Mpox

What is mpox?

Mpox (formerly referred to as monkeypox) is a rare condition that results from a virus and is characterised by flu-like symptoms and rashes. It belongs to the Orthopoxvirus genus, which is the same family as the virus causing smallpox.

One can contract the infection by being in close contact with an infected person or sometimes an animal.

There are two recognised clades or types of the mpox virus: Clade I, originating from Central Africa, and Clade II, originating from West Africa. The recent global outbreak (from 2022 to 2023) is connected to Clade IIb, a less serious subtype of the West African clade.

Mpox in the UK

Despite the recent increase in mpox diagnoses, only a small percentage of individuals in the UK have contracted the infection, and the risk is still low.

Mpox is unlikely to affect you if:

• You haven’t been in close contact with an infected person or someone with mpox symptoms (such as by touching or sharing clothes, towels,or bedding).
• You haven’t recently been to West or Central Africa.

Symptoms of Mpox

After contracting mpox, the initial symptoms typically take about 5 to 21 days to appear. The first common symptoms are:

• Headaches
• Increased temperature
• Muscle aches
• Backache
• Chill or shivering
• Swollen glands
• Fatigue
• Joint pain

A rash often develops between 1 to 5 days after the onset of these initial symptoms. Normally, it starts on the face and spreads to different body parts, including the genitals, mouth, and anus. One may also experience anal pain or bleeding.

At times, the rash can be mistaken for chickenpox since it begins as elevated spots that become fluid-filled blisters. Eventually, these blisters form scabs and fall off.

Symptoms mostly resolve within a few weeks. However, during this period, the virus can be transmitted to others.

Causes

Mpox is usually spread through contact with an infected person or animal.

Person-to-person transmission happens through direct contact with scabs, sores, respiratory droplets, and oral fluids of an infected person, often in close, intimate positions such as cuddling, kissing, or intercourse. While there is ongoing research, experts are not certain whether the virus can be passed on through vaginal fluids or semen.

On the other hand, animal-to-human spread happens through cracked skin, such as from scratches or bites, or by coming into contact with the blood, pox lesions (sores), or bodily fluids of an infected animal.

In addition, Mpox can be transmitted by being in direct contact with newly contaminated items, including outfits, bedding, or other linens belonging to an infected person or animal.

Diagnosis and Tests

How is mpox diagnosed?

Since mpox is not common, the doctor may initially suspect a different rash disorder, like chickenpox or measles. However, swollen lymph nodes often differentiate mpox from other similar illnesses.

During mpox diagnosis, the healthcare provider will collect a sample of the tissue from the lesion or open sore. It is then taken to the lab for polymerase chain reaction (PCR) testing to identify the virus’s genetic material. Also, blood samples may be ordered to look for the presence of the virus or antibodies that the immune system produces.

Treatment for Mpox

Mpox is often mild, and the majority of infected individuals get better after a few weeks, even without any treatment. However, if symptoms are severe, such that you become ill, treatment from the hospital may be necessary.

The possibility of requiring hospital treatment increases among:

• Young children
• Older adults
• Persons with compromised immune systems due to medical conditions or medications

Since mpox is transmittable, isolation is essential in people diagnosed with the infection. If you have mild symptoms, the provider can ask you to isolate yourself at home.

Vaccination to protect against mpox

The virus causing mpox also causes smallpox. Therefore, smallpox (MVA) vaccination provides significant protection from mpox.

Who can get the mpox vaccination?

The National Health Service provides the smallpox (MVA) vaccine to individuals at a high risk of mpox exposure. Those likely to get exposed are:

• Healthcare workers taking care of persons diagnosed with or suspected to have mpox
• Men who are bisexual, gay, or having sexual intercourse with other men and especially with multiple partners, engage in group sex, or go to sex-on-premises sites.
• Individuals who have come into contact with someone infected (preferably, the vaccine should be given within 4 days of exposure, but could also be administered up to 14 days afterward)

Healthcare workers and men who are gay, bisexual, or have intercourse with other men will receive two vaccine doses. The second dose is usually given 2 to 3 months following the initial dose. The local NHS services will notify you when it is time for the next dose.

Important: changes to mpox vaccination

Although the NHS vaccination program for mpox outbreak came to an end in July 2023, people who are eligible can still access the vaccine in London and Greater Manchester if:

• You reside in London or Greater Manchester
• Frequently travel to these areas for sexual activity
• Often travel to other states for sexual activity

Prevention

How do you prevent mpox?

Receiving a vaccination is essential in stopping the spread of the infection in people who are at high risk. Other preventive strategies involve reducing human contact, especially with infected animals, and minimising person-to-person transmission.

Mpox vaccines

Vaccines designed for smallpox protection are also useful with mpox. Currently, mpox vaccines are recommended only for exposed individuals or those at risk of virus exposure. You’re likely to be exposed if:

• You have been in direct contact with an infected person.
• A partner you had intercourse with during the last two weeks is diagnosed with the virus.
• You had sexual intercourse at a sex club, bathhouse, or any commercial sex place within the previous 6 months.
• You have engaged in sex at a location or event where mpox was transmitted.
• Your sex partner is in any of the above criteria.
• You believe you are in any of the above situations.

Men having intercourse with men, transgender individuals, or nonbinary persons may also have high risk if they:

• Have been found with one or more sexually transmitted infections (STIs) during the last 6 months, including acute HIV, syphilis, gonorrhea, chlamydia or chancroid.
• Had intercourse with more than one partner over the past 6 months.

Receiving a vaccination before or immediately after exposure is crucial. Consult your doctor if you are not sure whether you should get the vaccine. Also, if you prefer a more discreet vaccination site, your provider can administer the shot in the shoulder blade rather than the forearm.

Additional ways to prevent mpox

Apart from vaccination, other preventive measures against mpox are:

• Avoiding coming into direct contact with infected animals, particularly those that are sick or dead.
• Not touching bedding or other contaminated items.
• Thoroughly cooking all foods containing animal meat or its parts.
• Frequently cleaning hands with soap and water.
• Avoiding direct contact with infected people.
• Engaging in safe sex by using condoms and dental dams.
• Wearing a mask covering the nose and mouth when with other people.
• Cleaning and sanitizing regularly touched surfaces.
• Using personal protective equipment (PPE) while looking after infected patients.

Living With

How do I take care of myself?

For people with mpox symptoms, over-the-counter (OTC) drugs are available to make you feel better. They include:

• Painkillers and fever reducers: Medications such as ibuprofen (Advil®, Motrin®) and acetaminophen (Tylenol®) can help alleviate mpox symptoms.
• Oatmeal baths: A warm bath that includes colloidal oatmeal can soothe dry, itchy skin caused by rashes.
• Self-isolation if infected: Do not be in contact with other people till all lesions scab over.
• Cover single or local sores or ulcers: You can use gauze or bandages to prevent spreading the virus to those around you and the environment.
• Take care of yourself: If you are ill, it’s always advisable to stay and rest at home, wear a mask when you’re with people, and drink a lot of fluids.
• Avoid direct contact with pets, particularly rodents

When should I see my healthcare provider?

It’s important to contact your doctor if:

• You feel sick and have symptoms like aches, fever, or swollen lymph nodes.
• You develop new sores or rashes.
• You come into contact with an infected person.