Africa declares a continent-wide health emergency due to monkeypox. Mpox (monkeypox)

Monkeypox virus (MPOX monkeypox) is an orthopoxvirus that causes monkeypox (MPOX), a disease with symptoms similar to smallpox, although less severe. Although smallpox was eradicated in 1980, MPOX continues to occur in countries in central and western Africa. Since May 2022, cases have also been reported in countries outside the African region with no previously documented transmission of MPOX. Two distinct clades of monkeypox virus have been identified: clade I (previously known as the Congo Basin clade (Central Africa) and clade II (the former West African clade).

Monkeypox is a zoonosis, a disease that is transmitted from animals to humans, and cases are often found near tropical rainforests where there are animals carrying the virus. Evidence of monkeypox virus infection has been found in animals such as squirrels, Gambian rats, dormice, different species of monkeys and others.

The disease can also be transmitted from humans to humans. It can be transmitted through contact with bodily fluids, lesions on the skin or internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.

Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. The best diagnostic samples are taken directly from the rash (skin, fluid, or scabs) or from a biopsy when possible. Antigen and antibody detection methods may not be useful as they do not distinguish between orthopoxviruses.

Anyone can get mpox. It is transmitted through contact with infected people:

• people, through touching, kissing or sexual relations.
• animals, by hunting, skinning or cooking them.
• materials, such as contaminated sheets, clothing, or needles.
• pregnant people, who can pass the virus on to their unborn baby.

If you have mpox:

• Tell anyone close to you recently.
• Stay home until all the scabs fall off and a new layer of skin forms.
• Cover injuries and wear a well-fitting mask when around others.
• Avoid physical contact.

Mpox disease (formerly monkeypox) is caused by monkeypox virus (commonly abbreviated as MPXV), an enveloped, double-stranded DNA virus of the genus Orthopoxvirus in the family Poxviridae, which includes smallpox, cowpox, vaccinia, and other viruses. The two genetic clades of the virus are clades I and II.

Transmission

Person-to-person transmission of the human immunodeficiency virus (MPOX) can occur through direct contact with infected skin or other lesions, such as in the mouth or genitals; this includes contact that is;

• face to face (talking or breathing).
• skin to skin (touching or vaginal or anal sex).
• mouth to mouth (kisses).
• mouth to skin (oral sex or kissing the skin).
• respiratory droplets or short-range aerosols from prolonged close contact.

The virus then enters the body through broken skin, mucosal surfaces (e.g., oral, pharyngeal, ocular, genital, anorectal), or the respiratory tract. MPOX can spread to other household members and sexual partners. People with multiple sexual partners are at higher risk.

Transmission of MPOX from animal to human occurs from infected animals to humans through bites or scratches, or during activities such as hunting, skinning, trapping animals, cooking, playing with carcasses, or eating animals. The extent of circulation of the virus in animal populations is not known and further studies are underway.

People can get mpox from contaminated objects, such as clothing or bed linens, or from sharps injuries in healthcare facilities or in community settings, such as tattoo parlors.

Signs and symptoms

MPOX causes signs and symptoms that usually begin within a week, but may appear 1 to 21 days after exposure. Symptoms usually last 2 to 4 weeks, but may last longer in people with weakened immune systems.

Common symptoms of mpox are:

• Rash.
• Fever.
• Sore throat.
• Headache.
• Muscle aches.
• Backache.
• Lack of energy.
• Swollen lymph nodes.

For some people, the first symptom of mpox is a rash, while others may have different symptoms at first.

The rash begins as a flat sore that develops into a fluid-filled blister and may itch or hurt. As the rash heals, the lesions dry out, form scabs, and fall off.

Some people may have one or several skin lesions and others may have hundreds or more. These can appear anywhere on the body, such as:

• the palms of the hands and the soles of the feet.
• the face, mouth and throat.
• the groin and genital areas.
• the year.
• Some people also experience painful swelling in the rectum or pain and difficulty when urinating.

People with mpox are contagious and can spread the disease to others until all the sores have healed and a new layer of skin has formed.

Children, pregnant women, and people with weakened immune systems are at risk for complications from mpox.

Typically, in mpox, fever, muscle aches, and sore throat appear first.

Are gay, bisexual, and other men who have sex with men at increased risk for human immunodeficiency virus (MPOX)?

