Ashok Rattan
Mpox, a viral infection that was previously endemic in Central and West Africa, has now escalated into a global crisis. The World Health Organisation (WHO) declared a Public Health Emergency of International Concern (PHEIC) on July 23, 2022, as the outbreak rapidly spread to over 100 countries. This urgency underscores the need for immediate and coordinated action to prevent further spread. This year (2024), the WHO reported over 17,000 suspected cases in Africa alone, exceeding the total seen in 2023.
What’s the Reason?
The rapid global spread of the Mpox outbreak can be attributed to several interconnected factors. Mpox spreads through direct contact with lesions, bodily fluids, and respiratory droplets from infected individuals. The virus can also be transmitted from animals to humans, primarily through bites or scratches or during activities like hunting and cooking infected animals.
Mpox can survive on contaminated materials, such as clothing or bedding, allowing for indirect transmission. Genetic studies indicate that the Mpox virus has undergone mutations that enhance its ability to spread among humans. These changes may help the virus evade immune defences, making it more transmissible than in previous outbreaks. Increased global travel and interconnectedness allowed the virus to spread quickly across borders.
But unlike COVID-19, effective vaccines and antivirals are available to protect the population against the spread of infection.
PREVENTING & CONTROLLING MPOX
Vaccination: Vaccines are primarily preventive measures to protect individuals from contracting Mpox. The two main vaccines considered for Mpox are JYNNEOS and ACAM2000. JYNNEOS is a non-replicating vaccine that is safer for immunocompromised individuals, while ACAM2000 is a replicating vaccine that has a higher risk of adverse reactions. JYNNEOS, a live, non-replicating vaccine, is the primary vaccine recommended for Mpox prevention. It is approved by the FDA for the prevention of Mpox in individuals 18 years of age and older determined to be at high risk for Mpox infection.
Given vaccine supply is limited, access to vaccines will initially be prioritised to support strong outbreak management, and this may include those who are in close physical contacts of people infected with Mpox, and people whose occupations might put them at increased risk, including laboratory staff and healthcare workers.
Isolation and Contact Tracing: Confirmed Mpox cases are advised to isolate until all lesions have crusted, the crusts have fallen off, and a fresh layer of skin has formed underneath. This typically takes 2-4 weeks. Close contacts of cases are monitored for symptoms and may be advised to quarantine, depending on their risk level and vaccination status.
Infection Control Measures: Healthcare workers caring for Mpox patients should use appropriate personal protective equipment (PPE) including gowns, gloves, eye protection, and N95 respirators. Patients should cover lesions, avoid skin-to-skin contact, and follow good hygiene practices to prevent transmission to others.
Public Awareness campaigns: The campaigns are a key strategy in combating the spread of Mpox. These campaigns aim to educate high-risk populations about Mpox transmission, symptoms, and prevention measures. Importantly, they also address stigma and misinformation, which can hinder testing, reporting, and adherence to public health guidance. This highlights the need for comprehensive public education to control the outbreak.
Surveillance: Strengthening disease surveillance, especially in endemic regions, is critical to rapidly detect and respond to Mpox cases.
Antiviral therapies and vaccines play distinct yet complementary roles in managing Mpox viral infection. Antivirals are used to treat individuals who have already contracted Mpox, particularly in cases of severe disease or among high-risk groups. The primary antiviral agents include tecovirimat, brincidofovir and cidofovir. Tecovirimat is the most commonly used due to its specific activity against orthopoxviruses and favorable safety profile. While antivirals have shown promise in laboratory settings and animal models, their clinical efficacy in humans is still under investigation.
Ashok Rattan is Lead Advisor, Medical Committee & Quality, Redcliffe Labs
