Monkeypox: Symptoms, Transmission, Treatment

As of December 2023, the world is grappling with an outbreak of Monkeypox, now referred to as Mpox. This infectious disease, caused by the Monkeypox virus, has been reported in countries where the disease is not endemic, marking a significant shift in its geographical spread. The disease, which was renamed from Monkeypox to Mpox to avoid stigma, has been linked to increasing evidence of transmission through sexual contact, particularly among men who have sex with men, renewing fears of discrimination. This article aims to provide a comprehensive analysis of the Mpox outbreak, discussing its origins, symptoms, transmission, treatment, and prevention measures, as well as the societal and public health implications.

Origins and History of Mpox

• The Monkeypox virus was first discovered in 1958 in monkeys kept for research in Denmark. The first reported human case was a nine-month-old boy in the Democratic Republic of the Congo (DRC) in 1970.
• Following the eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, Mpox steadily emerged in central, east, and west Africa. A global outbreak occurred in 2022–2023.
• The disease has two genetic clades, Clade I and Clade II. Clade I is associated with Central and East Africa, while Clade II is linked to West Africa and other parts of the world.
• The natural reservoir of the Monkeypox virus is unknown, but various small mammals such as squirrels and monkeys can be infected. Non-human primates are known to be clinically susceptible.

Symptoms of Mpox

• Mpox symptoms include a painful rash, enlarged lymph nodes, and fever. Other symptoms can include chills, exhaustion, muscle aches, backache, headache, and respiratory symptoms like a sore throat, nasal congestion, or cough.
• The rash goes through several stages, including scabs, before healing. It can initially look like pimples or blisters and may be painful or itchy.
• The incubation period for Mpox is 3-17 days. During this time, a person does not have symptoms and may feel fine.
• Mpox symptoms usually start within 3 weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

Transmission of Mpox

• Mpox spreads from contact with infected persons, through touch, kissing, or sex. It can also spread from animals when hunting, skinning, or cooking them, and from materials such as contaminated sheets, clothes, or needles.
• Pregnant persons may pass the virus on to their unborn baby.
• A person with Mpox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed.

Treatment and Prevention of Mpox

• Currently, there is no treatment approved specifically for Mpox virus infections. However, the antiviral drug tecovirimat (TPOXX) has been used to treat Mpox through an expanded access program during the outbreak that began in 2022.
• Tecovirimat is prescribed most often for people with severe Mpox or people who are likely to get severely ill. It can reduce the amount of the virus in the body and may help treat severe Mpox disease involving the eyes, mouth, throat, genitals, and anus.
• Prevention steps include washing hands often with soap and water, or using an alcohol-based hand sanitizer, especially before eating or touching the face and after using the bathroom.
• If living in or visiting Central or West Africa, it is advised to avoid contact with animals that can spread the Mpox virus, usually rodents and primates.

Societal and Public Health Implications

• The Mpox outbreak has significant societal and public health implications. The disease can spread through sexual contact, particularly among men who have sex with men, leading to fears of discrimination.
• The outbreak has also put a strain on healthcare systems, particularly in countries like the Democratic Republic of the Congo, which is also dealing with other outbreaks like measles and cholera.

Monkeypox Outbreak in India

• The 2022–2023 monkeypox outbreak in India is part of the ongoing outbreak of human monkeypox caused by the West African clade of the monkeypox virus.
• The outbreak was first reported in India on 14 July 2022.
• The index case was reported in Kollam, Kerala, with the patient having been infected in the United Arab Emirates.
• As of the current date, there have been 23 confirmed cases and 1 death.
• The outbreak has affected 4 states and 1 union territory in India.

Highlights of Guidelines

• The Ministry of Health and Family Welfare, Government of India, has issued comprehensive guidelines for the management of monkeypox disease.
• Even one case of monkeypox is to be considered as an outbreak, and a detailed investigation by the Rapid Response Teams needs to be initiated.
• Any suspected case should be reported immediately to the DSU/State Surveillance Units (SSUs) and CSU (Central Surveillance Unit).
• Patient isolation at home or hospital and symptom alleviation are essential principles in the management of monkeypox cases.
• The guidelines also include specific surveillance measures to quickly identify and control cases and clusters of infection as soon as feasible.
• In addition to contact tracing and testing of all symptomatic cases after the detection of probable or confirmed cases, the core surveillance tactics include hospital-based and targeted surveillance.
• Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.
• The role of the smallpox vaccine in the prevention of monkeypox disease should be further explored.

Way Forward

• Emphasize the importance of case investigation with sensitivity and absence of stigma, and in-depth understanding of human-to-human transmission of Mpox in communities.
• Strengthen the One Health approach in areas where the Monkeypox virus circulates in possible mammalian hosts or reservoirs.
• Continue surveillance, case investigation, and contact tracing for Mpox.
• Encourage the use of preventive measures such as regular handwashing and avoiding contact with potential animal hosts.
• Continue research on potential treatments and vaccines for Mpox.

The Mpox outbreak presents a significant global health challenge. Understanding the disease’s origins, symptoms, transmission methods, and potential treatments is crucial for managing the outbreak and preventing further spread. As we move forward, it is essential to continue research, promote preventive measures, and ensure sensitive and stigma-free case investigation and management.