PULSE Medical Conditions | Monkeypox Basics

Monkeypox Overview

Mpox (formerly known as monkeypox) is a disease caused by infection with a virus, known as Monkeypox virus. This virus is part of the same family as the virus that causes smallpox. People with mpox often get a rash, along with other symptoms. The rash will go through several stages, including scabs, before healing. Mpox is not related to chickenpox.

Mpox is a zoonotic disease, meaning it can be spread between animals and people. It is endemic, or found regularly, in parts of Central and West Africa. The virus that causes mpox has been found in small rodents, monkeys, and other mammals that live in these areas.

Monkeypox History

Monkeypox virus was discovered in 1958, when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite being named “monkeypox” originally, the source of the disease remains unknown. Scientists suspect African rodents and non-human primates (like monkeys) might harbor the virus and infect people.

The first human case of mpox was recorded in 1970, in what is now the Democratic Republic of the Congo. In 2022, mpox spread around the world. Before that, cases of mpox in other places were rare and usually linked to travel or to animals being imported from regions where mpox is endemic.

The World Health Organization renamed the disease in 2022 to follow modern guidelines for naming illnesses. Those guidelines recommend that disease names should avoid offending cultural, social, national, regional, professional or ethnic groups and minimize unnecessary negative effects on trade, travel, tourism or animal welfare. The virus that causes it still has its historic name, however.

Monkeypox Types

There are two types of Monkeypox virus: clade I and clade II.

• Clade I causes more severe illness and deaths. Some outbreaks have killed up to 10% of the people who get sick, although more recent outbreaks have had lower death rates. Clade I is endemic to Central Africa.
• Clade II is the type that caused the global outbreak that began in 2022. Infections from clade II mpox are less severe. More than 99.9% of people survive. Clade II is endemic to West Africa.

(Ref: https://www.cdc.gov/poxvirus/mpox/about/index.html)

Monkeypox Transmission

Both types of Mpox can be spread from person to person mainly through

• Close contact with someone who has pox, including members of a household
• Close contact includes skin-to-skin (such as touching or sex) and mouth-to-mouth or mouth-to-skin contact (such as kissing).
  • It can also include being face-to-face with someone who has pox (such as talking or breathing close to one another, which can generate infectious respiratory particles).

People with multiple sexual partners are at higher risk of acquiring mpox. 

People can also contract mpox from contaminated objects such as clothing or linen, through needle injuries in health care, or in community settings such as tattoo parlours. 

During pregnancy or birth, the virus may be passed to the baby. Contracting mpox during pregnancy can be dangerous for the fetus or newborn infant and can lead to loss of the pregnancy, stillbirth, death of the newborn, or complications for the parent.

Animal-to-human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses or eating animals. The animal reservoir of the monkeypox virus remains unknown and further studies are underway.

Signs and Symptoms of Monkeypox

Mpox causes signs and symptoms, which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.

Common symptoms of mpox are:

• Rash
• Fever
• Sore throat
• Headache
• Muscle aches
• Back pain
• Low energy
• Swollen lymph nodes

For some people, the first symptom of mpox is a rash, while others may have fever, muscle aches or sore throat first.  

The mpox rash often begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet. It can also start on other parts of the body where contact was made, such as the genitals. It starts as a flat sore, which develops into a blister filled with liquid that may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.

Some people may have one or a few skin lesions and others have hundreds or more. These can appear anywhere on the body including: 

• Palms of hands and soles of feet
• Face, mouth and throat
• Groin and genital areas
• Anus

Some people also have painful swelling of their rectum (proctitis) or pain and difficulty when peeing (dysuria) or when swallowing. 

People with mpox can pass the disease on to others until all sores have healed and a new layer of skin has formed. Some people can be infected without developing any symptoms. Although getting mpox from someone who is asymptomatic (not showing symptoms) has been reported, information is still limited on how common it is.  

Children, pregnant people and people with weak immune systems, including people living with HIV that is not well controlled, are at higher risk for serious illness and death due to complications from mpox. 

Some people with mpox become very sick. For example, the skin can become infected with bacteria, leading to abscesses or serious skin damage. Other complications include pneumonia; corneal infection with loss of vision; pain or difficulty swallowing; vomiting and diarrhoea causing dehydration or malnutrition; and infections of the blood (sepsis), brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis). Mpox can be fatal in some cases.

How Do I Practice Self-care and Prevention from Monkeypox?

Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent transmitting mpox to others: 

Do

• Contact your health care provider for advice;
• Stay at home and in your own, well-ventilated room if possible; 
• Wash hands often with soap and water or hand sanitizer, especially before or after touching sores; 
• Wear a mask and cover lesions when around other people until your rash heals; 
• Keep skin dry and uncovered (unless in a room with someone else); 
• Avoid touching items in shared spaces and disinfect shared spaces frequently;  
• Use saltwater rinses for sores in the mouth; 
• Take warm baths with baking soda or Epsom salts for body sores; and 
• Take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen. 

