Monkeypox (Mpox)

Content of This Page

1- Introduction

2- Causes

3- Symptoms

4- Stages of The Disease

5- Treatment

6- What Should You Avoid

7- Life Expectancy

Introduction

Monkeypox, now officially referred to as (Mpox) by the World Health Organization (WHO), is a viral zoonotic disease caused by the monkeypox virus, a member of the Orthopoxvirus genus, which also includes the variola virus (the causative agent of smallpox). Although monkeypox was first discovered in 1958 in laboratory monkeys, the disease is primarily transmitted to humans from wild animals, such as rodents and primates, and is considered endemic in several Central and West African countries.

Human cases of monkeypox were first identified in 1970 in the Democratic Republic of the Congo. Since then, it has caused sporadic outbreaks across Africa, with the first major outbreak outside the continent occurring in the United States in 2003. The disease gained international attention again in 2024 when a global outbreak led to increased spread in non-endemic countries, prompting the WHO to declare it a public health emergency of international concern.

© image from www.researchgate.net

Causes

  1. Zoonotic Origin:

    • Animal Reservoirs: The primary cause of monkeypox is believed to be zoonotic transmission, meaning the virus is transmitted to humans from animals. The exact animal reservoirs are not fully identified, but the virus has been found in various animals, including rodents, primates, and squirrels. Rodents, particularly those in Central and West Africa, are considered the most likely reservoirs.
    • Animal to Human Transmission: Humans can acquire the virus through direct contact with the blood, bodily fluids, or skin/mucosal lesions of infected animals. This can happen through hunting, handling, or consumption of bushmeat, or through bites or scratches from infected animals.

  2. Human-to-Human Transmission:

    • Direct Contact: The virus can spread from person to person through close physical contact with infectious skin lesions, body fluids, or respiratory droplets. This includes direct contact with rash lesions or scabs, as well as indirect contact with contaminated materials like bedding, clothing, or utensils.
    • Respiratory Droplets: Transmission can also occur through large respiratory droplets, which typically requires prolonged face-to-face contact. This is more common in households or healthcare settings where close contact with an infected person occurs.
    • Mother-to-Child Transmission: In rare cases, the virus can be transmitted from mother to child during pregnancy, through the placenta, or during close contact after birth.

  3. Nosocomial Transmission:

    • Healthcare Settings: Transmission can occur in healthcare settings, particularly if proper infection control measures are not followed. Healthcare workers and family members caring for infected individuals are at higher risk if they do not use appropriate protective equipment.

Symptoms

  • Fever
  • Headache
  • Muscle aches (Myalgia)
  • Back pain
  • Swollen lymph nodes (Lymphadenopathy)
  • Chills
  • Fatigue/Exhaustion
  • Rash :-
    • Macules: Flat, discolored spots.
    • Papules: Raised, firm bumps.
    • Vesicles: Fluid-filled blisters.
    • Pustules: Pus-filled blisters.
    • Scabs: Lesions that crust over and eventually fall off.
© image from www.researchgate.net

Stages of The Disease

1. Incubation Period

  • Duration: 6 to 13 days (range of 5 to 21 days).
  • Characteristics:
    • During this period, the virus is present in the body but has not yet caused symptoms.
    • The person is not contagious.

2. Prodromal Stage (Early Symptoms)

  • Duration: 1 to 3 days before the rash appears.
  • Symptoms:
    • Fever
    • Headache
    • Muscle aches (Myalgia)
    • Back pain
    • Swollen lymph nodes (Lymphadenopathy)
    • Chills
    • Fatigue/Exhaustion
  • Characteristics:
    • The onset of fever is usually the first symptom.
    • Swollen lymph nodes are a key feature that differentiates Mpox from other similar diseases, such as smallpox.
    • During this stage, the person may start to become contagious.

3. Rash Development Stage

  • Duration: The rash appears 1 to 3 days after the fever starts and goes through several phases over 2 to 4 weeks.
  • Characteristics:
    • The rash typically begins on the face and spreads to other parts of the body, including the palms, soles, and genital area.
    • The rash progresses through the following stages:
      1. Macules: Flat, red spots.
      2. Papules: Raised, firm bumps.
      3. Vesicles: Small, fluid-filled blisters.
      4. Pustules: Pus-filled blisters that are more firm and deep-seated.
      5. Scabs: The pustules eventually dry out, forming scabs that crust over and fall off.
    • Each stage of the rash typically lasts for 1 to 2 days.
    • The person remains contagious until all scabs have fallen off.

