-pox (formerly known as monkey-pox) is a zoonotic infection that can spread from animals to humans. M-pox is caused by a virus related to the virus that causes smallpox. The viral disease can also be contracted from one person to another and causes high fever and body pains. The World Health Organisation declared m-pox a public health emergency of international concern in July 2022. So far, there have been about 87,000 confirmed cases of the disease internationally, with almost 140 related deaths. Recently, Pakistan confirmed its first two cases of m-pox. According to an NHS report, on April 17, a very sick person who had been deported from Saudi Arabia for overstaying landed in Islamabad with high-grade fever, rashes, headache, muscle aches and sore throat. The samples of the said person, who is a resident of Rawalpindi-Islamabad, were sent to the NIH, which confirmed that he was infected with the disease; he was then admitted to an isolation ward of the Pakistan Institute of Medical Sciences.

When do the symptoms develop after exposure?

M-pox symptoms usually start within three weeks of exposure to the virus. If someone has flu-like symptoms, they will usually develop a rash 1-4 days later.

The most common symptoms of monkey-pox include fever, headache, muscle aches, back pain, low energy and swollen lymph nodes, followed or accompanied by the development of a rash which may last for two to three weeks. People with m-pox often get a rash that may be located on hands, feet, chest, face or mouth or near the genitals, including the penis, testicles, labia, vagina and anus. During this time, a person does not have symptoms and may feel fine.

The rash can initially look like pimples or blisters and may be painful or itchy. The lesions will then mature into scabs and heal. Sometimes, people have flu-like symptoms, e.g., sore throat, nasal congestion or cough before the rash. Some people get a rash first, followed by other symptoms. Others only experience a rash.

Is it contagious?

Yes, a person with pox can spread it to others from the time symptoms start until the rash has fully healed and a fresh layer of skin has formed.

M-pox can spread to anyone through close, personal, often skin-to-skin contact with the m-pox rash and scabs from a person with the viral disease, as well as contact with their saliva, upper respiratory secretions (mucus) and areas around the anus, rectum or vagina. This direct contact can happen during intimate contact, including oral, anal or vaginal sex, or touching the genitals (penis, testicles, labia and vagina) or anus of a person with m-pox. Hugging, massage and kissing can also spread the disease. Hence it is a sexually transmitted disease. Prolonged face-to-face contact can also transmit infection.

Can this infection be transmitted to the fetus during pregnancy?

Yes, it can spread to the fetus during pregnancy and can cause stillbirth. It can also spread to the newborn by close contact during and after birth.

Can it spread to and from animals?

The most common route for transmission of m-pox from infected animals to people is direct contact with the infectious rash, scabs, crusts or fluids from sores, saliva or infected bodily fluids, including respiratory secretions. Urine and faeces that contain infectious viral particles may also be a source of infection. It is possible that people with m-pox can spread it to animals through close contact, including petting, cuddling, hugging, kissing, licking, sharing sleeping areas and sharing food.

M-pox is treated with supportive care. Most people with m-pox recover within two to four weeks. Complications include pneumonia, skin infection, confusion and eye infection leading to loss of vision. Patients must follow contact precautions as advised for Covid-19 infection.

Can m-pox spread through water?

No studies have found a clear link between m-pox and water in pools, hot tubs or splash pads. The m-pox virus is killed in water at the chlorine levels recommended for disinfection.

What is the treatment for an m-pox infection?

M-pox is treated with supportive care. Most people with m-pox recover within two to four weeks. Complications include pneumonia, skin infection, confusion, and eye infection leading to loss of vision.

Patients must follow contact precautions as advised for Covid-19 infection. Persons with m-pox should isolate at home or at a hospital if needed for the duration of the infectious period (from the onset of symptoms until lesions have healed and scabs fall off). Wash hands often with soap and water or use hand sanitiser, especially before or after touching sores. Wear a mask and cover lesions when around other people until the rash heals. Use saltwater rinses for sores in the mouth. Take

sitz-baths or warm baths with baking soda or Epsom salts for body sores. Take paracetamol/ ibuprofen for fever and pain.

How to prevent the disease?

Avoid close contact, including sex or being intimate with anyone suspected of having the disease. When you visit a clinic or hospital, wear a mask and sanitise your hands frequently. Do not pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or shave areas with sores until scabs have healed and you have new skin underneath.

When to get tested?

Currently, testing is only recommended in case of a rash consistent with mpox.

Laboratory confirmation of m-pox is done by testing skin lesion material by PCR. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. Testing blood is not recommended.

What is the role of vaccination?

JYNNEOS is a two-dose vaccine developed to protect against m-pox and smallpox infections. People need to get both doses of the vaccine for the best protection against m-pox. The second dose should be given four weeks after the first dose. The most common side effects after JYNNEOS vaccination are pain, redness and itching at the spot where the vaccine is given. It may also cause fever, headache, tiredness, nausea, chills and muscle aches.

Vaccination is contraindicated if a person develops a severe allergic reaction to it.

Note: The Centre for Disease Control recommends vaccination against m-pox if there is known or suspected exposure to someone with m-pox. It is recommended for front-line health care professionals, for those with multiple sexual partners, patients with low immunity as in case of having HIV infection, or those having other sexually transmitted infections. Pakistan has requested the provision of vaccines by WHO.

The writer is a consultant family physician [MBBS, FCPS, MRCGP(INT)], www.oladoc.com