Mpox Outbreak Declared Global Health Emergency by WHO: What You Need to Know

According to the International Regulations (IHR) (2005), the Director-General of World Health Organization (WHO) Dr. Tedros Adhanom Ghebreyesus has determined that the outbreak of mpox in the Democratic Republic of Congo (DRC) and an increasing number of African countries qualifies as a public health emergency of international concern (PHEIC). Mpox is an extremely contagious disease that has killed not less than 450 people in Democratic Republic of the Congo during its early outbreak. The Director-General was informed that there is a potential to spread mpox all over the countries of Africa and outside the continent too.

So, a global emergency has been proclaimed in response to the rapidly spreading mpox, which is used to be called monkeypox, in several parts of Africa.  Scientists are concerned about the swift spread of a new strain of the disease and its high mortality rate, as it has now extended to portions of central and east Africa. The Committee Chair of World Health Organization (WHO) Dimie Ogonia stated, “Mpox originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself.”

What is Mpox—and Is It Deadly?

Overview of Mpox

Monkeypox, often called mpox, is an infectious disease caused by a virus. It begins with fever, chills and muscle pains. A rash that originates as raised patches and develops into fluid-filled blisters is usually the next step. The final step is formation of scabs. This virus and the virus that causes smallpox belong to the same family. Monkeypox produces swelling in lymph nodes whereas smallpox doesn’t produce lymphadenopathy. Although the symptoms of monkeypox are milder than smallpox, monkeypox can cause death.

Severity and Mortality Rates

The virologist Bernard Moss explained two distinct genetic clades of mpox virus. Clade Ⅰ is responsible for the present outbreak that kills one out of every ten infected people with a mortality rate of 10%. Clade Ⅱ is the source of the 2022 epidemics and it is significantly less dangerous compared to the present one with a mortality rate of 1%. A new strain of the clade Ⅱ virus known as Clade Ⅰb has evolved in the current outbreak as a result of mutations. It prompted the declaration of emergency, since it may be more serious and contagious.

Impact on Different Populations

Pregnant women, children, newborns and those with existing immune deficiencies such as those with advanced HIV disease, may be more susceptible to more severe cases of mpox and even mortality.

How Does Mpox Spread?

Transmission Routes

The primary way that mpox spreads from person to person is through intimate contact with another mpox patient. In addition to mouth-to-mouth and mouth-to-skin contact like kissing, face-to-face contact also supports the spreading of mpox virus through infectious respiratory droplets. Moreover, the virus may remain for a while on bedding, towels, clothing, objects, electronics and surfaces that a mpox infected patient has touched or contacted. Anyone else who comes into contact with those places could also get infected, especially if they have cuts or abrasions on their skin or if they touch their mouth, nose, eyes or other mucus membranes without washing their hands.

Animal to Human Transmission

Monkeypox is a virus that is one of the zoonotic viruses belonging to the Orthopoxvirus genus in Poxviridae family. Despite the fact that monkeypox virus was first discovered in a macaque colony in Denmark, the precise animal reservoir and the virus’s initial animal-to-human transmission are still unknown. It has been demonstrated that the virus can spread from one animal to another and then to people through intermediate hosts. So, if a person may also contract mpox if they come into close personal contact with an animal that is infected with the virus, such as certain kinds of monkeys or terrestrial rodents like tree squirrels living in regions where the virus is endemic. Exposure to animals might happen as a result of bites, scratches or activities like trapping, hunting or meal preparation. Consuming raw or contaminated meat might potentially reveal a human to the virus.

Human to Human Transmission

The human to human virus transmission primarily taken place during the global outbreak started in 2022 was through sexual contact. Skin-to-skin contact during or after childbirth, mpox parent-to-child transmission and pregnant mother-to-fetus transmission can all result in the transmission of mpox virus from human to human. Since respiratory droplets are also sources that can spread mpox, face-to-face contact is one main mode of viral transmission among humans. Until all lesions on an mpox patient have crusted over, which typically takes two to four weeks, the patient is considered infectious. Therefore, mpox easily spreads among human population. 

Is Mpox a Sexually Transmitted Disease?