Do not

• Pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or 
• Shave areas with sores until scabs have healed and you have new skin underneath (this can spread the rash to other parts of the body). 

To prevent spread of mpox to others, people with mpox should isolate at home following guidance from their health care provider, or in hospital if needed, for the duration of the infectious period (from onset of symptoms until lesions have healed and scabs fall off). Covering lesions and wearing a well-fitting mask when in the presence of others may help prevent spread. Using condoms during sex will help reduce the risk of getting mpox but will not prevent spread from skin-to-skin or mouth-to-skin contact. If having sex, use condoms as a precaution for 12 weeks (about 3 months) after you have recovered.

Taking a break from sexual activity with new partners during periods of increased transmission can reduce the risk of getting mpox. Those who have had contact with someone with mpox should monitor for signs and symptoms for 21 days (3 weeks) and take precautions such as avoiding sexual activity during this period.

Health workers should follow infection prevention and control measures to protect themselves while caring for patients with mpox by wearing appropriate personal protective equipment (PPE) (i.e. gloves, gown, eye protection and respirator) and adhering to protocol for safely swabbing lesions for diagnostic testing and handling sharp objects such as needles.

Types of Vaccines and Availability for Mpox in Thailand

Vaccination Information: Thailand

There are mainly two types of vaccines available in Thailand, such as JYNNEOS (also by the trade names Imvamune or Imvanex) and ACAM2000. JYNNEOS is a non-replicating live vaccine, meaning that it is made from a modified virus unable to reproduce in human cells, which makes it safer for those with poor immune systems. The vaccination is given as a two-dose series 4 weeks apart. On the other hand, ACAM2000 is a live replicating virus vaccine usually administered as one dose. It has more side effects, especially in immune-compromised people, so it should be preserved generally for those who can't get JYNNEOS.

With the high-risk groups in Thailand, vaccination of JYNNEOS is given priority due to its safety profiles. These vaccines have been made available at selected healthcare centers across the country, with availability varying. However, it is very important to check with local health authorities for updated information about vaccine availability and eligibility.

Vaccination in High-Risk Groups:

In Thailand, vaccination mainly occurs among those at high risk. This includes the frontline health workers who are involved in the management of mpox cases, individuals with more than one sexual partner, and individuals living in, or intending to travel to, a region that is endemic to the disease. The government urges vaccination against these populations that are at an increased risk for the spread of the virus, especially during outbreaks.

Vaccination is protective against healthcare workers and the nosocomial spread of the infection. Persons with multiple sexual partners are susceptible to contracting and causing mpox. Notably, spread in communities has already been established. Travelers to endemic regions should therefore be vaccinated to reduce the risk of exposure.

Global Vaccine Efforts and the Role of Thailand:

Thailand belongs to the global coordination of fighting mpox through vaccination. It collaborates with international organizations, such as the World Health Organization, in vaccine acquisition and provision—especially during outbreaks. Such involvement ensures that the country gets its full share of vaccines in emergency situations while at the same time contributing to the overall global strategy in the control of mpox transmission.

There have also been regional distributions of vaccines to its neighbors in cases of outbreaks within the country, part of a larger Southeast Asian effort toward promoting public health. It provides safeguarding not only to the citizens within Thailand but also assures regional stability by curbing the spread of the virus from the surrounding regions.

Comparing Mpox and Covid-19

Read more: https://www.pulse-clinic.com/comparing-mpox-monkeypox-and-covid-19

	Monkeypox	Covid-19
Causative Agent	Monkeypox  virus	SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)
Strains & Genotypes	2 clades.	Multiple variants (e.g., Alpha, Delta, Omicron)
Reservoirs	Monkeys, rodents, and other small animals	Bats (likely origin); potential intermediary animals
Transmission	Face-to-face contact. Respiratory droplets. Exposure to infectious lesions, bodily fluids, animals. Mother-to-fetus.	Respiratory droplets. Aerosols, and contact with contaminated surfaces.
Incubation Period	5-21 days	2-14 days
Rash	Fluid-filled, umbilicated pustules. Concentrated on extremities, face and genitals.	Rare, if present, can include maculopapular or vesicular rash.
Duration of Illness	2-4 weeks	2-6 weeks and some may experience Long COVID
Fatality	1-10% of cases, depending on the strain.	1-2%; with higher rates in vulnerable populations.
Vaccine	Smallpox vaccine	mRNA vaccines (Pfizer-BioNTech, Moderna), viral vector vaccines (AstraZeneca, Johnson & Johnson), inactivated vaccines (Sinopharm, Sinovac)

Mpox Complications and Long-term Effects

Scarring due to skin lesions is one of the most visible long-term effects of mpox. The characteristic rash caused by mpox will often leave scars behind, particularly when the lesions were scratched or got infected. The scars can be very bad in persons with darker skin, and this may be important in view of the fact that hyperpigmentation problems may occur more frequently in Thailand.

