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A colourised transmission electron micrograph of monkeypox particles AP/Press Association
Explainer

The WHO has declared an emergency, but what exactly is mpox and why the extra concern now?

More than 14,000 cases and 524 deaths have been reported so far this year in DR Congo, already exceeding last year’s total.

LAST UPDATE | 15 Aug

THE WORLD HEALTH Organisation (WHO) yesterday declared that an mpox surge in Africa is a global public health emergency, sounding its highest possible alarm over the worsening situation.

Mpox has swept through the Democratic Republic of Congo, where the virus – formerly known as monkeypox – was first discovered in humans in 1970, and spread to other countries.

More than 14,000 cases and 524 deaths have been reported so far this year in DR Congo, already exceeding last year’s total.

Many of the mpox cases reported in DR Congo involve children who became infected through contact with animals or an infected household member.

The WHO convened a meeting of experts to study the outbreak, and the group recommended that a public health emergency of international concern (PHEIC) be declared.

Tedros Adhanom Ghebreyesus, WHO’s director general, accepted the recommendation, yesterday telling a press conference: “This is something that should concern us all.”

Different clades

Strains of mpox are known as ‘clades’.

The current outbreak in Africa is caused by clade I mpox; this tends to result in a higher number of severe infections and has a higher mortality rate.

A new virus strain, clade Ib, has been detected in the east of the DRC and has also been confirmed in Burundi, Kenya, Rwanda and Uganda.

Clade II mpox caused the global outbreak in 2022, which led to more than 95,000 cases across 115 non-endemic countries including Ireland. The vast majority of people who contact clade II mpox survive.

A case of clade I mpox was today notified in Sweden which is understood to be the first confirmed case in Europe. 

“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,” Tedros said yesterday.

“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 previously declared a public health emergency in July 2022 after outbreaks of the virus in several countries, but this status was lifted in May 2023.

What exactly is mpox?

Mpox is an infection caused by the monkeypox virus. The infection has symptoms similar to smallpox, although less severe.

Mpox is a zoonosis, a disease that is transmitted from animals to humans, with cases often found close to tropical rainforests where there are animals that carry the virus.

However, clade II mpox cases have been found in countries all over the world including Ireland.

Mpox can also spread from person to person through very close contact.

This can include:

  • sexual contact or other intimate contact (such as kissing or cuddling)
  • other types of very close contact, for example with people in your household
  • touching clothing, bedding or towels used by someone with the mpox rash or scabs
  • touching mpox skin blisters or scabs
  • the coughs or sneezes of a person with mpox when they’re very close to you

Anyone can get mpox but, during the outbreaks here in 2022 and 2023, most cases were among men who are gay, bisexual or other men who have sex with men (gbMSM).

It usually takes between five and 21 days for the first symptoms to appear.

What are the symptoms? 

  • an itchy rash
  • a high temperature (38.5 degrees Celsius or higher)
  • headaches
  • muscle aches
  • back ache
  • swollen glands
  • shivering (chills)
  • exhaustion
  • a cough
  • a runny nose

The rash usually appears one to five days after the first symptoms. Some people only have a rash.

The rash can start on your face, then spreads to other parts of your body. This can include your mouth, the palms of your hands and the soles of your feet.

Screenshot 2024-08-15 at 11.56.36 Mpox blisters Health Surveillance Protection Centre (HPSC) Health Surveillance Protection Centre (HPSC)

If mpox has been spread through sexual contact, the rash can appear around your bum or genitals. It may not spread.

The rash starts as raised spots, which turn into small blisters filled with fluid. These blisters eventually form scabs which later fall off.

What to do if you have mpox

If you think you have mpox, you should contact your GP or an STI clinic for advice. 

If you do have mpox, you will need to self-isolate until your rash is completely healed.

Self-isolation means staying indoors and avoiding contact with other people. This includes the people you live with.

If you have mpox, self-isolate until your rash has healed. Your GP can tell you when it is OK stop self-isolating.

If you live with someone who is self-isolating, avoid face-to-face contact until they have finished self-isolating.

Mpox treatment involves relieving the symptoms, there is no specific medicine available to cure it. Most people recover in two to four weeks.

Is there a vaccine?

A vaccination programme for mpox was introduced in Ireland in 2022 and was deemed a success, greatly reducing the number of confirmed cases.

Over 11,000 doses of the vaccine were delivered to around 5,000 people in 2022 and 2023.

More than 240 mpox cases were reported in Ireland in 2022 and 2023 (the vast majority in 2022), but relatively few cases are now reported. Only six cases have been reported to date this year, inlcuding one last week.

In December 2023, the HSE paused the mpox vaccination programme until further notice.

MPOWER – a programme run by HIV Ireland which aims to improve sexual wellbeing among gbMSM – previously called for the mpox vaccine to be made available as part of routine vaccinations in sexual health services.

Following yesterday’s WHO declaration, the HSE told The Journal it “will consider the need for a new vaccine programme”.

The HSE’s spokesperson noted that no cases of clade I mpox have been identified in Ireland to date.

“The HSE will be advised by the National Immunisation Advisory Committee (NIAC) and by a risk assessment under preparation by the European Centre for Disease Prevention & Control (ECDC).

“The HSE will consider the need for any new vaccination programme and the particular groups potentially in scope for vaccination.”

The spokesperson added that Ireland has “sufficient supplies” of the mpox vaccine “to meet any likely needs over the coming months”.

Contains reporting from © AFP 2024  

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