This Mpox Outbreak May Be Different – Experts Explain Why

If larger clusters of Mpox outbreaks occur, it's unlikely to blindside us like COVID-19 did, say experts.

Mpox cases surge around the world: Is this a cause for concern?

(Photo: iStock/ Altered by FIT)

A 38-year-old man who arrived in Kerala from the UAE last week made news after he was diagnosed with Mpox, an infectious viral illness that's currently surging in many countries.

Speaking to the press, Kerala Health Minister Veena George said the patient is undergoing treatment at Manjeri Medical College Hospital in the state's Malappuram district.

During the 2022 global Mpox outbreak, experts told FIT that the chances of a full-blown pandemic driven by Mpox were slim. But the situation isn't the same this time around.

What do we know about the virus? What has changed? How can we prepare for it? FIT explains.

What Do We Know About Mpox in India?

Speaking to FIT, Dr Sheeja P, the District Medical Officer (DMO) of Mallapuram District, Kerala, said the 38-year-old patient is recovering well.

"Lab test confirmed it to be Mpox on 18 September. He has fever and blisters, but his symptoms are getting better," she added.

According to Dr Sheeja, 16 contacts of the patient, including his close family members in Kerala and roommates in the UAE, have been contacted and are under observation.

Earlier this month, another man with a travel history was diagnosed with Mpox and underwent treatment at Lok Nayak Hospital in Delhi.

According to the World Health Organization (WHO), the typical symptoms of Mpox include:

• Blisters or sores on the face, palms, soles of the feet, groin, genitals etc.

• Fever

• Headache

• Muscle pain

• Swollen glands (lymph nodes)

In light of the recent surge in cases, the Union Ministry of Health and Family Welfare and the National Centre for Disease Control (NCDC) has released updated guidelines for the management of Mpox – and said that 35 laboratories have been designated for testing suspected cases of Mpox across the country.

‘The Global Surge This Time Is Worrisome'

Mpox isn't a new virus. In fact, it's been endemic in parts of Africa for years.

Dr TS Anish, a community medicine specialist and nodal officer at Kerala One Health Centre for Nipah Research and Resilience in Kozhikode, explained that there are two main variants, or clades, of the virus (MPXV) – Clade 1B which was found in the Congo basin in Central Africa, and Clade 2B which was found in the west African region.

"Mpox was, for years, confined to the continent of Africa, but this changed in 2022 as large clusters of cases were reported in Europe, the Middle East, and the Americas," he told FIT.

"In 2022 when there was an outbreak in many countries, the circulating strain was Clade 2B. While this was a matter of concern, it wasn't too troubling because this is a relatively mild and self-restricting variant."

Dr TS Anish

In 99 percent of the cases, this strain is transmitted through sexual contact. As a result, at the time, most of the people affected were men who have unprotected sex with other men.

But, in 2024, Clade 1B spread to several African countries and spilled over to the US and Canada. So far this year, 15,600 cases and 537 deaths have been reported.

"This is far more troubling because the severity of Clade 1 is higher than Clade 2," he says.

According to National Centre for Disease Control (NCDC), Clade 2B has a fatality rate of up to 1 percent, while Clade 1B has a fatality rate of up to 10 percent.

"In Africa, where the variant is endemic, it is known to kill children in a higher proportion compared to Clade 2B."

Dr TS Anish

The Clade 1B outbreak was declared a public health emergency of international concern by the WHO in August 2024.

So far, all the cases that were reported in India were of Clade 2. However, experts say this can change.

"We are waiting for the virological confirmation in this case (in Kerala). We are expecting that result in a few days. If it is Clade 1B, then it is a cause for concern. Then it will be the first recorded case of that clade in India," added Dr Anish.

'Larger Outbreaks Are Inevitable'

According to Dr Anish, now that Clade 1B is circulating in other countries, "we can say with relative certainty that it will come to India eventually and the transmission rate will be high."

One major reason for this is that Clade 1 doesn't just spread through sexual contact. It can spread through nonsexual close contact too —through droplets, surfaces, and even clothes — much like some variants of COVID-19.

