Mpox Threat Alert in Singapore: What You Need to Know

The emergence of Mpox (formerly known as monkeypox) has raised significant concerns globally, including in Singapore. As the World Health Organisation (WHO) declared the situation an emergency, Singapore’s health authorities are taking proactive measures to monitor and prepare for potential cases. This article will provide an overview of Mpox, its transmission, symptoms, and the current situation in Singapore, along with essential precautions for travellers.

Understanding Mpox

Mpox is an infectious disease caused by the monkeypox virus, which belongs to the Orthopoxvirus genus. It primarily manifests with symptoms such as fever, rash, and swollen lymph nodes. While many cases are mild and self-limiting, serious complications can occur, particularly in vulnerable populations such as young children and immunocompromised individuals.

Historically, Mpox was endemic to Central and West Africa, with most cases outside these regions linked to international travel or imported animals. However, since May 2022, an unprecedented outbreak has been reported in multiple countries not typically associated with the virus, prompting the WHO to declare a Public Health Emergency of International Concern (PHEIC).

Transmission and Risk Factors

Mpox spreads through direct contact with infected individuals, animals, or contaminated materials. The primary modes of transmission include:

Person-to-Person Contact: This includes skin-to-skin contact, respiratory droplets, and intimate contact, such as kissing or sexual activity.

Animal-to-Human Transmission: This can occur through bites, scratches, or handling infected animals.

Contaminated Materials: Infected fluids or materials, such as bedding or clothing, can also facilitate transmission.

The current outbreak has predominantly affected individuals engaging in high-risk sexual behaviours, particularly among men who have sex with men. However, the potential for non-sexual transmission exists, especially in close-contact environments.

Current Situation in Singapore

As of mid-August 2024, Singapore’s Health Minister Ong Ye Kung has indicated that the immediate risk of Mpox in the country remains low. This assessment is based on the absence of direct flights to the affected regions in Africa, where the outbreak is most severe. However, the minister acknowledged that Singapore’s extensive global flight connections could lead to imported cases as the virus spreads to Europe and the Middle East.

Recent Cases and Surveillance

Singapore has reported ten cases of Mpox as of July 27, 2024, with a total of 32 cases recorded in 2023. All cases identified in Singapore have been of the milder clade II strain, which is less severe than the clade I strain currently spreading in Africa. The Ministry of Health (MOH) has implemented several precautionary measures, including increased surveillance at borders and the requirement for travellers to report any mpox-related symptoms upon arrival.

Public Health Measures

The MOH has emphasised the importance of public awareness and health vigilance. Singaporeans are encouraged to maintain a healthy lifestyle, monitor their health for any unusual symptoms, and seek medical attention if they experience fever or rash. Close contacts of confirmed cases will be quarantined and monitored for up to 21 days to prevent further transmission.

Symptoms and Diagnosis

Symptoms of Mpox typically appear within one to three weeks after exposure and can last from two to four weeks. Common symptoms include:

• Fever: Often one of the first signs of infection.
• Rash: This may start as flat sores before developing into blisters and can appear on various parts of the body.
• Sore Throat: Accompanied by difficulty swallowing.
• Headache: A common symptom that may be severe.
• Muscle Aches: Generalised body aches and fatigue.

Swollen Lymph Nodes: This distinguishes Mpox from smallpox, as lymphadenopathy is not typically seen in smallpox.

Diagnosis can be challenging due to the similarity of Mpox symptoms to other illnesses. Therefore, health authorities have urged medical practitioners to remain vigilant and report suspected cases promptly.

Vaccination and Treatment

Currently, the JYNNEOS vaccine, a third-generation smallpox vaccine, is available in Singapore for post-exposure prophylaxis (PEP) for close contacts of confirmed cases. It is also offered as pre-exposure prophylaxis (PrEP) for individuals at higher risk of infection. While the vaccine is estimated to provide over 80% protection against Mpox, its long-term effectiveness is still under study.

Treatment for Mpox primarily focuses on symptomatic relief, as most patients recover without specific antiviral therapy. However, serious cases may require hospitalisation and supportive care. The use of antiviral medications, such as tecovirimat (TPOXX), is being considered for severe cases.

Precautions for Travellers

Travellers should take specific precautions to avoid Mpox while travelling. Here are key recommendations:

1. Vaccination

Get Vaccinated: If eligible, travellers should receive the JYNNEOS vaccine, which is effective in preventing Mpox. The vaccination regimen consists of two doses administered four weeks apart. Even if the first dose was received more than four weeks ago, the second dose should be obtained as soon as possible.

2. Avoid Close Contact

Limit Close Physical Contact: Travellers should avoid close physical contact with individuals who exhibit symptoms of Mpox, such as rashes or lesions. This includes refraining from hugging, kissing, or sexual contact with anyone who may be infected.

Stay Away from Animals: In areas where Mpox is endemic, avoid contact with animals that may carry the virus, particularly rodents and primates. Direct contact with infected animals poses a risk of exposure.

3. Practice Good Hygiene

Hand Hygiene: Regular handwashing with soap and water or using alcohol-based hand sanitisers is crucial. This should be done especially before eating, after using the restroom, and after touching potentially contaminated surfaces or objects.

Avoid Sharing Personal Items: Do not share eating utensils, towels, bedding, or personal items with anyone who may be infected. This includes razors, toothbrushes, and clothing.

4. Be Cautious in Social Settings

Modify Activities: If travelling to events or gatherings where close contact is likely, consider reducing participation in activities that involve skin-to-skin contact, especially in crowded settings like clubs or parties.

Use Barrier Protection: When engaging in sexual activity, use barrier methods such as condoms or dental dams to reduce the risk of transmission, even though these methods do not provide complete protection against Mpox.

5. Monitor for Symptoms

Self-Monitor: After potential exposure, monitor for symptoms of Mpox for up to 21 days. Symptoms include fever, rash, and swollen lymph nodes. If symptoms develop, seek medical attention immediately and avoid contact with others.

6. Stay Informed and Prepared

Stay Updated: Keep informed about the Mpox situation in your travel destination. Health advisories and guidelines can change rapidly, so being aware of local outbreaks or health recommendations is essential.

Travel Health Insurance: Consider obtaining travel health insurance that covers infectious diseases, including Mpox, to ensure access to medical care if needed.

Conclusion

As Mpox continues to pose a potential threat, Singapore’s health authorities are taking a cautious yet proactive approach to manage the situation. While the immediate risk remains low, the interconnectedness of global travel necessitates ongoing vigilance and preparedness. Public awareness, prompt reporting of symptoms, and adherence to health guidelines will be crucial in mitigating the impact of Mpox in Singapore and beyond. By following recommended precautions, travellers can protect themselves and help prevent the spread of this infectious disease.