Mpox: No global lockdowns, emphasis on increased education, vigilance, airport screening and monitoring

Source: National Institute for Communicable Diseases.

This declaration was prompted by rising cases in the Democratic Republic of the Congo (DRC) and other African countries.

Chris van Straten, global health advisor at International SOS, has reassured the public, however, that the Africa CDC is not recommending lockdowns or border closures at this time.

"There won’t be major restrictions on travel and business as long as everyone contributes by following public-health measures to bring this situation under control," Straten said.

"Instead, The Africa CDC emphasises increased education, vigilance, airport screening, and monitoring for symptoms. Business and travel can continue, but with informed and aware changes."

Straten was speaking at a webinar hosted by International SOS on the current mpox outbreak in Africa. His panel featured International SOS colleagues including Abraham Udoudom, medical director, Medical Services, Nigeria; and Anthony Renshaw, regional medical director, EMEA Consulting and Solutions, and Medical Services Northern Europe.

Focus on prevention

"We're not at the stage of lockdowns or shutting schools or anything like that, so let's focus on the health education, on doing our bit as individuals to protect our health for those around us," Renshaw said.

However, Straten reiterated that there will definitely be screening at airports around the world, including questionnaires monitoring for symptoms and signs, and possibly temperature checks, along with contact tracing.

Straten emphasised that each business would need to contextualise their own individual risk profile and adapt their mitigation efforts accordingly, based on where they are located in the world and the services they offer.

Manageable detection risks

Straten explained that regardless of the risk profile of each business, it is important to understand that the mpox outbreak as it stands is vastly different from the Covid-19 pandemic. "It takes time for mpox symptoms to appear, but when they do - unlike Covid-19 - they are visible and straightforward to diagnose," he said.

Also, according to the World Health Organization (WHO) and other scientific sources, the primary risk in potentially contracting the mpox virus lies in direct skin transmission.

This lies in stark contrast to Covid-19, which is primarily transmitted through respiratory droplets that are released into the air when an infected person coughs, sneezes, talks, or breathes. These droplets can be inhaled by people nearby, typically within a range of about 2m leading to infection.

In light of concerns around international travel and preventing the spread of the mpox virus across borders, Straten reassured that, "If you're on an airplane and practise basic hygiene—such as washing your hands after meals, before meals, and after using the bathroom—the risk of contracting the virus is small."

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In relation to direct travel to the DRC, he stated that he did not have health concerns for senior inbound travellers with robust immune systems going there. "This is partly because those vaccinated against smallpox have some immunity to the virus and because this disease doesn’t spread as easily or quickly as influenza or SARS-CoV-2," he said.

However, he warned that individuals who are malnourished or immune-compromised, such as those with HIV or those on immunosuppressants, may develop severe disease. "This can lead to secondary infections like pneumonia or sepsis, which can be fatal if left untreated," he noted.

Mutated mpox strain spreads

International SOS' Abraham Udoudom explained that mpox is a virus that was first discovered in 1958 and first reported in humans in 1970 in the eastern Congo and Nigeria. It is an orthopoxvirus, part of the same family of viruses as smallpox.

The strain in the DRC—known as clade 1b—is different from that in Nigeria (as of 19 August 2024, there were 39 cases in Nigeria). Clade 1b has spread to neighbouring countries such as Burundi, Kenya, Rwanda and Uganda. There are cases in Pakistan and Sweden.

"The numbers have ramped up quite significantly in the DRC, with several thousands of people getting infected," Udoudom said.

"The strain in the DRC appears to be a mutation of the previously known virus. What is particularly concerning is how infectious people are when they contract it, and how quickly it spreads.

"It's affecting everybody, (not just men who have sex with men), and a lot of young children in the DRC, especially in the refugee camps, where they're malnourished and/or immune suppressed. This is why there is a sense of urgency to take swift action to contain it, as this specific strain has not been seen before."

Straten said the symptoms of mpox include classic flu-like symptoms and lymphadenopathy (swollen lymph nodes), and that the rash forms as papules, which then become blisters. The disease is particularly unpleasant and painful, he said.

"As the blisters on the skin and in the mouth or throat rupture, there is a risk of developing a secondary bacterial infection, which can lead to conditions like abscesses or cellulitis. These would require treatment with a strong antibiotic. Immune globulin may also be used in severe cases."

However, most cases are mild or moderate.

"Your body is resilient, and your immune system will work to fight the infection. Most people will heal within two to four weeks.

"There are antiviral medications developed for smallpox and tested in animal models. While they are available in many areas, ongoing research is still evaluating their effectiveness for individuals who are already sick," Straten explained.

"Medically, epidemiologically, and financially, we need to continue engaging in business with informed, educated, and aware practices.

"Notably, in short, you will not - at this moment in time - be hearing about lockdowns or border closures. The WHO is not recommending that and Africa CDC is not recommending that.

"We'll keep you updated as the situation evolves."

International SOS is a global health and security services company that provides assistance, advice, and support to organisations and their employees, particularly in high-risk or remote locations.