Mpox: How dangerous is the new variant? | Expert Answers | CNA Explains

Introduction Mpox has been declared an emergency  by the WHO after a serious outbreak   in Africa. How worried should we be? I'm Chan Eu Imm and this is infectious diseases expert Dr Hsu Li Yang, and today we're answering your questions about mpox. What is mpox? What’s the difference between clade 1 and clade 2? What is mpox? Doctor, what is it? Mpox is a disease caused by the mpox virus, which belongs   to a large family of pox viruses that also  includes members such as smallpox and what's   And what's the difference between the clade 1 and the clade 2 strain?  These are like virus variants, kind of like   when we think of COVID-19 variants, for instance.   So the clade 1 virus originated from central Africa   while the clade 2 virus originated from West Africa. The disease for both is similar except that for the   clade 1 virus there's a higher risk of serious  illness and death.   How is mpox transmitted? How is mpox transmitted? How contagious is it, doctor? In the past, mpox was passed  mainly from small rodents to humans, and that's   what we call a zoonotic transmission. In the most  recent outbreaks, mpox has been spread between   humans by close contact - that means people who  are like, for instance, when we're talking to   each other, there is a very small chance that  the virus can transmit between us. In the outbreak   in 2022 and currently as well, sexual transmission  has featured very predominantly. Somehow, the virus   has changed such that initially clade 2 spread  more easily amongst humans and now it seems clade 1   has also changed or evolved to do the same.  How dangerous is mpox? How dangerous is mpox, doctor? Mpox has a chance   of causing death or disability, with clade 1 having the higher risk at close to 3% in Africa   as compared to the clade 2 virus, which has a less  than 1% risk of someone dying from it. Who is most at risk of serious illness? Who is most at risk if they contract the virus? From what we know currently, those with compromised immune   systems and in Africa that's mainly those with the  human immunodeficiency virus - or HIV infection - are  at higher risk of poor outcomes. Of course, we also  think that the elderly and very young children   would similarly be at risk of a worse outcome  if they're infected with mpox. What are the symptoms? And what are the symptoms, doctor? So, most people present with an  initial flu-like illness. They'll have fever,   body aches, maybe cough and respiratory tract symptoms.  And then a few days later, they will start   developing the pox or the boils on their body.  And this actually looks like a worse version of   chickenpox. So I think we are most familiar with  chickenpox, where there are crops of lesions   or boils on the body and the mpox boil is usually  about five or 10 times the size of a chickenpox boil.   Is it itchy? Does it hurt? Is it painful? Yes, it is itchy and it is painful as well. And this   will last for usually about two to four weeks before it  all fades away Okay, and after it fades will it leave a permanent scar?   Just like with chickenpox, there  is a risk that there would be a scar that's left behind, but most people heal and then the marks  fade over time. And like chickenpox, does the virus also stay in the body? Does it lie dormant in the body? I know the name sounds similar because   they all end with "pox", but the chickenpox is from  a very different family of viruses compared to the mpox virus. So the mpox virus doesn't stay in the  body long term, unlike the chickenpox virus.   Are there blood tests or swab tests that can be done at home? Is there a blood test to determine mpox? Are there any swab tests we can do at home?   Yes, there are blood tests and swab tests but the swab tests can't be  done at home because we don't have one of those   kits like for COVID-19 where you swab your nose  and then you run the test yourself. So currently,   mpox is confirmed via a test that detects the  DNA of the virus and that can only be done in the   microbiology laboratories in Singapore, including  our national public health laboratory. So if I were to feel ill and suspect that I have mpox, what should I do? Where should I go? The first thing is to go and see a doctor. I think most of us have never seen mpox in our lives and so going to a   doctor to confirm it would be best. And then, the  doctor - whether it's the polyclinic doctor or GP -   can best direct a person to maybe the National  Centre for Infectious Diseases if they feel that   the individual most likely has mpox. What are the incubation and post-recovery risk periods? What are the incubation periods and post-recovery periods for mpox?   In essence, how long should we self-quarantine?  The incubation period is about 2 weeks before the   symptoms first appear. As for how long it  takes to recover, generally it takes up to a month. I think in Singapore, someone with mpox  would be kept in a hospital isolated until all   the boils have disappeared before they are allowed  to go home. But I did mention that mpox can be   sexually transmitted and the current advice is  to abstain from sexual intercourse for about two months after recovery, because the virus can  be found in the semen of men who have recovered   from mpox up to more than a month after they have recovered. How do we treat mpox? How is mpox typically treated? Currently, we don't actually have a drug for mpox. There are  different medications that have been used, more recently one of the more promising ones, which  is Tecovirimat, has been shown to be not effective in   preventing death from mpox in a clinical trial  in Africa. So currently, most of the time we would   treat a patient symptomatically and they would  recover on their own. And how widely available is this medication? Tecovirimat is available in Singapore,  but not all doctors are able to prescribe it. Generally, one can get it at the National Centre for Infectious Diseases. Are there vaccines for mpox? Are there vaccines for mpox and are children vaccinated against it? Yes, there are two vaccines that are licensed for mpox.   These were originally designed for smallpox  but because they are very closely related viruses, vaccination against smallpox also protects  one against mpox. These vaccines are present   in Singapore but they are not easily accessed by  everyone. They're not on the childhood immunisation   schedule nor are they on the adult immunisation  schedule. Currently there's no need for these vaccinations to be on the immunisation schedule  because cases of mpox are very rare in Singapore.   How can we protect ourselves from mpox, doctor? What should we do? How can we protect ourselves from mpox? Mpox spreads by close contact   so the main thing is to avoid an individual with  mpox or someone who has got multiple boils and   you're unsure what they are. Will it spread like COVID-19? Will it spread like COVID-19? Is it as infectious as COVID-19? Are we possibly looking at another lockdown? Fortunately, mpox is not going to spread as readily as COVID-19.   COVID-19 spreads in the forms of droplets and aerosols and  that is many, many times more transmissible than mpox. Is it safe to travel to Cape Town? Is it safe to travel to Cape Town now? Is it safe?  The WHO has not recommended against travelling to   any African country and it is certainly safe to  travel to Cape Town. Is Singapore at risk of an mpox outbreak? Has it reached our shores? And given Singapore is a travel hub, are we at risk of a possible outbreak? So we have had mpox cases in   Singapore, just dozens each year, and these have all  been of the clade 2 mpox - the less deadly variant.   I think as the clade 1 variant spreads out of  Africa, then the risk will increase since after all   we are a travel hub to many countries around the world. Is Singapore’s healthcare system ready to manage the disease? What is the government doing in preparation   for mpox reaching our shores? I think  what this person is asking is, is our healthcare   system ready to manage the disease? The Ministry of Health has been giving regular press updates.   They are obviously surveying the countries and  to make sure, to be aware up to date where the   cases are. Doctors and the healthcare system  have also been informed to look out for cases of   mpox and because we don't expect a big outbreak in  Singapore, our healthcare system certainly is not   going to be challenged by this current outbreak.  That's all we have for this episode on mpox, if you enjoyed it, let us know. Leave us a comment and  subscribe and we'll see you in the next episode.