Context:

On August 14, the World Health Organization (WHO) declared the mpox outbreak in the Democratic Republic of the Congo and other African countries as a "global health emergency." This declaration was made by WHO Director-General Tedros Adhanom Ghebreyesus following the advice of the International Health Regulations (IHR) emergency committee. The outbreak, which first started in 2022, has seen a significant surge in cases globally, prompting the WHO to elevate its status to an acute grade 3 emergency.

What is Mpox?
Mpox, also known as monkeypox, is a zoonotic disease caused by the monkeypox virus, a member of the Orthopoxvirus genus in the Poxviridae family. Other diseases in this family include smallpox and cowpox. The virus is transmitted to humans through direct physical contact with an infected person or animal, including their blood, bodily fluids, or lesions. It can also spread through contact with contaminated materials or animal bites and scratches.

Two genetic clades of mpox exist: clade I, mainly found in central and east Africa, and clade II, more prevalent in west Africa. Although the exact source of the virus is unknown, small mammals like squirrels and monkeys are considered potential carriers.

Symptoms of Mpox
In humans, mpox typically manifests as rashes that develop into fluid-filled blisters, which can be itchy or painful. Other symptoms include fever, sore throat, headache, muscle aches, back pain, low energy, and swollen lymph nodes. The virus remains contagious until all the sores have healed and a new layer of skin has formed.

Symptoms usually appear within a week of infection but can take up to 21 days to surface. The illness typically lasts 2-4 weeks, with most people experiencing mild symptoms. However, children, pregnant women, and immunocompromised individuals may develop more severe illness.

Treatment and Vaccination

Current Treatment Options
There is no specific treatment for mpox, but the WHO recommends supportive care, including medications to relieve pain and fever. The symptoms often resolve on their own. Patients are advised to stay hydrated, maintain proper hygiene, and care for their rashes. An antiviral drug, tecovirimat, originally developed for smallpox, was approved in January 2022 by the European Medicines Agency for use against mpox in exceptional circumstances. However, its use is still limited.

Vaccination Against Mpox
Three vaccines—MVA-BN, LC16, and OrthopoxVac—developed for smallpox have been approved for preventing mpox. These vaccines are administered only to at-risk populations, as WHO does not recommend mass vaccination.

The Current Outbreak

Global Spread and WHO's Response
Mpox cases have spread to various regions outside Africa. Recently, Pakistan reported three cases of mpox, while Sweden detected the first case of clade I mpox outside Africa. The global outbreak has affected 116 countries, with over 15,600 cases and 537 deaths reported so far this year. The Democratic Republic of the Congo and neighbouring African nations remain the hardest hit, but the outbreak has also spread to the Americas and Europe. In June 2024, 19% of reported cases came from the Americas, and 11% were reported in Europe.

WHO's Emergency Declaration
The WHO has reclassified the global mpox outbreak as an acute grade 3 emergency under its Emergency Response Framework, requiring a maximal response. This classification is the highest level on the WHO's emergency list. A public health emergency of international concern (PHEIC) signals an extraordinary event that necessitates global action to prevent widespread international transmission. The goal is to mobilize immediate, coordinated responses to prevent the outbreak from escalating into a pandemic.

Mpox to Trigger Another Pandemic

How Different Is Mpox From COVID-19?

Experts say it is highly unlikely that mpox will trigger a pandemic similar to COVID-19 or swine flu. Pandemics are generally caused by airborne viruses that spread rapidly, even by individuals who may not display any symptoms. Mpox spreads much more slowly than the coronavirus.

After COVID-19 was identified in China, the number of infections surged rapidly, growing from hundreds to thousands within a short period. For example, in January 2020, COVID-19 cases increased tenfold in just one week. By March 2020, three months after its discovery, there were over 126,000 infections and 4,600 deaths globally. In contrast, mpox has taken much longer to spread. Since the outbreak began in 2022, global mpox cases have nearly reached 100,000, with around 200 deaths, according to the WHO.

Treatments for Mpox vs COVID- 19

One significant difference between mpox and COVID-19 is the availability of vaccines and treatments. When COVID-19 first emerged, there were no vaccines or antivirals available, which contributed to the rapid spread and high mortality. In the case of mpox, vaccines and treatments already exist, significantly reducing the chances of widespread outbreaks. “We have what we need to stop mpox,” said Dr. Chris Beyrer, director of Duke University’s Global Health Institute. "This is not the same situation we faced during COVID when there was no vaccine and no antivirals."

Should India Be Concerned About the Mpox Virus?

India has reported 27 cases of monkeypox since the disease was first identified in mid-2022. While the number of cases is relatively low, the risk of imported cases and the potential emergence of new viral strains underscore the importance of preparedness.

In response, Indian health authorities have initiated several measures, including contact tracing, enhanced surveillance, and public health advisories. India's ability to prevent potential outbreaks would be significantly bolstered if the Emergency Use Listing (EUL) process facilitated access to mpox vaccines.

Conclusion

The WHO is actively working to make vaccines accessible in low-income countries through emergency listings and strategic partnerships. To prevent further spread of the virus and reduce potential fatalities, a coordinated global response is essential, as emphasized by WHO and health experts. From an Indian perspective, while the number of reported mpox cases remains relatively low, the risk of imported cases and emerging viral strains underscores the need for robust preparedness.

Source: The Hindu