Mpox is in the news. Previously, and often still, known as Monkeypox (because it was originally identified in monkeys even though monkeys are not considered the natural hosts – there have been concerns around racist notions to do with monkeys and Africa in general), mpox is an infectious viral illness that affects humans and animals. It spreads by direct contact with infected lesions (at this time it is not thought to spread in the air) meaning that fairly close contact is required for spread. This includes sexual contact, family contact, situations that involve overcrowding and or poor hygiene, as well as meat handling and close contact with infected animals. Mpox has been known from around 1970 or so and has long been endemic in parts of Africa.

Mpox is usually a mild-moderate illness from which most people recover. Common symptoms include fever, fatigue, swollen glands, and a blister-type rash.  Complications can and do occur, especially in those with compromised immunity (malnourished, very young, HIV positive, elderly, etc.). Complication can include brain infection, pneumonia, blindness and more.

There is no specific treatment or vaccine for mpox although the smallpox vaccine (no longer in wide use) has been shown to be quite effective. It may be that the increasing prevalence of mpox in recent years is, at least in part, due to the declining use of smallpox vaccine over recent decades.

There are at least two important strains of mpox with clade 1 being more dangerous than clade 2. Fatality rates vary quite significantly, ranging from under 1% to as high as 10% is some studies. This is thought to be mainly due to the varying strains (clade 1 vs clade 2) but socio-economic and related factors pay a large role too (well fed folks with good access to healthcare do better than under nourished poverty-stricken folks with limited healthcare access).

In recent years (post 2022) there has been a notable increase in mpox cases in Africa. In 2024 there is growing concern and cases have been confirmed outside of Africa. The World Health Organisation has become quite concerned and there has been talk of “a new pandemic” in some quarters. Others though, consider this somewhat unduly alarmist and point to the need for a cautious balanced approach, remembering that the Covid-19 pandemic response is still being debated (many increasingly consider the response to have been heavy handed and or excessive). This is likely to be an ongoing debate for some time to come.

In August 2024 Mpox some 20-30 confirmed cases have been seen in South Africa, with three fatalities so far. It is quite possible there are more cases to come and the department of health has expressed concerns.

At this time, the best advice seems to focus on good personal hygiene (hand washing especially) and careful handling of both meat and animals at all times. Safer sex is an important measure as well.

Mpox is a well-known viral illness that has a variable but significant fatality rate even though most patients recover fully. There will be more learnings in the immediate future. It seems that sensible caution, but not panic and not excessive knee-jerk interventions with dubious benefits, is the best approach (personally, regionally, and globally) at this time.

Written by Dr Colin Burns