Zakariya Waqar-Uddin: Mpox - another global emergency
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Although the risk of spread further afield remains low, as of last week, one case has been reported in Pakistan, and one in Sweden, showing how quickly a virus can travel.
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Hide AdThe previous outbreak was in 2022, with over twenty-two thousand cases and around 900 deaths, this being less than one percent.
At the time there was much controversy. Firstly, the name monkey pox was seen as potentially racist and stigmatising. Furthermore, as the disease mostly affected homosexual and bisexual men, many individuals were reluctant to come forward for help.
At that time, the WHO declared a similar state of emergency. Thankfully with safe sex practices and vaccination, the spread was brought under control and the state of alert finished in early 2023.
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Hide AdThe virus was first identified in a group of research monkeys in Denmark in 1958, hence the name monkey pox.
However, it was not until 1970 that the first human case was identified in a young boy in the DRC. Since then, this has been where the majority of cases have been identified.
The virus is very similar to the smallpox virus. It has an incubation period of a few days during which the individual becomes unwell with the typical features of any viral illness.
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The classic rash is very similar to that of small pox, with fluid filled blisters that affect the face, chest, arms and sometimes the genitals.
For the majority of otherwise healthy individuals, the condition is short lived with a recovery period of a few weeks. In this time the blisters shed and healthy skin is restored.
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Hide AdYet, for children, pregnant women, those with weakened immune systems and the elderly, the course can be much more severe. Complications can include pneumonia, which can prove fatal.
It is thought that the resurgence of mpox may be in part due to not having immunity to small pox, its much more deadly cousin. Smallpox was eradicated in 1980, and now only exists inside laboratory conditions.
There are notable differences between this outbreak of mpox and that in 2022. There are two forms of the virus, Clade 1 and 2. That in 2022 was caused by Clade 2, which is common in the DRC. It mostly affected men who sleep with men. Though able to spread rapidly, fatality rate was around one percent.
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Hide AdThe outbreak at the present time is caused by Clade 1. This is far more virulent, especially in its subtype, named 1b. Unlike Clade 2, it is spread by any close contact including coughing and sneezing. It is present in shed skin cells hence can be caught by anyone in close contact with a person with the disease. It can be transmitted from household items such as towels and bedding.
Hence it is not a disease that just affects one particular demographic.
Most worryingly, mortality is much higher, at somewhere between 5-10 percent. Children tend to be at the higher end of this scale.
In terms of actual risk, the UK remains low. However, with global travel, anyone returning from a high-risk area is a potential carrier. Many countries have advised that they will be screening all individuals arriving from any such country for at least the next six months.
It is therefore prudent not to travel to any country where there is an outbreak at present. Apart from the DRC, the neighbouring countries Rwanda, Burundi, Kenya and Uganda are at present recording much higher numbers of cases than previously.
There are three vaccines available, all based on those previously used to treat small pox.
As with many viral illnesses, the majority of otherwise well persons will make a full recovery if they contract the illness.
However, at the present time it is perhaps safest to avoid any country where an outbreak has been declared.
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Dr. Zakariya Waqar-Uddin, General Practitioner.
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