Mpox: Mumbai doctors highlight why the viral disease is deadly

Pakistan confirmed its third case of the Mpox variant last week. It is the third in a series of cases being reported from around the world after Sweden, the Democratic Republic of Congo and other African countries in the last month.

The rising number has even led the World Health Organization (WHO) to declare Mpox, formerly called Monkeypox, as a public health emergency of global concern. In India, experts have come out to suggest screening at the airports. The rising number of cases is especially concerning because even India has seen rising cases of Mpox in the past, particularly in 2022. Ever since then, the WHO has reported 27 cases in India and one death from the disease.

Keeping the rising cases in mind, mid-day.com spoke to Dr Chhaya Vaja, internal medicine expert, Apollo Spectra Mumbai, and Dr Honey Savla, internal medicine, Wockhardt Hospitals, Mumbai Central to know more about the disease and how it affects people. They not only delve into the causes but also the effects, treatment and severity.

What is Monkeypox and how is it caused?
Vaja: The Monkeypox virus was discovered in 1958. Even though this disease was named Monkeypox, till that time the main reason behind its occurrence was not known. The first human case of monkeypox was seen in 1970. However, the World Health Organization changed the name of this disease in 2022, following the modern guidelines regarding the naming of diseases. That guideline suggests disease names should avoid offending cultural, social, national, regional, professional, or ethnic groups and was created to minimise unnecessary negative impacts on trade, travel, tourism, or animal welfare. However, the virus that causes the disease still has its historical name.

Savla: Mpox (previously referred to as monkeypox) is a viral zoonotic infection that is caused by monkeypox virus and results in a rash similar to that of smallpox. However, historically, person-to-person spread outside the household and mortality from mpox are significantly less than for smallpox. The rash of mpox can also be similar in appearance to more common infectious rashes, such as those observed in secondary syphilis, herpes simplex infection, and varicella-zoster virus infection.

The WHO has declared it a public health emergency of global concern. Why is the viral infection so deadly?
Vaja: There are two types of mumps viruses, Clade 1 and Clade 2. Clade 1 is a more serious disease than the others and can also cause death. Despite this, considering its seriousness it is not right to ignore it. Clade 2 is the cause of the outbreak that started in 2022. However, the symptoms in patients of this Clade 2 are indeed mild and 99 percent of people recover from this disease.

Savla: The mortality associated with mpox varies. In the 2023 outbreak in the Democratic Republic of the Congo (DRC), where it is prevalent, the estimated case fatality rate is 4 per cent overall, but is 11 per cent in children under five years of age. In earlier studies, the fatality rate in Central Africa was reported as approximately 10 percent, with deaths generally occurring in the second week of illness. Hence, it's a global emergency.

Who is most likely to suffer from the disease and why? Is it seen more in males and females?
Vaja: Mpox is seen in children and adults.

Savla: Most patients diagnosed with mpox reported high-risk sexual behaviour (for example: sex with multiple partners) as a potential risk factor. It is commonly seen in men having sex with men. Direct exposure to animals (including exposure to ill prairie dogs' urine and faeces) without personal protection equipment (PPE) was felt to be the likely source of transmission, although person-to-person transmission could not be entirely excluded.

What are the symptoms of Monkeypox and when should people visit the doctor?
Vaja: The symptoms include fever, feeling cold, swollen lymph nodes, tiredness, muscle and back pain, headache respiratory problems such as sore throat, nasal congestion and cough.

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What are the short-term and long-term effects of Monkeypox?
Vaja: The effects of monkeypox include painful rash, enlarged lymph nodes, and fever in the short term and severe complications like bacterial infection from skin lesions, mpox affecting the brain (encephalitis), and heart (myocarditis).

Savla: Long-term effects will be known in the coming years.

Can Monkeypox be treated? If not, how can people take care?
Vaja: Antiviral drugs are used to treat monkeypox.

Savla: Most immunocompetent patients with mpox have mild disease and will recover without medical intervention. However, some patients may require pain relief medication for pain related to proctitis or tonsillitis. In addition, for conditions like proctitis, stool softeners and sometimes sitz baths may need to be used. Tecovirimat was the agent most commonly used since it was available through an expanded access investigational new drug (EA-IND) protocol held by the CDC. However, data supporting the efficacy of antiviral therapy for patients with mpox are limited.

How can people prevent the disease? What are the precautions that people take?
Vaja: To prevent Mpox, it is important to get vaccinated. It is necessary to take both its recommended dosages within four weeks. If for some reason there is a delay in getting the vaccine, then it would be better to stay away from infected people. Avoid coming in skin-to-skin contact with people. Especially, do not touch people who are seeing Mpox-like rashes on their hands, face, chest, mouth, etc. Avoid kissing or having sex with people infected with mumps. If you belong to a place where this disease is spreading, avoid touching animals in such places, which carry the mumps virus.

Savla: Here are some of the precautions that people can take:
1. Skin lesions should be covered with long sleeves, long pants to minimise risk of contact with mpox lesions
2. Patients should avoid sharing their used clothes, towels, food, utensils, or face masks with others and should not allow animals to access them.
3. Individuals with mpox should wear a well-fitting facemask when around others, even if respiratory symptoms are not present. Ideally, household members should wear a facemask when in the presence of a person with mpox as well.
4. Household members providing care to patients with mpox should use disposable gloves for direct contact with lesions.

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Why are there increasing cases in African countries, Sweden and Pakistan? What is the prevalence in India and is there a possibility of it affecting people here?
Vaja: From Africa to Sweden and now Pakistan, mpox is spreading across the globe. It is a concerning viral infection that spreads through close contact with the infected person. At least 27 confirmed cases and one death due to Monkeypox have been reported in India since 2022, according to the WHO data.

How has monkeypox as a disease of concern evolved since it was first declared a health concern in 2022 by WHO?
Vaja: According to WHO data, at least 99,176 cases and 208 deaths from Mpox have been reported in 116 countries since 2022.

Can the symptoms of monkeypox be confused with any other disease in India?
Vaja: The mpox rash may be similar to chickenpox.

Savla: Mpox can be confused with smallpox or chicken pox or shingles. During the 2022 global outbreak, even India reported cases of mpox, albeit of the less deadly Clade 2 type. Initially, infections were reported among some people from Kerala who had a history of international travel. However, later even those without a history of international travel got infected in Delhi.