-threatening systemic response to infection.
• Disseminated infection: The virus can spread extensively, impacting multiple organs.

6. Complications in Pregnant Women

• Miscarriage: The virus may lead to fetal loss.
• Congenital mpox: Although rare, the virus can infect the fetus, causing complications at birth.

7. Long-term Effects

• Chronic pain or discomfort: Persistent pain may occur in areas affected by lesions.
• Psychological distress: Scarring and the stigma associated with the disease can lead to anxiety or depression.

8. Mortality

• The case fatality rate varies based on the clade (strain) of the virus and access to healthcare. Severe cases are more likely to occur in immunocompromised individuals and children.

How is mpox diagnosed?

1. Clinical Evaluation:

• History:
  • Patients are questioned about their symptoms, travel history, possible exposure to infected individuals or animals, and any activities that might heighten their risk (e.g., close contact with suspected cases).
• Symptoms:
  • Typical symptoms include fever, headache, muscle aches, swollen lymph nodes, fatigue, and a unique rash that evolves from macules to papules, vesicles, pustules, and eventually scabs.
• Physical Examination:
  • The rash is examined, usually beginning on the face and then spreading to other areas of the body, including the palms and soles.

2. Laboratory Testing:

• Specimen Collection:
  • Samples are collected from the rash (such as skin lesions, crusts, or swabs from vesicular or pustular lesions). Blood, respiratory, or oropharyngeal swabs may also be obtained in certain situations.
• Polymerase Chain Reaction (PCR):
  • PCR is the preferred method for diagnosing mpox, as it identifies the virus’s genetic material from the collected samples.
• Viral Culture:
  • In some specialized labs, viral culture can be performed to isolate the virus, although this is less common.
• Serological Testing:
  • The detection of antibodies (IgM and IgG) can assist in identifying recent or past infections, but it is not usually employed for acute diagnosis due to possible cross-reactivity with other orthopoxviruses.

3. Differential Diagnosis:

• Conditions that present with similar symptoms, such as chickenpox, smallpox, herpes simplex, and bacterial skin infections, must be excluded based on clinical presentation and lab result

4. Additional Considerations:

• Lymphadenopathy:
  • The presence of swollen lymph nodes is a significant characteristic that helps differentiate mpox from other pox-like illnesses, such as chickenpox.
• Public Health Reporting:
  • Suspected or confirmed cases should be reported to health authorities for contact tracing, isolation, and containment measures.

Management and Treatment of Mpox

1. General Supportive Care

• Symptom Relief:
  • Administer analgesics like acetaminophen or ibuprofen to alleviate fever and pain.
  • Offer antihistamines or calamine lotion to soothe itching from rashes.
• Hydration:
  • Encourage patients to drink fluids or provide intravenous fluids for those who are dehydrated.
• Nutrition:
  • Ensure a balanced diet to aid in recovery.

2. Isolation and Infection Control

• Preventing Transmission:
  • Keep affected individuals isolated until all lesions have crusted over and healed.
  • Caregivers should wear personal protective equipment (PPE), including gloves, masks, and gowns.
  • Thoroughly disinfect contaminated surfaces and linens.
• Contact Tracing:
  • Identify and monitor close contacts for any symptoms.

3. Antiviral Therapy:

• Tecovirimat (TPOXX):
  • This medication is approved for treating mpox in specific cases.
  • It can be given orally or intravenously and is usually reserved for severe cases, immunocompromised patients, or those with complications like secondary infections.
• Other Antivirals (Experimental/Off-label):
  • Cidofovir and brincidofovir have been researched but are not considered first-line treatments.
  • Their use is contingent on availability and clinical discretion.

4. Managing Complications

• Secondary Bacterial Infections:
  • Administer appropriate antibiotics if lesions become infected.
  • Ocular Involvement:
  • Refer to ophthalmology for eye lesions; topical antivirals or antibiotics may be necessary.
• Respiratory Issues:
  • Provide oxygen therapy or respiratory support for severe cases.

5. Vaccination

• Post-Exposure Prophylaxis (PEP):
• Administer the modified vaccinia Ankara (MVA-BN) vaccine (e.g., Jynneos) to close contacts within 4 days of exposure.
• Pre-Exposure Prophylaxis (PrEP):
• This is recommended for individuals at high risk, such as healthcare workers in endemic areas.

6. Monitoring and Follow-Up

• Regularly check symptoms, particularly in high-risk groups like pregnant individuals, children, and those with weakened immune systems.
• Address mental health issues, including anxiety or stigma associated with mpox.

Who should get vaccinated for mpox?

Mpox vaccines are currently recommended only for individuals who have been exposed to, or are likely to be exposed to, mpox. The guidelines for vaccination depend on the level of risk associated with different groups. These risks can vary based on your location or travel plans.

In the U.S., adults aged 18 and older who have risk factors should receive two doses of the JYNNEOS™ vaccine, spaced 28 days apart. Generally, you may be at risk if you have a known or suspected exposure to someone with mpox or if you find yourself in situations that could lead to exposure.

It’s important to check with your local public health officials for specific recommendations, such as those from the Centers for Disease Control and Prevention (CDC) in the U.S. If you’re unsure about whether you should get vaccinated, consult a healthcare provider.

How does mpox vaccination work?

1. Type of Vaccine

The mpox vaccine, like JYNNEOS (also known as Imvamune or Imvanex), is a live, non-replicating vaccine. It utilizes a modified vaccinia Ankara (MVA) virus, which is related to the smallpox virus but has been weakened so it cannot replicate in human cells. This makes it a safer option, particularly for those with weakened immune systems.
In some areas, the older ACAM2000 vaccine may be used, which contains a live, replicating vaccinia virus. While this vaccine is more effective against mpox, it also comes with a higher risk of side effects.

2. How It Works

The vaccine exposes the immune system to the vaccinia virus (a relative of monkeypox), which is similar enough to the monkeypox virus to trigger an immune response. After administration, the body identifies the vaccinia virus as a foreign invader, leading to the production of antibodies and the activation of T cells to combat it.
These immune components are also capable of recognizing and fighting the monkeypox virus if encountered later, thus providing protection against mpox.

3. Administration

JYNNEOS: Administered as a two-dose series, usually 28 days apart. The vaccine can be given subcutaneously (just under the skin) or intradermally (into the skin).
ACAM2000: Given as a single dose using a bifurcated needle to create a small lesion (scarification) on the skin.

4. Effectiveness

The JYNNEOS vaccine is about 85% effective in preventing mpox, based on studies involving similar orthopoxviruses like smallpox.
Immunity starts to develop within two weeks after the first dose, but it is most robust after the second dose.

5. Side Effects

• Common: You may experience redness, swelling, and pain at the injection site, along with mild fever or fatigue.
• Rare: There can be severe allergic reactions, myocarditis (inflammation of the heart), or more serious side effects, particularly with ACAM2000.

6. Importance

Vaccination plays a vital role in managing outbreaks, minimizing severe illness, and safeguarding vulnerable groups, especially as mpox cases increase in certain areas.

Monkeypox poses a significant public health challenge, linking the dynamics of zoonotic diseases with human behavior. It’s crucial to understand the symptoms, how the disease spreads, and the strategies for prevention to help control its transmission. As the world becomes more interconnected, the need to monitor and respond to emerging infectious diseases like monkeypox is more important than ever. By raising awareness and taking proactive steps, we can safeguard public health and reduce the risk of future outbreaks of this viral illness.