Should we get ready for another pandemic? Will another virus cause massive lockdowns? Well, before you panic, let's discuss the facts. In 2022, there was an Mpox outbreak caused by the clade II virus. The outbreak claimed 58 deaths out of 32,063 cases in the United States of America. ¹ Globally, there were 99,518 cases, 4,322 of them being in areas where Mpox is commonly reported, and 95,196 being in historically unreported areas. This goes to show the impact the virus had around the world in areas where the virus is not typically found. The endemic countries for Mpox were Cameroon, the Central African Republic, the Democratic Republic of Congo, and Nigeria. However, the majority of the countries where Mpox was found in 2022 were non-endemic countries including Canada, the United States of America, the United Kingdom, and Spain among others. ² The World Health Organization swiftly announced a public health emergency because of a confirmed case in Sweden on August 15, 2024. The patient was diagnosed with clade I virus. This clade is far more dangerous with a case fatality rate of up to 11%. ⁹

Brief History

According to the World Health Organization, Mpox (formerly known as Monkeypox) was first discovered in 1958 in Denmark. ³ A group of monkeys kept for research first displayed signs of a smallpox-like infection among them, hence the name monkeypox. However, the World Health Organization has since changed the name to Mpox to avoid offending cultural, social, national, regional, professional, or ethnic groups. ⁴ The Monkeypox Virus (MPXV) is an Orthopoxvirus that displays similar symptoms as smallpox in humans.

Symptoms

How can you tell if you have Mpox? Well, do you have any of the following symptoms? Initial symptoms include fever, chills, headache, myalgia or muscle ache, fatigue, and lymphadenopathy or swollen lymph nodes. You might be wondering, these are all symptoms of smallpox, how is Mpox different? The swollen lymph nodes are the key differentiating symptom between smallpox and Mpox. After 1-2 days, mucosal lesions form around the mouth, then lesions occur all over the body including the face, arms, legs, and genitalia. ⁵ However, some vulnerable patients may experience severe effects of Mpox including myopericarditis (inflammation of the heart casing and muscle), neurological complications, ocular infection, and complications from uncontrolled viral spread due to severe immunocompromise, particularly in advanced HIV infection. ⁶

Development of Rash and Transmission

Lesions go through four phases - macular, papular, vesicular, and, pustular, followed by a phase of scab formation. These evolve for 2-4 weeks in 1-2 day increments. The lesions will remain in the pustular phase for 5-7 days before crusts form. This is a lengthy, painful process for the patient. Lastly, the crusts will remain and evolve for 7-14 days before falling off which is when the patient is no longer considered infectious. The whole ordeal takes 3-4 weeks after symptoms onset. ⁵

Mpox is transmitted through close contact with an infected person, animal, or contaminated object. This can include direct, close, face-to-face, or intimate interactions with a person infected with the virus. Transmission can also occur through bodily fluids, skin lesions, and respiratory droplets of infected animals. ⁵

Mpox data suggests the virus first came from rodents and not monkeys. However, infections have been observed in squirrels, rats, mice, prairie dogs, and humans. There are two clades of this virus, clades I and II, further divided into subclades, Ia, Ib, IIa, and IIb. Clade I, known as the Central African clade, and clade II, known as the West African clade, are geographically distinct. Clade II is associated with higher human-to-human transmission causing the global outbreak in 2022. ⁷ However, clade II and its subclades are less severe and according to the Center for Disease Control (CDC), have a 99% survival rate. ⁴ Clade I, on the other hand, has a case fatality rate of up to 11%. ⁹ How do we know which clade is more transmissible between humans? In May of 2021, a traveling family returned from Nigeria (West Africa) to the United Kingdom and became infected with the Mpox virus. One member of the family was infected on day 0, another on day 9, and the last one on day 33. ⁸ This can demonstrate the transmission was through human-to-human contact. Instances similar to this have been observed with up to six sequential events of transmission between people. ⁹

Detection

How is Mpox detected? According to the World Health Organization, DNA polymerase chain reaction (PCR) is the preferred method of laboratory testing. The best samples are ones taken directly from the rash, whether it is a skin sample, fluid, or crust sample that is collected by vigorous swabbing. If skin lesions are not present, anal, rectal, or oropharyngeal swabs can be used. ¹⁰

Did you know Norgen Biotek offers both research use and approved, IVD use Total Nucleic Acid Preservation Tubes? This is ideal for swab DNA and RNA collection, especially for viral DNA or RNA isolation and analysis as it not only preserves the host nucleic acid but also all viral DNA/RNA present. Additionally, the tubes preserve DNA at room temperature for up to 4 months and RNA at room temperature for up to 2 months. That's what makes this kit great for situations where laboratory testing is not readily available. The kit allows for easier storage and shipping to laboratory facilities until further testing.

