Mpox (Monkeypox)

Mpox symptoms in humans, while similar to smallpox, are milder. The key symptom that sets it apart from smallpox is the enlargement or swelling of the lymph nodes. This distinction should provide some reassurance about the severity of the illness. The time from infection to symptoms for Mpox is usually 6-13 days but can range from 5-21 days.

Predominant Symptoms (0-5 days):

• Fever
• Headache
• Myalgia (muscle aches)
• Backache
• Lymphadenopathy
• Chills
• Malaise (tiredness)
• Exhaustion
• Sore throat
• Dry cough
• Dyspnea (shortness of breath)

Progression of the Disease:

Lesions appear within 1 to 3 days after the onset of fever on the tongue and mouth. The patient generally develops a rash, often beginning on the face and spreading to other body parts within 24 hours. By the 4th to 5th day, the lesions become raised and filled with pus. By the end of the 2nd week, they dry up and crust. The scabs usually remain for a week before they start to fall off.

This illness typically lasts for about 2-4 weeks, and lesions progress through the following stages:

• Macular stage: Flat, discolored spots appear on the skin.
• Papular stage: The spots become raised and firm.
• Vesicular stage: Lesions develop into small, fluid-filled blisters.
• Pustular stage: The blisters fill with pus and become more pronounced.
• Scabbing stage: Lesions dry out, form scabs, and eventually fall off.

Remember, the severity of the skin manifestations of Mpox depends on vaccination status, age, nutritional status, and immunity status. If all the news about Mpox has you worried, keep in mind that the symptoms are generally mild. There is no need to panic. Continue reading to get all your queries answered about Mpox.

Mpox is caused by the monkeypox virus, which belongs to the Poxviridae family. It is generally acquired through rodents such as rats, mice, and squirrels, which are carriers of the virus, in parts of West and Central Africa. Any person can get Mpox through the following ways:

• Bite from an infected animal or contact with its blood, body fluids, spots, blisters, or scabs.
• Consumption of meat from an infected animal from Central or West Africa that has not been cooked thoroughly.
• Touching the skin or fur of infected animals.

Transmission

The Mpox virus primarily causes animal-to-human transmission. In rare cases, human-to-human transmission is also possible through close contact or large respiratory droplets.

Animal-to-human transmission

• Direct physical contact with infected blood, body fluids, skin lesions, blisters, or scabs from an infected animal.
• Consumption of meat from an infected animal that is not cooked thoroughly.
• A bite or scratch from animals like rats or squirrels infected with the virus.

Human-to-human transmission

• Close physical contact with a person infected with the Mpox virus.
• Contamination of clothes, bedding, or towels by touching them after contact with the virus.
• Exposure to saliva or respiratory droplets through coughing or sneezing.
• Transmission from the placenta from mother to fetus.
• Transmission from mother to baby during and after childbirth.
• Unprotected sex with an infected person.
• Man-to-man sex.

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Anyone who has close physical contact with an infected animal or someone who has symptoms of Mpox is at the highest risk of developing the infection. Other individuals at greater risk of developing serious symptoms from Mpox include:

• Newborns
• Children
• Immuno-deficient patients
• Patients with a history of chronic illness
• Healthcare workers
• Laboratory professionals

The investigation should consist of the following:

• Examining the patients clinically using appropriate infection prevention and control (IPC) measures.
• Questioning the patient about possible sources of infection and the presence of similar disease or symptoms in the patient’s community and contacts.
• Collecting and dispatching the specimens safely for laboratory examination of Mpox.
• If Mpox is suspected, health workers collect an appropriate sample and transport it safely to a laboratory with proper capability.
• Samples are usually collected from a person showing symptoms, especially a traveler from a region where Mpox is endemic, during an outbreak, or in cases of community (person-to-person) spread.
• Asymptomatic travelers are observed for 21 days, and samples are collected once signs and symptoms appear.

