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CNA Explains: Who is at risk of monkeypox and how worried should you be?

What precautions can you take to protect yourself against monkeypox? Is it a sexually transmitted disease? Does smallpox vaccination offer protection? Experts answer frequently asked questions.

CNA Explains: Who is at risk of monkeypox and how worried should you be?

An electron microscope image of the monkeypox virus. (Image: iStock)

SINGAPORE: The immunocompromised are at higher risk of contracting severe monkeypox, but the chances of the disease spreading among the general public are "very slim", experts said. 

The virus that causes monkeypox is transmitted from human to human through large respiratory droplets or body fluids, especially from rashes and sores and intimate contact including hugging, kissing and sexual intercourse, they said. 

To date, Singapore has reported a total of 15 infections in the country since June. Of the 15 cases, five are imported while 10 are local. 

The latest two cases were reported on Aug 5, including the first local linked case - a contact of a man whose infection was confirmed previously.

The 54-year-old man had no recent travel history, said the Ministry of Health (MOH) in an update on its website.

But the chances of getting the disease are "extremely remote”, said infectious disease specialist Leong Hoe Nam, who runs a private practice at Mount Elizabeth Novena Hospital.

“To get it from individuals in Singapore in the local context, (the chances are) very slim, unless your partner has (it),” he said.

“The proof is in the pudding. The cases which we had of monkeypox, we quarantined all the contacts but none of them developed monkeypox subsequently.”

Dr Leong added that even in a crowded MRT train, “the physical proximity which you have is not sufficient (for the disease to spread)”.

From Jan 1 to Jul 4 this year, more than 6,000 laboratory-confirmed cases of monkeypox and three deaths have been reported to the World Health Organization (WHO) from 59 countries, territories and areas.

Q: Who is at higher risk?

Like many infectious diseases, those who are elderly or very young or are immunocompromised are at higher risk, said Dr Khoo Yoong Khean from the Duke-NUS Centre for Outbreak Preparedness.

The scientific officer added that the incidence in this current outbreak appears to be higher among men who have sex with other men.

"That doesn’t mean that they are at a higher risk of getting the disease, but that the disease is currently circulating within this community," he said. 

He added that one possible reason why it is more detected among this particular community is that more often than not, its members do regular testing and health checks, leading to heightened vigilance and detection. 

“As we try to understand the disease pattern, we need to communicate accurate facts to the public and avoid stigmatisation because this would lead to underreporting of cases by infected individuals and subsequently increasing spread,” he said. 

Dr Khoo added that while monkeypox can be sexually transmitted, it is not considered a sexually transmitted disease.

"Transmission usually occurs when there is close skin-to-skin contact with someone who may have been infected (including sexual contact)," said Dr Shawn Vasoo, who is clinical director at the National Centre for Infectious Diseases (NCID).

"Usual or transient interactions like sharing an office space, or sharing a meal are activities that are low risk and unlikely to spread monkeypox."

“While the reported population does appear to be disproportionately men and men who self-identify as men having sex with men, there is no specific advice for that community over and above the general advice around not coming into contact with persons who are demonstrating the signs of infection,” Senior Minister of State for Health Janil Puthucheary said in Parliament earlier this week.

Smallpox vaccination provides some cross-immunity, experts said. 

Dr Puthucheary said that the vaccine is up to 85 per cent effective in preventing monkeypox, but that it has significant side effects.

“For the general population, the risks of complications outweigh the benefits because the general population is at a low risk of being infected,” he said.

Q: How dangerous is monkeypox?

Dr Khoo said that while there should be some general vigilance about any disease, authorities and scientists are still working out how the current outbreak will spread and what the epidemiological pattern is. 

"Monkeypox is not a new disease, so there are established diagnostic and treatment protocols for it and there is some experience in dealing with the disease," he said. 

However, he noted that the situation is evolving, with WHO thinking about whether to declare it a Public Health Emergency of International Concern, similar to how COVID-19 was categorised. 

With continuous work being done on the disease and its spread, the medical community expects to see new evidence that will guide them in making better decisions, he said.

“My advice is to be vigilant on the symptoms. If you or someone you know who has monkeypox symptoms, to quickly seek medical attention. This will also help authorities to conduct public health intervention measures like contact tracing to stop the spread.”

Dr Vasoo noted that the monkeypox patients he has seen have been mostly mild. He added that in some cases, patients have had fever, and a rash on their body.

MOH said previously that a small percentage of those infected can fall seriously ill or even die. Other than immunocompromised individuals, those "particularly vulnerable" to complications are young children and pregnant women. 

According to the WHO, the case fatality ratio is around 3 to 6 per cent in recent cases. 

Q: How is monkeypox typically treated?

Dr Vasoo noted that most monkeypox patients do not require specific treatment, and the illness will heal with time.

However in some individuals who have severe disease or low immunity, they may need treatment with medications - for example antivirals such as cidofovir.

Dr Leong said that for those who are well and contract the disease, including those who have chronic illnesses, they will take two to three weeks to recover on their own.

“If you do get it, the major problem is the inconvenience of being quarantined for 21 days,” he added.

He noted that the immunocompromised, like some cancer patients and transplant patients, may suffer more serious effects. 

"In unusual circumstances in severe infections affecting the eye or brain (these would be uncommon), there could possibly be some post-infection complications," added Dr Vasoo.

This includes visual loss if the cornea of the eye is affected, he noted.

Q: How can people protect themselves?

Maintain a high standard of personal hygiene, including frequently washing your hands such as after going to the toilet or when your hands are dirty, said Dr Michael Wong, a family physician at Raffles Medical.

People should also avoid direct contact with skin lesions of infected living or dead persons or animals, as well as objects that may have become contaminated with infectious fluids, such as soiled clothing or items like bedding or towels used by an infected person.

Avoid consuming bush meat and stay away from wild animals that could harbour the virus, he added. The virus has been found in animals such as rope squirrels, tree squirrels and different species of monkeys.

Returning travellers, especially from areas with a monkeypox outbreak, should seek immediate medical attention if they develop symptoms like sudden onset of high fever, swollen lymph nodes and rash within three weeks of their return. 

“They should call the clinic ahead of their visit so that special precautions can be taken to protect others,” he said.

They should also inform their doctor of their recent travel history.

Additional reporting by Matthew Mohan

Source: CNA/ja(cy)

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