Mpox: Is it the new COVID?

The recent surge in Mpox cases has raised significant global alarm. While the virus has been endemic to parts of West and Central Africa for decades, the current outbreak presents a new challenge due to its rapid spread and the emergence of more virulent strains.

What is Mpox? 

Picture Credit - https://www.who.int/news-room/fact-sheets/detail/mpox

Mpox, previously known as monkeypox, is a rare viral illness that can be transmitted from animals to humans or through close contact with an infected person. It is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus, a group that also includes smallpox and cowpox.

First identified in 1958 in laboratory monkeys, Mpox is a zoonotic disease, meaning it can spread from animals to humans. While its exact origin remains unclear, the first human case was recorded in the Democratic Republic of Congo in 1970. 

Historically, monkeypox was primarily confined to certain endemic regions in West and Central Africa. However, in 2022, the virus spread globally, prompting the World Health Organization (WHO) to rename the disease to Mpox to avoid negative connotations associated with its previous name. This change aimed to minimise disruptions to trade, travel, and animal welfare.

Variants of Mpox: Why is it a bigger threat now?

There are two primary clades of the Monkeypox virus: Clade I and Clade II. Clade I, endemic to Central Africa, is associated with more severe illness and higher mortality rates, reaching up to 10% in some outbreaks. In contrast, Clade II, endemic to West Africa, which caused the 2022 global outbreak, is generally less severe, with a survival rate exceeding 99.9%. 

The recent outbreak is due to Clade Ib, a variant of Clade I, leading to heightened concerns. This strain is associated with a higher mortality rate and has also been linked to miscarriages. Its ability to spread through close skin contact, in addition to sexual contact, poses a greater risk of wider transmission. This shift in transmission dynamics underscores the evolving nature of the Mpox outbreak and highlights the need for continued vigilance and adaptive measures.

Symptoms, Treatment and Prevention

JYNNEOS, a 2-dose vaccine, offers protection against both Mpox and smallpox. Vaccination is crucial in preventing the spread of Mpox, although reinfection is possible, albeit rare. Subsequent infections are generally milder. JYNNEOS is recommended for those who have not had Mpox, with the second dose administered four weeks after the first.

Mpox symptoms typically appear within two to three weeks of exposure, including fever, headache, muscle aches, fatigue, swollen lymph nodes, and a characteristic rash. The rash, starting as flat, red bumps, can evolve into pus-filled blisters and crust over, lasting two to four weeks. While there are no approved antiviral treatments specifically for Mpox, drugs like cidofovir and tecovirimat, used for other viral infections, may be prescribed for severe cases. To prevent the spread, avoid contact with infected individuals or animals, practice good hygiene, and consider vaccination.

Spread and Global Response 

On August 14, 2024, the World Health Organization (WHO) declared Mpox a Public Health Emergency of International Concern (PHEIC), marking the second such declaration in two years. This move highlights the need for a coordinated global response, including faster access to vaccines and more resources for monitoring and addressing the virus. In Africa, the Africa Centres for Disease Control and Prevention (Africa CDC) declared the outbreak a Public Health Emergency of Continental Security (PHECS), granting it the authority to lead emergency responses across the continent.

Picture credit - https://www.statista.com/chart/27537/countries-with-monkeypox-cases/

Since January 2024, Mpox has affected 13 African countries, including Burundi, Cameroon, the Central African Republic, Congo, Côte d’Ivoire, DRC, Ghana, Kenya, Liberia, Nigeria, Rwanda, South Africa, and Uganda, with over 18,700 cases and 541 deaths reported. Of these countries, DRC, Rwanda, Burundi and Uganda detected the new mutant strain, Clade Ib, which made the situation more complex. South Africa, though, is currently dealing with an outbreak of Mpox Clade II and has not detected any cases of Clade I. However, given the rise in cases and the potential threat of the new Clade Ib strain, South Africa and other African countries are stepping up their surveillance efforts and public awareness campaigns.

The recent surge in Mpox cases has underscored the global health community's ongoing challenges in combating emerging infectious diseases. As we reflect on the lessons learned from the recent COVID-19 pandemic, it is imperative to avoid repeating past mistakes. By investing in robust public health infrastructure, promoting international cooperation, and prioritising research and development, we can better equip ourselves to prevent and mitigate future health crises. These global outbreaks serve as a stark reminder of the interconnectedness of our world and the importance of collective action to safeguard global health.