Mpox (Set 1 in English): Understanding Mpox - The Virus, Stigma, and Public Health

Title: Understanding Mpox: The Virus, Stigma, and Public Health

Host A: Hello everyone, and welcome to today’s episode of Sangyan Podcast. I’m Sakshi, and joining me is my co-host, Anu. Today, we’re diving deep into a topic that has garnered global attention—Mpox, previously known as monkeypox. There is so much to cover, from the virus itself to the stigma surrounding it, and we’re here to break it all down for you.

Host B: Hi everyone! Thanks for tuning in. You’re right, Sakshi. Mpox has been a major public health concern, especially since the 2022 global outbreak. We’ve seen it spread across multiple countries, and along with that, we’ve seen a lot of misinformation and stigma arise. We’ll touch on what Mpox is, how it spreads, its global impact, and what we can do to protect ourselves and others.

Host A: Absolutely! So, let’s start with the basics—what is Mpox? Mpox is a viral infection caused by the monkeypox virus, which belongs to the Orthopoxvirus family. This family of viruses includes other well-known viruses like smallpox and cowpox. The Mpox virus is divided into two main genetic groups, known as clades: clade I and clade II. Clade II, in particular, has been responsible for the large-scale global outbreak that began in 2022 and continues to spread across various regions. More recently, as of August 2024, a subclade of clade I, known as clade Ib, has been detected outside of Africa, which raises concerns about further geographic spread.

Host B: Yes, and although the natural reservoir of the virus remains unknown, research indicates that certain small mammals, such as squirrels and monkeys, are highly susceptible to the Mpox virus. Interestingly, the virus was first discovered in 1958 when monkeys in a research facility in Denmark exhibited a pox-like illness. This led to the initial name "monkeypox." However, the first recorded case in humans did not occur until 1970, when a young boy in the Democratic Republic of the Congo (formerly Zaire) presented with symptoms closely resembling smallpox, such as a rash and fever. This marked the beginning of human Mpox cases being documented.

Host A: And since then, Mpox has remained endemic in parts of Africa, with occasional outbreaks in other countries. But it wasn’t until the early 2000s that Mpox cases began appearing outside of Africa, like in the 2003 outbreak in the U.S. That outbreak was linked to infected pet prairie dogs, and it really highlighted the potential for Mpox to spread beyond its usual boundaries. Then, of course, the 2022 outbreak brought it to global attention, when cases started appearing in countries that had never reported Mpox before.

Host B: Exactly, Sakshi. And now, let’s discuss the global impact. According to the World Health Organization (WHO), since the 2022 outbreak, over 1,03,000 (One lakh three thousand)  Mpox cases have been confirmed in more than 120 countries. As of September 2024, there have been more than 25,000 suspected and confirmed cases and more than 700 deaths reported in 14 African countries alone. The virus predominantly affects men—96.4% of confirmed cases have been in males, with the median age being 34 years. The most affected group globally is males aged 18 to 44 years.In India, 30 cases of Mpox have been recorded since the WHO declared it a Public Health Emergency of International Concern (PHEIC) in 2022. Additionally, the country is said to be adopting preventive measures and public health strategies to manage possible future cases of Mpox.

Host A: And one thing we really need to address is the transmission patterns. Globally, the primary mode of transmission has been sexual contact, accounting for over 83% of cases. However, it’s important to note that Mpox is not a sexually transmitted infection (STI) in the traditional sense. It spreads through close physical contact, which is why sexual contact has been such a significant route. But in Africa, transmission is more varied. It includes not only person-to-person contact but also zoonotic exposure, meaning transmission from animals to humans.

Host B: That’s an important distinction. Mpox can spread through skin-to-skin contact, respiratory droplets, and even contaminated objects like bedding or towels. And while sexual contact has been the main driver of transmission globally, especially in men who have sex with men populations, it’s crucial to understand that anyone can contract Mpox through close contact.

Host A: Yes, and this brings us to the public health implications. Mpox has placed a significant burden on health systems, which are already strained by other crises like COVID-19. Diagnosing, treating, and preventing the spread of Mpox requires resources that could otherwise be allocated to other pressing health issues. And socially, the stigma associated with Mpox—particularly due to its connection with sexual transmission—has been a major barrier to effective response.

