Mpox (formerly known as monkeypox) is a disease caused by the monkeypox virus (MPXV) from the Poxviridae family. It is a zoonotic disease that spreads from animals to humans. However, the current common mode of transmission is from human to human through close contact with an individual who shows symptoms and signs of mpox infection.

Mpox is endemic in Central and West Africa and has spread to 116 other countries. There are two known clades of the monkeypox virus (MPXV) that can cause mpox: clade I and clade II. On August 14, 2024, the World Health Organization (WHO) declared mpox a Public Health Emergency
of International Concern (PHEIC) for the second time, based on the advice of the IHR Emergency Committee. This decision emphasized the faster spread of a new strain of mpox, clade Ib, in the Democratic Republic of Congo (DRC) and neighboring countries in the African region. Four East
African countries reported mpox cases for the first time: Burundi, Kenya, Rwanda, and Uganda. Cases of clade Ib mpox have also been reported outside the African region, with one case in Sweden on August 16, 2024, and one in Thailand on August 21, 2024.

In Malaysia, ten (10) cases of mpox were reported from 26 July 2023 till now, all of which were clade II. To date, no clade I mpox cases have been detected in the country. The number of mpox cases reported in each country can be checked on the website https://ourworldindata.org/mpox.

Individuals will typically show symptoms of mpox within 21 days after being exposed to the virus.

The common symptoms of mpox include fever, headache, body weakness, swollen lymph nodes, and a rash or blisters that can appear on any part of the body, most commonly on the face, palms, soles, and genital area. The rash or blisters may contain fluid and eventually form scabs, dry out, and fall off.

The rash or blisters can last for 2 to 4 weeks or longer, depending on the individual’s immunity.

Mpox does not spread easily, unless there is close contact with an individual infected with mpox.

Transmission from an individual infected with mpox to others can occur through direct contact with:

a. The rash or blisters on the skin of an infected person;

b. Sexual contact;

c. Surfaces or objects contaminated by the bodily fluids of an mpox patient.

Transmission can also occur through respiratory droplets, but it is rare, and only to a person who has prolonged and close face-to-face interaction.

Currently, there is no evidence that animals play a role in the transmission of mpox in Malaysia. However, transmission to humans from animals, particularly wild rodents, has been reported in West and Central Africa.

Activities that can spread the virus from animals to humans include:

• being bitten or scratched by an animal;
• handling animals or their carcasses; and
• cooking or consuming the animal.

The monkeypox virus can be transmitted to others from 1 to 4 days before symptoms appear until the scabs have fallen off the skin and the patient is no longer symptomatic

Individuals at risk of contracting mpox include:

a. Travellers returning from African countries which are facing an mpox outbreak;

b. Close contacts of mpox cases; and

c. Healthcare workers caring for mpox patients if proper infection prevention and control measures are not followed.

Most mpox infections resolve on their own without the need for treatment.

However, proper care of the rash or blisters is important—allowing them to dry and covering exposed blisters to prevent the spread of fluid.

Antiviral treatment may be administered based on the severity of the infection, following the advice of a Medical Specialist. Currently, antiviral medication is only given to individuals at high risk of complications, such as those with weakened immune systems or severe illness.

The World Health Organization (WHO) does not recommend mass vaccination for mpox. The Ministry of Health Malaysia (MOH) continuously monitors the need for vaccine use as the situation evolves.

If you are in a high risk group, you can go to a nearby health facility to undergo examination and testing to confirm your health status.

Immediately go to a nearby health facility for a medical evaluation.

As precautionary measures, you are advised to:

a. Avoid contact with others;

b. Cover your rash or blisters by wearing long-sleeved clothing;

c. Wash your hands frequently with soap and water or use hand sanitizer; and

d. Practice good cough etiquette, such as wearing a face mask when you are around others.

If you are suspected to have mpox infection, you will be instructed to isolate yourself either at home or in a hospital, based on the assessment of a medical practitioner, until your laboratory test results are known.

You will be instructed to isolate yourself either at home or in a hospital, depending on your health condition, until you have fully recovered.

