Understanding Mpox (Monkeypox)

Mpox (formerly known as Monkeypox) a zoonotic viral disease is a member of the Orthopoxvirus  genus. The Orthopoxvirus genus includes several viruses that are structurally similar and share genetic similarities. The most well-known member of this genus is the variola virus, which causes smallpox. Mpox has gained significant attention in recent years due to its potential to cause outbreaks beyond its endemic regions in Cental and West Africa. As of 2024, the global health community remains vigilant in monitoring and controlling the spread of this disease, especially the 2022 outbreak that brought monkeypox into the spotlight. 

Monkeypox was first identified in humans in 1970 in the Democratic Republic of the Congo. Historically, it remained confined to rural, rainforest areas of Central and West Africa. However, in recent years, there has been an increase in the number of cases reported outside these regions, largely attributed to international travel and the global trade.

The 2022 outbreak, which saw cases in Europe, North America, and other non-endemic regions, underscored the need for robust surveillance and rapid response mechanisms. As of 2024, monkeypox remains a concern, particularly in areas with limited access to healthcare. The disease is considered endemic in several African countries, with sporadic outbreaks occurring in other parts of the world.

There are two types of Monkeypox virus: Clade I and Clade II.

• Clade I causes more severe illness and deaths. Some outbreaks have killed up to 10% of the people who got sick, although more recent outbreaks have had lower death rates. Clade I is endemic to Central Africa.
• Clade II is the type that caused the global outbreak that began in 2022. Infections from Clade II mpox are less severe. More than 99.9% of people survive. Clade II is endemic in West Africa (CDC - Centers for Disease Control and Prevention).

Transmission

Monkeypox spreads through close contact with an infected person, or occasionally through contact with objects or surfaces that have been touched by an infected person. Here are some ways mpox can spread:

• Direct Contact: Touching an infected person's skin lesions, sores, or scabs, or coming into contact with their body fluids through shared bedding, towels, or toys.
• Respiratory droplets: Prolonged face-to-face interactions with an infected person can spread the virus through respiratory droplets. This can happen during conversations or when people are close together.
• Intimate Contact: Mpox can spread through intimate sexual contact, or by touching the genitals or anus of an infected person. 
• Animals: Mpox can spread from humans to animals, and then back to humans, through skinning, cooking, eating, or hunting infected animals. It can also spread if you are bitten or scratched by an infected animal.

Symptoms and Clinical Presentations

Monkeypox typically presents with a prodromal phase of fever, headache, muscle aches, and fatigue, followed by a distinctive rash. The rash usually begins on the face and then spreads to other parts of the body, including the palms of the hands and soles of the feet. The rash evolves from macules to papules, versicles, pustules, and finally scabs. The entire illness lasts between 2 to 4 weeks.

In severe cases, complications such as secondary bacterial infections, respiratory distress, and eye involvement can occur. The case fatality rate varies but is generally lower than that of smallpox, ranging from 1% to 10% in endemic regions. Vulnerable populations, such as immunocompromised individuals, pregnant women, and young children, are at higher risk of severe disease.

Treatment and Vaccination

There is no specific antiviral treatment for monkeypox, and care is mainly supportive. However, antivirus developed for smallpox, such as Tecovirimat (TPOXX), have shown some efficacy against monkeypox and are being used in certain cases under compassionate use protocols. 

Vaccination plays a crucial role in preventing monkeypox. The smallpox vaccine, which also provides protection against monkey pox, has been reintroduced in some regions for at-risk populations. Newer vaccines, such as Modified Vaccinia Ankara (MVA) vaccine, have been developed and are being used to contain outbreaks. In 2024, vaccination campaigns have been targeted towards healthcare workers, close contacts of confirmed cases, and individuals in endemic regions.

Response and Public Health Measures

The global response to monkeypox in 2024 is characterized by a coordinated effort to monitor, prevent, and control outbreaks. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) continue to provide guidelines for managing monkeypox cases, including isolation protocols, contact tracing, and vaccination strategies.

Countries have strengthened their surveillance systems, enabling quicker identification and reporting of cases. Public health campaigns focus on educating the public about the risk of monkeypox, how it spread, and the importance of vaccination and hygiene measures.

Coming to India, as of 2024, India continues to monitor and respond to monkeypox cases through a combination of surveillance, public health education, and targeted vaccination campaigns. The number of cases remains low, with the majority of infections traced back to international travel. However, the presence of monkeypox in neighboring countries and the ongoing risk of global transmission means that India remains on high alert. 

India's response to monkeypox has been shaped by its experience with other infectious diseases. The following key measures have been implemented. 

- Surveillance and Monitoring

- Travel Screening and Quarantine Measures

- Public Awareness Campaigns

- Vaccination Strategies

- Healthcare Infrastructure

Challenges and Future outlook

Despite advances in understanding and managing monkeypox, several challenges remain. These include the need for better access to vaccines and antiviral treatments in low-resource settings, addressing the stigma associated with the disease, and ensuring equitable distribution of resources during outbreaks. 

While the smallpox vaccine provides some protection, there is a need for greater access to newer monkeypox-specific vaccines, particularly in the event of an outbreak. Ongoing research is crucial to fill knowledge gaps, particularly regarding long-term immunity following infection or vaccination and the potential for monkeypox to adapt and become more transmissible. The global community remains vigilant, with continuous investments in public health infrastructure and research to mitigate the impact of future outbreaks. 

Coming to India, ensuring that accurate information about monkeypox reaches all segments of the population, especially in rural areas, is crucial for preventing misinformation and panic. As a country with significant international trade and travel, India must collaborate with global health organizations and neighboring countries to monitor and respond to monkeypox. 

India's approach to monkeypox reflect a broader trend of preparedness and adaptation in the face of emerging infectious diseases. The country remains committed to safeguarding public health. 

To conclude, Monkeypox in 2024 is a reminder of the interconnectedness of global health. While progress has been made in controlling its spread, the potential for outbreaks remains, necessitating ongoing vigilance, research, and international cooperation. As the global situation evolves, India will continue to play a vital role in the collective effort to control and eventually eradicate monkeypox ensuring that the health and well-being of its population are protected against this and other emerging trends.