Host B: That’s such a critical point, Sakshi. The stigma has been one of the most challenging aspects of managing Mpox. Many people, especially in the MSM community, are reluctant to seek care because they fear judgment or discrimination. It is a cycle that public health systems are trying hard to break.

Host A: Exactly. And speaking of stigma, it’s not just about sexual orientation. Mpox has also been stigmatized along racial and geographical lines, particularly because it’s endemic in certain African countries. The portrayal of Mpox as a disease of African or MSM populations has fueled negative stereotypes, making it even harder to combat the virus effectively. The WHO has been working on changing the language we use around Mpox, which is why they renamed it from "monkeypox" to Mpox to reduce some of that stigma.

Host B: Yes, language is so important. Mpox progresses through three stages: Incubation, Prodrome, and Rash. The incubation period, lasting 6 to 13 days (or up to 21 days), is the time between infection and symptom onset, during which individuals are not contagious. Physicians should monitor patients for the full 21 days. The prodrome phase follows, with symptoms like fever, headache, muscle aches, malaise, chills, sore throat, swollen lymph nodes, and cough. Finally, the rash stage involves the development of skin lesions that appear simultaneously and progress through four distinct phases: macular, papular, vesicular, and pustular.

Host A: And while the rash is the most distinctive symptom, other symptoms like back pain, sore throat, and fatigue can also be present. It’s important to remember that Mpox can be severe, especially for certain groups like children, pregnant individuals, and people with weakened immune systems. In rare cases, complications like pneumonia, encephalitis, and even death can occur, especially if medical care is delayed.

Host B: The World Health Organization (WHO) has approved the first Mpox testing kit for emergency diagnosis, called the Alinity m MPXV assay. Early detection and testing are crucial for controlling the spread of Mpox. The preferred diagnostic method is PCR testing, typically using samples from skin lesions. However, if no rash is present, throat or anal swabs can also be used. With testing now widely available through local health departments, early diagnosis plays a key role in effective treatment and in preventing further transmission

Host A: Prevention is also key here. Let’s talk about prevention strategies. Isolation is crucial for those infected—staying in a separate room, avoiding close contact with others, and practicing good hand hygiene can all help stop the spread. People should also avoid sharing household items like clothes and towels with others until they’ve fully recovered. Vaccination is another essential preventive tool. The WHO has approved the MVA-BN vaccine for Mpox, and it’s recommended for high-risk groups, including healthcare workers and individuals with multiple sexual partners.

Host B: Yes, the vaccine is highly effective, especially when given early, with post-exposure preventive treatment recommended within four days of exposure. It’s been a game-changer for controlling outbreaks in high-risk communities. But beyond vaccination, public health authorities stress the importance of reducing the stigma around Mpox. Inclusive messaging and empathy are critical in reaching affected populations and encouraging them to seek care without fear of judgment.

Host A: That’s so true. To overcome the stigma, we need to ensure public health messages are clear and compassionate. Media representation also plays a big role here. Unfortunately, some media outlets have perpetuated harmful stereotypes by focusing on specific populations or regions, which only fuels discrimination. We need ethical journalism that portrays the reality of Mpox—anyone can contract it, and we all need to stay informed and protected.

Host B: Absolutely. And speaking of protection, let’s not forget the general precautions people can take. If you think you’ve been exposed to Mpox, it’s important to seek health advice and self-isolate until you can get tested. Regularly checking yourself for symptoms and having open, non-judgmental conversations with sexual partners is also important for reducing risk.

Host A: And for those already recovering from Mpox, taking care of yourself at home is vital. Keep your rash clean and avoid scratching, as that can cause infections. Stay hydrated, get enough rest, and don’t hesitate to reach out for emotional support if you need it—recovery isn’t just physical, it’s mental too.

Host B : Such good advice, Sakshi. To wrap up, Mpox is a serious health issue, but it’s one we can manage with the right strategies. Reducing stigma, improving access to care, and focusing on prevention are all key to controlling this outbreak.

Host A: Absolutely. And remember, the virus doesn’t discriminate, so we need to support each other through this by spreading awareness, not fear. Thanks for joining us today, and if you found this episode helpful, share it with your friends and family to help spread accurate information about Mpox.

Host B: Yes, thank you for listening. Stay informed, stay safe, and we’ll catch you in the next episode of Sangyan.

Host A: Take care, everyone!