Mpox Virus- Outbreak, Symptoms, Treatment, Vaccine and Prevention

Table of content

• What is Mpox (Monkeypox)?

• WHO recommends a new name for monkeypox disease

• Mpox disease outbreak

• Mpox virus, India

• What is Mpox virus?

• Mpox virus pathogenesis

• Mpox Symptoms

• How does Mpox spread?

• Mpox Treatment

• Mpox Vaccine

• Take-home points

• FAQ on Mpox virus

Introduction

• A new disease named MONKEYPOX is creating havoc while some of you are recovering or struggling from COVID-19. Cases of monkeypox disease are increasing at a rapid rate around the world with most cases involving sexual connections.

• It is necessary to find the key factor for the outbreak of any infection to cease further growth and outbreak. Here are all the facts and misinformation related to monkey disease.

What is Mpox (Monkeypox)?

Mpox was previously called monkeypox. It is a infection caused by mpox virus. It belongs to the family of the smallpox virus. However, it is less contagious than smallpox.

WHO recommends a new name for monkeypox disease

 WHO changed the name from "monkeypox" to "mpox" in November 2022.

Recommendations are released on the WHO website on 22 December 2022.

Some of the important updates on mpox are summarised below:

• The case investigation form (CIF) and case reporting Form (CRF) are updated. The name from "monkeypox" is changed to "mpox."

• Investigations of cases exposed to infected animals

• To conduct a more in-depth epidemiological investigation of mpox cases.

• WHO prepared a macro-enabled Microsoft Excel form received through IHR communication channels for data collection.

• The in-depth case investigation form (CIF) is available on the Go. Data platform39 for local capture, analysis, and data sharing.

• Emailing godata@who.int will provide information related to the template and metadata description.

• Go.data has a "visualization" feature that allows visualizing outbreak response activities in real-time chains of transmission.

• The Known mpox case contact must avoid sexual contact for 21 days.

• Quarantine is not necessary as long as no symptoms developed.

• The patient investigation is to be carried out in a well-ventilated room.

• To conduct studies for a better understanding of the dynamics of human-to-human transmission, zoonosis studies, and animal-to-human transmission: SAGO.

Mpox disease outbreak

• Monkeypox disease is a rare infection caused due to one of the close strains of smallpox. Monkeypox virus is endemic to west or central Africa. Monkeypox disease in recent years has been found in southeast and south Nigeria. 

• In 1970, monkey disease was introduced to mankind in the town of Basankusu, Equateur Province. After 39 years, the first outbreak was reported in September 2017 and started to spread to multiple states as of May 2019. Also, note that the monkey disease made a few visits from 1996 to 2003. Let’s find out the pathogenesis, history, treatment, and prevention of monkeypox disease.

Mpox in the UK

The latest report shows that 2,208 cases are reported in the UK and 2,115 in England as of 21 July 2022. UK Health Security Agency (UKHSA) has acquired more than 100,000 extra doses as the cases increase from 2000 to 2,137 on 19 July 2022. The majority of monkeypox in the UK is seen in gay, bisexual, and men who have sex with men. However, there is no scientific evidence to relate this information. The states of the UK have a monkeypox disease, as per the reports one or more cases of monkey virus in Texas.

Mpox virus, Singapore

As of 24 July 2022, Singapore reached a total of eight cases, with four local and four imported cases. But none of the cases are interrelated. The first case of monkeypox, Singapore was reported on July 21 in an Estonian man who returned from London and tested positive for monkeypox symptoms of fever, rash, and swollen lymph nodes. Another Singaporean man is found with monkeypox virus infection in the groin and other parts.

Mpox virus, India

India has reported its fourth case of monkey disease on 26 July 2022 in a man in Delhi who has no foreign travel history. The first three cases are reported in kerala who travelled back from the Gulf region. Also the first case from the south east Asia region is from India. Recently the World Health Organization has declared monkeypox virus as a public health emergency of international concern (PHEIC), an highest level of alarm.

What is Mpox virus?

The monkeypox disease is caused by infection of the monkeypox virus that is zoonotic (from animals to humans) in nature.Monkeypox virus is related to thevariola virus family that causes smallpox. Monkey disease is less fatal and milder compared to smallpox and is not related to chickenpox.

Mpox virus pathogenesis

Monkeypox virus infection is spread by the monkeypox virus which is a double-stranded DNA virus that belongs to a family of Poxviridae and the genus of Orthopoxvirus. The monkeypox viral infection has two distinct strains: the Congo strain and the West African strain.  The Congo shein is considered to be more fatal compared to the West African strain. The mortality rate of the Congo strain is reported as 10% and for the western African strain as 1%. Back people are shown in media and articles for monkeypox pictures which have become a controversy recently. Is monkeypox deadly?

Monkeypox virus is not a deadly disease as many people have recovered without any problem except large scars.Monkeypox virus can cause a few complications such as secondary infections,pneumonia, sepsis,encephalitis, eye infection, or loss of vision. 

