Monkeypox (Mpox) Health Advisory
Written By: -
Updated On: 26th August 2024
Medically Reviewed by District Family Clinic
Background and Updates:
Mpox is a viral disease that is caused by two distinct clades of the monkeypox virus (MPXV), known as Clade I and II.
On 14 August 2024, the WHO declared that the mpox outbreak in the DRC and the growing number of countries in Africa constitutes a Public Health Emergency of International Concern (PHEIC).
As of 22 August 2024, 13 confirmed cases of mpox have been detected this year, all of which are of the less severe Clade II infections. There have been no mpox Clade I cases detected in Singapore to date. MOH is monitoring the global situation very closely.
Thus far, the outbreak remains generally confined to Africa, with two cases of the more severe Mpox Clade I reported in Sweden and Thailand.
There are currently no reports of local spread in these two countries.
Mpox Symptoms & Transmission
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Typically, the course of a person infected with Mpox will be as follows:
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Prodrome (Incubation Period of 5-21 Days)
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Symptoms:
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Fever, Malaise, Headache, Sore Throat, Swollen Lymph Nodes​
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Day 1 - 2
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Symptoms:
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Macular Rash; Centrifugal spread from face, arms, legs, then hands and feet. (Classical Spread)
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Clade 2 (e.g. from MSM contact) > Rash begins in anogenital/rectal region and spreads
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Clade 1 > Rash will NOT follow anogenital/rectal region pattern​
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Day 2 - 7
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Rash progresses from flat macules to raised papules, vesicles, then pustules.
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Day 7 - 14
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Scabs form and remain for a week before falling off.
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A person will still be infectious until the scabs fully resolve.
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Other symptoms that may appear are:
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Sores & Ulcers in the mouth
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Rash in anogenital region
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Swollen Lymph Nodes
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Clade 1 VS Clade 2: How do we differentiate them?
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Clade 1:
Typically starts with a fever > Rash will develop after D1-D3; Macular rash with centrifugal spread from face, arms, legs followed by hands and feet (Classical Spread)
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Clade 2:
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May not develop fever
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May only have a mild prodrome (mild symptoms) before the rash is noticeable
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Rash typically starts in the anogenital/rectal area
Clinical Definition for Suspect Cases
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Suspect persons who present with:
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Unexplained acute rash (differential diagnoses to be ruled out) AND
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≥ 1 accompanying symptom (Fever/Headache/Backache/Lymphadenopathy/Myalgia/Asthenia - Profound Weakness) AND
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Within the last 21 days from onset of illness:
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Had a travel history to areas or regions with recently reported confirmed cases of Mpox; OR​
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Had a history of close contact with an infected person(s); OR
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Had a history of sexual/intimate in-person contact with social or sexual networking experiencing Mpox activity (including men who have sex with men (MSM) and commercial sex workers) AND presents with lesions n or near the possible route(s) of exposure during sexual activity e.g. genitals, anus, oral or hand regions; OR
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Had contact with a wild animal(s), their bodily fluids, waste or products, in areas or regions where MPXV Clade I is endemic.
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​Travel Advisories
We advise travelers, especially to countries affected by Mpox, to take the necessary precautions which include:
• Maintaining a high standard of personal hygiene
• Avoiding direct contact with skin lesions of infected persons or animals
• Avoiding high-risk activities such as having multiple sex partners or casual sex
• Avoiding contact with wild animals and consumption of bush meat
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Returning Travelers:
Especially from countries affected by Mpox, should seek immediate medical attention if they develop symptoms (unexplained acute rash, fever, body aches) within 21 days of their return. They should inform their doctor of their recent travel and exposure history.
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Treatment, Prevention and Vaccinations:
Treatment is typically symptomatic.
The MVA-BN (JYNNEOS), a third-generation smallpox vaccine, is currently available as Post Exposure Prophylaxis (PEP) for persons who have been identified to be close contacts of confirmed mpox cases. While JYNNEOS is estimated to provide over 80% protection against mpox, current data remains limited in concluding the level and duration of protection conferred by vaccination, and persons are advised to continue adhering to the recommended precautions against the disease.
In line with international recommendations, mass population-wide vaccination is currently not recommended as a preventive strategy for mpox, as the risk to the general public remains low with disease transmission predominantly via close physical or prolonged contact.
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Sources Citations, Useful Articles and Latest Updates:
Singapore Ministry of Health Mpox Summary:
https://www.moh.gov.sg/diseases-updates/mpoxSingapore
Ministry of Health Weekly Infectious Diseases Bulletin:
Channel News Asia (CNA):
World Health Organization 2022-24 Mpox (Monkeypox) Outbreak: