Mpox, previously known as monkeypox, is an infectious disease that has attracted global attention due to its outbreaks in various regions. Most monkeypox outbreaks have occurred historically in Central and West Africa, often linked to imported animals or travelers from the affected areas. Monitoring of the mpox virus started in 2022, and up to 31st July 2024, over 100,000 confirmed cases and over 200 deaths were recorded by over 120 countries globally .A notable surge in cases was reported in the Democratic Republic of the Congo, contributing to the global conversation about the virus. Since May 2022, a multi-country outbreak of Mpox has been observed in various countries worldwide, causing widespread concern.
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What is MPox?

Caused by the monkeypox virus (MPXV), mpox is a viral infection that can lead to a painful rash, fever, and other flu-like symptoms. The disease often results in swollen lymph nodes, muscle aches, and low energy levels. While many people recover fully from mpox, some may experience severe complications. These symptoms can last 2 to 4 weeks, but people with weakened immune systems may experience more prolonged symptoms. The global outbreak in 2022 affected multiple countries, particularly in Africa, where clades Ia and Ib have been reported, mainly in the Democratic Republic of the Congo.

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The Severe Complications of MPox

While many people recover from mpox without serious complications, specific individuals may experience severe health issues, particularly those with weakened immune systems. One of the most common complications is the infection of the mpox rash. Once the rash is exposed to bacteria, it can become severely infected, leading to abscesses, open sores, or permanent skin damage. This bacterial infection may require additional treatment, including antibiotics, to prevent further skin deterioration.

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Mpox can also lead to respiratory complications, such as pneumonia, mainly if the virus spreads to the lungs. Pneumonia can cause difficulty breathing, chest pain, and severe fatigue, sometimes requiring hospitalization and intensive medical care.

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Another serious complication is corneal infection, which can occur if the virus spreads to the eyes. This can result in conjunctivitis (eye inflammation) and, in extreme cases, permanent vision loss. Individuals who experience eye pain, redness, or blurred vision while infected with mpox should seek immediate medical attention to prevent long-term damage.

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In some cases, mpox can cause pain or difficulty swallowing, especially if lesions form in the mouth or throat. This complication can lead to dehydration, malnutrition, or the inability to consume food and fluids properly, requiring medical intervention to manage symptoms and ensure proper nourishment.

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How is Mpox Transmitted?

Mpox is primarily transmitted through close contact with an infected person, making direct physical interactions a significant risk factor. The virus spreads through skin-to-skin contact, such as touching or engaging in sexual activity, as well as through mouth-to-mouth or mouth-to-skin contact. Individuals who live in the same household or engage in intimate activities with someone infected are at a higher risk. In particular, people with multiple sexual partners are more susceptible to contracting mpox due to the increased likelihood of close physical contact. The virus can also be passed from a mother to her baby during pregnancy or childbirth, posing risks for the infant.

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The virus can also spread indirectly through contact with contaminated objects, such as clothing, towels, or bed linens, touching an infected person’s rash or bodily fluids. Healthcare workers or individuals exposed to needles in clinical settings also face a higher risk, especially if proper precautions aren't taken.

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In addition to human-to-human transmission, mpox can be spread from animals to humans, a transmission mode particularly common in regions where the virus is endemic. Animal-to-human transmission typically occurs through bites or scratches from infected animals or during activities like hunting, skinning, trapping, cooking, or playing with animal carcasses. In some cases, people have contracted mpox from consuming undercooked meat from infected animals.

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Mpox Treatments

In most cases, people with mPox recover without extensive medical treatment. Treatments usually focus on managing the rash and pain. Keeping the affected areas clean and dry helps prevent infections, and over-the-counter medications like antihistamines can relieve itching. Pain relievers such as ibuprofen or acetaminophen reduce pain and alleviate fever.

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Proper wound care, including gentle washing with soap and water and covering the rash with clean bandages, is essential to avoid complications. If the rash affects the eyes, immediate medical attention is necessary to prevent severe issues like vision loss. For most, rest and hydration are enough for recovery at home, but severe cases may require medical attention or hospitalization.
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Prevention of MPox with the MPox Vaccine

The mpox vaccine is a critical tool in preventing the spread of the virus, especially for individuals at high risk, such as healthcare workers or those with multiple sexual partners. The vaccine is most effective when administered before exposure, but it can also be given after contact with someone with mpox. For post-exposure protection, the vaccine should be administered within four days of contact to prevent the onset of symptoms. If given between 4 and 14 days after exposure, it may still reduce the severity of the illness.

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The mpox vaccine helps the body build immunity against the virus, reducing the risk of severe symptoms or complications. It’s particularly recommended during outbreaks or in areas with ongoing transmission. Vaccination, good hygiene practices, and avoiding close contact with infected individuals offer the best protection against mpox.

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Under the Central for Health Protection programme in Hong Kong, the following high-risk target groups of Hong Kong residents can receive Mpox vaccination from Social Hygiene Service Clinics on a voluntary basis:

● Individuals with high risk sexual practices, e.g. men who have sex with men (MSM), having multiple sexual partners, sex workers, history of sexually transmitted infection within the past 12 months;

● Healthcare workers responsible for caring of patients with confirmed Mpox;

● Laboratory personnel working with zoonotic pox viruses; and

●Animal care personnel with high risk of exposure in case of Mpox occurrence in animals in Hong Kong

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The Ongoing Challenges of MPox

Mpox continues to be a public health concern, impacting individuals and communities worldwide. The virus’s ability to spread through close contact and its potential complications underscores the need for ongoing awareness and medical readiness. While most people recover with minimal intervention, the risk of severe symptoms and complications for some populations makes timely medical care and prevention efforts like vaccination vital.

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As the global community works to address and contain mpox, the collective focus remains on minimizing its impact through vaccines, proper healthcare, and reducing transmission. By prioritizing prevention and early treatment, we can better manage the risks associated with mpox and help mitigate its spread.

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Remarks:

1. ECDC. (2024). Epidemiological update, week 37/2024: Mpox due to monkeypox virus clade I. Available from: https://www.ecdc.europa.eu/en/news-events/mpox-monkeypox-epidemiological-update-week-37-2024

2. Centre for Health Protection. (2024). Mpox Vaccination Programme. Available from: https://www.chp.gov.hk/en/features/106090.html

3. World Health Organization. (2024). MPox. Available from:
https://www.who.int/news-room/fact-sheets/detail/mpox

4. World Health Organization. (2024) WHO Director-General declares mpox outbreak a public health emergency of international concern. Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern