​Outbreak Announcement

On July 9, 2024, twenty cases of monkeypox (Mpox) were reported in South Africa, including three deaths.
These are the first cases reported in South Africa since 2022 when five cases were reported with no fatalities, all involving international travelers.

Surveillance Data (May 8, 2024 – July 2, 2024)
  • 20 confirmed cases
  • 3 death cases
  • 18 cases requiring hospitalization

Monkeypox (Mpox)
Monkeypox (Mpox) is a viral disease that can cause a painful rash, swollen lymph nodes, and fever. Most people recover fully, but some may develop severe illness.
The Mpox virus is an enveloped double-stranded DNA virus belonging to the Orthopoxvirus genus within the Poxviridae family, which includes smallpox, cowpox, and other related viruses.
Disease Transmission 
  • The incubation period for the virus is typically 7-14 days but can range from 5-21 days.
  • Monkeypox (Mpox) can be transmitted from person to person through direct contact with infectious skin or lesions, such as those in the mouth or genital areas. 
  • The virus enters the body through broken skin, mucous membranes (e.g., mouth, pharynx, eyes, genitals, or rectum), or the respiratory tract. Monkeypox (Mpox) can spread to household members and sexual partners, with those having multiple sexual partners at higher risk.
  • Animal-to-human Monkeypox transmission occurs through bites or scratches from infected animals or through activities like hunting, skinning, trapping, cooking, handling carcasses, or eating infected animals. The extent of virus circulation in animal populations is not fully known, and further studies are ongoing.
  • Humans can contract monkeypox (Mpox) from contaminated objects like clothing or linens, or through sharp injuries in healthcare settings or community environments such as tattoo parlors.
Symptoms and Diagnosis
Monkeypox (Mpox) symptoms typically appear within a week but can range from one day to 21 days after virus exposure. Symptoms usually last 2-4 weeks but may persist longer in individuals with weakened immune systems. 
Common symptoms include:
  • Rash 
  • Fever 
  • Sore throat 
  • Headache 
  • Muscle aches 
  • Back pain 
  • Fatigue 
  • Swollen lymph nodes
Some individuals may first develop a rash, while others experience different symptoms initially.
The rash begins as flat lesions that evolve into fluid-filled blisters, which may itch or be painful. As the rash heals, the lesions dry up, crust over, and fall off.
Lesions can appear singly or in clusters, potentially numbering in the hundreds, and may occur on:
  • Palms and soles 
  • Face, mouth, and throat 
  • Groin and genital areas 
  • Anus
  • Some individuals may also experience painful rectal swelling or difficulty urinating.
Diagnosis
The preferred laboratory test for monkeypox (Mpox) is the detection of viral DNA using polymerase chain reaction (PCR). The best diagnostic samples are taken directly from the rash—skin, fluid, or crusts—collected through swabs. In the absence of skin lesions, diagnostic tests can be performed on swabs from the mouth, pharynx, anus, or rectum. Blood tests are not recommended, and antibody detection methods are not useful as they do not distinguish between different Orthopoxvirus species.

Treatment
The primary treatment goals for monkeypox (Mpox) are managing the rash, alleviating pain, and preventing complications. Several antiviral drugs, such as tecovirimat, initially developed to treat smallpox, are used for treating monkeypox (Mpox), with ongoing studies to evaluate their efficacy.

Vaccinations 
Some smallpox vaccines, such as ACAM2000 and JYNNEOS, may help prevent monkeypox. These vaccines can be used for monkeypox prevention because the monkeypox virus is closely related to the smallpox virus.

Prevention
Most people with monkeypox recover within 2-4 weeks. To help alleviate symptoms and prevent spreading the infection to others,
 it is essential to:
  • Stay at home and in a private room if possible.
  • Wash hands frequently with soap and water or use hand sanitizer, especially before or after touching lesions.
  • Wear a mask and cover lesions when near others until the rash heals.
  • Keep the skin dry and uncovered (unless in a shared room).
  • Avoid touching items in shared spaces and disinfect shared spaces regularly.
  • Rinse mouth sores with saltwater.
  • Take over-the-counter pain relievers like acetaminophen or ibuprofen.
  • Infected individuals should isolate themselves at home or in a hospital, if necessary, throughout the infectious period to prevent spreading monkeypox (Mpox) to others.
WHO Response
On July 23, 2022, the global monkeypox (Mpox) outbreak was declared a Public Health Emergency of International Concern by the World Health Organization (WHO). The WHO has published a strategic preparedness and response plan along with a set of technical guidance documents. Surveillance, diagnosis, risk communication, and community engagement remain crucial to halting the outbreak and eliminating human-to-human transmission of monkeypox (Mpox) in all settings.

References
  • World Health Organization (WHO)
  • Centers for Disease Control and Prevention (CDC)