Key facts

Transmission

Direct and indirect contact (with infected humans or animals), droplet-borne, and fluid-borne.

During outbreaks where transmission is primarily person to person:

Direct contact with mpox rash or scabs or contact with respiratory secretions and bodily fluids of a person with mpox
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 the above, plus:

Contact with the blood, stool, vomit, spit or sores of infected animals
Preparing infected bushmeat

Most Vulnerable

Most vulnerable to contracting the disease:

People in close physical contact with someone experiencing mpox infection
Varies according to mpox clade but may include: children, sex workers (or people who have multiple or new sex partners), and men who have sex with menHunters or others who may be in contact with infected animals through handling or processing of bush meat

Most vulnerable to severe disease:

Children
Young adults (those who have not been vaccinated against smallpox)
People with weakened immune systems (including people with untreated and advanced HIV)
Pregnant women

Symptoms

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)

Followed by:

Rash - starts out flat, becomes raised, fill with fluid, burst open, drain and becomes crusted and dry (usually)

What can you do to prevent and control an epidemic?

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

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, hygiene promotion,, vaccination, etc.)
Model following this advice and inform community members of current health practice advice
Work with other community groups who may have stronger outreach with marginalized groups (sex workers, men who have sex with men, displaced and mobile populations), depending on context
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

Immunization

Support pre-exposure vaccination activities for health workers at risk, and post-exposure vaccination activities for contacts of cases, where available.

Reservoir control and prevention (for epidemics driven by zoonotic origin)

Quarantine animals that are potentially sick with monkeypox

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?
Are there bushmeat markets? Where are they?
Where are the health facilities? (Include traditional healers)
Are there any advocacy and support local organizations for Lesbian, Gay, Bisexual, Transgender, and people of other gender and sexual orientations (LGBT+)? Where are they and what do they do?

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?
Do people cook bushmeat thoroughly before eating it?
Are there handwashing facilities in the community, at animal markets and other areas where bushmeat is slaughtered? Are soap and water always available?
What are the community’s habits, practices and beliefs about handling and slaughtering animals, especially animals that are sick or dead?
How common is it for people to live or work together in crowded spaces?
- Is there ventilation and fresh air in homes, schools, and workplaces?
Who and where are the vulnerable people? Who is most affected by mpox?
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.
What are the community’s perceptions about men who have sex with men and/or sex workers (as relevant)? Consider whether stigma (negative and often unfair believes) and discrimination (unfairly treating a person) against men who have sex with men, may affect whether they seek and are able to get health services, and the quality of the services they may receive.
- Could we disseminate key messages with accessible LGBTQ groups and/or sex workers?
- Could we partner with local organizations that support LGBTQ communities and/or sex workers, to disseminate key messages with LGBTQ and/or sex workers groups that we may have limited access to?
Is a social mobilization or health promotion programme in place?
Which sources do people use/trust the most for information?
Are there rumours or misinformation about vaccines? What are the rumours?

Volunteer actions

01. Community-based surveillance 02. Community mapping 03. Communicating with the community 04. Community referral to health facilities 05. Volunteer protection and safety 06. Personal protection equipment (PPE) for highly infectious diseases 19. Psychosocial support 20. Isolating sick people 25. Mass vaccination campaigns 26. Respiratory hygiene and coughing etiquette 28. Physical distancing 29. Hygiene promotion 31. Good food hygiene 34. Handwashing with soap 35. Handwashing in a highly infectious epidemic 41. Handling and slaughtering animals 42. Promoting safe sex 43. Social mobilization and behaviour change

Other resources

WHO Mpox Questions and Answers Aug 2024

Guidance for WASH Practioner on Mpox