CNA Explains: Who’s at risk of mpox, and how worried should you be?

SINGAPORE: For the second time in two years, the infectious disease mpox has been declared a public health emergency of international concern.
The World Health Organization’s (WHO) highest level of alert – same as how COVID-19 was categorised – comes on the back of an outbreak in the Democratic Republic of Congo spreading to neighbouring countries.
The latest alert was issued on Aug 14, 2024.
In mid-2022, thousands of mpox cases circulated around the world, including in Singapore, leading to the WHO making a similar declaration.
The disease was previously known as “monkeypox” until that term was phased out in November 2022.
The virus that causes mpox is transmitted from human to human through large respiratory droplets or body fluids, especially from rashes and sores and intimate contact including hugging, kissing and sexual intercourse.
The chances of getting the disease are “extremely remote”, said infectious disease specialist Leong Hoe Nam, who runs a private practice at Mount Elizabeth Novena Hospital.
“To get it from individuals in Singapore in the local context, (the chances are) very slim, unless your partner has (it),” he said.
“The proof is in the pudding. The cases which we had of mpox, we quarantined all the contacts but none of them developed mpox subsequently.”
Dr Leong added that even in a crowded MRT train, “the physical proximity which you have is not sufficient (for the disease to spread)”.
“Transmission usually occurs when there is close skin-to-skin contact with someone who may have been infected (including sexual contact),” said Dr Shawn Vasoo, who is clinical director at the National Centre for Infectious Diseases (NCID).
“Usual or transient interactions like sharing an office space, or sharing a meal are activities that are low risk and unlikely to spread mpox.”
Like many infectious diseases, those who are elderly or very young or are immunocompromised are at higher risk, said Dr Khoo Yoong Khean from the Duke-NUS Centre for Outbreak Preparedness.
The scientific officer added that the incidence in this current outbreak appears to be higher among men who have sex with other men.
“That doesn’t mean that they are at a higher risk of getting the disease, but that the disease (circulates) within this community,” he said. 
He added that one possible reason why it is more detected among this particular community is that more often than not, its members do regular testing and health checks, leading to heightened vigilance and detection. 
“As we try to understand the disease pattern, we need to communicate accurate facts to the public and avoid stigmatisation because this would lead to underreporting of cases by infected individuals and subsequently increasing spread,” he said. 
Dr Khoo added that while mpox can be sexually transmitted, it is not considered a sexually transmitted disease.
“While the reported population does appear to be disproportionately men and men who self-identify as men having sex with men, there is no specific advice for that community over and above the general advice around not coming into contact with persons who are demonstrating the signs of infection,” Senior Minister of State for Health Janil Puthucheary said in Parliament in 2022.
“Mpox is not a new disease, so there are established diagnostic and treatment protocols for it and there is some experience in dealing with the disease,” said Dr Khoo. 
With continuous work being done on the disease and its spread, the medical community expects to see new evidence that will guide them in making better decisions, he said.
“My advice is to be vigilant on the symptoms. If you or someone you know who has mpox symptoms, to quickly seek medical attention. This will also help authorities to conduct public health intervention measures like contact tracing to stop the spread.”
Dr Vasoo noted that the mpox patients he has seen have been mostly mild. He added that in some cases, patients have had fever, and a rash on their body.
MOH said previously that a small percentage of those infected can fall seriously ill or even die. Other than immunocompromised individuals, those “particularly vulnerable” to complications are young children and pregnant women. 
Dr Vasoo noted that most mpox patients do not require specific treatment, and the illness will heal with time.
However in some individuals who have severe disease or low immunity, they may need treatment with medications – for example antivirals such as cidofovir.
Dr Leong said that for those who are well and contract the disease, including those who have chronic illnesses, they will take two to three weeks to recover on their own.
“If you do get it, the major problem is the inconvenience of being quarantined for 21 days,” he added.
He noted that the immunocompromised, like some cancer patients and transplant patients, may suffer more serious effects. 
“In unusual circumstances in severe infections affecting the eye or brain (these would be uncommon), there could possibly be some post-infection complications,” added Dr Vasoo.
This includes visual loss if the cornea of the eye is affected, he noted.
No vaccines are yet available, although efforts are underway to change that and work out who best to target. 
Smallpox vaccination meanwhile provides some cross-immunity, experts said. 
Dr Puthucheary said this is up to 85 per cent effective in preventing mpox, but has significant side effects.
“For the general population, the risks of complications outweigh the benefits because the general population is at a low risk of being infected,” he said.
Otherwise, the advice is to maintain a high standard of personal hygiene, including frequently washing your hands such as after going to the toilet or when your hands are dirty, said Dr Michael Wong, a family physician at Raffles Medical.
People should also avoid direct contact with skin lesions of infected living or dead persons or animals, as well as objects that may have become contaminated with infectious fluids, such as soiled clothing or items like bedding or towels used by an infected person.
Avoid consuming bush meat and stay away from wild animals that could harbour the virus, he added. The virus has been found in animals such as rope squirrels, tree squirrels and different species of monkeys.
Returning travellers, especially from areas with a mpox outbreak, should seek immediate medical attention if they develop symptoms like sudden onset of high fever, swollen lymph nodes and rash within three weeks of their return. 
“They should call the clinic ahead of their visit so that special precautions can be taken to protect others,” he said.
They should also inform their doctor of their recent travel history.
Additional reporting by Matthew Mohan