Mpox: emergence of a new threat

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A new threat related to mpox is emerging, in the shape of a Clade Ib mpox outbreak centred in the Democratic Republic of the Congo (DRC), which has prompted the World Health Organisation (WHO) to declare a global health emergency of international concern. This blog outlines where this new threat has come from, and its possible implications.

Mpox (previously known as Monkeypox) is a disease caused by the Monkeypox virus (MPXV) which was first identified in monkeys in 1958 and as a disease in humans in the 1970s. Until the last couple of years, mpox was restricted to fairly localised outbreaks in Africa. However, in 2022, a global outbreak of mpox occurred, which was circulating mostly in young gay, bisexual, and other men who have sex with men (GBMSM). This outbreak, caused by Clade IIb has reached around 10,000 cases worldwide, and has been identified in many parts of the world.

Earlier this year, it became apparent that something new and different was emerging in Africa, mainly in the DRC. A new outbreak emerged with some different features. Whilst details are still a bit sketchy, this new outbreak is caused by a different clade (or genetic sub-type) of MPXV called Clade Ib, it’s associated with an even gender split and a higher rate of serious disease and mortality. Historically, Clade I mpox has been associated with a case fatality rate of more than 10%, although the early data linked to the Clade Ib outbreak suggests that the case fatality rate is around 3%.

Mpox is caused by the enveloped, monkeypox virus belonging to the Orthopoxvirus genus, Poxviridae family, which includes cowpox virus, variola virus (causing smallpox) and vaccinia virus. Mpox is a disease characterised initially by a fever followed by the development of a painful rash. Most people recover fully, but some patients will suffer serious complications. Treatment for mpox is mainly supportive; some antiviral treatments are available for serious disease and high risk patients. Vaccination is an effective measure to prevent mpox, and is available for some high risk groups. There is no specific vaccine for mpox so vaccines developed for smallpox are used – the viruses are sufficiently similar for these to be effective.

Mpox can be transmitted via contact and through the air. Mpox is usually transmitted only through close physical contact – most commonly via sexual contact. Mpox can less commonly also be transmitted via contact with a contaminated environment or through contact with infected animals. The vaccina virus, which is used as a testing surrogate for MPXV, is stable in the environment when dried onto surfaces, and it’s likely that MPXV will have the same properties. In one study, the vaccina virus survived for at least 28 days when dried onto various different porous and non-porous materials under different environmental conditions. Several studies have undertaken environmental sampling and found both MPXV DNA and cultured viable MPXV from environmental surfaces in healthcare settings. One study found 56 (93%) of 60 samples were positive for MPXV DNA in the rooms of patients with mpox. Therefore, thorough cleaning and disinfection of the environment is a vital part of preventing transmission of mpox, especially in healthcare settings.

Since MPXV is an enveloped virus, it is susceptible to inactivation by a wide range of chemical agents used for disinfection in healthcare settings. Clinell Universal and Clinell Peracetic Acid Wipes have both passed the relevant disinfectant testing standard (EN14476) to demonstrate virucidal activity, with testing undertaken in accredited third-party laboratories (please contact us for further details). GAMA Healthcare also provide hand wipes and other infection prevention solutions, such as room disinfection systems and the Rediroom (a patient containment solution), which could form a part of planning to prevent the spread of mpox in healthcare settings.

High levels of community transmission of Clade Ib mpox outside of Africa seems unlikely at this stage, but the situation is evolving. With mpox Clade Ib cases continuing to spread in Africa, now is the time to prepare to identify and manage a patient with mpox wherever you are in the world!

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