The fatality ratio of the monkeypox virus ranged from zero to 11% in the past and is reported higher in young children. The monkeypox virus is less contagious and less severe compared to smallpox. In the recent outbreak, the fatality rate of the monkeypox virus is around 3 to 6%. As per the World Health Organization [WHO], a total of around 16,000 cases including 5 deaths are reported worldwide due to monkey disease

Mpox Symptoms

The most common monkeypox symptoms include fever, swollen lymph nodes, a rash that forms blisters, muscle pains, and swollen glands with many lesions at a particular place or all over the body. The exposure to monkeypox symptoms ranges from 5 to 21 days and the duration may last for 2 to 4 weeks. Monkey disease can affect anyone but is more in children, pregnant women, or people with less immunity. 

Symptoms of Mpox Infection

The monkeypox infection is divided into 2 stages: the invasion period, and the eruption period.

Invasion period

Inversive period of monkeypox virus ranges between 0 to 5 days from the onset of viral infection. The monkeypox symptoms in the invasion period are fever, intense headache, lymphadenopathy (swollen lymph nodes), back pain, myalgia (muscle pain), and intense asthenia (lack of energy). The characteristic feature of this period is lymphadenopathy that may appear similar to other diseases such as chickenpox, smallpox, and measles.

Eruption period

The eruption period begins within 1 to 3 days of onset of fever. The rashes on the face and extremities appear to be more concentrated compared to the rashes on the trunk. The skin eruption affects the face palms of the hands and soles of the feet, oral mucous membranes, genitalia conjunctiva as well as cornea. The rashes in the eruption period go through different stages from macules (flat base lesions) to papules (slightly raised and firm lesions), vesicles (clear fluid-filled lesions), and pustules (yellowish fluid-filled lesions), and finally form a crust that will dry up and fall off.

How does Mpox spread?

The monkeypox virus disease will spread from animals to humans or humans to humans. Monkeypox transmission involves the transmission from one person to another through close contact, small droplets, body fluids, lesions, and personal things. Monkeypox transmission can occur from animal to human which is rare and can spread through bites, scratches, infected blood, fluids or skin of the animal, food, and bedding of the infected animal.

Monkeypox transmission can be airborne. A person with monkey disease can spread the virus from the onset of monkeypox symptoms till all the lesions have dried and fallen off, with trace evidence of spread for more than a week even after the lesions are crusted. A significant proportion of the monkeypox virus is seen in men who have sex with men, especially in Kannada Kama Spain, and the UK.

Factors that include monkeypox transmission or eating raw or inadequately cooked meat, and infected animal products. People who live near or in forest areas will have indirect or a low level of exposure to the infected animals. Monkeypox transmission can also occur from the mother to the fetus through the placenta or during childbirth due to close contact. But there is no scientific evidence for all of these.

Mpox Treatment

Monkeypox treatment has not yet been discovered. But can be prevented through vaccination of smallpox that contains vaccinia. In 1980, in Africa, the smallpox vaccine was tested and calculated as a post-exposure prophylaxis method for people in close contact with an infected individual. 

With the present outbreak, many countries have started buying monkeypox vaccines and releasing them for use. Also, the use of antivirals for smallpox is recommended against the monkeypox virus as they are close strains. Some of the antivirals are tecovirimat, brincidofovir, cidofovir, acyclovir, etc. This may help in monkeypox treatment to some extent in people with severe illness.

Mpox Vaccine

Smallpox vaccines such as Imvanex/Jynneos will provide about 85% of protection against monkey disease. However, there is no scientific evidence to prove the same. According to the Centers for Disease Control and Prevention (CDC), two subcutaneous vaccinations of Imvanex or Jynneos are administered four weeks apart.

Mpox Diagnosis

Based on the availability, monkeypox diagnosis is done by cell culture, polymerase chain reaction (PCR), immunohistochemistry, and electron microscopy. Monkeypox image of an infected person is full of lesions and swollen lymph nodes.

Mpox Prevention 

For monkeypox, prevention is necessary to raise awareness of risk factors and by educating people about the prevention strategies. Many scientific studies are underway to assess the feasibility and appropriateness of vaccination and antivirals for the prevention and control of the monkeypox virus. 

Reduce the risk of human-to-human monkeypox transmission

• Avoid close contact, and skin-to-skin contact with people who have rashes like the monkeypox virus.

• Do not touch the rash or scab or wound of any monkeypox virus infected person.

• Do not kiss, touch, hug, cuddle, or have sex with anyone with monkeypox virus.

• Do not share any personal items of monkeypox virus infected persons.

Reduce the risk of zoonotic transmission

• Avoid unprotected direct contact with animals. 

• Always properly cook all foods that contain animal meat or parts.

• Wash your hands with soap and water after touching animals.

Prevent Mpox virus through restrictions on animal trade

• Stop animal trade and impose regulations to import rodents and non-human primates. 

• Quarantine other animals from the infected captive animals.

• Any animal in contact with infected animals should be quarantined for 30 days. 

Difference between smallpox and monkeypox 

Take-home points

• Monkeypox virus is a rare disease that is spreading all over the world in recent times with about 14000 registered cases.

• Monkeypox virus is closely related to the smallpox virus and can be transmitted through direct contact.

• Quarantine the animals or people if found to be monkeypox virus infected.

• Always wash your hands with soap and water to prevent infection from animals after touching them.

• Never neglect the monkeypox symptoms and consult a doctor immediately.

• As a preventive measure you can get vaccinated with smallpox vaccines.

• For monkeypox treatment antivirals are suggested to protect against the monkeypox virus in severe cases.

References

• NCBI

• NCBI

• PUBMED

• NCBI