The risk of contracting MPOX is not limited to sexually active people or to gay, bisexual, and other men who have sex with men. Anyone who has close contact with someone who has symptoms is at risk, as is anyone who has multiple sexual partners.

Most of the cases reported in the 2022/2023 multinational outbreak were identified among gay, bisexual, and other men who have sex with men. Because the virus is transmitted from person to person on these social networks in many countries, gay, bisexual, and other men who have sex with men may be at higher risk of exposure if they have sex or other close contact with someone who is contagious. People who have multiple sexual partners or new sexual partners are currently most at risk.

It is essential to engage communities of gay, bisexual, and other men who have sex with men to raise awareness in order to protect those most at risk. If you are a man who has sex with men, be aware of your risks and take steps to protect yourself and others. Anyone who has symptoms that could be mpox should see a health care provider right away to get tested and receive care.

How can I protect myself and others from monkeypox?

To protect yourself and others from monkeypox, know the signs and symptoms, how the virus spreads, what to do if you get sick, and what the risk is in your area or community.

If monkeypox is spreading in your area or community, talk openly with people you have close contact with about any symptoms you or they may have. Avoid close contact with anyone who has monkeypox, especially sexual contact. Wash your hands often with soap and water or an alcohol-based hand rub.

If you think you may have monkeypox, you can take action to protect others by seeking medical advice and isolating yourself from others until you have been assessed and tested. If you have monkeypox, you should isolate yourself from others until all the lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath. This will prevent you from passing the virus on to others. Follow the instructions of your local health authority about isolating yourself at home or in a health facility. Use condoms as a precaution for 12 weeks after recovery if you have sex.

In countries where animals carry the monkeypox virus, protect yourself by avoiding unprotected contact with wild animals, especially sick or dead animals (including their meat and blood). All foods containing animal parts or meat should be thoroughly cooked before eating.

What do we know about mpox and sex?

MPOX can be spread through any type of close contact, including kissing, fondling, and penetrative oral, vaginal, or anal sex with an infected person. People who have sex with multiple partners or with new partners are most at risk.

Anyone with new, unusual rashes or lesions should avoid having sex or any other type of close contact with others until they have been tested for sexually transmitted infections (STIs) and mpox. Remember that the rash can also appear in places on the body that may be hard to see, such as the mouth, throat, genitals, vagina, and anus/anal area.

If mpox is spreading through sex in your community or area, consider reducing your risk until the outbreak is under control:

• communicating openly with their partners about the symptoms and risks of mpox;
• exchanging contact information with their sexual partners so that they can inform each other if they develop symptoms;
• taking a break from sexual relations;
• reducing the number of new sexual partners, casual sexual partners, or anonymous sexual partners;
• Use condoms consistently;
• Avoid group sex;
• Avoid places where public sex is practiced (such as cruising bars, saunas, and dark rooms); and
• Avoid using alcohol or drugs in sexual contexts (including chemsex).

While monkeypox virus has been detected in semen, it is not currently known whether mpox can be transmitted through semen or vaginal fluids. Using a condom will not completely protect you from mpox, but it can reduce your risk or degree of exposure and help protect yourself and others from HIV and a variety of other STIs. People with mpox are advised to use condoms for 12 weeks after recovery.

What should I do if I have mpox symptoms or have been exposed to someone who has mpox?

If you have been in close contact with someone who has mpox, monitor your signs and symptoms for 21 days. Practice hand hygiene and respiratory etiquette (covering your nose and mouth with a tissue when coughing or sneezing) and avoid contact whenever possible with immunocompromised people, children, or pregnant women (who may be at higher risk for severe symptoms if exposed).

If you have symptoms that could be mpox, contact your healthcare provider for advice, testing, and medical care, even if you have not had known contact with someone with mpox.

Until you receive your test result, isolate yourself from others if possible. If your mpox test result is positive, your healthcare provider will advise you whether you should isolate yourself at home or in a healthcare facility and what care you need.

If you are diagnosed with mpox, continue taking your regular medications, including those for HIV, tuberculosis, or viral hepatitis. If you have been diagnosed with mpox and don't know if you have HIV, ask to be tested for HIV. This will help your healthcare provider make sure you get the best care possible.

I have mpox; what can I do to protect other people from getting infected?

If you have mpox, your doctor will advise you on what to do while you recover. Follow national advice on whether you should recover at home or need care in a health facility.

