Mpox is a viral illness caused by the monkeypox virus, a species within the Orthopoxvirus genus. This disease, historically known as monkeypox, is related to the smallpox virus. While global attention to Mpox increased during the 2022-2023 outbreaks, the virus has a long-standing presence, particularly in the Democratic Republic of Congo. Understanding its origins and characteristics in this region provides important context.
Mpox in the Democratic Republic of Congo
The first human case of Mpox was identified in 1970 in a nine-month-old child in the Democratic Republic of Congo (DRC), then known as Zaire. This occurred just two years after smallpox was declared eradicated in the country. Since this initial detection, the DRC has consistently reported the majority of Mpox cases worldwide, establishing it as an endemic region.
Mpox virus exists in different genetic groups, known as clades. The Congo Basin clade, now Clade I, is historically prevalent in the DRC. This clade causes more severe disease than other strains, such as Clade II (formerly West African clade), which caused the 2022-2023 global outbreak. Only Clade I has been detected within the DRC’s borders.
Factors contributing to Mpox persistence in the DRC include extensive forested areas and human interaction with animal reservoirs. Historically, infections were often traced to contact with animals in rainforests, affecting children through hunting rodents. Increased human penetration into jungle areas, often due to war, migration, and poverty, has increased exposure to infected animals. Declining immunity to poxviruses after smallpox vaccination programs ceased has also played a role in Mpox’s continued emergence.
Understanding Mpox Symptoms and Transmission
Mpox infection begins with an incubation period of 3 to 21 days, during which a person shows no symptoms. After this period, initial symptoms often resemble a flu-like illness, including fever, headache, muscle aches (myalgias), back pain, exhaustion, and swollen lymph nodes. These prodromal symptoms may appear before the rash, or the rash may be the first or only noticeable sign.
The characteristic rash develops 1 to 4 days after flu-like symptoms begin. This rash progresses through distinct stages:
Flat spots (macules)
Raised bumps (papules)
Fluid-filled blisters (vesicles)
Pus-filled lesions (pustules)
Crusting over and forming scabs
These lesions can be painful, becoming itchy as they heal, and often appear on the face, hands, feet, chest, mouth, or near the genitals and anus. The illness lasts for two to four weeks until the scabs fall off and new skin forms.
Mpox primarily spreads through close, prolonged personal contact with an infected individual. This includes direct skin-to-skin contact with the rash, scabs, or bodily fluids, such as during intimate contact. Contact with contaminated materials like bedding, towels, or clothing used by an infected person can also lead to transmission. While less common, the virus can spread through respiratory droplets during prolonged face-to-face contact. Pregnant individuals with Mpox can also transmit the virus to the fetus during pregnancy or to the newborn during or after birth.
Prevention and Treatment of Mpox
Preventing Mpox infection involves several practical measures. Avoid close, skin-to-skin contact with individuals who have Mpox symptoms, especially those with a rash. Practice good hand hygiene, such as frequent washing with soap and water or using an alcohol-based hand sanitizer. Also, avoid contact with contaminated materials like bedding or towels used by an infected person.
Vaccination plays a role in preventing Mpox, particularly for individuals at higher risk of exposure. The JYNNEOS vaccine is approved for both smallpox and Mpox prevention. This vaccine contains a weakened form of the vaccinia virus, related to the Mpox virus, which cannot cause the disease. The JYNNEOS vaccine is administered as a two-dose series, given four weeks apart, with full protection developing about two weeks after the second dose.
Most Mpox cases are mild and resolve on their own without specific antiviral treatment within a few weeks. Treatment for these cases focuses on supportive care to manage symptoms. This includes pain relief using over-the-counter medications like acetaminophen or NSAIDs, fever reduction, ensuring adequate fluid intake, and proper skin care for the rash. Antiviral medications, such as tecovirimat (TPOXX), are available but are generally reserved for severe cases or individuals who are immunocompromised. While tecovirimat is FDA-approved for smallpox, its use for Mpox is often under an investigational protocol. Studies suggest that for patients without severe disease or risk factors, supportive care and pain management are typically sufficient for recovery.