What is Mpox? Everything you need to know about 2024 Monkeypox outbreak
A single case of Mpox - formerly known as monkeypox - has now been detected in the UK. The individual tested positive for Clade 1b Mpox, which seems to spread more easily between people, after being on holiday in one of the affected countries.
They developed flu-like symptoms on 22 October and a rash a couple of days later. They are being treated at the Royal Free Hospital's specialist high consequence infectious disease unit in London.
The World Health Organisation deemed Mpox - formerly known as Monkeypox - a public health emergency of international concern (PHEIC) after a surge of cases in the DRC and other African countries.
The announcement was made on August 14 2024, after the WHO Director-General Dr Tedros Adhanom Ghebreyesus met with an IHR Emergency Committee of independent experts to discuss data collected by WHO and affected countries.
It was agreed that Mpox has the potential to spread further across countries in Africa and possibly outside the continent.
The disease was previously given PHEIC status in July 2022 after a multi-country outbreak of mpox spread rapidly across a range of countries where the virus had not been seen before - including the UK. The PHEIC was declared over in May 2023 after a sustained decline in global cases.
This time, a new strain of the virus has been found in over 100-laboratory confirmed cases in four countries neighbouring the Democratic Republic of Congo, where the disease is considered to be endemic. These countries are Burundi, Kenya, Rwanda and Uganda, and experts believe the number of cases to actually be much higher.
Last year in the DRC, reported cases increased significantly. The number of cases reported so far in 2024 have already exceeded last year’s total, with more than 15,600 cases and 537 deaths.
In declaring the PHEIC, Dr Tedros said, 'The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighbouring countries are very worrying. On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.'
Mpox was first detected in humans in 1970, in the DRC. The disease is considered endemic to countries in central and west Africa. There are currently two vaccines available to help prevent catching and transmitting the disease.
What is Monkeypox and how do you get it?
Read on for everything you need to know about Mpox, including symptoms, treatment, and the likelihood of it triggering an mpox lockdown in 2024.
Is Mpox related to Smallpox?
It is. 'Monkeypox is a pox virus of the same family as smallpox. It causes an illness that can look similar to smallpox when the rash develops – though it is less transmissible,' explains Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia.
It's vital to know that Mpox does not manifest in one, sole way. 'Virologists recognise two strains of Monkeypox virus,' adds Dr Michael Skinner, Reader in Virology, Imperial College London.
'The Congo strain is more severe (up to 10% mortality) and probably more transmissible in humans than the West African strain.' With the West African strain, mortality is estimated at about 1%.
'With cases in high-income countries it seems that there is only now a lot of attention on Monkeypox, an infection that regularly causes epidemics in impoverished, neglected communities in Central and West Africa,' Prof Piero Olliaro, Professor of Infectious Diseases of Poverty, University of Oxford, told Women's Health in June 2022, when there were cases of the disease in the UK.
'It is with a certain sense of frustration that we see again the same pattern repeating itself: attention is paid only when certain diseases hit high-income countries – an example of our collective failure to properly address "epidemic preparedness" and "global health," though they are nominally on top of our agenda with the COVID-19 pandemic.'
What are the symptoms of Mpox?
According to the NHS, the first symptoms of Mpox are flu-like. They include:
a high temperature
a headache
muscle aches
backache
swollen glands
shivering (chills)
exhaustion
A raised rash can develop in those infected. Often itchy and sometimes painful, this typically begins on the face, before spreading to other places on your body – particularly the soles of the feet and the palms of the hands. Initially, this rash presents as raised spots, which turn into fluid-filled blisters.
For most people, symptoms tend to clear in 2-4 weeks.
How is Mpox treated?
Most cases of Mpox are, thankfully, mild. 'There is no effective treatment and most cases will recover by themselves,' says Prof Hunter.
One piece of good news is that we already have vaccines that seem to protect against the infection. 'It does appear that smallpox vaccine is also effective against Mpox – though of course, not many of the UK population will have had smallpox vaccine during the past five decades,' he adds.
'The smallpox vaccine can be used pre and post exposure, and is up to 85% effective in preventing Mpox,' says official UK guidance.
How is Mpox diagnosed?