For PCR testing, the DNA from the swab sample must be isolated first. Norgen Biotek’s approved Saliva DNA Isolation Kit provides high-quality isolation without the presence of PCR inhibitors or other contaminants in the sample. The DNA isolated is compatible with most downstream applications. For high throughput (research use) requirements, the Pathogen/Viral Nucleic Acid Isolation Kit (Magnetic Bead System) is perfect. The magnetic systems are fast and easy to use, and it is fully compatible with most automation platforms.

Treatments

According to the CDC, there are no approved treatments for patients with MPXV infection as most patients are able to recover on their own with the help of supportive care and pain control. Tecovirimat is a novel antiviral that was available for some patients during the 2022 outbreak. The drug is currently under trial and it is still unknown who might benefit from Tecovirimat. What specific clinical benefits might occur using this drug is still under investigation. However, it is currently the only option for Mpox besides pain management and supportive treatments. ⁶

Due to the painful nature of the rashes from the virus, it is important to consider medication for patients displaying rash symptoms. Topical steroids and anesthetics such as lidocaine can be considered for local pain relief. However, in more severe cases, prescription medications such as gabapentin and opioids have been used for short-term management of significant pain. ⁶

Vaccination

Fortunately, there are two vaccine options available against Mpox in the United States of America. First, let's talk about the JYNNEOS (Bavarian Nordic, Hellerup, Denmark) that was approved for the prevention of smallpox and Mpox in 2019. JYNNEOS, also known as MVA-BN, is a third-generation non-replicating live vaccine. It is an attenuated vaccine that does not replicate in the body but rather creates antibodies that fight the active virus. The vaccine is approved for adults 18 years or older who have an increased likelihood of MPXV infection. ¹¹ There are two subcutaneous doses, one on day 0 and another on day 28. ¹² The vaccine is very effective with an 85% success rate at protecting patients against Mpox. ¹¹ According to the CDC, during the 2022 outbreak, MVA-BN was the primary vaccine choice for most people.

The second available vaccine is ACAM2000 (Emergent Product Development Gaithersburg, MD, USA) which is a second-generation vaccine containing a live vaccinia virus. It is licensed by the United States to prevent smallpox however, it is recommended by the Advisory Committee on Immunization Practices (ACIP) for some people at risk of orthopoxvirus exposure. This vaccine requires informed consent and it is administered via a single percutaneous dose with a bifurcated needle. The reason for MVA-BN being the main vaccine is due to the lesser display of adverse effects compared to ACAM2000. According to a review by Poland, Kennedy and Tosh, some “mild side-effects including pain at the site of injection (85% of recipients); redness, swelling, itching, and induration at the site of injection (40–60%); fatigue, muscle pain, and headaches (20–40%); nausea (17%), chills (10%)” were reported. Fever is rare, with only around 2% of recipients reporting it. Similarly, cardiac events were only reported in around 2% of recipients, and myopericarditis was not found in any vaccine recipients. ¹²

Say you are not vaccinated and contract the virus. What now?

Thankfully, the CDC has a solution to help you! They suggest you take the MPXV vaccination within 4 days of exposure for your best shot at preventing disease onset. Yes, you read that right, you can get vaccinated after exposure. If the vaccine is taken within 4-14 days of exposure, it may reduce symptoms but it will not prevent the infection.

Now that we have discussed the facts, it is unlikely there will be massive lockdowns or another pandemic. Although frightening, Mpox transmission can be reduced with proper hygiene, personal protective equipment, vaccines, and other preventative measures. Sure, it’s a good idea to be prepared for the worst-case scenario, but panicking will help no one. With the help of Norgen Biotek’s Total Nucleic Acid Preservation Tubes and Saliva DNA Isolation Kit Dx, researchers can learn more about the virus and design strategies to fight it better.

During the pandemic, Norgen was at the forefront of producing millions of COVID-19 detection kits and supplying them worldwide. Norgen is ready, yet again, to help you with detecting and studying this emerging disease. With high-quality collection, preservation, and DNA isolation products that are high throughput and automation-friendly, Norgen strives to make research and development straightforward and comfortable. At Norgen Biotek, we deliver excellence and we deliver it fast.