Mpox is a viral disease discovered in 1958 in Danish laboratory monkeys. It is primarily a zoonotic disease caused by the monkeypox virus, a member of the orthopoxvirus family that also includes the smallpox virus.
The disease can be transmitted to humans through direct contact with infected animals or through consumption of contaminated meat.
The World Health Organisation (WHO) has issued a public health emergency alert in response to the first case of the new mpox strain reported in India. The first case has been confirmed in a 38-year-old man who belonged to the southern state of Kerala and had recently returned from Dubai.
This dangerous virus variant has spread to countries outside of Africa, such as Sweden, Thailand, and Pakistan. In India, more than 30 mpox cases have been reported in the last two years due to the older Clade 2 strain, which is thought to be less infectious.
The WHO is working closely with health authorities in affected countries to contain the spread of the new mpox strain and prevent a global outbreak.
The mpox virus is divided into clades, groups of organisms that share a common ancestor and all of their living and extinct descendants.
What are the Different Strains of Mpox Virus?
The monkeypox virus (MPXV) has been classified into two main clades. Clade I, also known as the Central African strain, is more virulent and has a higher mortality rate, historically linked to outbreaks in the Democratic Republic of the Congo (DRC). This clade has been associated with severe cases and a mortality rate estimated between 10% and 11%.
In contrast, Clade II, which includes the West African strain, is generally less severe, with a lower mortality rate of around 3%–4%. The current global outbreak that began in 2022 is primarily caused by Clade IIb, a subtype of Clade II.
This strain has shown an increased ability to spread through human contact, including sexual transmission, which marks a notable shift in its transmission dynamics compared to earlier outbreaks that were predominantly animal-to-human transmissions.
Recent studies indicate that Clade Ib, a subgroup of Clade I, has emerged with mutations that suggest it may have been circulating among humans for some time. This clade appears to be spreading more readily in densely populated areas, contrasting with Clade Ia, which is more common in rural settings. The mutations observed in Clade Ib's genome may contribute to its enhanced transmissibility among humans.
What are the symptoms?
The symptoms of mpox (formerly known as monkeypox) can vary in severity and presentation, typically beginning within 3 to 21 days after exposure to the virus. The most distinctive feature of mpox is a rash, which can appear on various parts of the body, including the face, mouth, hands, feet, and genital areas.
This rash often starts as flat lesions that progress to raised bumps or blisters filled with fluid, which may be painful or itchy. The rash generally lasts between 2 to 4 weeks, going through several stages before forming scabs that eventually fall off.
In addition to the rash, individuals with mpox may experience a range of other symptoms that include fever, chills, swollen lymph nodes, exhaustion, muscle aches, back pain, and headache. Some people may also report respiratory symptoms such as a sore throat or nasal congestion.
The severity of symptoms can differ; while some individuals may have mild symptoms, others can develop more serious illnesses requiring medical attention. Complications can include severe skin infections, pneumonia, and other systemic effects. However, the rash goes through different stages before forming scabs and eventually falling off.
How is it transmitted?
Mpox (formerly known as monkeypox) is transmitted through several routes, primarily involving close contact with infected individuals or animals. Here are the key transmission methods:
Person-to-Person Contact: Mpox spreads mainly through close physical interactions, including skin-to-skin contact, kissing, and sexual activity. This can occur through direct contact with the rash, sores, or bodily fluids of an infected person.
Respiratory Droplets: The virus can also be transmitted through respiratory droplets when an infected person talks, breathes, or coughs in close proximity to others. This highlights the importance of maintaining distance from infected individuals.
Contaminated Objects: Mpox can spread through contact with contaminated materials such as clothing, bedding, towels, and other objects that have been in contact with an infected person's bodily fluids or rash.
Animal-to-Human Transmission: The virus can be transmitted from infected animals to humans through bites or scratches, or by handling the blood or bodily fluids of an infected animal. Certain species of rodents and primates are known carriers of the virus.
Vertical Transmission: Pregnant individuals can transmit the virus to their foetus during pregnancy or to their newborn during or after birth through close contact.
Is the monkeypox virus severe?
The severity of the monkeypox virus (mpox) can vary significantly based on several factors, including the strain of the virus, the individual's health status, and access to medical care. Generally, mpox can lead to a range of symptoms, from mild to severe.
Severe cases may involve larger and more widespread lesions, particularly affecting sensitive areas such as the mouth, eyes, and genitals. Complications can arise, including secondary bacterial infections of the skin or blood, pneumonia, and even encephalitis (inflammation of the brain).
According to available data, the mortality rate for mpox ranges from 0.1% to 10%, depending on various factors like healthcare access and underlying health conditions—individuals with compromised immune systems, such as those with advanced HIV, are at a higher risk for severe disease and death. Young children and pregnant individuals are also more vulnerable to severe outcomes.
Most people recover from mpox within 2 to 4 weeks with supportive care; however, severe cases may require hospitalisation and antiviral treatments to manage symptoms and reduce recovery time. The differences in severity are also tied to the clade of the virus: clade I strains tend to be more virulent than clade II strains.
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