Mpox on the Rise: Understanding the Global Health Emergency

Following the rise in cases over the last few months, yesterday the World Health Organization (WHO) declared mpox a global health emergency. This decision comes in the wake of a significant increase in mpox cases across various continents, prompting health authorities worldwide to ramp up surveillance, preventive measures, and public awareness campaigns.

But what exactly is mpox? Why has it become such a pressing concern? Here, we delve deeper into understanding this disease, its symptoms, current outbreaks, and how we can combat its spread.

 

What is mpox?

Mpox, formerly known as monkeypox, is a rare viral zoonotic disease — meaning it’s transmitted from animals to humans — caused by the mpox virus. Mpox was first identified in lab monkeys in 1958, and the first human case was reported in the Democratic Republic of Congo in 1970. Since then, outbreaks have happened sporadically over the last 50 years, predominantly in Central and West Africa.

The virus belongs to the Orthopoxvirus genus, which also includes variola virus (which causes smallpox) and vaccinia virus (used in the smallpox vaccine). While mpox is less contagious and typically less severe than smallpox, it shares similar symptoms, making early detection and isolation crucial.

 

Current mpox outbreaks

Historically, mpox outbreaks were largely confined to Africa. However, since late 2023, there’s been an unprecedented surge in cases across Europe, North America, and parts of Asia.

As of August 2024, over 50 countries have reported confirmed cases, with the most significant clusters in:

• Europe: Particularly in the UK, Spain, and Germany
• North America: The US and Canada have seen rising numbers
• Asia: Countries including India and Japan are also reporting increasing cases

The NHS has observed a sharp increase in cases, especially among people who have travelled recently or had close contact with someone currently infected. The WHO attributes this global spread to increased international travel, lack of immunity in populations (especially post-smallpox vaccination era), and close-contact events.

On 15^th August 2024, the BBC reported that Sweden’s public health agency had recorded what it says is the first case of a more dangerous type of mpox outside the African continent.

The person became infected during a stay in an area of Africa where there was a major outbreak of mpox Clade 1.

 

Recognising the symptoms of mpox

According to the NHS and WHO, mpox’s incubation period (the time from infection to symptoms) ranges from 6 to 13 days but can extend up to 21 days. The disease typically manifests in two phases:

1. Invasion period (lasts 0–5 days):
   • Fever
   • Intense headache
   • Swelling of the lymph nodes*
   • Back pain
   • Muscle aches
   • Fatigue

*Swelling of the lymph nodes is a distinguishing feature of mpox compared to other similar diseases.

1. Skin eruption period (within 1–3 days after the start of fever):
   • The rash often begins on the face and then spreads to other parts of the body
   • Lesions progress through the following stages before falling off: macules, papules, vesicles, pustules, and scabs
   • The number of lesions can vary from a few to several thousand

Most patients recover within 2 to 4 weeks. However, severe cases can occur, especially in children and individuals with compromised immune systems.

 

Why is mpox a serious concern?

While mpox is generally less severe than smallpox, several factors contribute to its current global threat status:

• Mortality rate: Mpox has a case fatality of 3-6%, but the rate can be higher in children and people who are immunocompromised
• Lack of immunity: Since the smallpox vaccination ended in the 1980s, there’s a growing population with no immunity to orthopoxviruses
• Human-to-human transmission: The current outbreaks indicate human-to-human transmission through close contact and respiratory droplets

 

Treatment options

Currently, there’s no specific treatment approved for mpox. However, due to its genetic similarity to smallpox, antiviral drugs developed for smallpox can be effective. The NHS and WHO suggest the following:

• Supportive care: This includes alleviating symptoms, managing complications, and preventing long-term issues. Ensuring proper nutrition, hydration, and secondary bacterial infection management is vital.
• Antiviral agents: Tecovirimat, an antiviral developed for smallpox, has been successful against mpox in some studies.
• Vaccination post-exposure: The smallpox vaccine can be effective in preventing mpox if administered shortly after exposure.

 

Prevention is the best defence

Preventing mpox requires a multi-faceted approach:

1. Vaccination: The NHS is currently offering the smallpox vaccine to high-risk groups, including healthcare workers and close contacts of confirmed cases. The WHO recommends considering vaccination strategies in outbreak areas.
2. Public awareness: Understanding transmission is crucial. Mpox spreads through close contact with infected people, their body fluids, or contaminated materials. Avoiding contact with potential carriers and practicing good hygiene can significantly reduce risk.
3. Isolation and contact tracing: Prompt isolation of confirmed cases and thorough contact tracing can help contain outbreaks.
4. Safe practices: In areas where mpox is on the rise, avoiding contact with animals that could harbour the virus (like rodents and primates) and thoroughly cooking all animal products is advised.

 

Conclusion

The resurgence of mpox as a global health emergency serves as a reminder of zoonotic diseases. While the rise in cases is concerning, acting quickly, public cooperation, and sticking to health guidelines can minimise the spread.

Stay informed through reliable sources like the NHS and WHO. If you experience symptoms or believe you’ve been exposed, contact your GP as soon as possible or ring NHS 111.

 

References:

1. NHS Mpox Information: NHS – Mpox
2. World Health Organization – Mpox Fact Sheet: WHO – Mpox
3. BBC News – BBC Mpox