The World Health Organization on Aug. 14 declared Mpox a public health emergency of international concern (PHEIC), WHO’s highest level of alarm. This is the second time WHO has declared Mpox a PHEIC in two years. This has created panic amongst a lot of people wondering what this condition is and some comparing it to the global pandemic that was covid-19.
Closer to home they has been a recent outbreak of cases of Mpox in South Africa. All the cases were classified as severe cases of Mpox and required hospitalization. Interestingly all cases are male, between the ages of 30 and 39 with co-morbidities (HIV-positive), and five of the seven identified as “men who have sex with men.” Preliminary investigations indicate that all the confirmed cases had no history of travel to countries with ongoing Mpox outbreaks.
Mpox (previously referred to as monkeypox) is a viral zoonotic infection that is caused by monkeypox virus and results in a rash similar to that of smallpox. Some animals which transmit the disease to humans include squirrels, rats, and certain species of monkeys. Mpox virus can be acquired through contact with an infected animal’s bodily fluids or through a bite. It can also be acquired through preparation of bushmeat.
Human to human transmission occurs through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects. The virus can cross the placenta from the mother to her foetus, which can lead to congenital Mpox, although the rate of transmission or risk by trimester is not known.
The time period from exposure to the virus to the development of symptoms can range from 4 to 21 days. Mpox has traditionally caused a systemic illness that includes fevers, chills, and body pains, with a characteristic rash that is important to differentiate from that of other vesicular eruptions.
However, during the 2022 to 2023 multi-country outbreak, some patients presented with genital, anal, and/or oral lesions without the systemic illness. Other common sites of the rash include the trunk, arms, legs, hands and feet. About a third of patients diagnosed with Mpox have concomitant sexually transmitted infections, which include gonorrhoea, chlamydia, herpes simplex virus and syphilis.
The management of this condition includes managing the skin lesions and the pain. Patients should be counselled to avoid scratching the lesions as much as possible. It is important to keep the lesions clean and dry. They lesions can be cleaned with sterile water or an antiseptic. The aim is to prevent secondary bacterial infection.
The lesions can be extremely painful, particularly the rectal and penile lesions and these are often the reasons for hospitalisation. Pain management can be done with simple analgesics, anti-inflammatories and often escalated to injectable options.
There is antiviral medication which was initially developed for the treatment of small pox that can be used to treat Mpox. This medication unfortunately is not readily available and is reserved for those with severe and complicated disease.
There seems to be a lot of panic surrounding Mpox. It is worth noting that this disease has been around for some years. It is also very unlikely that we will go into “lockdown” because of the disease looking at its mode of transmission, however people must still remain vigilant and be on the lookout for symptoms or signs of the disease and avoid spread when we eventually start seeing cases of it.
