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Infectious Diseases, Viruses
Mpox (Monkeypox) Outbreaks 2024: What To Know About The Global Health Emergency
Table of contents
Cynomolgus monkey, a known reservoir of the Monkeypox virus
In recent months, the mpox virus (formerly monkeypox) has become a major health crisis globally. The outbreak started small but now exploded to over 15,600 cases and 537 deaths as of August 2024 in the Democratic Republic of the Congo (DRC). This rapid increase is largely due to a new deadly strain, Clade 1b, which emerged last year in the country.
This strain of the mpox virus is spreading rapidly, mainly through sexual networks. It has now reached African countries like Burundi, Kenya, Rwanda, and Uganda for the first time. The virus also spread to Europe, with Sweden reporting its first case.
Responding to the crisis, the World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern (PHEIC) on August 14, 2024. This declaration highlights the serious nature of the spread and the potential for even more unreported cases. It’s a call to the international community to join forces and help contain the virus, supporting affected countries in managing this escalating threat.
While it’s important not to panic, it is helpful to stay aware of the symptoms, diagnosis, treatment, and ways to prevent the infectious disease.
What is mpox (formerly monkeypox)?
Mpox is an infectious disease caused by the mpox virus. The virus belongs to the same family as the smallpox virus. The disease was originally named monkeypox after it was first detected in lab monkeys in 1958. In 2022, WHO renamed the infectious disease to ‘mpox’, to align with modern guidelines and eliminate “racist and stigmatizing language” associated with the name.
The first human case of mpox was not discovered until 1970 in the Democratic Republic of Congo [2]. The virus belongs to the Orthopoxvirus genus of the Poxviridae family and is an enveloped double-stranded DNA virus. Other members of poxviridae include smallpox (variola), cowpox, buffalopox, and aracatuba [2].
This 1997 image was created during an investigation into an outbreak in the Democratic Republic of the Congo (DRC) and depicts the palms of an mpox case-patient. It is important to note how similar this maculopapular rash appears to be compared to the rash of smallpox, also an Orthopoxvirus. Image courtesy of CDC/Dr. Brian W.J.Mahy
How do you get mpox? How does it spread?
According to WHO, the mpox virus can spread from person to person through various ways, including:
- By talking or breathing close to an infected person
- Skin-to-skin contact
- Mouth-to-mouth transmission (like kissing)
- Oral sex or kissing skin
- Droplets in the air from close contact for a prolonged period.
Notable outbreaks
2024
- As of August 2024, the WHO has reported over 15,600 Mpox cases and 537 deaths in the DRC. This is a significant increase compared to the total numbers for all of 2023.
- Just hours after the WHO declared mpox as an emergency, the Swedish government confirmed their first case of the dangerous mpox variant, clade 1b. The affected individual was infected in Africa.
2023
- Between January-December, 2023, there were 92,783 lab-confirmed cases of mpox reported globally.
- 14, 626 cases and 654 deaths were in the DRC alone.
Among these cases, 581 resulted in suspected mpox-related deaths, reflecting a case fatality ratio of 4.6%. According to WHO, this is the highest number of cases ever recorded. Even more worrying is that several cases have been reported in regions that had not previously reported mpox cases.
2022
From January 1 to September 13, 2022, 4,494 cases of mpox (171 fatal) were reported in the Democratic Republic of Congo.
Cases in the Democratic Republic of Congo, 1970 – 2019
Notable mpox outbreaks in the past
- During the single year of 1967, almost eleven thousand cases occurred in West and Central Africa.
- The most unusual disease outbreak of mpox occurred in 2003 when 81 humans in the American Midwest were infected through contact with infected prairie dogs – themselves infected by rodents imported from Ghana. Fortunately, all patients recovered and did not face longer-term effects of the infection.
- From 2018 to 2019, five Nigerian travelers were found to have mpox – in Israel, Singapore, and London.
Who is at risk of getting infected?
Mpox is endemic to Central and West Africa, which puts people in these regions at higher risk of getting mpox.
Other vulnerable people include:
- Those with compromised or weak immune systems
- Children under one year old (However, the 2024 mpox outbreaks shows a higher proportion of infections in children below 15 years)
- People with a history of eczema
- People who are pregnant
- Men who have sex with men (MSM).
Symptoms
According to the US CDC, mpox symptoms usually appear within 3-17 days after a person is first infected (incubation period).
Mpox symptoms start with:
- Fever
- Headache
- Muscle pain and backache
- Swollen lymph nodes
- Chills
- Extreme tiredness
- Sore throat, cough, or other respiratory issues.
A characteristic rash develops after a few days (1-4). Note: Infected persons can spread the virus 1-4 days before symptoms appear, making it even more important to get tested early if you suspect an infection.
Diagnosis
Mpox symptoms can be confused with that of chickenpox and smallpox, but a distinguishing feature of mpox is the presence of swelling in the lymph nodes.
Differential diagnosis must include other rash-related illnesses like scabies, skin infections, and syphilis. The most common diagnostic tool is a physical examination by trained physicians and the PCR (polymerase chain reaction).
However, for this test to provide accurate results, samples from skin lesions or fluid from the rash vesicles or pustules work best. PCR blood tests for mpox, and antigen and antibody tests are usually inconclusive, according to WHO.
Treatment
Mpox often goes away on its own within 2-4 weeks so treatment for mpox usually focuses on alleviating symptoms and taking care of the rash.
There are no therapies specifically designed to treat mpox but outbreaks can be controlled with drugs (antivirals) and the mpox vaccine which can be given within 4 days of contact with an infected person. If there are no symptoms, the mpox vaccine can be given up to 14 days. [7].
Prevention
A person who is infected with mpox can help prevent the spread of the disease by staying at home and isolating from others, washing hands often with soap, cover the rashes when around others (but can otherwise leave them open to dry and heal), do not share bedlinen, towels, or other items until fully recovered, and take regular over-the-counter pain medication to help ease symptoms.
There are two mpox vaccines currently approved for use by WHO. However, the global organization is requesting vaccine manufacturers to ramp up production of the mpox vaccine to help during this public health emergency.
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References
[1] “Multi-country monkeypox outbreak in non-endemic countries,” Who.int. [Online] [Accessed: 26-May-2022].
[2] H. Adler et al., “Clinical features and management of human monkeypox: a retrospective observational study in the UK,” Lancet Infect. Dis., 2022.
[3] “Monkeypox,” Cdc.gov, 20-May-2022. [Online] [Accessed: 26-May-2022].
[4] “Monkeypox,” nhs.uk. [Online][Accessed: 26-May-2022].
[5] Z. Jezek, M. Szczeniowski, K. M. Paluku, M. Mutombo, and B. Grab, “Human monkeypox: confusion with chickenpox,” Acta Trop., vol. 45, no. 4, pp. 297–307, 1988.
[6] “Monkeypox,” Who.int. [Online][Accessed: 26-May-2022].
[7] “Monkeypox,” Cleveland Clinic. [Online][Accessed: 26-May-2022].
[8] P. Joi, “How the smallpox vaccine stockpile could stop monkeypox in its tracks,” Gavi.org, 24-May-2022. [Online][Accessed: 26-May-2022].
- Sklenovská and M. Van Ranst, “Emergence of Monkeypox as the most important Orthopoxvirus infection in humans,” Front. Public Health, vol. 6, p. 241, 2018.