Could The Monkeypox Virus Impact Your International Travel Plans?

Published on September 1, 2024

Thailand has confirmed Asia’s first case of Mpox, prompting experts to monitor the spread of two Monkeypox strains now emerging in other countries. The World Health Organization (WHO) has raised the alarm over the rising Mpox cases in several African nations, declaring it a public health emergency. This disease, caused by the Mpox virus, has been a concern since the first human case was documented 50 years ago in the Democratic Republic of Congo, making it a persistent health issue in parts of Africa since 1970. The virus gained significant attention during a 2022 outbreak, when the Clade II strain, native to West Africa, led the WHO to declare a global health emergency. This declaration was lifted in mid-2023, after 10 months.

On August 14, 2024, the WHO once again declared a “public health emergency of international concern” following an unprecedented surge in cases in Congo and neighboring African countries. While the 2022-23 outbreak was primarily linked to the Clade II variant, two new offshoots – Clade I and Clade Ib – are now spreading. These more severe strains have been detected in several Asian nations, including Singapore, the Philippines, Thailand, Malaysia, and Pakistan, leading to increased vigilance among travelers and health authorities.

Which countries are affected by the outbreak?

As of August 28, 2024, Clade Ib of the Monkeypox virus has been reported in 13 African nations: Côte d’Ivoire, Kenya, Liberia, South Africa, Cameroon, Uganda, Gabon, Burundi, Rwanda, Nigeria, , the Republic of the Congo, the Central African Republic, and the Democratic Republic of Congo (DRC). Outside Africa, the virus has also been detected in countries including Singapore, the Philippines, Pakistan, Sweden, Thailand, and Malaysia.

The first case outside Africa was reported in Sweden shortly after the WHO issued its latest emergency declaration. The patient had traveled through an African region experiencing a Mpox outbreak and was found to have the Clade I variant.

Singapore

Passengers arriving at Seletar and Changi airports, as well as seafarers, will now undergo Mpox screening if they come from high-risk regions. Singapore’s Health Ministry has issued health advisories at these airports to guide travelers on necessary precautions. Those exhibiting symptoms are encouraged to report them via the SG Arrival Card upon arrival for further medical testing. Vaccinations will be available for individuals who may have been in close contact with infected persons, alongside contact tracing efforts to prevent future outbreaks.

Thailand

Inbound travelers to Thailand must now register for the Thailand Health Pass. After passing any required screening, they will receive a QR code and a health pass, which they can use to report any future symptoms.

India

India is proactively preparing for potential Mpox cases by deploying an indigenous RT-PCR testing kit. The country has equipped 32 laboratories at international airports to manage screenings. The IMDX Mpox Detection RT-PCR Assay will be produced at a molecular diagnostics facility in Vadodara, capable of manufacturing one million test reactions annually. The factory is poised to distribute the kits as needed.

Pakistan

In Pakistan, officials are conducting Mpox screening for passengers at all airports and border crossings with Afghanistan, China, India, and Iran to detect potential infections.

China

China will monitor both incoming travelers and cargo for signs of Mpox over the next six months to detect and control any potential outbreaks.

Africa

Following the WHO’s announcement, numerous African nations have intensified efforts to contain the virus by implementing various precautionary measures. Botswana and Zimbabwe have recently started screenings after several deaths were reported from the new strain in Southern Africa. Countries such as Burundi, Kenya, Rwanda, Uganda, Malawi, Nigeria, and South Africa are also enhancing health screening procedures for travelers. Additionally, Nigeria has mandated the declaration of medical status before travel to other African regions.

Europe

After Sweden recently reported its first case of Mpox (Clade Ib), the WHO expressed concern over the spread of more dangerous strains into Europe. Although the European Centre for Disease Prevention and Control (ECDC) maintains that the risk level remains “low,” EU member states are on high alert and prepared to take necessary precautions.

Essential Information About Monkeypox

How is Monkeypox Transmitted?

Monkeypox spreads from person to person through direct contact with the skin lesions or body fluids of an infected individual, including respiratory secretions, or through contact with contaminated items like bedding, clothing, towels, and personal objects such as razors, utensils, needles, or toothbrushes. The virus can also be transmitted during sexual intercourse or close contact with an infected person, with multiple sexual partners increasing the risk of infection.

The WHO has noted that the Clade Ib strain primarily spreads through sexual networks, which is especially concerning given its detection in countries neighboring the DRC. This situation was a significant factor in declaring a Public Health Emergency of International Concern (PHEIC). Clade Ib is rapidly spreading in countries adjacent to Congo, including Burundi, Kenya, Rwanda, and Uganda.

Who is Most at Risk?

Children are among the highest-risk groups for Mpox infection.

Is the Clade I Strain More Dangerous?

The Centers for Disease Control and Prevention (CDC) in the United States reports that Clade I infections have a higher mortality rate compared to Clade II, which has a 99.9 percent survival rate. While Clade II transmission was primarily associated with sexual contact, Clade I is also known to spread through physical contact.

What Are the Symptoms of the Mpox Clade I Variant?

Symptoms typically appear between 5 to 21 days after infection. These include fever, chills, headaches, muscle aches, joint pain, back pain, rash or lesions, swollen lymph nodes, and fever. According to Dr. Aggarwal, individuals with Mpox may develop rashes on their hands, feet, chest, face, mouth, or near the genitals.

Do Vaccines Protect Against Monkeypox?

Dr. Suraj Saggar, Chief of Infectious Disease and Chair of Infection Prevention at Holy Name Medical Center in New Jersey, advises that individuals at risk of Mpox exposure should consider getting vaccinated.

Key Information for Travelers

Before embarking on international travel, Dr. Saggar advises checking whether your destination is listed as an affected area by the WHO. With the rising number of cases, leisure trips to high-risk regions are not recommended. Even if you’re traveling to areas with minimal or no reported cases, it’s crucial to stay informed, take precautions, and consult a healthcare provider, especially if you have a history of viral susceptibility or pre-existing medical conditions.

How Travelers Can Protect Themselves from Monkeypox and Its Variants

Dr. Saggar strongly recommends vaccination for those in high-risk groups and advises reducing risky behaviors, particularly when traveling abroad during this time.

Here are some preventive measures to help curb the spread:

• Avoid contact with individuals who have a rash resembling Mpox, and refrain from skin-to-skin and sexual contact.
• Do not share clothing, bed linens, or other porous materials that may have been in contact with lesions. If sharing is necessary, ensure items are washed and disinfected after each use. Avoid sharing eating utensils or personal hygiene items like razors.
• If you have Monkeypox lesions, keep them covered with clothing, bandages, or gloves to reduce the risk of transmission.
• Wash your hands thoroughly with soap and water after any contact with an infected person or animal.
• Wear a medical mask if you are around others for an extended period.
• Engage in safe sexual practices, including the use of condoms and dental dams.
• Ensure that all foods containing animal meat or parts are thoroughly cooked.