Direct and indirect contact (with infected humans or animals), droplet-borne, and fluid-borne.
During outbreaks where transmission is primarily person to person:
- Contact with respiratory secretions or skin lesions of an infected person
- Contact with objects recently contaminated with infected secretions / body fluids
- Direct and prolonged contact (for example, through kissing or sexual intercourse) with infected saliva, nose mucous or genital secretions
- Mother-to-child transmission during or immediately after birth
During outbreaks where cases are originating in animals. All of the above, plus:
- Contact with the blood, stool, vomit, spit, or sores of infected animals
- Preparing infected bushmeat
- Eating infected bushmeat that has not been thoroughly cooked
Most vulnerable to contracting the disease:
- People in close physical contact with someone experiencing mpox infection
- Men who have sex with men
- Hunters or others who may be in contact with infected animals
Most vulnerable to severe disease:
- Young adults (those who have not been vaccinated against smallpox)
- People with weakened immune systems
- Pregnant women
At the beginning there may be:
- Fever (usually)
- Swelling or painful lumps in neck, groin, or underarms (usually)
- Strong headache (sometimes)
- Back pain (sometimes)
- Muscle aches (sometimes)
- Feeling tired (sometimes)
- Rash - starts out flat, becomes raised, fill with fluid, burst open, drain and become crusted and dry (usually)
What can you do to prevent and control an epidemic?
Reservoir control and prevention
- Quarantine animals that are potentially sick with monkeypox
Monitor the community and identify sick people
- Identify and isolate sick people
Treatment and management
- Rapidly refer suspected cases to health facilities
- Support contact tracing and follow-up of contacts
- Provide psychosocial support to patients and family members
Sanitation and waste management
- Promote disinfection of reusable supplies
- Solid waste management
- Promote proper and safe disposal of dead animals
Personal protection and hygiene
- Promote handwashing with soap, especially:
- After caring for or visiting sick people
- After handling or slaughtering sick animals
- After preparing bushmeat
- Promote the use of personal protective equipment (PPE) when caring for sick people or when touching sick or dead animals, specifically gloves and mask
- Discourage people from unnecessary touching of sick or dead animals or things that might have been contaminated by their blood or body fluids
Food hygiene and safety (during outbreaks originating in animals)
- Discourage small bushmeat as a food source if possible
- Encourage people to cook bushmeat fully before consuming
Social mobilization and health promotion
- Find out the specific advice being given by health and other relevant authorities
- Promote recommended health practices (such as practising safe sex, use of PPE, smallpox vaccination, etc.)
- Model following this advice and inform community members of current health practice advice
- Offer support and encouragement to follow the advice
- Try to gain understanding about if and why health practice advice is not being followed
- With the guidance of your supervisor and health authorities, work with communities to overcome barriers to following health advice and recommended practices
- Support pre-exposure vaccination activities for health workers at risk, and post-exposure vaccination activities for contacts of cases, where available.
Mapping and community assessment
1. Make a map of the community
2. Mark the following information on the map:
- How many people have fallen sick with mpox? Where?
- How many people have died? Where? When?
- Who and where are the vulnerable people?
- Who is most affected by mpox?
- Where are the health facilities? (Include traditional carers)
- Are there bushmeat markets? Where are they?
3. Record the following information on the back of the map:
- When did people start to fall sick with mpox?
- How many people live in the affected community?
- How many are children under 5?
- Which people in the community have contact with monkeys and small animals?
- Which people eat bushmeat?
4. Do people cook bushmeat thoroughly before eating it?
5. Are there handwashing facilities in the community, at animal markets and other areas where bushmeat is slaughtered? Are soap and water always available?
6. What are the community’s habits, practices and beliefs about handling and slaughtering animals, especially animals that are sick or dead?
7. How common is it for people to live or work together in crowded spaces?
8. Is there ventilation and fresh air in homes, schools, and workplaces?
9. Who and where are the vulnerable people? Who is most affected by mpox?
10. What are the community’s habits, practices, and beliefs about caring for and feeding sick people? Consider any differences in roles and responsibilities between women and men.
11. Is a social mobilization or health promotion programme in place?
13. Are there rumours or misinformation about vaccines? What are the rumours?