Mpox: why was it declared a public health emergency?
University virologist Dr Niluka Goonawardane provides her insights into the Mpox virus that was declared a public health emergency by World Health Organisation just weeks ago.
Mpox is a viral illness caused by the Mpox virus, a double-stranded DNA virus of the family Poxviridae. Mpox is similar to smallpox but less severe.
It was first discovered in 1958 in monkeys, hence the name ‘monkeypox’, but has since been detected in various other mammals including rodents and squirrels.
The first human case of Mpox was diagnosed in 1970 in the Republic of the Congo, Central Africa. There are two distinct clades of the virus: clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb). Mpox remains a threat to public health.
There was an upsurge in Mpox cases in 2022, where the virus spread rapidly outside of its traditional endemic regions in Central and West Africa. This led to an international outbreak that led to global attention.
The first case outside of Africa was reported in the UK in May 2022, quickly followed by cases across Europe, North America and other regions.
Since 1 January 2022, cases of Mpox have been reported in 121 countries including the UK, Spain, Germany, France, the US, Brazil and 19 counties across Africa.
As of early August 2024, over 100,000 laboratories confirmed cases of the virus and over 223 deaths have been reported to the World Health Organisation (WHO). Actual numbers may be much higher due to delays in reporting.
This led the WHO to declare Mpox a public health emergency of international concern (PHEIC) on two occasions (May 2022 and August 2024).
The resurgence of Mpox in 2024 poses a significant public health challenge, with African countries bearing the brunt of the crisis.
International efforts are underway to contain the spread and mitigate its impact. Currently, health authorities and the WHO continue to monitor new cases and variants, particularly in areas where the virus remains endemic.
The most common symptoms are fever, swelling of lymph nodes and mucosal lesions (or skin rashes). Rashes typically start on the face and spread to other parts of the body, which progresses from macules to papules, vesicles, pustules, and finally scabs.
Most of those infected recover but some develop more severe disease. Those who recover have a mild illness lasting 2-4 weeks. Severe cases occur in those with a weakened immune system such as those who are pregnant and young children.
Mpox spreads via contact with infected people through touch (skin to skin contact). Contact with infected animals (bites, scratches, skinning or cooking) or through infected materials such as contaminated linen and needles in tattoo parlours in the community setting. The virus also can be passed on during pregnancy.
Those with close contact to an infected individual are at high risk of infection. The virus can spread through direct contact with respiratory droplets or body fluids from infected individuals. Whilst everyone is at risk, the current outbreak is overwhelmingly affecting sexually active, bisexual men and men who have sex with men.
If you think you have monkeypox, you should seek medical advice and isolate yourself if you are showing symptoms. Infected individuals should avoid close contact with others until lesions have completely healed.
I think we all have a role to play in stopping its spread. It is about understanding the risk, spread, signs and symptoms of the virus and, importantly, knowing what to do if you become unwell.
Currently, there is no vaccine licensed in the UK or Europe for immunisation against Mpox. Since Mpox is related to smallpox, vaccines against smallpox can provide protection. Smallpox Modified Vaccinia Ankara – Bavarian Nordic (MVA-BN) is currently distributed under two brand names: Imvanex and Jynneos.
You should talk to your clinicians for advice on vaccination, particularly if you are at risk of contracting the virus or have been in close contact with someone who is infected.
About Dr Goonawardane
Dr Goonawardane is a virologist and a Wellcome Trust Fellow (Principal Investigator) within the Faculty of Biological Sciences. She specialises in emerging and re-emerging viral infectious diseases, particularly those that jump from wild animals or vectors (e.g. ticks) into humans and infect the brain. These cause a diverse range of clinical diseases and are a threat to human health. Her lab studies how these viruses interact with the immune system to establish central nervous system (CNS) infections and they use the latest multidisciplinary yet complementary approaches that recapitulate the natural infections in the brain. Connect with Niluka by visiting her staff profile.
