Public Health and Animal Health Perspectives of Mpox

History & Ongoing Global Disease Outbreaks

Mpox, formerly known as monkeypox, is a viral infectious disease caused by an Orthopoxvirus with symptoms similar to smallpox. The disease was initially identified in captive monkeys in 1958, hence the original misnomer ‘monkeypox’ (caused by the Monkeypox Virus-MPXV), when two outbreaks of pox-like disease occurred in colonies of monkeys kept for research. The first mpox was detected in 1970 in the Democratic Republic of Congo (DRC).

The disease was renamed in 2022 due to concerns about the racist language associated with the original name. Although the disease has primarily been considered zoonotic and originally confined to the tropical rainforests of central and west Africa, it has spread to other regions over the years. Most cases outside Africa have been linked to international travel and animal imports. Currently, there are two main strains of the mpox virus: Clade I and Clade II. Clade I, primarily found in Central Africa, is more pathogenic, while Clade II, mainly found in Western Africa, causes less severe infections.

Clade II was responsible for the global mpox outbreak in 2022-23. However, a more deadly subtype of Clade I, known as Clade Ib, has started spreading from the DRC to other countries. This new subtype is responsible for most of the current transmission and its rapid spread in eastern DRC, along with reports of cases in neighbouring countries, is cause for significant concern.

The recent outbreak has shown it can be a global threat. Since the start of the year, the Democratic Republic of Congo has reported over 13,700 cases and 450 deaths. Sweden announced the first mpox case outside Africa of a more dangerous variant of mpox, likewise, within days Pakistan also confirmed the first mpox-infected patient who had returned from a gulf country. In India, the first case of monkeypox was reported in a 35-year-old man, who arrived from the Middle East in July 2022.

The World Health Organization (WHO) declared the spread of mpox a global public health emergency on August 14 2024, for the second time in two years.  According to the WHO, children under 15 are currently at the highest risk, accounting for about 70% of cases and 85% of deaths. There have been 535 fatalities worldwide and the total number of cases has alarmingly increased by 160% compared to last year.

Epidemiology, Signs, Testing & Prevention

Mpox is a zoonotic disease and is transmitted from infected animals such as primates/monkeys, rodents and squirrels to humans through direct or indirect contact. Human-to-human transmission occurs through direct contact with infectious skin lesions, skin-to-skin contact and respiratory droplets. The virus can enter through broken skin, the respiratory tract, eyes, nose and mouth. Contaminated objects like bedding, clothing and towels can also act as a source of infection.

The incubation period for Mpox is typically 7-14 days but can range from 5-21 days. A person is not contagious during this period. The signs and symptoms of Mpox are similar to, but milder than, those of smallpox. The illness typically begins with fever, headache, backache, muscle aches, fatigue, chills and swollen lymph nodes. Lymphadenopathy is a characteristic feature of Mpox, and lymph nodes may swell in the neck (submandibular & cervical), armpits (axillary), or groin (inguinal) and can occur on both sides of the body or just one.

A person may be contagious during this period. After the fever breaks, a rash often develops, starting on the face and spreading to other areas, including the palms of hands, mouth, throat and soles. The rash can be painful and itchy, evolves sequentially through different stages and eventually forms scabs and then crusts, which dry up and fall off causing scarring. A person is contagious until after all the scabs on the skin have fallen off and a fresh layer of intact skin has formed underneath.

Severe cases can involve lesions on the entire body, including the mouth, eyes and genitals. Although cases of Mpox are not life-threatening, some people may be more likely to get severely ill, including people with severely weakened immune systems/history of eczema/ pregnant, and children.

The preferred laboratory diagnostic test for mpox is detecting viral DNA using polymerase chain reaction (PCR) from skin lesion samples. Mpox is treated with supportive care, which includes pain management and wound care. In some cases, vaccines and therapeutics developed for smallpox and approved in certain countries can also be used for mpox.

The WHO lists three available vaccines, but they are usually given only to individuals at risk or have been in close contact with an infected person. To prevent the spread of Mpox, isolate the infected individual and avoid contact with others, including pets. Seek medical care promptly for appropriate treatment and guidance. Maintain rigorous hygiene practices by washing hands frequently with soap and water and using alcohol-based sanitizers, particularly after touching lesions.

For Veterinarians and Animal Health Officials

Infected animals can potentially spread Mpox to people or other animals including companion animals, livestock or production animals, zoo animals, and wild animals (captive and free-ranging, as well as household pests such as mice and rats). Infection of pets like dogs and cats is possible. Animals should be tested for Mpox if they meet the suspect case definition.

Clinical Criteria in animals include rash or poxvirus-like lesions which may be macular, papular, vesicular, or pustular (generalized or localized). Other possible signs include conjunctivitis with or without ocular secretion, Coryza (crusty nose) and/or nasal secretions, cough, loss of appetite, laboured breathing, bloating and fever.

People with Mpox could spread the virus to pets through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas, and sharing food. No pets or other animals were confirmed to have Mpox during the 2022-2023 global Mpox outbreaks. A vulnerable group of people should not care for animals or be in contact with animals that are potentially exposed to Mpox.

Preventing Transmission in Veterinary Settings

To prevent Mpox transmission in veterinary settings, animals with suspected or known Mpox exposure within the past 21 days should be kept away from waiting areas and common treatment rooms, and all procedures should be conducted in a private exam room. Also, limit the number of staff in the exam room and restrict their contact with the animal. After each use, thoroughly clean and disinfect the exam room and any areas the animal has been in. Additionally, use personal protective equipment (PPE) such as goggles or a face shield and masks when handling animals with Mpox.

Bottom line: The World Health Organization has declared Mpox a global health emergency, prompting urgent action. We should implement Mpox screening for international travellers from affected regions and issue a public advisory to keep everyone informed and prepared. This situation highlights the critical need for collaboration and resource sharing, endorsing SKUAST-Kashmir’s initiative to establish a School of One Health. Let’s unite in our efforts to ensure a safer, healthier future for all.

The authors are from Division of Veterinary Epidemiology & Preventive Medicine, FVSc & AH (SKUAST-K) Shuhama

By: Aijaz Dar

Nuzhat Hassan

Shanaz Bashir