Many film aficionados would remember the film Out of Africa, which was based on the life of Danish author Karen Blixen-Finecke when she lived in Kenya.
It was released in 1985 and won seven Academy Awards, including for Best Picture.
However, this article is not so joyful as it is about mpox (previously called monkeypox), which came out of Africa and spread to other continents.
On Aug 14 (2024), the World Health Organization (WHO) director-general declared mpox a public health emergency of international concern (PHEIC) under the 2005 International Health Regulations (IHR).
In the press release, IHR Emergency Committee chair Professor Dr Dimie Ogoina had said: “The current upsurge of mpox in parts of Africa, along with the spread of a new sexually-transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe.
“Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022.
“It is time to act decisively to prevent history from repeating itself.”
Spread of mpox
Mpox is a viral infection that can spread between humans, mainly through close contact, and occasionally from the environment to humans through objects and surfaces that have been touched by an infected person.
In settings where the virus is present among wild animals, it can also spread from infected animals to humans who have contact with them.
The mpox virus has two main types, called Clades 1 and 2.
Prior to 2022, mpox infections were primarily reported in parts of Central (Clade 1) and West Africa (Clade 2) where it is endemic.
Almost all cases occurring outside of Africa were linked to international travel to endemic regions or through imported animals.
Since the beginning of the global outbreak in 2022 and until the end of July (2024), 99,176 confirmed cases – including 208 deaths – have been reported by 116 countries.
According to the Africa Centres for Disease Control and Prevention (CDC), 14,719 suspected and 2,822 confirmed cases (total: 17,541) have been reported in the African continent this year (2024) to date, including 517 deaths.
The emergence and rapid spread of the new virus strain, Clade 1B, in the Democratic Republic of the Congo (DRC) in 2023, and its detection in countries neighbouring the DRC, was one of the main reasons for the WHO’s declaration of the PHEIC.
In the past month, more than 100 laboratory-confirmed cases of Clade 1B have been reported in four DRC neighbours, which have not reported mpox before.
These countries are Burundi, Kenya, Rwanda and Uganda.
Since the WHO’s declaration of PHEIC, mpox has been reported in many countries.
At the time of writing, it has been reported in Sweden in a person who arrived from Africa; in Pakistan in an arrival from Saudi Arabia; in the Philippines in a person with no travel history; and in Thailand in a foreigner who arrived from Africa.
More reports are expected from other countries as time goes on.
Common symptoms
Mpox causes a range of clinical features.
Some infected persons have less severe symptoms, while others have more serious illness.
The features of both clades are indistinguishable.
The most common symptoms include a rash that lasts for two to four weeks, which is accompanied or followed by fever, headache, muscle aches, back pain, malaise and swollen glands.
The rash, which looks like blisters or sores, affect the face, palms, soles, groin, vagina, anus or rectum.
It may also be found in the mouth, throat or eyes.
The number of sores varies.
Some patients develop an inflamed rectum and/or genitals, which causes severe rectal pain and/or difficulties urinating.
In most instances, the symptoms resolve spontaneously within a few weeks with supportive care, e.g. medicines for pain or fever.
Clade I infections are characterised by more severe disease than Clade II infections.
Newborns, children, pregnant women and immunocompromised individuals are at increased risk of severe illness and death.
Severe disease includes larger, more widespread sores, especially in the mouth, eyes and genitals; lung infections; and secondary bacterial infections of the skin or blood.
The virus can also affect the brain (encephalitis), heart (myocarditis) or lungs (pneumonia), and eyes.
Severe mpox require hospitalisation, supportive care and anti-viral medication.
Current data indicates that the mortality (death) rate for Clade I infections is about 10% (one in 10 infected), and 0.1% (one in 1,000 infected) for Clade II infections.
The clinical features of mpox, varicella zoster infections (i.e. chicken pox and shingles) and smallpox are similar with some differences.
Smallpox has been eradicated globally since 1980.
For chicken pox and shingles, the symptoms of fever, headache and malaise are either mild or absent, and there are usually no swollen glands.
The distribution of rashes in chicken pox and shingles is centripetal, i.e. moves from the limbs to trunk of the body.
Meanwhile, mpox rashes are distributed centrifugally, i.e. moves from the trunk to the limbs.
It is rare to find sores in the palms and soles in chicken pox and shingles, but it is common in mpox.
Protection against mpox
There is no cure for mpox infections and its management is supportive.
However, a third-generation smallpox vaccine is currently available as post-exposure prophylaxis for close contacts of confirmed mpox cases, and pre-exposure prophylaxis for those at higher risk of being infected.
While the vaccine is estimated to provide more than 80% protection against mpox, there is limited data on the level and duration of protection.
In order to protect oneself and others, it is important to know the clinical features of mpox, how it spreads, what to do if one gets infected, and the risk in the local community.
It would be prudent to be vigilant and adhere to the following precautions, where applicable:
- Observe and practise good personal hygiene at all times.
- Wash hands regularly with soap, especially before handling food or eating, after going to the toilet, or when the hands are dirty from coughing or sneezing.
If water is not available, an alcohol-based hand sanitiser with at least 60% alcohol can be used.
- Avoid contact with sick persons, especially those with rash or other lesions.
- Avoid sharing common items that may be contaminated with body fluids.
- Engage in safe sexual practices and avoid high-risk activities like having multiple sex partners or casual sex.
- Avoid feeding or touching animals, especially stray or wild animals.
- Avoid consuming the meat or blood of wild animals.
Travellers from countries affected by mpox should monitor themselves for symptoms for 21 days upon return from those countries.
Seek immediate medical attention if unwell or there are symptoms like sudden high fever, swollen lymph nodes and rash, and inform the doctor of any travel or exposure history.
If mpox is confirmed, isolate from others until all the lesions have crusted over, the scabs have fallen off and a new layer of skin has formed underneath.
This will limit the spread of the virus.
Adhere to local health authority instructions on isolation at home or in a health facility.
And if having sex, be sure to use condoms as a precaution for 12 weeks after recovery.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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