Besides the physical scarring, mpox can also have some psychological effects. Stigma for infectious diseases, in particular one like mpox that might have visible characteristics, can have wide impacts on feelings of isolation and mental distress. The people who recover from mpox can be very stigmatized in society, depending on the norms and cultural perceptions about the visibility of different diseases. Isolation during the infection period may lead to anxiety, depression, and alienation.

Post-Recovery Care:
These practices are all about taking proper care of the skin and overall health to ensure a smooth transition back to normal life after an episode of mpox.

1. Skin Care and Scar Prevention: Good skin care is essential for reducing scarring after mpox. One should not pick on scabs or scratch lesions, as it will only worsen the scarring. After the healing of lesions, gentle moisturizers or scar-reducing creams can be applied to the skin for better appearance. Such creams contain ingredients like silicone, vitamin E, and aloe vera, which help to heal and reduce the appearance of scars. In severe cases of scarring, a dermatologist may be consulted to get special treatments, such as laser therapy or microneedling.
2. Psychological Support: Much as the psychological effects of mpox are as important to deal with as the physical ones. People recovering from mpox will be in dire need of mental health support due to possible isolation and associated stigma. Counseling or therapy is going to help them a lot when they are in stress or depression due to the disease. Support groups in the community, whether online or off, provide a great platform for sharing experiences and encouraging one another, as coming from people who have gone through similar challenges.
3. Reintegration of Individuals Back into Society: Public education and awareness campaigns should help reduce stigma and foster understanding as individuals recover and reintegrate themselves back into society. In addition, public education programs should be considered and encouraged in Thailand to support individuals recovering from mpox and to explain the process and mode of transmission. Employers and community leaders should be urged to adopt best practices that are inclusive and accommodate their return to work or social activities after recovery from mpox.
4. Monitoring and Follow-up: Even post-recovery, health should continue to be monitored. One needs to be observant about the appearance of residual symptoms or other health problems that might have been induced by an infection in the body. Regular check-ups with healthcare providers can ensure early detection and timely treatment of any complication that could arise. This becomes even more critical for a person who has gone through a severe case of mpox or has underlying health conditions that may pose complications post-recovery.

Travel Considerations

When considering travel to or from areas where mpox is endemic or experiencing an outbreak, it’s essential to take precautions to protect yourself and others. Travelers should stay informed about the current situation in the regions they plan to visit and consider vaccination if they belong to a high-risk group or will be in close contact with local populations. Preventive measures during travel include practicing good hygiene, avoiding contact with sick individuals or animals, and carrying personal protective items like hand sanitizer and masks.

Upon returning from high-risk areas, travelers should monitor their health for symptoms such as fever, rash, or swollen lymph nodes for 21 days. If symptoms develop, seeking prompt medical advice is crucial to ensure early diagnosis and reduce the risk of spreading the virus to others. Additionally, maintaining communication with local health authorities or healthcare providers can help travelers stay informed about any updates or necessary actions related to their recent travel.

PULSE Clinic branches in Thailand
Branch	Email	Telephone Number	WhatsApp	Line
PULSE Clinic Silom	info.bkk@pulse-clinic.com	Tel: +66 65237 1936	Official WhatsApp	Official Line
PULSE Clinic Nana	info.bkk@pulse-clinic.com	Tel: +66 95915 6385	Official WhatsApp	Official Line
PULSE Clinic Sukhumvit 37	info.bkk@pulse-clinic.com	Tel: +66 92497 9353	Official WhatsApp	Official Line
PULSE Clinic Asoke – Executive Health Center	info@eu-health.org	Tel: +66 64742 6528	Official WhatsApp	Official Line
PULSE Clinic South Pattaya	info.bkk@pulse-clinic.com	Tel: +66 62828 7969	Official WhatsApp	Official Line
PULSE Clinic North Pattaya	info.bkk@pulse-clinic.com	Tel: +66 62828 7969	Official WhatsApp	Official Line
PULSE Clinic Patong Beach, Phuket	info.phuket@pulse-clinic.com	Tel: +66 95261 5282	Official WhatsApp	Official Line
PULSE Clinic Phuket Town, Phuket	info.phuket@pulse-clinic.com	Tel: +66 64059 1495	Official WhatsApp	Official Line
PULSE Clinic Nimman Chiang Mai	info.cnx@pulse-clinic.com	Tel: +66 99479 7168	Official WhatsApp	Official Line1