Clarifying Transmission

Although Mpox can be transmitted from person to person through sexual contact, it is not belonging to the category of Sexually Transmitted Diseases (STDs). But still men who have sex with men, people who have multiple sex partners, sex workers and their clients are at a high risk of getting infected with mpox virus.

Skin-to-Skin Contact

Any form of sexual contact either anal or vaginal sex has the ability to transfer the mpox virus. And also non-sexual close contact like skin-to-skin, such as touching and kissing with an infectious person might readily transfer the mpox virus.

Public Perception and Stigma

The current outbreak of monkeypox has sparked stigma in the form of negative attitudes and discriminatory behaviors like bullying, hate speech, violence and isolating some groups from others. They are directed towards individuals like gay, bisexual, transgender as well as individuals who are infected with the virus and those who have got contacted with an infected person belonging to the areas of West and Central Africa. Stigmatization and discrimination can have a detrimental effect on people’s willingness to reveal symptoms and contact information. This will further hinder the efforts to reduce the spread of the disease. So, contact tracers should encourage the people to inform their symptoms and sexual partners privately and to get in touch with healthcare officials to get tested or treatments.

Are There Tests and Vaccines Available?

Diagnostic Tests

The healthcare practitioner will evaluate the patient’s medical history, symptoms and any possible exposures before determining the requirement to carry out an mpox diagnostic test. The best sample type which is most likely to yield a reliable test result is lesion material. Thus a sample will be taken by swabbing the skin or oral lesion surrounding skin. More than one lesion may be swabbed by the medical professional. Other sample types such as an oropharyngeal swab from the back of the throat or anal and vaginal area swabs may be taken if there are no visible skin lesions. The early detection of the disease could aid in the prevention of further spreading of the virus.  

Vaccination Options

The World Health Organization (WHO) as recommended several vaccines to prevent mpox. Some of the vaccines that have been used to eradicate smallpox are recommended to be used against mpox as well in different countries. Both the 1^st and 2^nd doses of MVA-BN vaccination which is also called as JYNNEOS are considered highly effective against mpox. Currently, the WHO advises to use either LC16-KMB or ACAM2000 vaccines, when other vaccines are not accessible. Only those who are at risk such as those who have had intimate contact with an infected person or those who are members of a group that is particularly vulnerable to the infection like sex workers and elderly should be given the opportunity to receive the mpox vaccination. Currently, the mass immunization is not recommended. As it takes several weeks to boost the immunity of the body, the vaccinated patient should still take a good care to avoid contacting with viral sources. 

Vaccine Availability and Distribution Challenges

According to certain analyses, high-income countries were able to obtain substantial supplies of Mpox vaccines, while low- and middle-income countries were unable to obtain the vaccine on their own. Thus, the low- and middle-income countries are forced to rely on Mpox vaccine donations from high-income countries. These issues in global south were primarily related to vaccination hesitancy, limited cold chain equipment for vaccine distribution and insufficient capacity for vaccine production as a result of a lack of skilled labor and specialized infrastructure for complete vaccine development and manufacturing. In order to expedite vaccination availability for lower-income countries that have not yet received their own national regulatory approval, the Director General has initiated the procedure for the Emergency Use Listing of mpox vaccines. It facilitates the procurement of vaccinations for distribution by partners such as UNICEF and Gavi. WHO is coordinating with partners through the temporary Medical Countermeasures Network to enable fair access to vaccines, medicines, diagnostics and other instruments. It is also collaborating with nations and vaccine manufacturers regarding possible vaccine donations.    

Conclusion

The head of Africa Centers for Disease Control and Prevention organization, Jean Kaseya issued a warning that the current mpox outbreak could be out of control unless quick steps were not taken to manage its spread. Accordingly, he said “we must be proactive and aggressive in our efforts to contain and eliminate this treat.”

So, if mpox virus is believed to be spreading in a particular area or community, all the close contacts including sexual contact with anyone belonging to that community must be avoided. And if any individual is infected with mpox he must be honest to refrain from getting contacted with anyone until all the lesions on skin are healed. Isolating the mpox infected patient in a separate room until he recovers, directly supports the prevention of mpox spreading.