The various clinical samples that can be collected to make the diagnosis are:

1. During rash phase
   • Nasopharyngeal and oropharyngeal swabs or lesions from the roof, base scraping, fluid, and crust or scab.
   • Blood in specialized tubes like EDTA and SSGT.
   • Urine in a sterile container.
2. During the recovery phase
   • Additional tests are conducted to ensure the patient has fully recovered and is no longer infectious. These tests include blood in an EDTA/SSGT tube and urine in a sterile container.
   • Blood in an EDTA/SSGT tube.
   • Urine in a sterile container.

For the confirmation of Mpox on the suspected clinical specimens (Blood, Lesion, swabs, urine):

• PCR for Orthopoxvirus genus [Cowpox, Buffalopox, Camelpox, Mpox] is performed.
• If the specimen shows positivity for the Orthopoxvirus, it would be further confirmed by Mpox-specific conventional PCR or real-time PCR for Mpox DNA.
• Additionally, virus isolation and Next Generation Sequencing of clinical samples might be used for the characterization of the positive clinical specimens.

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Mpox prevention depends on decreasing human contact with infected animals and limiting person-to-person spread. Mpox can be prevented by following these measures:

• Avoid contact with infected animals, especially sick or dead ones.
• Cook all foods that contain animal meat or parts thoroughly.
• Avoid any kind of contact with bedding and other materials contaminated with the virus.
• Maintain hygiene by washing your hands with soap and water or alcohol hand rub after coming into contact with an infected animal or person or handling their products.
• Avoid close contact with an infected person.
• Use personal protective equipment (PPE) when caring for an infected person.
• Get vaccinated.

Humans have a close connection with microorganisms. Viruses are tiny microorganisms that range in size from about 20 to 400 nanometers in diameter. Read how viruses are transmitted and ways to prevent them.

Vaccination for Mpox

JYNNEOS TM, also known as Immune or Imvanex, is a live attenuated (weakened) virus vaccine that has been approved by the U.S. Food and Drug Administration (FDA) for the prevention of mpox. However, it is not yet widely available. Smallpox vaccines can protect against Mpox. Certain countries require timely vaccination of close contacts as post-exposure prophylaxis or for certain groups of health care workers as pre-exposure vaccination. However, after 1980, when WHO declared that smallpox was eradicated globally, no vaccine has been manufactured in India. Thinking about why adults would need vaccinations? Read this to know the most common vaccinations that adults require.

Before undertaking the treatment of Mpox, let's learn about the protocol for handling suspected Mpox patients first:

Protocol for Handling Patients with Suspected Mpox

Suspected patients should be referred for further evaluation and treatment.

Patient Handling and Isolation:

• Patients must be handled with strict infection control measures.
• Staff should use personal protective equipment (PPE) when dealing with suspected cases.
• Upon arrival, patients with fever, rash, or contact with confirmed Mpox cases should be assessed immediately.
• Key symptoms to identify include fever, headache, muscle aches, back pain, swollen lymph nodes, chills, exhaustion, and specific skin lesions like rash that can develop into vesicles and pustules.

Isolation/Holding Area:

• Suspected patients should be placed in a designated isolation area to avoid contact with others.
• Beds are reserved for isolating Mpox patients, based on the emergency recommendation.
• These beds serve as temporary holding areas until the patient is transferred to definitive care.

Notification to IDSP:

• Notify the Integrated Disease Surveillance Programme (IDSP) at 8745011784.
• Provide patient details, history, clinical findings, and contact information to the IDSP.

Treatment of Mpox

Currently, there are no specific clinically proven treatments for Mpox infection. However, it's important to note that Mpox is usually a mild and self-limiting disease. Most patients with mild diseases recover without medical intervention, instilling a sense of hope and optimism. The treatment and management mainly involve the following:

Supportive Care

• Skin Rash:
• Avoid touching or scratching the lesions to prevent worsening the rash and increasing the risk of infections.
• Clean the area with an antiseptic ointment such as mupirocin acid or fucidin and cover the lesion with a light dressing.
• In case of a secondary bacterial infection, antibiotics may be prescribed. It's important to use antibiotics as directed by a healthcare professional to prevent antibiotic resistance.
• Ulcers:
• Sitz bath for genital ulcers.
• Warm salt gargling and use of topical oral anti-inflammatory gel for mouth ulcers.
• Dehydration:
• Take adequate fluids like juices and ORS.
• Eat a balanced, nutrient-rich diet.
• In severe cases, intravenous drip may be required.
• Other Symptoms:
• Paracetamol for fever.
• Antiemetics like Ondansetron and Metoclopramide for nausea and vomiting.
• Antihistamines like Cetirizine for itching.

