With more than 14,000 monkeypox cases reported in over 70 countries and territories since May, the World Health Organisation (WHO) held an emergency meeting yesterday to decide whether the outbreak constitutes what it calls a public health emergency of international concern.

Five deaths, all in Africa, have been reported in this outbreak.

Singapore now has six cases, of which three are local. None of them is linked.

Associate Professor Hsu Li Yang, an infectious diseases expert at the National University of Singapore’s Saw Swee Hock School of Public Health, said the outbreak here has not been controlled yet.

“The silver lining is that the number of cases remains very small, with new cases popping up sporadically,” Prof Hsu added.

Monkeypox is endemic in Central and West Africa, but it is now spreading mostly in Europe, and in networks of men who have sex with men.

Cases have been picked up at sexual health clinics overseas.

Here, the Department of Sexually Transmitted Infections Control clinic, run by the National Skin Centre (NSC), has seen one confirmed case, said Professor Roy Chan, a senior consultant and medical adviser at NSC.

Q What symptoms do monkeypox patients have?
A Symptoms include fever, body ache and a rash. Associate Professor Lim Poh Lian, director of the high-level isolation unit at the National Centre for Infectious Diseases, said the rash may start out as a small pimple in parts of the body that do not usually get pimples, like the genital area, but over a few days, these develop into blisters. Some patients also get swollen lymph glands in the groin, Prof Lim added.

The disease can be painful.

In the United States, there have been reports of painful lesions in the anus, genitals and mouth.

In a July 15 release from the WHO office in Europe, a patient said he first fell ill with fever, and then his lymph nodes felt achy, very painful and swollen.

Initially, one blister appeared on his nose. It then got bigger and more painful, and he also had lesions in his throat.

He was put on heavy painkillers, and antibiotics because of a secondary bacterial infection, and fed through an intravenous drip.

Q Can monkeypox be transmitted asymptomatically?
A Prof Hsu said: “We don’t know as yet, but asymptomatic cases of monkeypox have been described during this outbreak, which is novel in the sense that we had previously assumed that virtually all monkeypox cases would have symptoms and the rash.”

The extent of asymptomatic cases and whether they can spread the virus are still unknown, he added.

Prof Lim said: “We never say never in medicine, but most monkeypox cases are spread by close skin-to-skin contact and through contaminated bedding.

“We should be aware of all the ways monkeypox can spread, but it is helpful to focus on what the current evidence shows us, which is (that it is) mainly spread by symptomatic cases through intimate contact.”

Q What can I expect if I contract monkeypox?
A Most cases recover well.

Prof Lim said the fever usually lasts two to three days, and is generally mild. New skin blisters will continue to develop over a week or so, then take two weeks to dry up, and for the scabs to fall off and for new healthy skin to form, she said.

“The scabs are infectious, so the infectious period – when the individual has to remain in isolation to prevent spread of infection to others – is likely to be three weeks or more.”

Young children, pregnant women and persons with weakened immune symptoms may experience more severe disease. There have been overseas reports of cases requiring intensive care but those remain very rare.

Generally, no specific anti-viral treatment is needed for mild cases, said Prof Lim. “However, we do have anti-viral medications, such as cidofovir... Such medications have known risks so we would use them only if the patient’s clinical condition warrants it.”

Q Are there any vaccines for monkeypox?
A Smallpox vaccines are being used as the monkeypox virus is closely related to the virus that causes smallpox. In the US, the Food and Drug Administration has licensed two vaccines – Jynneos and Acam2000 – for use against monkeypox.

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