In the meantime, it is important to avoid close contact with other people, including sexual contact.

If you are advised to isolate yourself at home, protect the people you live with as much as possible:

• asking friends and family to help bring you the things you need;
• isolating themselves in a separate room;
• using a separate bathroom or cleaning surfaces you touched after each use;
• cleaning and disinfecting frequently touched surfaces with soap and water and a household disinfectant;
• avoiding sweeping or vacuuming (this could disturb the virus particles and cause other people to become infected);
• using separate utensils, objects and electronic devices or cleaning them thoroughly with soap and water or disinfectant before sharing them;
• not sharing towels, bedding or clothing;
• wash your own clothes (carefully lift bedding, clothes and towels without shaking them, put clothes in a plastic bag before putting them in the washing machine and wash them in hot water above 60 degrees Celsius);
• open the windows for good ventilation; and
• encourage everyone in the house to wash their hands regularly with soap and water or an alcohol-based hand sanitizer.

If you can't avoid being in the same room as someone else or having close contact with someone else while you're isolating at home, do everything you can to limit your risk:

• avoiding touching each other;
• cleaning your hands often with soap and water or an alcohol-based hand sanitizer;
• covering your rash with clothing or bandages (until you can isolate yourself again; your rash will heal better if it is uncovered);
• open the windows of the whole house;
• making sure that you and anyone in the room with you wear well-fitting medical masks; and
• keeping at least 1 metre away from others. If you are unable to wash your own clothes and someone else must do it for you, you should wear a well-fitting medical mask, disposable gloves and take the washing precautions mentioned above.

What care does a person with mpox need to fully recover?

The care a person needs will depend on their symptoms and their risk of developing more severe illness. People with mpox should follow the advice of their health care provider. Symptoms usually last 2 to 4 weeks and often go away on their own or with supportive care, such as pain or fever medications (such as pain relievers and fever reducers).

It is important for anyone with mpox who is recovering at home to stay hydrated, eat well and get enough sleep. People who are self-isolating should look after their mental health by doing things they find relaxing and enjoyable, staying in touch with loved ones using technology, exercising if they feel well enough and can do so while in isolation and reaching out for mental health support if they need it.

People with mpox should avoid scratching their skin and care for their rash by washing their hands before and after touching the lesions and keeping the skin dry and uncovered (unless they are unavoidably in a room with another person, in which case they should cover it with clothing or a bandage until they can isolate themselves again). The rash can be kept clean with sterile water or an antiseptic. Saltwater rinses can be used for mouth sores, and warm baths with baking soda and Epsom salts can ease the discomfort of sores on the body. Acetaminophen can be used to help control pain caused by the lesions, if necessary. If stronger painkillers are needed, medical help should be sought.

Is there a treatment for fowlpox?

Many years of research into smallpox therapies have led to the development of products that may also be useful for treating avian pox. In January 2022, the European Medicines Agency approved an antiviral developed to treat smallpox (tecovirimat) for the treatment of avian pox in exceptional circumstances. Experience with these therapies in the context of an avian pox outbreak is increasing but is still limited. For this reason, their use is often accompanied by enrolment in a clinical trial or an expanded access protocol accompanied by the collection of information that will improve knowledge on how best to use them in the future.

WHO has made a small number of tecovirimat regimens available for compassionate use, particularly for those with severe symptoms or who may be at risk of poor outcomes (such as those who are immunocompromised and people living with HIV with advanced HIV disease).

Is there a vaccine against smallpox?

Yes. There are three smallpox vaccines. Many years of research have led to the development of newer, safer vaccines for an eradicated disease called smallpox. Three of them (MVA-BN, LC16, and OrthopoxVac) have also been approved for the prevention of smallpox. Only people who are at risk (for example, someone who has been in close contact with someone who has smallpox or someone who belongs to a group at high risk of exposure to smallpox) should be considered for vaccination. Currently, mass vaccination is not recommended.

If you are at high risk of exposure to smallpox due to an ongoing outbreak in your community, talk to your health care provider about vaccine options that are available to you. WHO currently recommends vaccines for people who have been in close contact with someone who has smallpox or people who belong to a group at high risk of exposure to smallpox. Vaccines are one of the tools we have at our disposal to protect communities against mpox and should be used in combination with other public health and social measures.

