Asia Sees Rising Mpox Cases; Takes Action with Control and Treatment Measures
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Bracing from another health crisis?
Since May 2022, monkeypox (now named mpox), caused by Clade I and Clade II of the monkeypox virus, a species of the genus Orthopoxvirus, has been reported in both non-endemic and endemic countries. Notably, many cases involve travel to Europe and North America rather than the traditionally affected regions of West and Central Africa.
This unprecedented spread marks the first instance of widespread mpox clusters across such diverse geographical areas simultaneously. Citing the latest World Health Organization (WHO) data, an estimated 99,000 mpox cases have been reported worldwide across 116 countries from January 1, 2022, to June 30, 2024, with 208 deaths.
In May 2022, mpox cases caused by mpxv Clade IIb emerged outside of Africa, including in Singapore, prompting the WHO to declare a global Public Health Emergency (PHEIC) on 23 July 2022. This status was lifted on 10 May 2023 after a decline in cases, but mpox transmission continues at low levels worldwide. In 2023, the DRC saw a rise in cases from the endemic Clade I, with outbreaks spreading to other African countries by July 2024. On 14 August 2024, the WHO declared this regional outbreak a PHEIC following a similar declaration by the Africa CDC. So far, Clade I has largely stayed within Africa, except for one exported case in Sweden.
Asia on alert
In Southeast Asia, Singapore was the first to report a case of mpox, according to Reuters in 20221. The patient, a 42-year-old British flight attendant, tested positive on June 20 and is stable at the National Centre for Infectious Diseases. Thirteen close contacts are quarantined for 21 days, with ongoing contact tracing. Singapore’s last monkeypox case was three years ago. Australia had reported eight cases as of June 10, with its first case on May 20. Other cases have been reported in other parts of Asia since then.
Typical symptoms of mpox include a skin rash or mucosal lesions that last 2–4 weeks, along with fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.
Indonesia has recorded at least 88 mpox cases since 2022, with Jakarta being the most affected. 2 The cases include 59 in Jakarta, 13 in West Java, nine in Banten, three each in East Java and Yogyakarta, and one in the Riau Islands. Out of these, 87 have recovered. The peak occurred in October 2023. The Clade IIb variant, which is mainly spread through sexual contact and has a lower fatality rate, was involved in 54 cases.
Over in Malaysia, the country has recorded a total of nine mpox cases from July to November 2023. According to reports, aall affected individuals had a history of high-risk activities and have recovered, with no reported deaths. Despite rising infections in Africa, Malaysia has not reported any new cases recently.3Nonetheless, the Health Ministry advises travelers to countries with mpox to practice good hygiene and avoid risky activities, and to monitor their health daily for 21 days upon returning to Malaysia.
In Pakistan, the Khyber Pakhtunkhwa health department reported three mpox cases detected in patients arriving from the United Arab Emirates (UAE). The WHO has declared the recent outbreak a public health emergency due to a new virus variant. The specific variant in these cases is not yet known.4
Similarly, the Philippines’ Department of Health (DOH) disclosed a new mpox case in the country, increasing its total cases to 10.5 This case, the first detected in 2024, involves a 33-year-old Filipino with no recent travel history but with close, intimate contact three weeks prior to symptoms. The patient, who initially experienced a fever followed by a rash, tested positive for mpox using a PCR (polymerase chain reaction) test, which detects genetic material from specific organisms such as viruses. The DOH said that all previous mpox cases in the country have recovered, with no deaths reported. Health experts said that while isolation facilities are not required, home isolation and handwashing are recommended.
Casualties from the virus
In August 2023, Thailand reported its first mpox death: a 34-year-old patient with HIV and syphilis, who had also developed infections in his lungs and brain. The patient, diagnosed with mpox three weeks prior, showed elevated white blood cell levels, prompting treatment with antibiotics and antiviral medication.