4. Recovery Stage

  • Duration: 2 to 4 weeks after the onset of the rash.
  • Characteristics:
    • As the scabs fall off, new skin forms underneath, and the individual gradually recovers.
    • Once all the scabs have fallen off, the person is no longer contagious.
    • In some cases, scarring may occur where the rash was present.

5. Potential Complications

  • Severe cases:
    • In some individuals, particularly those who are immunocompromised, children, or pregnant women, the disease can lead to complications such as secondary bacterial infections, respiratory issues, sepsis, encephalitis, and eye infections, which can result in loss of vision.
  • Mortality Rate:
    • Historically, the case fatality rate has ranged from 1% to 10%, depending on the virus clade (Central African clade tends to be more severe than the West African clade).

Treatment

1. Symptomatic Treatment

  • Fever and Pain Relief: Antipyretics (e.g., acetaminophen) and analgesics (e.g., ibuprofen) can be used to reduce fever and alleviate pain.
  • Hydration: Maintaining adequate fluid intake is essential, especially in cases with fever and dehydration. Oral rehydration solutions or intravenous fluids may be necessary in severe cases.
  • Skin Care: Proper care of the skin lesions is crucial to prevent secondary bacterial infections. This includes keeping the skin clean, avoiding scratching, and using antiseptic dressings if necessary.

2. Antiviral Medications

  • Tecovirimat (TPOXX): This antiviral drug has been approved for the treatment of Mpox. It targets the orthopoxvirus and has shown efficacy in reducing the severity and duration of the illness. It is especially recommended for severe cases, those with complications, or immunocompromised patients.
  • Cidofovir and Brincidofovir: These antiviral agents have been used in some cases of Mpox, particularly in severe or complicated infections. They are more commonly used in cases where Tecovirimat is not available or not effective.

3. Vaccination

  • Post-Exposure Prophylaxis (PEP): Vaccination with the smallpox vaccine (JYNNEOS or ACAM2000) can be given as post-exposure prophylaxis to individuals who have been in close contact with someone infected with Mpox. The vaccine is most effective when administered within 4 days of exposure but can still provide benefits up to 14 days after exposure.
  • Pre-Exposure Prophylaxis (PrEP): For high-risk groups, such as healthcare workers, laboratory personnel, or individuals at high risk due to occupational or personal exposure, vaccination may be recommended as a preventive measure.

4. Isolation and Infection Control

  • Isolation of Patients: Infected individuals should be isolated to prevent the spread of the virus. Isolation should continue until all lesions have crusted over and fallen off.
  • Infection Control in Healthcare Settings: Strict infection control measures, including the use of personal protective equipment (PPE), should be implemented in healthcare settings to protect healthcare workers and other patients.

5. Management of Complications

  • Secondary Bacterial Infections: Antibiotics may be prescribed if there is evidence of secondary bacterial infection in the skin lesions.
  • Ocular Involvement: If the eyes are affected, ophthalmic care may be required to prevent complications such as vision loss.
  • Respiratory Support: In severe cases involving respiratory complications, supplemental oxygen or mechanical ventilation may be necessary.

6. Supportive Care

  • Nutrition: Providing adequate nutrition to support the immune system is important, particularly in children, pregnant women, or those with weakened immune systems.
  • Monitoring: Close monitoring of vital signs, fluid balance, and the progression of the rash is essential, particularly in hospitalized patients.

7. Patient Education and Counseling

  • Education on Disease Transmission: Patients should be educated about the importance of isolation, hygiene, and avoiding close contact with others to prevent transmission.
  • Psychosocial Support: Providing psychological support and counseling can help patients cope with the stress and anxiety associated with the disease.

What Should You Avoid

  • Close contact with others (including physical contact).
  • Sharing personal items (e.g., towels, bedding, utensils).
  • Scratching or picking at skin lesions.
  • Covering lesions with non-breathable materials.
  • Unnecessary travel, especially to public places.
  • Touching your face, especially eyes, nose, and mouth.
  • Using over-the-counter creams or ointments without medical advice.
  • Exposure to pets or animals.
  • Contact with individuals who are immunocompromised, pregnant women, and children.
  • Going to work, school, or public gatherings until fully recovered.

Life Expectancy

  • Overall Mortality Rate: The mortality rate for mpox is relatively low compared to some other viral infections. Historically, the mortality rate has been reported to range from (1% to 10%), depending on the outbreak and the specific strain of the virus. For example, the West African strain generally has a lower mortality rate (around 1%) compared to the Central African strain (which can be as high as 10%).

  • Complications: The risk of severe complications is higher in immunocompromised individuals, young children, and pregnant women, which can affect overall outcomes. These groups may experience a higher risk of severe disease or death.

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