Mpox update

First Suspected Case of mpox reported from India in a person having travelled abroad .

No need to panic

Mpox (formerly known as monkeypox) is an infectious viral disease affecting humans and other animals.

Mpox is caused by a DNA Virus unlike COVID virus which is a RNA virus (it’s important to know because RNA virus undergo rapid mutations)

Symptoms: Symptoms include a *rash -> blisters -> crusts over, *fever, and swollen lymph nodes. Exhaustion, muscle aches, sore throat.

Some people, the first symptom of mpox is a rash, while others may have fever, muscle aches or sore throat first.

The mpox rash often begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet.
{It can also start on other parts of the body where contact was made, such as the genitals}.
Rash starts as a flat sore, which develops into a blister filled with liquid that may be itchy or painful.

As the rash heals, the lesions dry up, crust over and fall off.

Some people may have one or a few skin lesions and others have hundreds or more.

These can appear anywhere on the body including:
palms of hands and soles of feet
face, mouth and throat
groin and genital areas
anus.

Note: Blisters are a feature of Chicken Pox but chicken pox is not usually associated with Swollen Lymph Nodes

Secondly Mpox blisters are mainly on palms and soles

Latent period:
The time from exposure to the onset of symptoms ranges from 3 -17 days,

Duration:
symptoms last from 2-4 weeks.

Symptoms can be severe, especially in children, pregnant women, or people with suppressed immune systems.

Transmission:
Close contact includes
🤝◆ skin-to-skin (such as touching or sex)
🥰◆ mouth-to-mouth, or (Lip Kissing)
😘◆ mouth-to-skin contact (such as kissing),
😫😤◆ face-to-face with someone who has mpox (such as talking or breathing close to one another, which can generate infectious respiratory particles).

◆Occasionally surface touch to abraded skin, 📞mucus membranes like nose, eyes so Handwashing is important .

Hand wash with Soap Water or Alcohol Based sanitizer.

Avoid
◆ Sharing Mobile Phones
◆ Sharing towels, beds linen etc

◆Usually transmitted from one person to another through *contact with *infectious lesion* material or fluid on the skin, in the mouth or on the genitals; this includes touching, close contact, and during sex.

🫷◆The disease is not known to spread by air respiratory route – for example, across rooms, in markets or classrooms, etc.

At Risk
-Sex workers and their clients
-Men having sex with Men
-People with Multiple sex partners
-Close contacts
-Health workers (use PPE, hand washing, mask)

Period of infectivity:
until all their lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath, and all the lesions on the eyes and in the body (in the mouth, throat, eyes, vagina and anus) have healed too, which usually takes from 2 to 4 weeks.

🧐
Diagnostic method
Viral DNA PCR on blister Fluid/ Scraping/Scab

Differential diagnosis
Chickenpox, smallpox, Scabies

Prevention
Smallpox vaccine, hand washing, covering rash, PPE, social distancing

⚓Vaccination:
Limited human studies and some animal studies have shown protection against Mpox following vaccination with Smallpox vaccines
MVA -BN or JYNNEOS (live attenuated nonreplication vaccine given ID or SC)
Only those with high risk of exposure are advised to have vaccine.

🙋‍♂️
1️⃣ Does Chicken pox vaccination protect against Mpox?
No If someone has chickenpox vaccination or infection, it offers no cross protection against mpox because they are entirely different and unrelated viruses,
However, the skin lesions look the same in both. In fact, one can be confused with the other.

2️⃣ Does previous vaccination against small pox provide any protection against mpox?
Unlikely so.
Several cases of mpox have been reported in previously immunized persons with smallpox. Best is to take precautions .

Treatment
Supportive treatment, pain fever management nutrition hydration Isolation. Prevention of secondary infection

Medication
Tecovirimat, not yet freely available but as trial enrollment

Prognosis
Most people recover

Should We curtail foreign trip?
No. Just observe safe sex practices and avoid contact with high risk community

Will mpox blow up like Covid?
No.
◆Because it is DNA Virus which does not change so often
◆Vaccine already in place
◆Treatment already in place
◆High risk community is limited.

Nevertheless be informed and vigilant

drskgupta@gmail.com