Mpox – Is It Safe to Travel?
On August 14, 2024, the World Health Organisation (WHO) announced that the significant increase of Mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern. Clade I Mpox cases have been reported beyond the epicentre of the outbreak, the DRC, with nine additional countries reporting cases including Sweden who reported Clade I Mpox in a traveller who had returned from Africa. (August 2024).
History of MPox
Mpox was initially discovered in Monkeys in 1958 and human Mpox was first described in 1970 when sporadic cases presented in rural areas of Democratic Republic of Congo. Outbreaks have since occurred in 9 central African region countries.
There are 2 distinct clades of the Mpox virus: Clade I Mpox is currently considered more severe than Clade II Mpox, leading to its classification as a high consequence infectious disease.
What is Mpox?
Mpox is a rare disease caused by infection with the Monkeypox virus. It is related to but distinct from the viruses that cause smallpox and cowpox. It is a viral infection with potential human transmission through close contact and in countries where Mpox is present among wild animals it can be transmitted to people who have contact with them.
How is it transmitted?
MPox can be transmitted not only from animal hosts but also from infected humans. The virus enters the body through broken skin, the respiratory tract or the mucus membranes (e.g. eyes, nose, mouth and genitals). This occurs when a person comes into close contact with infected lesions, body fluids (e.g. sexual intercourse and kissing, respiratory droplets or contact with material contaminated with the virus (e.g. bedding, towels and clothing).
Incubation is between 5 and 21 days, but typically 6 to 13 days following exposure. Usually, it is a self-limiting illness with spontaneous and complete recovery within 3 weeks of onset.
Severe illness is higher in newborn babies, children, pregnant women, immunosuppressed individuals, and especially persons with advanced HIV disease it can lead to complications and death.
Death rates in different settings may differ due to access to healthcare and underlying immunosuppression, including undiagnosed HIV.
Signs and symptoms: Between one and five days after a fever has developed, a generalised rash can appear around the genital area, bottom region or the face, which can spread to other parts of your body. The rash will go through different stages and will end up with a scab.
A person will be contagious until after the scab falls off and the skin underneath becomes intact. It is important to note that the scab may also be infectious. Other signs and symptoms to look out for are Headache, Muscle aches, Backache, Swollen glands(lymph nodes), Shivering (chills), and Exhaustion.
While you have symptoms, you can pass Mpox on to other people. Anyone who thinks they may be experiencing possible Mpox symptoms should contact NHS 111 for advice and self-isolate.
Where is the risk?
The countries reporting laboratory-confirmed Clade I mpox (historic or current) include: DRC, Republic of the Congo, Central African Republic, Burundi, Rwanda, Uganda, Kenya, Cameroon and Gabon
The countries where there may be a risk of Clade I mpox exposure (based on sharing a border with the DRC) currently include:
Angola, South Sudan, and Tanzania
MPox Treatment
Clinical diagnosis can be difficult, and it is often confused with other infections such as chickenpox. Anyone who thinks they may be experiencing possible Mpox symptoms should be advised to contact NHS 111 for advice and self-isolate. Real-time polymerase chain reaction of skin lesions is used to diagnose Mpox.
Treatment for Mpox is mainly supportive, with persons who have severe disease or those who are at risk of severe disease receiving antiviral medication.
MPox Prevention
A vaccine has been made available to protect high risk individuals during outbreaks.
Only persons who are at high risk (e.g. Occupational risk or persons who have been in close contact with someone who has Mpox or someone who belongs to a group at high risk of exposure to Mpox) are currently considered for vaccination.
People who were vaccinated against smallpox in childhood may experience a milder disease.
Travellers and Occupational Risks
- Persons working in laboratories where pox virus are handled and others at risk of exposure to pox virus (designated healthcare staff) should consider receiving the vaccine.
- All travellers should be fully immunised according to the UK schedule. If the traveller belongs to a high-risk group for Mpox, they may be able to arrange the Mpox vaccine through their local sexual health clinic.
- Inform travellers of the signs and symptoms, transmission and what to do if they become ill with Mpox.
- Inform the traveller of the ongoing risk in the country they are visiting.
- The traveller should avoid close contact, including sexual contact with persons who may be infected. Wearing a condom will not fully protect you from Mpox but may reduce your risk and it will help protect you from HIV and other sexually transmitted infections.
- Clean hands frequently with soap and water or an alcohol-based hand rub.
- In countries where some animals have been found to carry the Mpox virus (East, Central and Western Africa) avoid unprotected contact with wild animals especially those that are sick or dead.
- Any meat should be thoroughly cooked.
Fact sheet developed using both direct quotes and summaries from formal sources.
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Resources
ECDC Mpox Factsheet 2024. Available at: Factsheet for health professionals on mpox (europa.eu) Accessed 22/08/2024
NaTHNaC) 2024. Mpox. Available at: Mpox (who.int) Accessed 22/08/24
NHS England 2022. Mpox Available at: Mpox – NHS (www.nhs.uk) Accessed 22/08/2024
PubMed Mpox and HIV: a Narrative Review. Saldana, Kelley, Aldred and Cantos. 2023 May 13: 1-9 Available at: Mpox and HIV: a Narrative Review – PMC (nih.gov) Accessed 22/08/2024
UK Health Security Agency. 2022. Greenbook Smallpox and Monkeypox. Available at: Green Book Chapter 29 Smallpox and monkeypox (publishing.service.gov.uk) Accessed 22/08/2024
UK Health Security Agency. 2024 Mpox: background information. Available at: Mpox: background information – GOV.UK (www.gov.uk) Accessed 22/08/2024
UK Health Security Agency. 2022 Recommendations for the use of Pre-and post-exposure vaccination during a monkeypox incident. Available at: Pre- and post-exposure vaccination during a monkeypox incident (publishing.service.gov.uk) Accessed 22/08/2024
UK Health Security Agency. 2024. WHO declares Mpox outbreak a public health emergency of international concern. Available at: WHO declares mpox outbreak a public health emergency of international concern– GOV.UK (www.gov.uk) Accessed 22/08/2024
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