"A person is infectious even before they present with symptoms. So, it's difficult to prevent it. By the time you know you have it, you’ve already transmitted it to your family, friends, and colleagues. "

Dr Anish

Another reason for this could be waning heard immunity against smallpox.

Speaking to FIT, renowned epidemiologist Dr J P Muliyil explained, "Because the Mpox virus is similar to the smallpox virus, immunity against the smallpox virus also protects against Mpox."

"The last doses of smallpox was given in the late 70s, so the people who received the vaccine are a minority in our country. Now, only some older people have immunity to smallpox and by extension, Mpox in India. This could be one of the reasons we are seeing a surge in cases."

Dr JP Muliyil

"There is nothing that the disease has acquired newly, it's only that human activity has become more diverse, and more people are travelling much more easily and getting exposed to it," he added.

But This Isn’t Necessarily a Cause for Panic

If larger clusters of outbreaks occur, it's unlikely to blindside us like COVID-19 did, say experts. This is because we know this virus, we know how to deal with it, we have effective anti-viral treatments, and we have vaccines.

"When the outbreak does happen, the human intervention will be a lot quicker than in the case of COVID," said Dr Anish.

The Mpox virus is also very different from SARS-CoV2 in how it mutates.

"It is an old virus, of DNA type, which generally mutate infrequently as compared to RNA viruses, to which SARS-CoV2 belongs," explained Dr Vineeta Bal, immunologist and scientist at IISER-Pune.

This is good news because it means the virus is less likely to surprise us with deadly mutations even as it spreads fast.

If Vaccines Are Available, Why Aren’t They Being Administered?

Smallpox vaccines are effective against Mpox. Although the former were discontinued when smallpox was eradicated, countries still have reserves of the vaccine.

But there is a catch.

The original smallpox vaccines were known to have brutal side effects.

"I hope they don't fiddle around with that," said Dr Muliyil when asked if rolling out smallpox vaccines as a preemptive measure to prevent Mpox is a good idea.

Elaborating on this, he said the side effects of the vaccine are 'no joke', ranging from high fever to delirium.

"I have had the smallpox vaccine. I'm 72 now. Younger people haven't had the chance to. It was given to everyone because smallpox is a deadly disease but thank God it's gone!"

Dr J P Muliyil, Epidiemologist

Although some companies have come out with newer, more tolerable vaccines for Mpox, its reach is yet limited.

There are only two Mpox vaccines that have been approved by the US Food and Drug Administration (FDA).

On 13 September, the MVA-BN vaccine became the first mpox virus to be added to the WHO's prequalification list. However, it has only been approved for use in the US, Canada, and the European Union.

We Have Treatment, but We Need Better Surveillance, Awareness

• Need Better Surveillance

Speaking to FIT for a previous article, Dr Bal said that how well we are able to contain the spread of the disease ultimately "depends on the health infrastructure of the place where you are."

Of the 32 cases of Mpox that have been reported in India so far (including the 30 cases reported in 2022), 16 are from Delhi and 16 from Kerala. According to Dr Anish, "this is peculiar."

"If the cases are being brought in from other parts of the world, some cases should emerge in other states also. But that hasn’t happened yet."

This, he said, "is an indication that the surveillance system of most states in India is poor, and not capable enough to detect Mpox cases."

He added that if surveillance systems in India are not able to detect cases to begin with, our health system may not be capable of handling a surge in cases. "Then the damage may be high."

• Need More Awareness

Dr Sheeja, DMO of Malappuram district, told FIT that the patient in Kerala self-reported his illness. "He works in UAE where cases are high right now. He was aware of the illness and its symptoms, so when he started noticing blisters, he immediately reported it and could get immediate medical attention," she explained.

Because the legions can be mistaken for other illnesses like chickenpox, measles, and foot and mouth disease, it is important that people are aware of the possibility of Mpox.

"This is why we have to raise awareness among healthcare workers across fields – paediatricians, radiologists, skin specialists – to detect and report cases," said Dr Anish.