What Is Mpox (Monkeypox)? What Cancer Patients Need to Know

Mpox, formerly known as monkeypox, can pose risks particularly for people with weakened immune systems. It is a viral infection. Cancer patients may be more susceptible because treatment can weaken their immune systems. The disease has not yet been reported in Turkey, and the Ministry of Health is carefully carrying out all necessary work to prevent its spread there. Given how the disease spreads and its severity, cancer patients and their families would nevertheless benefit from understanding it.

Frequently Asked Questions About Mpox

1. Is It a New Disease?

Mpox is not new. It was first identified in monkeys in 1958, and the first human case was recorded in the Democratic Republic of the Congo in 1970. Since then, it has been common, particularly in the tropical rainforests of Central and West Africa. In 2022, however, it began spreading widely outside Africa for the first time (MD Anderson Cancer Center).

2. Why Is It Attracting So Much Attention Now? How Large Is the Ongoing Global Outbreak?

The first large-scale mpox outbreak outside Africa began in 2022, accelerating the disease's spread beyond the continent. From May 2022, it spread rapidly worldwide, particularly in Europe and the United States, affecting more than a hundred thousand people. This prompted the World Health Organization (WHO) to declare a global public health emergency. The outbreak was brought under control in 2023, but a new, more severe outbreak began in Africa.

3. Is the Cause of the Disease Known?

Yes. Mpox is caused by monkeypox virus (MPXV), which is closely related to the smallpox virus. It has two genetic subtypes: the West African subtype (clade 2) and the Central African (Congo Basin) subtype (clade 1). Clade 1 can cause more severe disease (CDC).

4. Is the Virus Transmitted to Humans From Monkeys?

Mpox is transmitted to humans from rodents rather than monkeys. Rodents are considered its natural reservoir. The name "Mpox" replaced "monkeypox" because of concerns that naming diseases after animals could lead to discrimination.

5. How Is the Virus Transmitted to Humans?

Mpox spreads through direct contact with infected animals or people. The virus can enter through the skin or mucous membranes of the mouth, nose and eyes. Infected people's bodily fluids and skin lesions pose the greatest transmission risks. Sexual transmission has also been observed.

Although respiratory transmission is possible, mpox does not spread widely through aerosols in the way infections such as COVID-19 do. It spreads primarily through direct contact with an infected person's skin lesions or bodily fluids. Respiratory transmission requires close contact, such as prolonged face-to-face interaction, and generally occurs when infected saliva or other respiratory secretions directly reach another person's mucous membranes (mouth, nose or eyes).

6. Is It Similar to Smallpox and Chickenpox?

Mpox shares some features with viral infections such as smallpox and chickenpox. However, it is more closely related to smallpox and can be distinguished by its skin lesions and swollen lymph nodes. Smallpox has also been eradicated worldwide through vaccination.

7. What Are the Signs and Symptoms?

Mpox causes symptoms such as fever, headache, fatigue, widespread body aches, swollen lymph nodes and skin rashes. These generally appear 6-13 days after exposure to the virus. Skin lesions are particularly concentrated on the face, arms and legs and change over time.

8. Can Infection Occur Without Symptoms?

Although asymptomatic mpox cases are rare, the virus usually causes noticeable symptoms. This allows infected people to be identified and isolated. Therefore, mpox is not expected to cause a widespread pandemic like COVID-19.

9. How Long Should People Exposed to Mpox Be Monitored?

People exposed to mpox should be monitored for symptoms for 21 days after their last exposure. They should seek medical care if any symptoms develop during this period.

10. How Is the Disease Diagnosed?

Mpox is diagnosed by examining samples taken from skin lesions using a PCR test. This can be performed in biosafety level 2 laboratories, rather than routine laboratories.

11. Can the Disease Be Fatal?

Although mpox is generally mild, it may be more severe in immunocompromised people and young children. Overall, 1-6% of patients may die, most of them young children.

12. Are Treatment and Vaccines Available?

There is no widely used medicine for mpox. Cases to date have been controlled using antivirals such as cidofovir, brincidofovir and tecovirimat (ST-246), and smallpox immunoglobulin. Their effectiveness has not been conclusively established, and research continues. Following animal and human studies, tecovirimat was approved in 2022 by the European Medicines Agency (EMA) and the United States FDA, but it is not widely available worldwide.

In the United States, the FDA approved a vaccine for mpox in 2019 called JYNNEOS^TM (also known as Imvamune and Imvanex). This weakened (attenuated) vaccine is effective against smallpox and mpox and contains Modified Vaccinia Ankara virus. This strain was most likely developed as a smallpox vaccine strain through serial passage of horsepox virus in the vaccine laboratories of Refik Saydam Hıfzıssıhha Enstitüsü. Researchers at the University of Munich subsequently serially passaged the Vaccinia Ankara strain in chicken fibroblast tissue cultures to obtain a safer vaccine. Limited supplies are known to be available for laboratory workers handling such viruses and for exposed people during outbreaks. Vaccination can also be given after exposure.

The mpox vaccine is currently neither available nor administered in Turkey. However, previous smallpox vaccination is said to provide some protection against mpox.

13. Does the Smallpox Vaccine Protect Against Mpox?

Smallpox vaccination is known to provide 85% protection against mpox. However, it has not been administered since 1980, so it is not fully known how much protection persists today.

14. Could It Cause a Pandemic?

Because mpox has obvious symptoms and the virus undergoes fewer mutations, it appears unlikely to cause a pandemic like COVID-19. However, faster spread and increased mortality in the outbreak beginning in 2023 have raised concerns.

15. Have Cases Been Detected in Turkey?

Mpox cases were detected in Turkey in 2022, but the total was not officially announced. By 2024, the more transmissible clade I variant, which had caused a serious outbreak particularly in Africa, had been detected in Sweden. Swedish authorities said it was a subtype of the strain spreading in Africa and could be more contagious. In contrast, according to the Turkish Ministry of Health's August 14, 2024 statement, no mpox cases had yet been detected in Turkey and there was currently no need for restrictions or additional measures.

Following WHO's declaration of a "global emergency," the Ministry of Health announced that it was closely monitoring developments and would continue informing the public. All necessary work to prevent mpox from spreading in Turkey is being carried out carefully.

16. How Can Mpox Be Prevented?

Prevention requires isolating patients, identifying contacts, using appropriate personal protective equipment, vaccinating at-risk groups and providing accurate public information.

17. Should Cancer Patients and Their Families Take Special Precautions?

Cancer patients are at higher risk from mpox because their immune systems may be suppressed. They should avoid close contact with infected people and, where possible, take necessary precautions before visiting hospitals or treatment centers. Transmission routes include direct skin contact, contact with bodily fluids and contact with contaminated surfaces. In addition to hygiene measures, masks and other personal protective equipment are therefore particularly important.