The current outbreak of mpox in Africa it was declared a global public health emergency by the World Health Organization (WHO) last Wednesday (14). The statement comes in light of the circulation of clade 1B, a strain with greater transmissibility and a higher mortality rate on the African continent, with chances of spreading to other regions of the world.
There are still no cases of mpox caused by the new variant.
Below, check out the main questions regarding mpox and the current outbreak, answered by experts.
1. What is mpox?
Mpox is an infectious disease caused by a virus from the smallpox virus family (now eradicated), Orthopoxvirus. Transmission occurs through contact with infected people or materials contaminated by the virus.
The disease is characterized by lesions on the skin, mucous membranes and internal organs. According to Paulo Abrão, vice-president of the São Paulo Society of Infectology (SPI), there are several degrees of severity of mpox and it can be fatal.
2. How is mpox transmitted?
According to the WHO, transmission of mpox can occur through direct contact with infected skin or other lesions, such as in the mouth or genitals.
Transmission from infected people to people without the disease occurs mainly through skin-to-skin and mouth-to-skin contact (including sex), mouth-to-mouth (kissing) and respiratory droplets from close and prolonged contact.
Transmission from infected animals to uninfected humans can also occur. In this case, transmission can occur through animal bites or scratches and during activities such as hunting, capturing, cooking and/or eating infected animals.
3. What are the symptoms of mpox?
According to Abrão, the symptoms of mpox mainly include skin lesions in the form of pustules. “They mainly affect the genital and perianal areas, through sexual transmission, but they can affect any part of the skin, mucous membranes and internal organs,” he says.
Skin lesions may be flat or slightly raised, filled with clear or yellowish fluid, and may form crusts that dry and fall off. They usually begin to appear one to three days after the fever begins, but sometimes they may appear before the fever.
The number of skin lesions can range from a few to thousands. The rashes tend to be concentrated on the face, palms of the hands and soles of the feet, but can appear anywhere on the body, including the mouth, eyes, genitals and anus.
Other signs may also indicate the disease, such as fever, body aches, headache, chills and weakness. According to the Ministry of Health, the time interval between the first contact with the virus and the onset of the first symptoms of mpox (incubation period) is typically three to 16 days, but can reach 21 days.
4. What does a global public health emergency mean?
A Public Health Emergency of International Concern (PHEIC) represents the highest level of WHO alert for a disease, as provided for in the entity’s International Health Regulations.
For an outbreak to be considered a global emergency, several epidemiological aspects are taken into account, including the potential for transmission, the susceptible population, the severity of the disease, the capacity to impact international travel, among other factors.
The alert emphasizes the risk of a disease spreading to other countries through international spread, in addition to warning of the need for a coordinated international response to contain this disease.
5. What is the current situation of mpox?
“There has been a very significant increase in cases, with a new variant, in the Democratic Republic of Congo and in African countries. There may be spread to several other countries,” says Abrão.
The new variant in question is clade 1B, a subtype of clade 1, the most transmissible and most lethal form of the disease. This clade is endemic in the Democratic Republic of the Congo and is responsible for the current outbreak. Clade 2 was responsible for the global outbreak that began in 2022, according to the US Centers for Disease Control and Prevention (CDC).
“The WHO’s biggest fear is that clade 1 will leave the Democratic Republic of Congo and spread throughout the world, which is what happened with clade 2 in 2022,” explains infectious disease specialist Álvaro Costa, who has Mpox as the central theme of his doctoral research.
6. Could a new variant reach?
Yes. According to Giliane Trindade, a professor of microbiology at the Institute of Biological Sciences at the Federal University, there is a chance that the new variant will spread to other regions of the world besides Africa.
“We live in a globalized world, and what we are seeing in the Democratic Republic of Congo is that it is a very transmissible variant. So, there is community transmission happening and this is not under control. So, it is always a risk when associated with the factor of globalization”, says the professor.
7. Is it possible for a mpox pandemic to occur?
According to experts heard yes, it is possible for a mpox pandemic to occur.
“We know that, nowadays, there is no longer any infectious disease that is concentrated in a single place with all the movement of people [de um país para o outro]”, says Raquel Stucchi, professor at the State University of Campinas (Unicamp) and consultant for the Brazilian Society of Infectious Diseases (SBI). “So, it is possible that it will reach other countries on several continents, especially since it is more transmissible”, she says.
Renato Kfouri, vice president of the Brazilian Society of Immunizations, explained in an interview
that the WHO’s declaration of a global public health emergency means that the disease has the potential to spread and have consequences for several countries and locations.
“This new variant has been infecting children more easily than the previous version, and has spread to other countries very quickly,” warned Kfouri.
8. What differentiates the current mpox outbreak from the previous outbreak?
The current outbreak is more concentrated in African countries, mainly the Democratic Republic of Congo. “A new variant of the Mpox virus has been detected in these locations. It will be necessary to assess its impact on the severity and spread of the disease in current cases,” explains Abrão. This new variant is 1B, which is more lethal and transmissible.
So far, the Democratic Republic of Congo alone has recorded a total of 15,600 confirmed cases and 537 deaths this year. This number is already higher than the 2022 outbreak: despite 85,000 cases recorded, there were only 120 deaths.
This is mainly because the 2022 outbreak was caused by clade 2, which is less severe and less lethal.
9. How is mpox treated?
Treatment for MPOX consists of clinical support to alleviate symptoms, prevent and treat complications, and avoid sequelae. According to the Pan American Health Organization, symptoms of mild and moderate cases of the disease usually disappear spontaneously, without the need for treatment.
According to the health agency, rashes caused by mpox should be allowed to dry naturally or covered with a moist bandage. In addition, products such as mouthwash and eye drops that contain cortisone should be avoided by those infected.
10. Is there a cure for mpox?
Yes. The antiviral Tecovirimat first developed for common smallpox, was licensed by the European Medicines Agency (EMA) for mpox in 2022, based on data from animal and human studies.
In Brazil, in 2022, the National Health Surveillance Agency (Anvisa) approved the exemption from registration for the Ministry of Health to import and use the drug.
11. Is there a vaccine for mpox?
Yes. According to the Ministry of Health, immunization before exposure to the virus is prioritizing people at greater risk of developing severe forms of the disease. These include cisgender men, transvestites and transgender women aged 18 or over who are living with the HIV virus.
In addition, laboratory workers who work directly with microorganisms and are between 18 and 49 years old. Vaccination also prioritizes people who have already had contact (classified by the WHO as high or medium risk) with bodily fluids and secretions of people suspected, probable or confirmed to have mpox.
12. In addition to the vaccine, how is mpox prevented?
According to the Ministry of Health, the main forms of prevention are to avoid direct contact with people with suspected or confirmed disease and to regularly wash your hands with soap and water.
Infected people must comply with social isolation, which includes not sharing personal materials and objects, such as towels, brushes, sheets and clothes.
