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Mpox, formerly known as monkeypox, is a zoonotic viral disease caused by the monkeypox virus, a species of the genus Orthopoxvirus. There are two main clades: clade I (subclades Ia and Ib) and clade II (subclades IIa and IIb). The 2022-2023 global outbreak was driven by the Clade IIb strain, primarily spreading through human-to-human contact, which may mean sexual networks (1). Children under 15 years in Central and Western Africa have contracted mpox through contact with infected animals, household transmission, or patient care, with wild animals often serving as reservoirs in endemic areas (2).
The Democratic Republic of Congo (DRC) had an increase of over 15,600 cases and 537 deaths in 2024 (3). Since the declaration of a Public Health Emergency of International Concern (PHEIC) by the WHO in 2022, India has reported 30 cases (5). These cases have been confirmed in Kerala, Delhi, Maharashtra, Uttar Pradesh, and the Union Territory of Chandigarh. As of 31 August 2024, 106,310 laboratory-confirmed cases, including 234 deaths, have been reported to WHO (4).
According to the World Health Organization (WHO), MVA-BN was the first vaccine added to its list of approved vaccines for mpox. Currently, three vaccines are approved for mpox:
- Modified vaccinia Ankara-BN (MVA-BN or JYNNEOS, Imvamune, Imvanex), a 2-dose 3rd generation smallpox vaccine licensed in the USA, Canada, and Europe.
- LC16-KMB is licensed in Japan.
- OrthopoxVac, licensed in the Russian Federation.
Currently, the WHO does not advise on mass vaccination for mpox (1). The key public health actions that are necessary to prevent or mitigate symptoms. The primary prevention method for Mpox involves awareness of risk factors and educating individuals to reduce exposure to the virus. This includes isolation of infected individuals, enhancing vaccination rates, and enhancing awareness in healthcare providers and the community regarding identification of symptoms and early reporting to surveillance systems (6).
References:
- National Centre for Disease Control. (2024, August). CD Alert: Mpox. //ncdc.mohfw.gov.in/wp-content/uploads/2024/08/CD-Alert-Mpox-August-2024.pdf
- CDC. (2024, September 6). Mpox in the United States and Around the World: Current Situation Summary. Centers for Disease Control and Prevention. //www.cdc.gov/poxvirus/mpox/outbreak/index.html
- World. (2024, August 14). WHO Director-General declares mpox outbreak a public health emergency of international concern. Who.int; World Health Organization: WHO. //www.who.int/news/item/14-08-2024-who-director-general-declares-Mpox-outbreak-a-public-health-emergency-of-international-concern
- 4. World. (2024, August 26). Mpox. Who.int; World Health Organization: WHO. //www.who.int/news-room/fact-sheets/detail/mpox
- Prime Minister Shri Narendra Modi continues to monitor the MPox situation in view of its declaration as a Public Health Emergency of International Concern by WHO | स्वास्थ्य एवं परिवार कल्याण मंत्रालय | भारत सरकार. (2024, August 30). Mohfw.gov.in. //mohfw.gov.in/?q=hi/node/7596
- Kuehn, R., Fox, T., Guyatt, G., Lutje, V., & Gould, S. (2024). Infection prevention and control measures to reduce the transmission of mpox: A systematic review. PLOS Global Public Health, 4(1), e0002731–e0002731. //doi.org/10.1371/journal.pgph.0002731
Posted : September 18, 2024 6:14 pm
Mpox has once again surged to global attention as WHO and the Africa Centres for Disease Control and Prevention (CDC) declare it a public health emergency. With the Democratic Republic of the Congo at the epicentre of this outbreak, the virus's spread beyond Africa has raised international alarm, particularly with the emergence of a new clade, 1b. Health authorities are scrambling to contain the virus amid limited vaccine supplies, inadequate testing, and the need to balance responses to multiple public health threats.
Mpox (formerly known as monkeypox), an infectious disease caused by the monkeypox virus (MPXV), was discovered in 1958 and first reported in humans in 1970. Before 2017, mpox primarily occurred in central and western Africa, with sustained MPXV transmission in local animal reservoirs and sporadic spillover into human populations, mostly in rural areas. Ongoing human-to-human transmission in western Africa has occurred since 2017 and led to occasional exportation to other countries from 2018 to 2021. The virus is primarily transmitted from person to person through direct contact with infected lesions and bodily fluids, but transmission through respiratory droplets and via contact with fomites might occur. Two genetic clades of the MPXV exist—clade I and clade II, which includes subclades IIa and IIb.
In India, 30 Mpox cases have been reported since the WHO's 2022 PHEIC declaration. Further, India is reportedly implementing preparatory measures and public health strategies to address potential Mpox cases.India has been taking proactive measures against Mpox. The country has implemented a comprehensive strategy involving expert consultations, enhanced surveillance, laboratory preparedness, and awareness campaigns. While remaining vigilant, Indian health authorities have assessed a low risk of a large-scale outbreak, demonstrating a balanced approach to public health management in the face of emerging infectious diseases.
References
Mpox declared a public health emergency, Adepoju, Paul, The Lancet, Volume 404, Issue 10454, e1 - e2
Gessain, A., Nakoune, E., & Yazdanpanah, Y. (2022). Monkeypox. The New England journal of medicine, 387(19), 1783–1793. //doi.org/10.1056/NEJMra2208860
Jezek, Z., & Fenner, F. (1988). VI. Epidemiology of Human Monkeypox. In Human monkeypox (Vol. 17, pp. 81-110). Karger Publishers.
Ulaeto, D., Agafonov, A., Burchfield, J., Carter, L., Happi, C., Jakob, R., ... & Lewis, R. F. (2023). New nomenclature for mpox (monkeypox) and monkeypox virus clades. The Lancet Infectious Diseases, 23(3), 273-275.
