Acknowledge threat of mpox resurgence to Southeast Asia

By: Dr. Jasmine Elanie Khairat

The spectre of the monkeypox virus, once thought to be largely contained, looms large once again. While the 2022 global outbreak (clade II) garnered significant attention, the current resurgence, particularly of the concerning clade I variant in Africa, underscores the urgent need for comprehensive global action and preparedness.

This is especially crucial in regions like Southeast Asia (SEA), where healthcare infrastructure may be strained in the face of a widespread outbreak. Globally, from January 2022 until now, more than 99,000 laboratory-confirmed cases of mpox, including over 200 deaths, have been reported to the WHO from 116 countries. While the global situation is worrying, the emergence of cases closer to home in SEA raises alarm bells. As of August 2024, there are at least 14 confirmed cases of mpox in the region, with 13 cases in Singapore (all Clade II) and 1 case in Thailand (Clade I).

The disheartening results of the recent tecovirimat (TPOXX) trial in the Democratic Republic of the Congo (DRC) in 2023 have dealt a blow to hopes for a readily available and effective treatment for mpox. The drug, currently used to treat mpox despite limited clinical evidence, showed no significant benefit in reducing the duration of symptoms caused by the clade I infection compared to a placebo. While the lower mortality rate among trial participants offers a glimmer of hope, it also highlights the critical importance of supportive care in managing this disease. However, the challenge lies in translating this level of care to resource-limited settings, where access to healthcare may be limited.

A key difference between the 2022 and 2024 outbreaks lies in the modes of transmission and the virus variant. While the 2022 outbreak, fueled by the clade IIb strain, was primarily driven by close personal contact, often during sexual encounters, the current outbreak, dominated by clade I, exhibits a broader transmission pattern. It also spread largely uncontained due to international travels from endemic regions in Africa to other non-endemic countries.

Now, in addition to close contact, we are witnessing transmission through household interactions, zoonotic exposure (animal-to-human), and non-sexual routes. This shift necessitates a more comprehensive strategy for containment, encompassing not only sexual health interventions but also measures to curb animal-to-human transmission and reinforce hygiene practices in households.

The need of the hour is a multi-pronged approach that focuses on prevention, treatment, and global cooperation. We must accelerate vaccination efforts, ensuring equitable access for all nations, regardless of economic standing. Simultaneously, the development of novel antivirals targeting clade I is essential to combat this specific strain.

Strengthening healthcare infrastructure in vulnerable regions is also paramount, ensuring that those infected receive the necessary care. Lastly, public health education campaigns must be intensified to foster early detection and prevention, highlighting the diverse transmission routes observed in this outbreak.

The situation in SEA, particularly in Malaysia, demands attention. While the immediate risk of mpox in Malaysia remains low to moderate, the emergence of cases in neighbouring SEA countries serves as a stark reminder that we cannot afford complacency. The virus’s unchecked spread in regions with limited vaccine access and a lack of effective antivirals for specific clades raises the possibility of broader transmission. As we have learned, infectious diseases transcend borders; an outbreak anywhere poses a potential threat everywhere.

As Malaysians, we must remain vigilant and informed. The recent surge in global cases underscores the unpredictable nature of this outbreak. While we should not succumb to panic, we must acknowledge the risks and take proactive measures to protect ourselves and our communities.

Dr. Jasmine Elanie Khairat is a Senior Lecturer at the Institute of Biological Sciences, Faculty of Science, Universiti Malaya. She may be contacted at jasmine@um.edu.my