The rise of Monkeypox (Mpox) cases in several African countries has caused the World Health Organisation (WHO) to declare it a public health emergency. This infectious disease is caused by a virus of the same name. The first case of Monkeypox in humans can be traced back 50 years to the Democratic Republic of Congo, making it a public health concern in parts of the continent since 1970. The virus first gained significant public attention during an outbreak in 2022, when the Clade II strain, endemic to West Africa, prompted the WHO to declare a global health emergency. This warning ended after 10 months in mid-2023.
On August 14, 2024, the WHO announced a similar “public health emergency of international concern” after Congo and surrounding African nations began witnessing an unprecedented uptick in cases. While most of the 2022-23 outbreak was attributed to the Clade II variant of the Mpox virus, two offshoot variants – Clade I and Clade Ib – are on the spread now. Considered relatively severe, these mutations have now spread to several Asian countries, including Singapore, the Philippines, Thailand, Malaysia, and Pakistan, leading to heightened vigilance among authorities and those who travel.
As of August 28, 2024, the Monkeypox virus Clade Ib cases have been detected in 13 African countries: Côte d’Ivoire, Kenya, Liberia, South Africa, Cameroon, Uganda, Gabon, Burundi, Rwanda, Nigeria, Republic of the Congo, Central African Republic, and the Democratic Republic of the Congo (DRC). Beyond Africa, several other countries have detected the virus, including but not limited to Singapore, the Philippines, Pakistan, Sweden, Thailand, and Malaysia.
The first case outside the African continent was reported in Sweden just after the WHO announced the emergency for the second time in two years. The patient who travelled through a region in Africa that was reporting a Mpox outbreak was detected with the Clade I variant.
Asia’s first known case of the Clade Ib variant was confirmed in Thailand in mid-August – a 66-year-old patient who had also travelled to Africa. “Thailand’s Department of Disease Control wishes to confirm the lab test result which shows Monekypox Clade 1b in a European patient,” the Department of Disease Control said in a statement.
Passengers from both Seletar and Changi airports, along with seafarers, will now undergo Mpox screening if arriving from high-risk countries. According to Singapore’s Health Ministry, health advisories are available at airports to inform travellers about necessary precautions, and anyone showing symptoms is advised to report on arrival via the SG Arrival Card to undergo further medical testing. Vaccinations will be available for those who may have had close contact, along with contact tracing to contain future spread.
Inbound travellers to Thailand will now have to register for the Thailand Health Pass, and after clearing any mandatory screening, they will receive a QR code and a health pass to report any future symptoms.
India is taking precautionary action against potential cases with an indigenous RT-PCR testing kit and has equipped 32 labs at international airports to manage screenings. “IMDX Mpox Detection RT-PCR Assay will be manufactured at our molecular diagnostics manufacturing unit in Vadodara, which has a manufacturing capacity of one million reactions per year. The factory is all set to make the kits available,” Siemens Healthcare Private Ltd said in a statement to ANI.
Authorities in Pakistan have been screening passengers for potential Mpox infections at all airports and border crossings with Afghanistan, China, India, and Iran.
China will be monitoring both inbound travellers and cargo for signs of Mpox for six months to detect and contain any possible outbreak.
Following the WHO announcement, many countries in Africa have ramped up efforts to contain the virus by introducing several precautionary and containment measures. Botswana and Zimbabwe have recently started screening after several deaths were reported from the new strain in Southern Africa. Burundi, Kenya, Rwanda, Uganda, Malawi, Nigeria, and South Africa will also continue to increase traveller health screening procedures. Nigeria has also made it mandatory to declare medical status before travelling to other African regions.
After Sweden reported its first case of Mpox (Clade Ib) last week, WHO expressed concern over more dangerous strains infiltrating Europe. While the European Centre for Disease Prevention and Control (ECDC) maintains that the level of risk remains “low”, EU member countries are still on high alert and ready to take any precautionary action needed.
“Human-to-human transmission occurs through direct contact with the skin lesions or body fluids of infected persons, including respiratory secretions, or through contact with materials contaminated with the virus such as bedding, clothing, towels, and personal objects used by an infected person (razors, utensils, needles, toothbrushes, etc.). The virus can also be contracted during sexual intercourse or other close contact with an infected person. Having multiple sexual partners may also increase the overall risk of infection,” said Dr Santosh Kumar Aggarwal, Senior Consultant (Internal Medicine) at Marengo Asia Hospitals, Faridabad.
The WHO states that the Ib strain spreads “mainly through sexual networks, and its detection in countries neighbouring the DRC is especially concerning, which is one of the main reasons for the declaration of the PHEIC.” Clade Ib is spreading quickly in nations neighbouring Congo, including Burundi, Kenya, Rwanda, and Uganda.
According to UNICEF, the group at highest risk is children.
According to the Centers for Disease Control (CDC), the federal public health agency of the United States, Clade I infections have a higher mortality rate compared to Clade II infections with a 99.9 percent survival rate. While Clade II transmission was mostly isolated to sexual contact, Clade I is also known to spread through physical contact.
Doctors report that symptoms can appear 5 to 21 days after contracting the infection. “These include fever, chills, headache, muscle aches, joint pain, back pain, rash or lesions, swollen lymph nodes, and fever. People with Mpox may develop rashes on their hands, feet, chest, face, mouth, or near the genitals,” Dr Aggarwal explains.
Dr Suraj Saggar, Chief of the Department of Infectious Disease and chair of Infection Prevention at Holy Name Medical Center in New Jersey, US, told T+L Southeast Asia that people at risk of exposure to Mpox should consider vaccination.
“Those with specific outlined risks, i.e., known or suspected exposure to someone with Mpox, gay, bisexual, or other men who have sex with men, or a transgender, nonbinary, or gender-diverse person who in the past 6 months has had a new diagnosis of an STI or other defined high-risk behaviour, should consider two doses of Jynneos administered four weeks apart,” Dr Saggar said.
The CDC, US, recommends Jynneos as the primary preventative vaccine for Mpox, which is associated with fewer potential side effects than ACAM2000. “Both one and two doses of the vaccine protect against Mpox, but two doses provide optimal protection. People are considered fully vaccinated about two weeks after their second shot. Effectiveness is 66 to 85 percent after two doses,” he added.
If you are planning to undertake international travel now, Dr Saggar recommends first ascertaining whether your destination is among the affected areas as per WHO guidelines. Given the growing number of cases, leisure travel to high-risk areas is not advised. Suppose you are travelling to countries with few or no reported cases. In that case, it is still important to stay informed, follow precautions, and seek medical advice if you have a history of susceptibility to viral diseases or have a medical condition before travelling.
Dr Saggar emphasises getting vaccinated if in a high-risk group and considering mitigating risky behaviours, especially if travelling abroad during this period.
Here are some recommended ways to prevent the spread:
(Main and featured image credit: Ismail Mohamed – SoviLe/Unsplash)
This story first appeared on Lifestyle Asia Singapore.
Sneha Chakraborty is a journalist and photographer covering how travel intersects with food, culture, and identity. Her reporting has appeared in National Geographic Traveller India, Lonely Planet, Conde ..Read More
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