Mpox: Understanding the Disease, Its Spread, and Global Impact

Mpox, formerly known as monkeypox, is a viral disease that has garnered global attention in recent years. It is caused by the monkeypox virus, a member of the Orthopoxvirus genus, which also includes the smallpox virus. While mpox was initially identified in African regions, particularly the Congo Basin, it has spread across continents, leading to international concern.

What is Mpox?

Mpox is a zoonotic disease, meaning it can spread from animals to humans. It was first discovered in 1958 when outbreaks occurred among monkeys kept for research, giving the disease its original name. The first human case was recorded in 1970 in the Democratic Republic of the Congo. While it shares similarities with smallpox, mpox is generally less severe, though some strains, particularly Clade 1, can cause serious complications.

How Does Mpox Spread?

Mpox primarily spreads through close contact with infected individuals, their bodily fluids, or materials contaminated with the virus, such as bedding. It can also be transmitted from animals to humans, with rodents and non-human primates being the most common carriers. In recent outbreaks, human-to-human transmission has occurred primarily through direct contact, including sexual contact, making sexual networks a significant driver of recent cases. Respiratory droplets can also spread the virus, although this is less common.

The virus can enter the body through broken skin, the respiratory tract, or mucous membranes (eyes, nose, or mouth). It can spread within households, healthcare settings, or through interactions in social or sexual networks.

Global Spread and Cases

Mpox became a global concern in 2022 when cases surged outside of endemic African regions. According to the World Health Organization (WHO), as of September 2024, there have been over 103,000 confirmed cases of mpox globally, spanning 121 countries across all six WHO regions. These include 223 confirmed deaths from the virus, highlighting its public health implications.

In July 2024 alone, 1,425 new cases and six deaths were reported, with Africa accounting for the majority of cases (55%), followed by the Americas (24%), and Europe (11%). South-East Asia, including India, reported 1% of total global cases. This uptick in global cases prompted the WHO to declare mpox a public health emergency of international concern in August 2024, particularly due to the emergence of the Clade 1b strain.

Mpox in India

India reported its first mpox case in 2022, but it was in September 2024 that the country confirmed its first case of the Clade 1b strain. A 38-year-old man from Kerala's Malappuram district, who had traveled from the United Arab Emirates, tested positive for the virus. His symptoms included fever and a rash that resembled chickenpox, and upon medical suspicion, tests confirmed the presence of mpox. This case marked a significant development, as Clade 1b is associated with more severe symptoms and complications than the previously identified Clade 2 strain in India.

Prior to this, India had seen 31 mpox cases, all linked to Clade 2, which is generally less severe. However, the emergence of Clade 1b in India, known for its rapid spread and association with more severe outcomes, has heightened concerns, particularly in densely populated areas where public health systems may be challenged by containment efforts.

Symptoms of Mpox

Mpox presents with a range of symptoms, most of which are similar to smallpox but milder. The disease typically begins with a fever, which is followed by:

Headache

Muscle aches

Back pain

Swollen lymph nodes

Chills

Exhaustion

Within one to three days (sometimes longer) after the onset of fever, the patient develops a rash, often starting on the face before spreading to other parts of the body. The rash evolves through several stages, starting as flat lesions (macules), progressing to raised lesions (papules), and eventually becoming pustules before forming scabs. These lesions can be painful and can leave scars once they heal.

One of the hallmark symptoms of mpox, which differentiates it from smallpox, is the presence of swollen lymph nodes, particularly in the neck and groin areas.

Severity and Complications

While most cases of mpox resolve within 2 to 4 weeks, severe cases can occur, especially in children, pregnant women, and individuals with weakened immune systems. Complications may include secondary infections, bronchopneumonia, sepsis, encephalitis, and infection of the corneas, leading to vision loss.

Clade 1 strains of the virus, particularly those found in the Congo Basin, are associated with higher mortality rates and more severe complications. In contrast, Clade 2, which was responsible for most of the earlier global cases, typically causes milder symptoms.

Deaths from Mpox

Globally, mpox has resulted in 223 deaths as of September 2024. While the mortality rate remains low compared to other viral diseases, certain populations are more vulnerable, including people with compromised immune systems, those with underlying health conditions, and young children. The majority of deaths have occurred in African nations, particularly the Democratic Republic of the Congo, where healthcare infrastructure may struggle to manage outbreaks.

In India, no deaths have been reported from mpox thus far, but the identification of Clade 1b raises concerns about the potential for more severe outcomes if containment measures are not adequately implemented.

Prevention and Treatment

There is currently no specific treatment for mpox, but antiviral drugs developed for smallpox, such as tecovirimat (TPOXX), have been used in severe cases. Vaccination can also prevent mpox; the smallpox vaccine provides cross-protection due to the viruses' genetic similarities. The WHO has recommended vaccination for those at high risk, including healthcare workers and individuals in close contact with infected patients.

Preventing the spread of mpox involves isolating infected individuals, maintaining good hygiene practices, and using personal protective equipment (PPE) in healthcare settings. Public health campaigns focused on awareness, particularly in sexual networks where transmission is more likely, are also critical in reducing the spread.

Conclusion

Mpox has evolved from a disease largely confined to Africa to a global public health issue. With over 103,000 cases and 223 deaths worldwide, its spread has underscored the importance of vigilance in monitoring emerging viral threats. India's first Clade 1b case in 2024 has highlighted the need for continued surveillance, public awareness, and preparedness to contain the virus and prevent further outbreaks.

As public health authorities continue to grapple with the virus, the global community must collaborate to provide resources for affected regions, especially those with weaker healthcare systems. Containment efforts, combined with vaccination and public education, remain the most effective strategies to combat mpox.