Crew Health Advice: Mpox

Mpox 2024 - What you need to know…

In 2022 we issued an update about the Monkey Pox virus due to an outbreak which spread from
Africa right across Europe. This outbreak was declared over in May 2023 due to a sustained decline
in cases.

Now with the more catchy name of Mpox, the virus is increasing again and the World Health
Organisation (WHO) has this week declared this outbreak as a public health emergency of
international concern under the International Health Regulations (2005)..

This means that there is potential for Mpox to spread further across countries in Africa and outside
the continent. It’s due to the emergence of a new clade of Mpox which is sexually transmittable.
The first case outside Africa was confirmed in Sweden in mid August 2024.

There’s a lot of information in the media and coming with COVID-19 and the last outbreak as not
too distant memories, it’s inevitable that people will be concerned. So, what do you need to know?

Background

1. There were two strains (clades) of Monkeypox. The Congo Basin clade has a 10% fatality
rate, and the West African clade runs at about 1% fatality rate. In the 2022 outbreak, all
cases were due to the West African clade. Fatalities are largely due to limited resources and
poor access to healthcare.

2. The new clade, known as clade 1b, has been reported in over 100 laboratory confirmed
cases in four countries close to DRC, but who have not reported cases of Mpox before. This
strain is classed as a sexually transmitted virus.

3. Other outbreaks due to different clades have occurred in different countries, with different
modes of transmission and therefore different levels of risk.

4. This year the number of cases in DRC has already exceeded last year's total with more than
15,600 cases and 537 deaths.

5. Fatalities outside Africa are rare as people have access to better healthcare and drugs.

6. Monkeypox is zoonotic, which means it normally passes from monkeys and small mammals,
such as rodents, to humans.

7. Most outbreaks in humans can be traced back to travel in affected areas (Central/West
Africa), consuming contaminated meat or importing exotic pets (generally illegal activity).
For instance, an outbreak of 71 cases in the USA in 2003 was traced back to Gambian rats
sold as exotic pets.

8. It rarely passes from human to human, but it can.

9.Mpox is completely different to COVID, mostly because we already know how it operates.
We already have vaccines available if needed and drugs such as the anti-viral Cidofovir can
help with symptoms.

10. Anyone who has had the smallpox vaccine (if you were born prior to 1971 in the UK) may
already have some immunity. But, the effectiveness of vaccines does reduce over time and
cases of monkeypox were predicted to increase to fill the gap left by the eradication of
smallpox.

What to look for

One of the ‘great’ things about monkeypox is that people develop some very specific and distinctive
symptoms before they become infectious. This helps massively in keeping cases contained.
The incubation period is a long 5 to 21 days from infection to the onset of symptoms and it generally
starts (like so many viruses) with flu-like symptoms. So expect to see fever, aches and pains and
distinctive swollen lymph nodes.

The rash will start within 1-3 days after the fever and it goes through 5 stages - macules, papules,
vesicles, pustules and finally scabs that will fall off.

How it spreads

Pox viruses rarely transmit before the onset of symptoms which helps to contain the spread. As we
said earlier, Mpox was most likely to transmit through being scratched or bitten by something small
and furry - rats, squirrels, non-human primates, black-tailed prairie dogs, African brush-tailed
porcupines, pigs, shrews or rabbits.
But, it can spread from person to person through:

1. Respiratory droplets and aerosols from prolonged face-to-face contact.

2. Direct contact with bodily fluids or monkeypox lesions.

3. Indirect contact with contaminated items such as clothing or bedding.

This means that the most common person to person infection is of people sharing a home with
someone who has monkeypox, or healthcare workers. However it takes a lot of virus (viral load) to
transmit.

It’s also what’s known as an enveloped virus, which happily means that normal soap, detergent and
disinfectants will kill it off nicely.

Most reported cases have been identified through sexual health or other health services in
primary or secondary health-care facilities and have involved mainly, but not exclusively,
men who have sex with men. Monkeypox wasn’t sexually transmitted specifically, but if there’s a lot of direct contact and you’re breathing all over each other, then it’s likely to be passed on and
remember that the new strain is classed as sexually transmitted.

The outbreak is being driven by environmental, social and behavioural factors.

What can you do?

MPXV spreads through contact with infected animals, close contact with infected persons, and contaminated materials. Recent cases show increased person-to-person transmission, especially among high-risk groups.

1. Be vigilant and aware of the symptoms.

2. Personal hygiene is paramount… but we know this from COVID. Wash and/or sanitise your
hands regularly.

3. Be careful who you’re kissing!

4. If you’re bitten or scratched by any African rodents or small mammals, seek medical advice.

5. On ship, especially if you’ve called into port in West Africa, be alert for vermin onboard.

6. If you suspect you are developing symptoms, isolate straight away and seek medical advice.

7. Avoid touching contaminated items or wild animal in mpox-prevalent regions.

8. If you suspect you are developing symptoms, isolate straight away and seek medical advice.

Finally, if you’d like to up your knowledge of Mpox, the WHO has a short free training course that
you can take online here: lnkd.in/e6-VTpbV.