Mpox: Frequently Asked Questions

With more clients asking us questions about the Mpox outbreak, Chief Clinical Officer DR. MATT EDWARDS and Lead Nurse JO THOMPSON answer some of your questions. (Last updated: 4th September)

What is it? Previously known as Monkeypox, it’s a viral disease caused by the Monkeypox virus, a member of the Orthopoxvirus genus, the same family as the Smallpox virus.

What’s going on? According to the WHO so far this year there have been over 18,000 suspected cases, including 629 deaths. This upsurge is being driven by two separate outbreaks of two strains.

Where are the outbreaks? Both are in the Democratic Republic of Congo (DRC): the first is in the north west and is primarily affecting children. The second is in the north east, and is a new offshoot, or ‘clade’ of the first. This second clade was first detected in September last year and is spreading rapidly, mainly via sexual transmission among adults.

As of the 1st September 2024, the countries in central and east Africa where Clade 1 cases have been reported are: DRC, Republic of the Congo, Central African Republic, Burundi, Rwanda, Uganda, Kenya, Cameroon, South Africa and Gabon. Sweden and Thailand have reported confirmed cases of Clade 1 Mpox in a traveller with some links to countries involved in the current Clade 1 outbreak. The rapid spread, and its detection in neighbouring countries, has caused the WHO to declare a public health emergency of international concern. And both clades are more severe than the clade which caused the global outbreak in 2022.

What are the symptoms? Fever, a sore throat, muscle aches, swollen lymph nodes, back pain, headaches, low energy, and a rash. This rash begins as a flat sore that develops into a blister filled with liquid and may be itchy or painful. As the rash settles, the lesions dry up, crust over and fall off.

For some, the first symptom is a rash, while others may have different symptoms first. Some may have one or a few skin lesions and others have hundreds or more. They can appear anywhere on the body. Symptoms usually begin within a week but can start 1–21 days after exposure, typically lasting 2–4 weeks but may last longer in someone with a weakened immune system. People with Mpox can become very sick.

How is it transmitted? In four different ways. Firstly, through close skin-to-skin contact with an infected person’s rash, scabs, or bodily fluids. Secondly, via respiratory droplets during prolonged face-to-face contact, particularly in enclosed spaces. Thirdly, by touching contaminated objects such as clothing, bedding, or surfaces. And fourthly, via animal-to-human transmission, especially through contact with infected rodents or consuming undercooked meat from infected animals. People with Mpox are infectious and can pass the disease on to others until all sores have healed and a new layer of skin has formed.

How can I protect myself? By avoiding contact with individuals with the infection, or with contaminated materials. Gloves and other personal protective clothing and equipment should be worn while taking care of the sick, whether in a health facility or in the home. Covering lesions and wearing a medical mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk but will not prevent spread from skin-to-skin or mouth-to-skin contact.

How is it diagnosed? It can be difficult to diagnose as other infections and conditions can look similar. For these reasons, testing is key for people to get treatment as early as possible and prevent further spread. A PCR swab is the best way to diagnose. Swabs taken directly from the rash are best – skin, fluid or crusts – collected by vigorous swabbing. If there are no skin lesions, testing can be done through other swabs (oropharyngeal, anal or rectal).

How do you treat it? Early and supportive care is the main way of treating Mpox and avoiding further problems. So managing the rash, pain relief and preventing complications are the mainstay of management while the body fights the illness. People with Mpox should be isolated from other people for ten days. Several antivirals, such as Tecovirimat, originally developed to treat Smallpox have been used to treat Mpox and further studies are underway, this is usually reserved for serious infections and trials.

Are certain groups at a higher risk? Yes, those at higher risk include: people with weakened immune systems (e.g., HIV-positive individuals); children under the age of eight years old; pregnant individuals; and those with existing skin conditions (e.g. eczema).

Does it affect pregnancy? Although information and data is limited, Mpox during pregnancy may lead to complications such as congenital infection or preterm birth. Pregnant individuals should seek immediate medical care if exposed or symptomatic.

Is there a vaccination? Yes, though its availability is limited at present, and we are unable to offer it through Thrive. We suggest you check with the health service in your country. It is not currently recommended for general travel purposes. The vaccine should be given within 4 days of contact with someone who has Mpox (or within up to 14 days if there are no symptoms). A full course of two doses given at least 28 days apart is recommended for those at risk. It is recommended for people at high risk to get vaccinated to prevent infection, especially during an outbreak. This includes: health workers at risk of exposure, men who have sex with men, people with multiple sex partners, sex workers.

I’ve had the smallpox vaccine, am I covered? The Smallpox vaccination offered some cross-protection. Family and community members, health workers and laboratory personnel who were vaccinated against smallpox in childhood may have some remaining protection against Mpox.

Is it safe to travel? Generally the risk of Mpox is very low for most travellers. But to reduce your risk, take the following steps:

Avoid contact (including sexual contact) with anyone who is unwell or has an unusual rash.
If you have symptoms, isolate yourself until you’ve spoken to a clinician.
Stay alert for symptoms after you have close skin to skin or sexual contact with someone new, because it can take up to three weeks for symptoms to appear after being in contact with someone with Mpox.
Avoid touching potentially contaminated items such as bedding, clothing, eating utensils, cups, food or drink.
Wash hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
Keep your hands away from your eyes, nose, and mouth. If you need to touch your face, make sure your hands are clean.
Avoid animals when travelling.

If you develop symptoms seek medical advice by telephone initially.

How can organisations prepare for potential cases amongst staff? We suggest four things. Firstly, develop clear protocols for prevention, detection, and management of cases. Secondly, ensure access to medical care where possible and establish evacuation plans for severe cases. Thirdly, provide basic education and training on Mpox for all staff members. Fourthly, maintain a stock of necessary PPE and hygiene supplies.

Where can I go for further advice? This situation may change rapidly. Check our website and social media for updates, or visit the World Health Organisation’s website.

We can offer vaccines, vaccine reviews, remote consultations and face to face appointments at our travel health clinic in London. Check out our services here.