Monkeypox Transmission and Prevention 2024

Contents

Introduction

Monkeypox (Mpox) is a zoonotic orthopox virus that can cause infections in humans and animals. Monkeys were identified with the first case of infection, giving the disease its name. Humans transmit the disease through close contact with infected bodily fluids (urine, semen, droplets), fomites (contaminated inanimate objects), and direct contact with infectious rashes.
WHO has classified Mpox as a global epidemic in 2022 due to an outbreak beyond Africa, where it is endemic. In 2024, WHO has again declared it as a public health emergency due to the spread of a new virulent strain of Mpox. Therefore, it is important for prevention of further transmission of the disease leading to a global pandemic, disrupting daily life as in Covid-19.

Human to Human: Mpox can spread through contact with infected patients. Sexual contact, contact with skin, contact with contaminated objects can lead to infection. The virus can be viable for some time on objects like towels, utensils etc. (fomites), and lack of hygiene leads to infections. LGBTQ+ community are at higher risk of transmission.
Animals to humans: The virus can spread from animals like monkeys, rodents (rats, squirrels), prairie dogs, hedgehogs, pigs etc. Viruses can spread through cuts, scratches while hunting, and through eating contaminated meats.
Human to Animals: the virus can spread from humans to animals. Experts advise preventing contact with pets (dogs, cats, etc.) and livestock.

High-risk groups: Immunosuppression (HIV), newborn, pregnant women are at higher risk for fatal Mpox.

The main symptom of Mpox is Rash lasting for 2-4 weeks. Rashes can affect the soles of the feet, palms of the hands, groin or genital region, throat, or mouth, ranging from a few to thousands.
Fever, headache, swollen lymph nodes, muscle pain, and low energy are the other symptoms to watch for.

Patient history and physical examination to initially identify Mpox. Mpox symptoms can resemble those of diseases like syphilis and chickenpox. Therefore, healthcare providers must rule out the conditions with further evidence. They perform Polymerase Chain Reaction (PCR) to detect the DNA of the Mpox virus from collected samples. They collect samples from lesions inside the mouth, anus, or genital areas.

Maintaining personal hygiene, cleaning and disinfecting objects can prevent transmission. Take protective measures while handling wild animal carcasses and blood. Proper cooking of meat before eating is essential.
Vaccination information: MVA-BN (JYNNEOS) or LC16, or ACAM2000 are the WHO recommended vaccines. Vaccination is recommended only for high-risk groups.

Government and health organization guidelines: The WHO has developed guidelines for clinical management and prevention of Mpox. Healthcare providers use the antiviral drug tecovirimat for Mpox under the Monitored Emergency Use of Unregistered and Experimental Interventions (MEURI) framework.
Quarantine and isolation protocols: Authorities design protocols to prevent the further spread of Mpox. They isolate infected individuals, conduct contact tracing, and impose travel restrictions.
Community and global efforts: Global efforts are taken to combat Mpox. WHO Strategic Framework (2024-2027) provides a roadmap to control the Mpox outbreaks. Public Health Emergency of International Concern (PHEIC) was declared by the WHO to promote international collaborations for controlling outbreaks. PHEIC recommends the use of vaccines and antivirals in case of emergency as per the MEURI framework.

Common misconceptions about Monkeypox are:
(1) Mpox was created in the lab: No. It is a zoonotic disease.
(2) Mpox is a new disease: No. Researchers identified the disease in monkeys in 1958.
(3) Mpox only affects monkeys: It can affect various animals.
(4) Mpox spreads easily through casual contact: It is not easily transmissible and spreads through prolonged contact. (5) Only certain groups are at risk: Anyone can get Mpox from an infected person.

Mpox is a zoonotic disease that can affect humans and animals. It is important to understand transmission of the orthopox virus to implement strategies to combat the disease. The WHO has announced Mpox as a public health emergency and is taking adequate measures to prevent a global outbreak. Following the protocols and guidelines are crucial in managing and controlling the spread of Mpox globally.

Written By: Ayoob Mansoor, PharmD, RPh