During the same period, Thailand recorded 161 mpox cases among Thai citizens and 28 among foreigners. By September, 42 new cases were reported, including 33 males in the male-to-male transmission group and 17 with a history of risky sexual contact. Of these new cases, 29 were also HIV-positive.6
Mpox spreads to humans through contact with an infected person, contaminated objects, or infected animals. It is confirmed in the lab by testing skin lesion samples with PCR.
Meanwhile, Vietnam has reported 199 mpox infections and eight deaths in Southern Vietnam since 2023, with most cases and deaths occurring in Ho Chi Minh City (HCM). Of the total cases, 150 were reported in 2023 and the remainder from early 2024 to the present. Health Authorities found that all patients were men aged 18 to 53, with 84% identifying as part of the ‘men who have sex with men’ (MSM) community. Men aged 30-39 made up 46% of the city’s cases. Notably, 55% of those diagnosed were also HIV-positive, and 7% were on pre-exposure prophylaxis (PrEP). The virus is primarily transmitted within the MSM community through unsafe sexual practices. The city’s health department said that it is actively monitoring the outbreak through community surveillance and at border gates.7
The country reported its first mpox death in 2023, involving a 29-year-old male who died 18 days after being diagnosed with the virus. The patient, a resident of Long An Province, had a severely compromised immune system due to HIV, according to reports. 8
Armed with preventive measures
The Indonesian government is among those that have tightened health inspections at entry points to curb the mpox surge.9
The Indonesian Health Ministry has intensified health checks for foreign nationals entering Indonesia, including state guests, as a precautionary measure to prevent the entry of the mpox. Stringent measures at the entry points as well as filling up of basic questionnaires that ask about medical history, contact activity and last travel destination, for foreign visitors are implemented.
Mpox treatment can include smallpox vaccines and therapies, approved for use in some countries, and used for mpox in certain situations.
Meanwhile, in response to the WHO’s emergency declaration, South Korea has strengthened its mpox surveillance and quarantine measures. The Korea Disease Control and Prevention Agency (KDCA) met with medical and academic experts on August 16 to discuss the potential entry of mpox into the country and develop response strategies.10
As of August 9, South Korea has reported around ten mpox cases this year, a decrease from 151 cases in 2023. This year’s cases involve men aged 20 to 40, with nine domestic cases and one linked to overseas travel.
To ensure safety, authorities have increased quarantine and surveillance efforts but have not reissued the crisis alert lifted last May. The KDCA has also implemented quarantine measures at airports for direct flights from key countries, with epidemiological investigators and public health doctors deployed on-site. Moreover, campaigns to raise public awareness on treatment and prevention have been in place. The KDCA also ensures that it has sufficient supplies to manage new cases, including about 20,000 doses of the Jynneos mpox vaccine and treatments for 504 people.
As Asia remains vigilant in response to the rising global mpox cases, the region is expected to implement and enhance safety measures to effectively control the surge. Drawing on lessons learned from the COVID-19 epidemic, Asia is better prepared to manage and mitigate the impact of mpox, ensuring a more robust and responsive public health strategy.
Sources:
1. https://www.reuters.com/business/healthcare-pharmaceuticals/singapore-confirms-one-imported-case-monkeypox-2022-06-21/
2. https://bernama.com/en/world/news.php?id=2330815
3. https://www.bernama.com/en/news.php?id=2329721
4. https://www.gmanetwork.com/news/topstories/world/917358/mpox-virus-detected-in-pakistan-health-authorities-say/story/
5. https://www.pna.gov.ph/articles/1231466
6. https://www.nationthailand.com/thailand/general/40031265
7. https://tuoitrenews.vn/news/society/20240818/mpox-infects-199-claims-8-lives-in-southern-vietnam-since-2023/81523.html
8. https://e.vnexpress.net/news/news/vietnam-reports-first-monkeypox-death-4668946.html
9. https://asiatoday.id/read/indonesia-to-tighten-health-checks-for-arriving-foreigners-due-to-mpox
10. https://www.thestar.com.my/aseanplus/aseanplus-news/2024/08/17/south-korea-to-enhance-mpox-surveillance-following-who-emergency-alert
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