Mpox, formerly known as monkeypox, has been causing havoc in the Democratic Republic of the Congo (DRC) and neighboring countries. The ongoing outbreak has been fueled by a new variant of the virus, which is believed to be more lethal than the strain responsible for the global mpox outbreak in 2022. As the number of cases continues to surge, understanding the severity of mpox and the available treatments is crucial in combating this deadly disease.
### The Severity of Mpox
Studies have shown that the fatality rate among individuals infected with the clade I variant of mpox, which is driving the current outbreak, ranges from approximately 1 to 11 percent. The variation in reported fatality rates can be attributed to differences in the affected populations and challenges in disease surveillance, according to Lilith Whittles, a researcher at Imperial College London.
Certain demographic groups, such as infants, children, and individuals with compromised immune systems like those with HIV, are at a higher risk of developing severe and potentially fatal mpox infections. Infants and children, whose immune systems are still developing, may be more susceptible to the virus’s severe effects compared to adults. Additionally, individuals with suppressed immune systems are more vulnerable to severe complications from mpox.
Furthermore, limited access to healthcare in some regions results in inadequate mpox surveillance, leading to only the most severe cases being detected in healthcare facilities. Mild cases of mpox often go undetected, skewing fatality rates and hindering accurate assessment of the disease burden. Misdiagnoses of mpox symptoms as other common illnesses, such as measles or chickenpox, also contribute to underreporting and mismanagement of cases.
When fatalities do occur due to mpox, they are often attributed to complications like sepsis, where the infection spreads to the bloodstream and causes organ failure, or lung damage caused by inflammation triggered by the mpox virus, as explained by Piero Olliaro from the University of Oxford.
### Available Treatments for Mpox
In regions like the DRC and neighboring countries at the epicenter of the outbreak, specific treatments for mpox are largely unavailable. Healthcare providers focus on managing symptoms, which typically persist for two to four weeks. This involves alleviating fevers and headaches with medications like paracetamol (acetaminophen) and cleaning skin lesions to prevent bacterial infections, as outlined by Jean Claude Udahemuka from the University of Rwanda.
However, in more developed countries like the UK and US, healthcare professionals have access to antiviral medications to treat severe cases of mpox. Tecovirimat, initially developed for smallpox treatment, has shown efficacy against mpox in animal studies. The drug works by binding to a protein present on the surface of both mpox and smallpox viruses, inhibiting their ability to spread to other cells.
Additionally, antivirals like cidofovir have demonstrated protective effects against lethal doses of the mpox virus in animal models. This medication targets an enzyme essential for the virus to replicate its genetic material, thereby impeding its ability to spread and cause further harm.
Another treatment approach involves injecting antibodies against smallpox, sourced from individuals who have received smallpox vaccines, into mpox-infected patients. This method, known as VIGIV, enhances the immune response against the virus, potentially aiding in recovery and reducing the severity of mpox infections.
### Effectiveness of Mpox Treatments
While preclinical studies have shown promising results for mpox treatments, their effectiveness in human patients remains uncertain. Initial findings from a recent randomized controlled trial conducted in the DRC revealed that tecovirimat did not accelerate the healing process of painful lesions in children and adults infected with the clade I variant of mpox.
However, the trial did report a lower mortality rate of 1.7 percent among participants who received the antiviral compared to the typical 3.6 percent mortality rate observed in the DRC. This improvement in outcomes could be attributed to the close monitoring and care provided to trial participants in a hospital setting, as noted by Olliaro.
Moving forward, further research is needed to develop more effective treatments for mpox and enhance our understanding of the disease’s severity. Lucille Blumberg from the University of Pretoria emphasizes the importance of ongoing efforts to protect individuals, particularly those in at-risk regions like the DRC, from the devastating impact of the ongoing outbreak.
In conclusion, combating the severity of mpox and improving treatment options are critical in addressing the current outbreak and preventing future epidemics. Researchers and healthcare professionals must continue to collaborate and innovate to develop effective therapies and interventions to mitigate the impact of this deadly disease on vulnerable populations.
