Mpox

Mpox, originally known as monkeypox, is a viral disease first identified in 1958 in laboratory monkeys, though it primarily affects squirrels (clade I, mainly in Central Africa) and rodents (clade II, mainly in West Africa) in the wild.

The first human case was recorded in 1970 in the Democratic Republic of Congo. The virus is part of the orthopoxvirus genus, related to smallpox. Historically, mpox was confined to Central and West Africa. Human infections by mpox were mainly affecting people who had been in direct contact with infected animals. As a result, infections and outbreaks were sporadic and limited to certain areas in endemic countries. In recent years the mpox viruses have mutated into forms that can be transmitted between humans, without contact with affected animals, hence the faster spread of the disease among humans. In 2022, a significant outbreak linked to the clade II occurred in multiple non-endemic countries, raising global concern and leading to a broader international response. The outbreak was declared closed in May 2023, though low-level transmission still occurs; there are currently around 100 cases per month in Europe.

In DRC, where clade I is endemic in several provinces, a mutation occurred in South Kivu and this clade Ib rapidly expanded to neighbouring North Kivu province. The country is now struggling with both Ia and Ib clades on its territory and DRC is by far the most affected country with 20,015 suspect and confirmed cases and 632 deaths from January to September 2nd 2024, according to Congolese authorities. Outside of Africa, one case linked to clade Ib was confirmed in Sweden on August 15th and one in Thailand in august 22nd and one in Thailand in august 22nd.

Symptoms

Mpox can cause a range of signs and symptoms. Common symptoms of mpox include a rash which may last for 2–4 weeks. This may start with fever, headache, muscle aches, back pain, low energy and swollen glands (lymph nodes). While some people have less severe symptoms, others may develop more serious illness and need care in a health facility.

It is diagnosed suspected clinically by a medical professional and then confirmed by lab (PCR test).

Treatment

In most cases, the symptoms of mpox go away on their own within a few weeks with supportive care, such as medication for pain or fever.

Most of the patients recover within a month, but in some people, the illness can be severe or lead to complications and even death. Newborn babies, children, people who are pregnant and people with underlying immune deficiencies such as from advanced HIV disease may be at higher risk of more serious mpox disease and death. People with severe mpox may require hospitalization, supportive care and antiviral medicines to reduce the severity of lesions and shorten time to recovery.

Currently, there is no clinically proven treatment for monkeypox virus infection with significant effect. Specific antiviral (Tecovirimat) is only available in some countries, and for limited use. The mainstay of case management is supportive care, including analgesia, hydration, skin and mucosal care and management of complications (ie pneumonia, cellulitis, ocular infections, etc.).