Understanding the Severity of Mpox and Available Treatments

Mpox, previously known as monkeypox, continues to be a significant health concern, particularly in the Democratic Republic of the Congo (DRC) and surrounding regions. The ongoing outbreak has been exacerbated by a new variant of the virus, which is reportedly more lethal than the strain responsible for the global outbreak in 2022. As cases rise, understanding the severity of mpox and the treatments available is crucial for managing this public health crisis.

How Deadly is Mpox?

Mpox is a viral disease with varying degrees of severity, largely depending on the specific variant of the virus and the health condition of the infected individual. The current outbreak in the DRC and neighboring countries is driven by the clade I variant of the virus, which has shown a fatality rate ranging from approximately 1% to 11%. The wide range in these figures is due to several factors, including differences in population health, disease surveillance quality, and healthcare access.

Vulnerable Populations:

Children, particularly infants, are at a higher risk of developing severe, potentially fatal mpox infections due to their underdeveloped immune systems. Likewise, individuals with compromised immune systems, such as those living with HIV, are more susceptible to severe outcomes from mpox. The risk of death increases significantly for these groups, making it crucial to prioritize their protection during outbreaks.

Healthcare Access and Surveillance Issues:

In regions where healthcare infrastructure is limited, such as parts of the DRC, many mpox cases go undetected, especially milder ones. This can skew fatality rates higher than they might actually be. Furthermore, the misdiagnosis of mpox as other illnesses like measles or chickenpox also contributes to underreporting and challenges in understanding the true scope of the outbreak.

Complications Leading to Death:

When mpox does result in death, it is often due to complications rather than the virus itself. Common complications include sepsis—where the infection spreads to the bloodstream, leading to organ failure—and severe lung damage caused by the virus’s inflammatory effects. These complications highlight the need for timely and effective treatment to prevent fatal outcomes.

Available Treatments for Mpox

The treatment landscape for mpox varies significantly depending on the region. In areas like the DRC, where the outbreak is most severe, specific treatments for mpox are scarce. Healthcare providers primarily focus on managing symptoms, such as reducing fever and pain with paracetamol (acetaminophen) and cleaning skin lesions to prevent secondary bacterial infections.

Symptom Management:

In many parts of Central and West Africa, where the healthcare system is under strain, treatment primarily involves symptomatic relief. This approach includes the use of antipyretics like paracetamol to manage fever and pain, as well as maintaining hygiene to prevent secondary infections of the skin lesions that are characteristic of mpox.

Advanced Treatments in Developed Countries:

In contrast, countries with more advanced healthcare systems, such as the UK and the US, have access to antiviral treatments like tecovirimat. Originally developed for smallpox, tecovirimat has shown promise in treating severe cases of mpox by inhibiting a viral protein that is crucial for the virus to spread between cells. This antiviral has been supported by animal studies, although its efficacy in humans remains under investigation.

Other antiviral options include cidofovir, which has demonstrated effectiveness in animal models by disrupting the virus’s ability to replicate its DNA. Additionally, VIGIV (Vaccinia Immune Globulin Intravenous) is a treatment that involves injecting antibodies derived from individuals vaccinated against smallpox into those infected with mpox. This treatment aims to bolster the immune system’s response to the virus, potentially reducing the severity of the disease.

Effectiveness of Mpox Treatments

While animal studies have suggested that these treatments could be effective against mpox, evidence from human trials is still limited. A recent randomized controlled trial conducted in the DRC examined the effectiveness of tecovirimat in treating mpox. The trial found that tecovirimat did not significantly accelerate the healing of the painful lesions caused by the clade I variant of mpox. However, the trial did report a lower mortality rate of 1.7% among participants treated with tecovirimat, compared to the 3.6% mortality rate typically observed in the region.

It is important to note that the lower mortality rate could be attributed to the high level of care provided to trial participants in a hospital setting, which may not reflect the typical conditions in which most mpox patients receive care.

The Need for Better Treatments and Understanding

As the mpox outbreak continues to challenge public health systems, particularly in Central and West Africa, there is an urgent need for more effective treatments and a deeper understanding of the virus’s lethality. The current reliance on symptomatic treatment and the limited availability of antiviral therapies underscore the necessity of developing and distributing more effective interventions.

Future Research and Development:

Ongoing research is critical to improving the management of mpox. There is a need for more comprehensive studies to assess the effectiveness of existing treatments in humans and to develop new therapies that can reduce mortality and prevent severe complications. Moreover, improving disease surveillance and healthcare access in affected regions will be essential to better understanding and controlling the spread of mpox.

Public Health Implications:

As mpox continues to pose a significant threat, particularly in regions with limited healthcare resources, international cooperation and investment in public health infrastructure are crucial. This includes not only the development of better treatments but also the implementation of robust surveillance systems to detect and respond to outbreaks more effectively.

Conclusion

Mpox remains a deadly disease, especially in vulnerable populations and regions with limited healthcare access. While treatments like tecovirimat and VIGIV offer hope, their effectiveness in human cases of mpox, particularly in the ongoing outbreak driven by the clade I variant, remains to be fully determined. Continued research, improved healthcare access, and better public health strategies are essential to reducing the impact of mpox and protecting those at greatest risk.

Keywords: Mpox, monkeypox, mpox outbreak, clade I variant, mpox fatality rate, tecovirimat, VIGIV, mpox treatments, antiviral therapy for mpox, healthcare access in DRC, mpox complications, public health emergency, viral infections, Central Africa, West Africa, disease surveillance, sepsis, lung damage, immune response, HIV and mpox, smallpox vaccine.