Opinion: A comprehensive overview of Mpox virus and public health response

Mpox, formerly known as monkeypox, is a zoonotic viral disease caused by the monkeypox virus, a member of the Orthopoxvirus genus in the family Poxviridae.

The disease was first identified in laboratory monkeys in 1958, which is how it derived its name, although its natural reservoir is likely rodents. The first human case was recorded in 1970 in the Democratic Republic of Congo (DRC).

Since then, Mpox has been reported in several Central and West African countries, with occasional outbreaks occurring outside of Africa, often linked to international travel or imported animals.

The monkeypox virus is closely related to the variola virus, which causes smallpox. It exists in two distinct genetic clades: the Central African (Congo Basin) clade and the West African clade.

The Central African clade is known to be more virulent and transmissible, with a higher case fatality rate compared to the West African clade.

The symptoms of Mpox are similar to, but milder than, smallpox. They include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a rash, often beginning on the face and then spreading to other parts of the body.

The illness typically lasts for 2 to 4 weeks, and in some cases, it can lead to severe complications or death.

Transmission of the monkeypox virus occurs through direct contact with the blood, bodily fluids, or cutaneous or mucosal lesions of infected animals. Secondary, or human-to-human transmission, can result from close contact with respiratory secretions, skin lesions of an infected person, or recently contaminated objects.

The virus enters the body through broken skin, the respiratory tract, or the mucous membranes. Human-to-human transmission is relatively limited, which is why large outbreaks are uncommon.

Diagnosis of Mpox relies on clinical assessment and laboratory testing. Polymerase chain reaction (PCR) is the preferred laboratory test given its accuracy and sensitivity. The clinical differential diagnosis must consider other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies.

Confirmation of monkeypox depends on the type and quality of the specimen and the type of laboratory test. Thus, samples must be transported in accordance with national and international regulations for infectious substances.

There is no proven, safe treatment specifically for monkeypox virus infection. For purposes of controlling a potential outbreak, smallpox vaccine, cidofovir, ST-246, and vaccinia immune globulin (VIG) can be used.

A newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) has been approved for the prevention of monkeypox.

The effectiveness of the smallpox vaccine in preventing monkeypox is well-documented through retrospective observational studies in Africa. This vaccine is considered to be about 85% effective in preventing monkeypox.

Public health education and communication strategies are essential in preventing and controlling monkeypox outbreaks. This includes educating communities about the risks of interacting with wildlife, the symptoms of monkeypox, and the importance of seeking medical advice if symptoms develop. Surveillance and rapid identification of new cases are critical for outbreak containment.

Health care workers must be aware of the disease and the necessary precautions to avoid infection, including the use of personal protective equipment (PPE).

The resurgence of monkeypox in recent years, particularly in non-endemic countries, underscores the need for robust global surveillance and response systems. The international community must collaborate to ensure that countries have the capacity to detect and respond to outbreaks promptly. Research must continue to develop effective treatments and vaccines, and to understand the ecology and transmission dynamics of the virus better.

In conclusion, while Mpox remains a relatively rare disease, its potential to cause significant outbreaks requires ongoing vigilance. The lessons learned from smallpox eradication provide a solid foundation for managing monkeypox risks. Continued investment in public health infrastructure, research, and international cooperation is essential to mitigate the threat posed by this emerging infectious disease.