As of August 2024, the World Health Organization (WHO) and the Africa Centers for Disease Control and Prevention (Africa CDC) declared the continued rise of Mpox (formerly known as monkeypox) to be a Public Health Emergency of International Concern. This decision was prompted by a significant increase in cases, particularly in the Democratic Republic of the Congo (DRC), where the disease has been severe, especially among children. The DRC has reported over 14,000 cases and 511 deaths in 2024 alone.
WHO and the Africa Centre for Disease Control and Prevention (Africa CDC) have expressed urgent concern about the spread of the virus, especially in regions with limited health resources. They have called for an aggressive and coordinated response to prevent further transmission and reduce the impact on vulnerable populations, particularly children, who have been disproportionately affected by this outbreak.
Globally, while Mpox cases have declined in other regions, the situation in Africa has worsened, prompting international health organizations to step up surveillance, vaccination and treatment efforts to control the spread.
Dr Muzamil Sultan, a physician at the Department of Critical Care Medicine at Marengo Asia Hospitals, Gurugram, said, “Monkeypox is a viral disease caused by the monkeypox virus, which is related to the smallpox virus. According to studies in Central and West Africa, the incubation period for monkeypox is usually 6-13 days, but can also range from 5-21 days.”
“Human Mpox typically begins with a combination of the following symptoms: fever, headache, chills, exhaustion, asthenia, swollen lymph nodes (lymphadenopathy), back pain, and muscle aches. In cases in endemic areas (Africa), within three days of the onset of these prodromal symptoms, a centrifugal maculopapular rash begins from the site of primary infection. It rapidly spreads to other parts of the body and progresses to develop vesicles. The palms and soles of the feet are involved in cases of disseminated rash, which are characteristic of the disease. The number of lesions may vary from a few to thousands, and an increasing number of lesions correlates with increasing disease severity,” he added.
Most cases of MPOX in humans present with mild to moderate symptoms that typically last two to four weeks, followed by full recovery with supportive care. Disease severity can vary depending on the route of transmission, host susceptibility, and amount of virus inoculated, with invasive modes of exposure resulting in more severe disease and a shorter incubation period.
Complications in endemic countries include encephalitis, secondary bacterial skin infections, dehydration, conjunctivitis, keratitis and pneumonia.
MPXV is transmitted to humans through close contact with an infected animal or human, or contact with materials contaminated with the virus. The virus enters the body through broken skin or mucous membranes. Person-to-person transmission of Mpox occurs through close contact with infectious materials from the skin or mucosal lesions of an infected person, respiratory droplets in prolonged face-to-face contact, and fomites. Sexual contact appeared to be a particular risk factor driving the Mpox outbreak in 2022. Cases were identified primarily, but not exclusively, among men who have sex with men (MSM). Certain sexual practices (e.g., having multiple and frequent anonymous sexual contacts and receptive anal sex) may have contributed to putting people at higher risk of infection. People who interact closely with an infected person, including healthcare workers, household members, sexual partners, and commercial sex workers, are at higher risk of infection. MPXV is more frequently detected in skin, anal, and throat samples than in blood, urine, and semen.
There is emerging evidence that infected individuals can transmit the hepatitis C virus up to four days before the onset of symptoms. This evidence comes from modelling studies, studies of paired transmission partners with known exposure times.
Real-time polymerase chain reaction (real-time PCR) on skin lesion materials (e.g., swabs, exudate, or crusts from lesions) is used to diagnose Mpox.
Recommendations for those who are infected mainly include the following, as shared by Dr. Muzamil Sultan:
• Cases should remain in their own room, when at home, and use designated household items (clothing, bedding, towels, eating utensils, plates, glasses, etc.), which should not be shared with other household members.
• They should avoid contact with immunosuppressed people and others at risk for serious illness (such as infants and pregnant women) until the rash has completely healed.
• They should be monitored by public health authorities (e.g. by phone calls or other means, in accordance with national guidelines).
• They may temporarily leave their home (for example, for medical appointments and outdoor exercise necessary for the stability of their mental health), as long as they wear a medical mask and their rash is covered (for example, by wearing long sleeves and pants).
• They should practice careful respiratory hygiene and wear a medical mask when in contact with other people. In addition, Mpox cases and their household contacts should practice careful hand hygiene at all times.
• They should abstain from sexual intercourse until the rash has completely healed, that is, until no new lesions appear, the scabs have fallen off, and new skin has formed.
• They should avoid contact with any mammalian animal (see also the section “Special considerations to mitigate the risk of animal-to-human and human-to-animal transmission”).
Treatment is primarily symptomatic and supportive (relief of fever, itching and pain, and hydration), including prevention and treatment of secondary bacterial infections. Tecovirimat is the only antiviral drug with an indication for
The main mode of transmission of human immunodeficiency virus (MPXV) is thought to be direct contact with Mpox lesions or with objects contaminated with lesions, such as clothing and bedding (fomites). Therefore, caregivers and household members should avoid touching skin lesions with bare hands, wear disposable gloves when handling materials that have been in contact with a patient's bare skin (including clothing, bedding, and towels), and observe strict hand hygiene before and after using gloves.
In healthcare settings, prevention of transmission is based on standard contact and droplet infection control precautions during the care of patients with symptoms, suspected and confirmed Mpox infection. ECDC has developed guidance on Mpox infection prevention and control for primary and acute care settings.
To reduce transmission from animals to humans in areas with active circulation of MPXV among wildlife, it is recommended to avoid contact with (potential) animal reservoirs as well as any material that has been in contact with a potentially infected sick or dead animal.
Finally, she added: “Similarly, human cases of Mpox should avoid close direct contact with animals, including domestic animals, livestock and wild (captive) animals. Close contacts of cases should also avoid close direct contact with animals for 21 days after last exposure to the virus. To mitigate the risk of wild animals coming into contact with the virus, waste, including medical waste, should be disposed of safely and should not be accessible to rodents and other scavenging animals.”
