Case of Mpox confirmed: What Nepal should do to control it?

The World Health Organization declared Mpox a public health emergency of international concern (PHEIC) on 14th August 2024. It was spread across central and east Africa, but the first case was reported in Asia a few months back and now it has reached Nepal.

A 36-year-old man from Tanahun, tested positive for the disease as he returned from Saudi Arabia. Currently, he is receiving treatment at Sukraraj Tropical and Infectious Disease Hospital in Teku. Dermatologists all over the country have been notified to refer suspected cases for testing. Thailand confirmed the first case of the clade I b Mpox strain in Asia a few months back. An Indian 26-year-old man from Hisar in India  with a recent history of an M-pox-infected nation tested positive for the virus (Mpox clade 2) in September 2024.

As Nepal shares an open border with India, the chances of spreading are even higher compared to other countries. Twompox strains are clade I and clade II. Clade II is milder and was responsible for the 2022 outbreak, but this time, clade I, known as clade I b, causes more serious diseases and higher death rates.

Mpox is caused by the mpox virus, which is brick or oval in shape and has a size of 200-250nm and linear double-stranded DNA. The transmission is from face-to-face (talking or breathing), skin-to-skin (touching or vaginal/anal sex), mouth-to-mouth, and respiratory droplets. Animal (rodents and primates) to human transmission is seen.

The incubation period is generally 1-21 days from exposure, and symptoms can last 2-4 weeks. The main symptoms are rashes with fever, sore throat, headache, and muscle aches. A rash begins as a flat sore that develops into a liquid blister and may be itchy or painful. It is important to distinguish Mpox from chicken pox, measles, herpes, or some other bacterial skin infection rashes, as people may get confused.

The confirmatory laboratory test is PCR (Polymerase Chain Reaction), which is done by collecting swab samples from the rashes. If people are in contact with someone with mpox, then vaccination within four days is recommended, or if there are no symptoms, then within fourteen days, vaccination should be done. There is another question in everyone’s mind: can it be fatal? Yes, it can be. At present, WHO recommends the use of MVA-BN or LC16 vaccines or the ACAM2000 vaccines when the others are not available. Travelers who are traveling from such outbreak reasons are also advised to be vaccinated.

Last year, a 60-year-old foreigner -a woman-was confirmed positive for mpox in Nepal. As it has already entered Nepal, preventive measures should be the priority. Early detection and isolation are crucial as WHO recommends contact tracing and quarantine measures. The country should have quarantine facilities for people returning from disease-prone zones at the airport and border areas. Vaccination facilities should be available in hospitals and Nepal after having a history of Mpox disease the country still doesn’t have the facility of vaccination service.

One who doubts having the infection can go into quarantine. Washing hands with soap in case of contact and using masks near the infected person can prevent the disease. Nepal should be ready to handle the cases as there is a possibility of a new health emergency. The hospitals must have a standard operating procedure (SOP) that details the steps to handle the cases of mpox.

(Jaishi is a research scholar and currently working in a virology lab at South Asian University, India.)