Given that symptoms could be easily confused with another infection, such as Chickenpox, a definite diagnosis is only reached following an assessment by a medical professional and a test, which is performed in a specialist lab.
How does Mpox spread?
'Mpox seems to require close contact to spread,' says Dr Skinner. 'We’ve seen infection of close family or household members and carers in hospitals, which might also include intimate contact.'
That's not to say that skin-on-skin contact is necessary, for infection to pass between people. 'Depending on the stage of infection, close range respiratory or droplet transmission can probably occur,' he adds. 'Direct contact with lesions will probably transmit the virus, which might enter by the mouth.'
The scabs which are left as the lesions heal are another potential method of transmission. 'When the lesions have healed, the scabs (which might carry infectious virus) can be shed as dust, which could be inhaled,' Dr Skinner notes.
How do we stem the flow of Mpox?
As with any infectious disease, isolation of contacts is a key part of nixing spread. 'It important that potential cases are identified, isolated and their contacts traced,' says Dr Skinner. 'The general public have no need for concern, but clinicians and public health authorities need to be on alert to spot infected cases early to limit transmission.'
Again, the smallpox vaccine can be used pre and post infection, meaning a dose could be given to close contacts of those infected.
'Isolation is one of the most effective measures to contain the spread of a disease, particularly a viral disease, because it limits the number of susceptible individuals that can be exposed to the virus,' adds Dr Carlos Maluquer de Motes, Reader in Molecular Virology, University of Surrey.
'Isolation of confirmed cases and the identification and vaccination of all their close contacts creates a circle of protected people around a positive case that is very effective in breaking chains of transmission. This "ring vaccination" strategy was successfully used to eradicate smallpox, so it is a proven strategy to contain poxvirus disease.'
Is Monkeypox a sexually transmitted disease?
Many identified cases of Mpox have occurred in people who identify as men who have sex with men. That is not to say, however, that Mpox is sexually transmitted – more that sex is naturally a close contact in situation. As such, it's conducive to spreading an infection.
'The transmission is likely occurring as a result of the close skin to skin contact that occurs during sex rather than being a truly sexually transmitted infection,' says Professor Kate Baker, Chair in Applied Microbial Genomics, University of Liverpool.
Prof Francois Balloux, Professor of Computational Systems Biology and Director of UCL Genetics Institute, University College London (UCL), agrees.
'I would urge some caution at this stage before concluding that Mpox has morphed into a Sexually Transmitted Infection (STI). Mpox is not particularly transmissible and the number of cases to date where the route of transmission is known remains relatively small.
'What is known is that Mpox is transmitted between people in close contact through body fluids, respiratory droplets, lesions or even contaminated materials such as bedding. "Sexual contact" very generally qualifies as "close contact."
'Thus, the recent observations of apparent transmission through sexual contact in the UK do not necessarily imply any recent change in the virus’ route of transmission.'
Can you get Monkeypox if you had Chickenpox?
If you have had Chickenpox, this doesn't mean that you are safe from catching mpox - the two diseases are totally unrelated. The 'pox' in their names refers to the scarring left by the itchy lesions once they have blistered.
Mpox is an orthopoxvirus, related to the virus that causes smallpox. Meanwhile, Chickenpox is caused by a variation of the herpes virus, which also causes shingles.
What should I do, if I think I have Mpox?
The NHS recommends that you contact your GP, or call 111, if:
You have a rash with blisters and either:
you've been in close contact with someone who has Mpox or has symptoms of Mpox
you've been to west or central Africa in the past 6 weeks
You should stay at home and avoid close contact with others, until a medical professional has told you what to do.
Will there be another lockdown in 2024?
Understandably, the WHO's statement has left people worrying about a Mpox pandemic - and with it, restrictions on daily life as experienced during the Coronavirus outbreak. At present, this seems to be highly unlikely.
Government figures, which are accurate up to July 31 2024, reveal that at present only a tiny percentage of the population have been diagnosed with the virus.
In 2023 and 2024 there have been a total of 286 cases of Mpox reported in the UK, and not all of them 'acquired' the disease here, some people were diagnosed after returning from a country where the virus is more prevalent. The figures also reveal that it's predominantly men who have sex with men who have been presenting with the disease, but it is transmissible to people of all genders and sexualities.
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