Mpox: An Overview of the Infectious Disease
Mpox formerly known as monkeypox, is an emerging infectious disease caused by the monkeypox virus (MPXV). Characterized by a painful rash, enlarged lymph nodes, fever, headache, muscle aches, back pain, and low energy, mpox poses significant health challenges. While most individuals fully recover, some cases can lead to severe illness and even death.
Cause and Virology
Mpox is caused by the monkeypox virus, an enveloped double-stranded DNA virus belonging to the Orthopoxvirus genus in the Poxviridae family. This family also includes other notable viruses such as variola (smallpox), cowpox, and vaccinia. MPXV exists in two distinct clades:
- Clade I: Further divided into subclades Ia and Ib.
- Clade II: Comprising subclades IIa and IIb.
A global outbreak of clade IIb began in 2022 and continues to persist, including in several African nations. Additionally, outbreaks of clades Ia and Ib have been increasing in regions like the Democratic Republic of the Congo, with clade Ib detected beyond Africa as of August 2024.
The natural reservoir of MPXV remains unidentified, though various small mammals, including squirrels and monkeys, are susceptible to the virus.
Transmission
Mpox spreads primarily through close contact with an infected individual. This includes:
- Person-to-Person Contact: Skin-to-skin interactions (e.g., touching, sexual contact) and mouth-to-mouth or mouth-to-skin contact (e.g., kissing).
- Respiratory Droplets: Face-to-face interactions where infectious respiratory particles are generated through talking or breathing.
- Contaminated Objects: Transmission can occur via contaminated clothing, linens, or surfaces. Healthcare settings and community venues like tattoo parlors also pose risks.
- Animal-to-Human Contact: Bites, scratches, or handling infected animals during activities such as hunting, skinning, or cooking.
Individuals with multiple sexual partners, those in close-knit communities, and healthcare workers are at heightened risk. Additionally, the virus can be transmitted from mother to baby during pregnancy or childbirth, potentially leading to severe complications or fatal outcomes.
Signs and Symptoms
Symptoms of mpox typically manifest within 1 to 21 days post-exposure, usually within a week. The illness generally lasts between 2 to 4 weeks, though it may extend longer in individuals with weakened immune systems. Common symptoms include:
- Rash: Often the first symptom for some, starting on the face and spreading to other body parts, including the palms, soles, and genital areas. The rash progresses from flat sores to fluid-filled blisters, which may be itchy or painful before crusting over and healing.
- Fever and Flu-like Symptoms: Including sore throat, headache, muscle aches, back pain, and low energy.
- Swollen Lymph Nodes: A distinguishing feature of mpox compared to other similar diseases.
- Additional Complications: Painful rectal swelling (proctitis), difficulty urinating (dysuria), and swallowing challenges.
While most recover fully, severe cases can involve bacterial skin infections, pneumonia, corneal infections leading to vision loss, and systemic infections affecting vital organs. Fatal outcomes, though rare, have been documented.
Diagnosis of mpox
Diagnosing mpox can be challenging due to symptom overlap with other diseases like chickenpox, measles, herpes, and bacterial skin infections. Accurate diagnosis is crucial for timely treatment and preventing further spread. The preferred diagnostic method involves:
- Polymerase Chain Reaction (PCR): Detects viral DNA from skin lesions, fluid, or crusts. Throat or anus swabs are alternatives when skin lesions are absent.
Blood testing is not recommended, and antibody detection methods may lack specificity. Additionally, individuals diagnosed with mpox should be offered HIV testing, and other sexually transmitted infections should be considered.
Treatment and Vaccination
Currently, there is no proven antiviral treatment specifically for mpox. Management focuses on:
- Supportive Care: Addressing symptoms, managing pain, and preventing complications.
- Vaccination: Available vaccines can prevent infection, especially when administered as pre-exposure prophylaxis to high-risk groups or as post-exposure prophylaxis within four days of contact with an infected individual.
High-risk groups include healthcare workers, individuals with multiple sexual partners, those living in close communities with infected persons, and sex workers. Some antivirals have received emergency use authorization and are under clinical evaluation, but robust clinical trials are needed to confirm their efficacy.
For individuals with HIV and mpox, maintaining antiretroviral therapy (ART) is essential, with ART initiation recommended within seven days of HIV diagnosis.
Prevention and Self-Care from mpox
Preventing mpox involves minimizing exposure to the virus through:
- Avoiding Close Contact: Steering clear of individuals exhibiting mpox symptoms.
- Hygiene Practices: Regular handwashing and disinfecting contaminated surfaces and objects.
- Safe Sexual Practices: Reducing the number of sexual partners and using protective barriers.
- Vaccination: As outlined above, vaccination remains a critical preventive measure.
Most individuals with mpox recover within a month, but maintaining good personal hygiene and avoiding contact with infected individuals are key to preventing transmission.
History and Epidemiology
The monkeypox virus was first identified in 1958 in Denmark among monkeys kept for research. The first human case emerged in 1970 in the Democratic Republic of the Congo. Following the global eradication of smallpox in 1980 and the cessation of smallpox vaccination, mpox has increasingly surfaced in central, eastern, and western Africa. Notable outbreaks include:
- 2003 USA Outbreak: Linked to imported wild animals (clade II).
- Ongoing Cases in the Democratic Republic of the Congo: Thousands reported annually since 2005.
- 2017 Nigeria Re-emergence: Continued human-to-human transmission and international spread.
From January 2022 to August 2024, over 120 countries reported mpox cases, with more than 100,000 laboratory-confirmed instances and over 220 deaths. The 2022 global outbreak rapidly spread across Europe, the Americas, and all six WHO regions, primarily affecting men who have sex with men through sexual networks. Additionally, clade Ib has been identified outside Africa, indicating the virus’s expanding reach.
Mpox in India
As of the latest data up to August 2024, India has reported cases of mpox, aligning with the global trend of the virus’s spread beyond its traditional endemic regions. The Indian health authorities have been actively monitoring the situation, implementing measures such as:
- Surveillance and Reporting: Enhancing detection capabilities to identify and report new cases promptly.
- Public Awareness Campaigns: Educating the public about mpox symptoms, transmission, and preventive measures.
- Vaccination Programs: Targeting high-risk groups to curb potential outbreaks.
- Healthcare Preparedness: Equipping healthcare facilities to manage and treat mpox cases effectively.
While specific numbers and detailed information on mpox in India are continuously evolving, the country’s proactive approach aims to mitigate the impact of the disease and prevent widespread transmission.
Mpox remains a significant public health concern with its potential for severe illness and global spread. Continued vigilance, research, and effective public health strategies are essential to manage and eventually control mpox outbreaks. Vaccination, early diagnosis, and supportive care play pivotal roles in combating this infectious disease. As the virus evolves and spreads, international collaboration and robust healthcare responses will be crucial in safeguarding populations worldwide.
Know more about other virues in India
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