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Understanding Monkey pox: A Re-Emerging Zoonotic Disease

A zoonotic viral disease is an infection caused by a virus that can be transmitted from animals to humans. These diseases may either be caused by domesticated or wild animals and they spread using an infected animal’s secretions, urine, or other body fluids. However, there are times when the viruses pass through intermediary hosts as in the case of mosquito or tick bites.

Monkey pox is a zoonotic viral disease caused by the Mpox virus, a member of the Orthopoxvirus genus. It is mostly found in Central and West African countries; however, it has now been spotted in other areas due to travel and animal trade. Humans can get Mpox via contact with infected animals or their body fluids. It can also be contracted through respiratory droplets or direct contact between human beings. Fever, headache, swollen lymph nodes, and a unique itchy rash are its main symptoms which go through various stages of severity. Despite being mostly self-limiting, Mpox can bring about serious illness in young children, pregnant women, and people with weak immune systems.

Mpox is caused by the Mpox virus, a member of the Orthopoxvirus genus that also includes the variola virus responsible for smallpox. While smallpox has been eradicated, Mpox remains due to its zoonotic nature, primarily circulating among wild animals. Human cases of Mpox were first identified in 1970 in the Democratic Republic of the Congo. The virus has since spread in Central and Western Africa, particularly in rural areas near tropical rainforests, where contact with infected animals is more common.

There are two genetic clades of the Mpox virus:

• Central African (Congo Basin) clade: It causes more severe transmissible disease.
• West African clade: Typically results in milder clinical presentations.

Recent outbreaks in Europe, North America, and Asia highlight the risk of global transmission, particularly linked to international travel and the trade of infected animals. These events underscore the need for global surveillance and quick public health responses.

Mpox transmission occurs in both animal-to-human and human-to-human forms:

• Animal-to-human Transmission: This happens through direct contact with the blood, bodily fluids, or skin lesions of infected animals. African rodents, such as squirrels and dormice, are believed to be the primary reservoirs, but primates can also carry the virus. Transmission can occur through bites, scratches, handling infected animals, or consuming undercooked meat of the infected wildlife.
• Human-To-Human Transmission: Although less efficient, it can occur through:

1. Respiratory Droplets: Prolonged face-to-face contact.
2. Direct Contact: Touching bodily fluids, lesions, or contaminated items like clothing or bedding of the affected person. 
3. Vertical Transmission: From mother to fetus during pregnancy or close contact after birth.

The disease follows two distinct phases:

• Prodromal Phase (1 to 5 days): Symptoms include fever, headache, lymphadenopathy (enlarged lymph nodes), back pain, myalgia, and fatigue. Lymphadenopathy is a key differentiating feature from smallpox.
• Eruptive Phase: Characterized by the onset of a rash that begins on the face and spreads to the body, including the palms and soles. The rash progresses through stages like macules, papules, vesicles, pustules, and scabs. Unlike chickenpox, Mpox lesions are at the same stage of development across the body.

• Secondary bacterial infections, pneumonia, sepsis, encephalitis and corneal infections which may cause permanent vision loss. 
• While Mpox is generally self-limiting, severe cases are more likely in children, pregnant women, and immunocompromised individuals.

Diagnosing Mpox requires both clinical evaluation and laboratory confirmation. 

• Clinically, Mpox should be suspected in patients with an unexplained rash, particularly if there is a history of travel to endemic areas, contact with known cases, or exposure to potential animal reservoirs.
• Laboratory testing: Polymerase Chain Reaction (PCR) testing of specimens from skin lesions, such as vesicular fluid or scabs, is the gold standard due to its high sensitivity and specificity. Serological tests and antigen detection are less reliable due to cross-reactivity with other orthopoxviruses.

While there is currently no specific antiviral treatment for Mpox, ongoing research aims to improve management options. Researchers are exploring antiviral medications and therapies that could target Mpox more effectively. These treatments are still under investigation, but they promise to enhance our ability to manage and control the disease. 

One promising avenue is the use of Tecovirimat, an antiviral drug originally approved for smallpox. Tecovirimat has shown potential in treating other orthopoxvirus infections and may be beneficial for Mpox cases, helping to reduce the severity and duration of the illness. 

As studies progress, these emerging treatments could play a crucial role in future Mpox outbreak responses.

• Stay in regular touch with your healthcare provider to update them on any changes in your condition. Report any new or worsening symptoms promptly to ensure timely adjustments to your treatment plan.
• Ask about specific recovery steps, including medications, follow-ups, and lifestyle changes. 
• If you have questions or concerns about potential complications or long-term effects, address them with your provider to receive clear guidance and support.

• Isolate-infected patients: Keep people with Mpox away from others to prevent the spread of the virus. Isolation helps ensure that they receive proper care and reduces the risk of transmission to healthy individuals.

  Use proper personal protective equipment (PPE): Wear gloves, masks, and gowns when caring for Mpox patients or handling their items. PPE helps protect healthcare workers and others from coming into contact with the virus.

  Sterilize contaminated surfaces: Regularly clean and disinfect surfaces that may have come into contact with Mpox patients or their fluids. This helps kill the virus and prevents it from spreading to others.

  Administer JYNNEOS vaccine: The JYNNEOS vaccine helps protect against Mpox by stimulating the immune system. Vaccinating high-risk groups (healthcare workers or people in affected areas) can prevent the disease or reduce its severity if exposed. The vaccine is not yet available in India.

• Cook Meat Thoroughly: Ensure that all meat, especially from wild animals, is cooked to an internal temperature of at least 165°F (74°C) to kill any potential viruses.
• Avoid Raw Wildlife Meat: Refrain from eating raw or undercooked meat from wild animals, as it poses a higher risk of transmitting zoonotic diseases like Mpox.
• Practice Hygiene: Wash hands and surfaces thoroughly after handling raw meat or coming into contact with potential sources of infection to prevent cross-contamination.
• Public Awareness and Education play a vital role in managing and preventing Mpox outbreaks. It’s essential to inform communities about the symptoms of Mpox. Educating the public on recognizing these symptoms can lead to early detection and prompt medical treatment, reducing the risk of severe complications and spread. Additionally, raising awareness about the risks associated with handling wild animals, especially in endemic areas, can help prevent zoonotic transmission.
• Good hygiene practices are crucial for preventing Mpox transmission like regular hand washing with soap and water and avoiding close contact with individuals showing symptoms. 
• Addressing misinformation and reducing the stigma around Mpox is also important. Public health efforts should focus on providing accurate information through various channels to counteract myths and encourage individuals to seek medical help without fear. By ensuring that people are well informed and prepared, communities can better manage and control Mpox outbreaks.

Mpox is a re-emerging zoonotic disease with the potential for global spread, making it vital for healthcare professionals and the general population to be well informed. Understanding the etiology, transmission dynamics, clinical presentation, diagnostic criteria, and control measures is crucial for early detection and effective management. For the latest updates on Mpox, consult reliable sources like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).