Medical Management

Certain cases of Mpox are treated with the following:

• Antivirals: Several antivirals may be helpful in the treatment of Mpox. These drugs were approved for treating smallpox based on animal models but are expected to have the same effect on human Mpox.
• Tecovirimat: It is a potent inhibitor of an orthopoxvirus protein. The recommended dose depends upon the patient's weight.
• Brincidofovir: This drug was approved in June 2021 for use in the United States to treat smallpox and can also be used for Mpox.
• Cidofovir: The drug shows promise by effectively combating Mpox in lab tests and protecting animals from severe infection.

Home management guidelines for non-hospitalized patients

• Isolation: Keep the patient in a separate room; limit contact with other family members.
• No Leaving Home: The patient should stay home unless seeking medical care.
• No Visitors: Do not allow visitors in the home.
• Masking: Patients with respiratory symptoms should wear a surgical mask; others may wear masks when near the patient.
• Gloves: Use disposable gloves for direct contact with lesions and dispose of them properly.
• Cover Lesions: Cover skin lesions (e.g., long sleeves, pants) to reduce contact risk.
• Waste Disposal: Contain and dispose of contaminated waste in biomedical waste bags.
• Hand Hygiene: Wash hands with soap and water or use alcohol-based hand rub after touching lesions or contaminated items.
• Laundry Care: Wash soiled laundry in warm water; handle carefully to avoid spreading infection.
• Utensils: Do not share dishes or eating utensils; wash them thoroughly after use.
• Surface Disinfection: Clean and disinfect contaminated surfaces using standard household products.
• Pets: Keep pets and domestic animals away from the patient's environment.

Masks have proven to be a powerful tool in our fight against infectious diseases, providing a crucial layer of protection. With cases of Mpox increasing around the world, the correct use of masks is more important than ever, offering reassurance and confidence in our ability to prevent the spread of disease.

People with Mpox are infectious to others from the onset of fever until all lesions scab over. Mpox complications include:

• Dehydration due to:
  • Vomiting
  • Diarrhea
  • Decreased food intake due to painful oral lesions
  • Fluid loss from widespread skin disruptions
• Pneumonia
• Sepsis (reaction to an infection that causes widespread inflammation in the body)
• Bacterial superinfection of skin
• Permanent skin scarring
• Hyperpigmentation or hypopigmentation of skin
• Permanent scarring of the cornea (vision loss)
• Encephalitis (inflammation of the brain)
• Shortness of breath, chest pain, difficulty in breathing
• Altered consciousness
• Seizures
• Decrease in urine output
• Lethargy

With the increase in cases, the stigma around Mpox is bound to rise. Social stigma generally refers to the negative association between a person or group with certain characteristics of a specific disease. This may result in individuals being labeled, stereotyped, discriminated against, treated separately, and experiencing a loss of status due to a perceived link with the disease, especially during an outbreak. Such stigma can negatively affect patients as well as their caregivers, family, and friends. The current rise in Mpox cases and media coverage can also lead to increased stress and anxiety for patients and their family members. Here are some tips to cope with the psychological effects:

• Do not believe the experiences of others all the time.
• Discuss mental health issues with healthcare professionals.
• Avoid hiding away or isolating yourself from the world.
• Reach out to family, friends, and life coaches for support.
• Seek help from a therapist or psychologist if needed.
• Join a mental health support group if required.
• Understand that it’s not personal.

Mpox is causing similar uncertainty among the public as COVID-19 did during its early stages.