Continue to follow control and prevention measures and seek immediate treatment if your symptoms worsen.

You will be instructed to undergo isolation under Section 14 of the Prevention and Control of Infectious Diseases Act 1988 [Act 342], based on the assessment of a medical practitioner to determine whether you need to isolate either at home or in a hospital until you are no longer at risk of transmitting the infection to others.

Mpox was previously called monkeypox because it was first identified in a colony of monkeys kept for research in 1958. It was only detected in humans in 1970.

On 28 November 2022, the World Health Organization (WHO) renamed the disease from monkeypox to mpox after a series of discussions and consultations with experts worldwide. This change aimed to reduce the stigma and discrimination associated with the original name of the disease.

There is a risk of mpox clade I transmission in Malaysia due to the entry of travelers (both citizens and non-citizens) from endemic countries and those reporting mpox cases among humans. However, the risk of mpox clade I spread in Malaysia is low. Until now, no case of mpox clade I has been reported in Malaysia.

Malaysia has reported mpox cases previously, with a total of ten cases— the first case was reported on 26 July 2023 and the last in 16 September 2024. All cases have history of high-risk activity. All the cases were mpox clade II and no deaths have been reported so far.

At this moment, WHO does not recommend any travel or trade restrictions for countries reporting mpox cases.

Travelers can continue with their planned travel, both domestically and internationally, and are advised to take preventive measures as recommended by Ministry of Health Malaysia.

Upon arrival in Malaysia, travellers are advised to monitor their health for 21 days from the date of arrival and seek immediate care at a nearby healthcare facility if symptoms develop.

All travellers arriving from countries reporting mpox are required to undergo screening at the International Points of Entry (PoE), either temperature screening, self-referral, or referred by an Immigration Officer. If the traveller is found to be symptomatic, a health assessment will be conducted and if necessary, the traveller will be referred to a nearby healthcare facility for further management.

Travellers who do not have symptoms are advised to monitor their health for 21 days from the date of arrival in Malaysia.

Group activities such as official meetings, sports events, social gatherings, and others are permitted with precautionary measures.

a) Delegates from countries reporting mpox cases will undergo screening at PoE.

b) Individuals under isolation order are not allowed to participate in any group activities

c) The public is advised to always practice personal hygiene and healthy lifestyle

d) Organizers should ensure participants are well and always cooperate with the nearest District Health Office in the control of mpox spread in Malaysia.

Some of the preventive measures for mpox are as follows.:

1. Enhancing monitoring at all International Points of Entry (PoEs), where all travelers arriving from countries reporting mpox are required to self-monitor their health for mpox symptoms daily, for a period of 21 days from their arrival in Malaysia.
2. Ensuring that all medical practitioners in government and private healthcare facilities promptly notify the nearest District Health Office of suspected and confirmed mpox cases to ensure that preventive and control measures can be implemented. For mpox case management, medical
   practitioners can refer to the “Guidelines on mpox management in Malaysia 2023” available on the MOH official website (www.moh.gov.my).
3. Ensuring that laboratories for testing and diagnostics are prepared; currently, there are 14 laboratories performing PCR tests for confirmation, including six (6) private laboratories.
4. Ensuring that establishments providing services involving skin contact with clients, such as spas, massage centers, and other high-risk activities, consistently practice personal and environmental hygiene and ensure that no workers or clients show symptoms or signs of mpox, such as rashes or blisters. If any worker or client exhibits such symptoms, they should seek health evaluation immediately.
5. Increasing mpox awareness activities and distributing educational materials to at-risk groups in collaboration with non-governmental organizations at identified locations such as spas and saunas; and
6. Conducting public health advisories on mpox across all social media and conventional media platforms, as well as community empowerment activities on preventive and self-health control measures.

MOH advises individuals with symptoms of mpox, such as rashes and blisters on the skin, to immediately seek treatment at a nearby healthcare facility. Those at high risk are advised to avoid direct contact with symptomatic individuals to reduce the transmission of mpox.

Individuals who visit high-risk countries or are exposed to suspected or confirmed cases of mpox should self-monitor their health for 21 days after returning or after exposure.