14 August 2024，WHO Director-General Dr Tedros Adhanom Ghebreyesus has determined that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). Dr Tedros’s declaration came on the advice of an IHR Emergency Committee of independent experts who met earlier in the day to review data presented by experts from WHO and affected countries. The Committee informed the Director-General that it considers the upsurge of mpox to be a PHEIC, with potential to spread further across countries in Africa and possibly outside the continent. It is therefore important for ship personnel to be educated and take proper measures to prevent further spread.   

I. Overview

The monkeypox virus was discovered in Denmark (1958) in monkeys kept for research. The first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the Congo (1970). Mpox is an infectious disease that can cause a painful rash, enlarged lymph nodes, fever, headache, muscle ache, back pain and low energy. Most people fully recover, but some get very sick. Mpox is caused by the monkeypox virus (MPXV). It is an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family, which includes variola, cowpox, vaccinia and other viruses. There are two distinct clades of the virus: clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb).

II. Outbreaks

Following the eradication of smallpox in 1980 and the end of smallpox vaccination worldwide, mpox steadily emerged in central, east and west Africa. Since then, mpox has been reported sporadically in central and east Africa (clade I) and west Africa (clade II). In 2003, an outbreak in the United States of America was linked to imported wild animals (clade II). Since 2005, thousands of cases are reported in the Democratic Republic of the Congo every year. In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travelers to other destinations.

In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and then all six WHO regions, with 87,000 reported cases and 112 deaths in 110 countries. Since July 2024, cases of clade Ib have also been detected in Burundi, Kenya, Rwanda, and Uganda. According to WHO statistics, a total of 121 countries have reported mpox between Jan 2022 – Aug 2024, with over 100,000 laboratory-confirmed cases reported and 223 deaths among confirmed cases.

III. Transmission 

Mpox spreads from person to person mainly through close contact with someone who has mpox, including members of a household. Close contact includes skin-to-skin (such as touching or sex) and mouth-to-mouth or mouth-to-skin contact (such as kissing), and it can also include being face-to-face with someone who has mpox (such as talking or breathing close to one another, which can generate infectious respiratory particles).

People with multiple sexual partners are at higher risk of acquiring mpox. People can also contract mpox from contaminated objects such as clothing or linen, through needle injuries in health care, or in community settings such as tattoo parlours.

During pregnancy or birth, the virus may be passed to the baby. Contracting mpox during pregnancy can be dangerous for the fetus or newborn infant and can lead to loss of the pregnancy, stillbirth, death of the newborn, or complications for the parent.

Animal-to-human transmission of mpox occurs from infected animals to humans from bites or scratches, or during activities such as hunting, skinning, trapping, cooking, playing with carcasses or eating animals. The animal reservoir of the monkeypox virus remains unknown and further studies are underway.

More research is needed on how mpox spreads during outbreaks in different settings and under different conditions.

IV. Symptoms

Mpox presents with fever, an extensive characteristic rash and usually swollen lymph nodes. It is important to distinguish mpox from other illnesses such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies. 

The mpox rash often begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet. It can also start on other parts of the body where contact was made, such as the genitals. It starts as a flat sore, which develops in 2 to 4 weeks into a blister filled with liquid that may be itchy or painful. As the rash heals, the lesions dry up, crust over and fall off. 

Some people with mpox become very sick. For example, the skin can become infected with bacteria, leading to abscesses or serious skin damage. Other complications include pneumonia; corneal infection with loss of vision; pain or difficulty swallowing; vomiting and diarrhoea causing dehydration or malnutrition; and infections of the blood (sepsis), brain (encephalitis), heart (myocarditis), rectum (proctitis), genital organs (balanitis) or urinary passages (urethritis). Mpox can be fatal in some cases.

V. Self-care

Most people with mpox will recover within 2–4 weeks. Things to do to help the symptoms and prevent transmitting mpox to others:

Do

• contact your health care provider for advice;
• stay at room and in your own, well-ventilated room if possible;
• wash hands often with soap and water or hand sanitizer, especially before or after touching sores;
• wear a mask and cover lesions when around other people until your rash heals;
• keep skin dry and uncovered (unless in a room with someone else);
• avoid touching items in shared spaces and disinfect shared spaces frequently; 
• use saltwater rinses for sores in the mouth;
• take warm baths with baking soda or Epsom salts for body sores; and
• take over-the-counter medications for pain like paracetamol (acetaminophen) or ibuprofen.

Do not

• pop blisters or scratch sores, which can slow healing, spread the rash to other parts of the body, and cause sores to become infected; or
• shave areas with sores until scabs have healed and you have new skin underneath, this can spread the rash to other parts of the body.

VI. Advice to seafarers

Ships sailing around the world are susceptible to monkeypox epidemics, with the crew’s living quarter relatively closed and the on-board medical support not always in place. The prevention of infectious diseases on board ships is particularly important. Identifying mpox can be difficult because other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmitted infections, and medication-associated allergies.

Shore leave must be controlled strictly, especially at a port with epidemic cases. Even if it is a necessary leave, crew members are advised to wear masks and keep clear from outsiders. It also applies to ship to shore interface operation, such as cargo handling, bunkering, supplier visit, etc.

Rat guards should be arranged properly, especially for bulk carriers loading and unloading grain.

Purchase meat and other food from regular suppliers.

Crewmembers should wash their hands with soap, bathe and change clothes frequently.

Once symptoms such as fever are found, report to the captain in time and self-isolate on the ship.

The goal of treating mpox is to take care of the rash, manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems.

For more information, please contact Managers of the Association.