//ncdc.mohfw.gov.in/wp-content/uploads/2024/08/CD-Alert-Mpox-August-2024.pdf
Posted : September 19, 2024 11:05 am
Mpox (formerly known as monkeypox) is a transmissible disease that can impact humans and animals. The Mpox virus (MPXV) was first described in humans in the 1970s in the Democratic Republic of the Congo (DRC) causing a primarily endemic disease throughout the rainforests of Central and Western Africa with no reported outbreaks elsewhere (Meyer et al., 2002). In 2003, Mpox was reported in Wisconsin, USA (“Multistate Outbreak of Monkeypox--Illinois, Indiana, and Wisconsin, 2003,” 2024), and was later reported in other countries outside Africa. This threat, if not contained, can potentially add to the economic losses the world has been facing since the advent of the COVID-19 pandemic era in 2019 (Pak et al., 2020).
The Africa Centres for Disease Control and Prevention (Africa CDC) declared the ongoing Monkeypox (Mpox) outbreak in the Democratic Republic of Congo (DRC) and surrounding areas a ‘public health emergency of continental security’ and subsequently, the World Health Organization (WHO) announced that it is a ‘public health emergency of international concern (PHEIC). Recent Mpox outbreaks worldwide highlight the importance of improved universal health care systems. The unpredictable and widespread nature of MPXV indicates the shortcomings of current surveillance systems. Considering the complex impact of MPXV infections on pregnant women, children, and immunosuppressed individuals, these clusters of the population need to be included in the disease surveillance system (Zinnah et al., 2024).
The WHO has released a document on Strategic Preparedness, Readiness, and Response Plan for controlling Mpox outbreaks. The critical points listed in the document include:
• The state must form an incident management team and ensure coordination and networking between all stakeholders for managing outbreaks.
• Risk assessment to be carried out for vulnerable populations.
• Establish a multi-selector task force to work in high-risk areas in case of need.
• A provision for emergency regulatory approvals, legalization, and market authorization of Mpox diagnostic kits, vaccines, and therapeutics.
• Standard operating procedures (SOPs) to be shared with all stakeholders at all levels of health care.
• Staff to be trained through a short course or trained staff can be called from national or international partners to be deployed rapidly in case of need.
• The preparedness for the Mpox outbreak to be analyzed regularly in an endemic country or state.
• A system should be in place to streamline emergency fund transfers from the government to the national level to arrange for outbreak preparedness.
• The state must form an incident management team and ensure coordination and networking between all stakeholders for managing outbreaks.
• Risk assessment to be carried out for vulnerable populations.
• Establish a multi-selector task force to work in high-risk areas in case of need.
• A provision for emergency regulatory approvals, legalization, and market authorization of Mpox diagnostic kits, vaccines, and therapeutics.
• Standard operating procedures (SOPs) to be shared with all stakeholders at all levels of health care.
• Staff to be trained through a short course or trained staff can be called from national or international partners to be deployed rapidly in case of need.
• The preparedness for the Mpox outbreak to be analyzed regularly in an endemic country or state.
• A system should be in place to streamline emergency fund transfers from the government to the national level to arrange for outbreak preparedness.
The implications for this call to action are significant. Governments should rapidly engage with global public health organizations to coordinate responses to mitigate the spread as much as possible, with heightened vigilance in travellers from locations with active disease. Rapid education campaigns to halt the spread should be developed and disseminated so that individuals are aware of essential vectors, including sexual health
practices. MSM stigma is higher in these countries. Campaigns must ensure that they reach all groups at risk, not limited by their sexual condition. Finally, rapid upscaling of vaccination programs in heavily affected areas, targeting vulnerable populations, is critical to limit mortality ((Sah et al., 2024).
practices. MSM stigma is higher in these countries. Campaigns must ensure that they reach all groups at risk, not limited by their sexual condition. Finally, rapid upscaling of vaccination programs in heavily affected areas, targeting vulnerable populations, is critical to limit mortality ((Sah et al., 2024).
Reference:
Meyer, H., Perrichot, M., Stemmler, M., Emmerich, P., Schmitz, H., Varaine, F., Shungu, R., Tshioko, F., & Formenty, P. (2002). Outbreaks of Disease Suspected of Being Due to Human Monkeypox Virus Infection in the Democratic Republic of Congo in 2001. Journal of Clinical Microbiology, 40(8), 2919–2921. //doi.org/10.1128/jcm.40.8.2919-2921.2002
Multistate outbreak of monkeypox--Illinois, Indiana, and Wisconsin, 2003. (2024). MMWR. Morbidity and Mortality Weekly Report, 52(23). //pubmed.ncbi.nlm.nih.gov/12803191/
Pak, A., Adegboye, O. A., Adekunle, A. I., Rahman, K. M., McBryde, E. S., & Eisen, D. P. (2020). Economic Consequences of the COVID-19 Outbreak: The Need for Epidemic Preparedness. Frontiers in Public Health, 8. //doi.org/10.3389/fpubh.2020.00241
Mohammad Ali Zinnah, Md Bashir Uddin, Hasan, T., Das, S., Khatun, F., Md Hasibul Hasan, Ruenruetai Udonsom, Md Masudur Rahman, & Ashour, H. M. (2024). The Re-Emergence of Mpox: Old Illness, Modern Challenges. Biomedicines, 12(7), 1457–1457. //doi.org/10.3390/biomedicines12071457
Sah, R., Apostolopoulos, V., Mehta, R., Rohilla, R., Sah, S., Mohanty, A., ... & Rodriguez-Morales, A. J. (2024). Mpox Strikes Once More in 2024: Declared Again as a Public Health Emergency of International Concern. Travel Med Infect Dis., 61.
Posted : September 19, 2024 3:23 pm