Mpox now a global emergency: a reality versus myths

The long-lasting aftermath of COVID-19 has sensitized the world about the news of any novel or newly extensively monitored and studied. A study reported that 42.7% of participants believed the mpox virus was a new discovery [2]. However, mpox is not a newly identified virus. The available medical literature revealed that mpox was first identified in the laboratory in monkeys in 1958. But it was 1970 when cases of mpox were discovered in humans [3].

The cases were discovered in Congo and had a higher incidence in Central and West African countries. A limited number of these cases have also been found in countries like Israel, Singapore, the UK, and the USA.

It is crucial to make clear that, even though mpox is not a recently discovered disease, current events have departed from previous norms. Mpox has been observed in several nations, deviating from its prior patterns by not being restricted to limited endemics. With this difference, we can better convey to our readers how mpox’s epidemiological features are changing. However, we have a pool of authentic data and tested established medical information and guidelines.

It’s worth mentioning that the smallpox vaccine is efficacious against the mpox virus. Further, newer vaccines are being developed. Additionally, for treatment purposes, there is also an existing antiviral medication.

With the recent surge in the number of mpox, the idea of sexual transmission of this disease has been propagated widely. However, despite the involvement of genital areas, it cannot be exclusively labeled as a sexually transmitted disease. Rather, it can spread from one person to the other with close contact, respiratory droplets, sharing fomites, and also through vertical transmission.

Moreover, animal-to-human transmission is also possible. Humans can contract this infection by coming in contact with bodily fluids or through bites of rodents and different species of monkeys [4].

This is a widely propagated concept that mpox involves only men having sex with men and bisexual men [5]. However, it is against the scientific evidence. The review of the medical literature reveals that although it is more prevalent in homosexual and bisexual men, this infection is not solely present in these groups of the population [6]. Pan et al. have revealed numerous transmission mechanisms in their study work. These include transmission from lesions through contact with infectious bodily fluids, respiratory transmission via upper respiratory tract droplets, transmission through sexual contact, transmission between animals and humans, and vertical transmission [7].

It is worth mentioning that this false perception that mpox only affects specific groups of the population such as men having sex with men and bisexual men can lead to the development of stigmatization among the LGBTQ+ community, which can cause significant health disparity.

Although the number of mpox cases has increased tremendously in the past few weeks, the extensive coverage of this infectious disease in print and electronic media has created hype that mpox is the next pandemic affecting the globe just like SARS-CoV-2 [8]. It is propagated that mpox will drastically affect the lives of the masses globally. This statement is false at many levels. First, mpox and SARS-CoV-2 are entirely different viruses belonging to two different virus classes. Furthermore, mpox is not as contagious as COVID-19. The review of the available medical literature revealed that mpox has an annual primary attack rate of 1.7/10,000 in individuals who were not vaccinated for smallpox. Additionally, it is much lower in the vaccinated individuals (0.04/10,000) [9,10]. In contrast, in the case of COVID-19, the overall attack rate was found to be 45% with a 95% confidence interval of 38–53 [11]. The second crucial difference between the epidemics of mpox and COVID-19 is in clinical presentation. COVID-19 mainly involves the respiratory tract, whereas mpox manifests as a painful maculopapular rash. They subsequently develop into vesicles and pustules. These cutaneous lesions are usually well-circumscribed with a central umbilication. The disease usually is self-limiting and resolves over two to four weeks [5].

Historically, the first case of mpox was discovered in the Democratic Republic of Congo, Africa. Afterward, multiple outbreaks of mpox have been reported in Central and Western Africa. The higher prevalence in African countries resulted in a perception that mpox is just limited only to African countries and does not pose any significant risk for the rest of the world. This is factually incorrect as the review of the recent medical literature reveals that mpox also affected United Kindom, Spain, Portugal, Canada, Germany, France, Netherlands, the United States of America, Australia, Italy, Belgium, Switzerland, and the United Arab Emirates [12].

This myth culminated in a false sense of discrimination against certain national, cultural, social, regional, professional, or ethnic groups. Additionally, it negatively affected trade, travel, and tourism in the so-called highly endemic areas. Hence, the WHO has changed the names of two old variants of mpox. The virus found in Central Africa (the Congo Basin virus) was named Clade I, whereas the one found in Western Africa was called Clade II. The WHO has also changed the name of mpox [13].

With the tremendous increase in the cases of mpox, initially, there was confusion about mpox as a major public health concern. Therefore, even the public health experts were reluctant to label it as a major public health emergency during the early course of the pandemic. However, on 23 July 2022 WHO announced the multi-countries outbreak of mpox. It also stressed that mpox represented a public health emergency of international concern [14]. However, it is important to note that the status of mpox as a public health emergency has changed over time. Currently, mpox is not a public health emergency.