For most people at risk, mpox vaccines provide protection against infection and severe disease. Once you've been vaccinated, continue to take care to avoid getting and spreading mpox. This is because it takes several weeks to develop immunity after vaccination.

Initial results from several vaccine efficacy studies are promising and indicate that a good level of protection against mpox is provided following vaccination. Further studies on the use of mpox vaccines will provide additional information on the efficacy of these vaccines in different settings. Our understanding of the protection provided by mpox vaccines continues to increase.

Are immunocompromised people at higher risk for developing severe mpox (including people living with HIV)?

Evidence suggests that immunocompromised people are at higher risk of developing severe mpox or dying. Symptoms of severe mpox include larger and more widespread lesions (especially in the mouth, eyes, and genitals), secondary bacterial skin infections, or infections of the blood and lungs. Data show that the most severe symptoms occur in people with severe immunocompromised conditions.

People with advanced HIV disease (late onset, low CD4 count and high HIV viral load) are at increased risk of death if they develop severe mpox. People living with HIV who achieve viral suppression through antiretroviral therapy do not appear to be at increased risk of severe mpox than the general population. Effective HIV treatment reduces the risk of developing severe mpox symptoms if infected. People with untreated HIV and advanced HIV disease may be immunosuppressed and therefore at increased risk of severe mpox. WHO recommends that countries integrate HIV and mpox prevention and care.

Sexually active people who do not know their HIV status are encouraged to get tested for HIV, if available. People living with HIV who receive effective treatment have the same life expectancy as their HIV-negative peers.

Severe cases of mpox seen in some countries highlight the urgent need to increase equitable access to mpox vaccines and therapies, and to HIV prevention, testing and treatment. Without this, most affected groups are left without the tools they need to protect their sexual health and wellbeing.

If you are living with HIV, continue taking your HIV medication as directed. If you think you may have mpox, talk to a doctor.

If you think you are at risk for mpox or have been diagnosed with mpox, you may benefit from getting tested for sexually transmitted infections (STIs). If you don't know your HIV status, ask your health care provider to test you for HIV. This will help your health care provider make sure you get the best care possible.

What should I do if a child in my care has mpox?

Children can get mpox if they have close contact with someone who has symptoms. Children can be exposed to the virus at home from their parents, caregivers, or other family members through close contact. Teenagers who have had sex with someone with mpox can also be exposed. The mpox rash may initially look like other common childhood illnesses, such as chickenpox and other viral infections. If a child in your care has symptoms that could be mpox, see a health care provider. They will help you get tested and access the care you need.

Children may be at higher risk for severe mpox than adults. They should be monitored closely until they have recovered in case they need further care. A health care worker responsible for the child may recommend that they be seen at a health care facility. In this situation, a parent or caregiver who is healthy and at low risk for mpox will be allowed to stay with them.

If you have or suspect monkeypox and are breastfeeding, see your doctor. He or she will assess the risk of transmitting monkeypox, as well as the risk of not breastfeeding your baby. If it is possible for you to continue breastfeeding and have close contact, he or she will advise you on how to reduce the risk by taking other steps, such as covering lesions. The risk of infection will need to be carefully weighed against the potential harm and distress caused by stopping breastfeeding and close contact between parent and child. It is not yet known whether the monkeypox virus can be transmitted from parent to child through breast milk; this is an area that needs further study.

What are the risks of getting mpox during pregnancy?

Getting mpox during pregnancy can be dangerous for the fetus or newborn and may result in pregnancy loss, stillbirth, or complications for the parent. If you are pregnant, avoid close contact with anyone who has mpox. Anyone who has close contact with an infected person can get mpox, no matter who they are. If you think you have been exposed or are developing symptoms that could be due to mpox, contact your healthcare provider. They will help you get tested and access the care you need.

I had monkeypox in the past. Can I get it again?

Currently, we know very little about how long immunity lasts after a monkeypox infection. We still don't know for sure whether a previous monkeypox infection gives you immunity against future infections, and if so, for how long. Some cases of second infections have been reported. Even if you have had monkeypox in the past, you should do everything you can to avoid getting infected again.

If you have had monkeypox in the past and someone in your household has it now, you can protect others by being the designated caregiver, as you are more likely to have some immunity than others. However, you should take every precaution to avoid becoming infected.

RELATED POST: https://bio-farma.es/reviews/8/monkeypox-what-should-we-know

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