Mpox Overview and Port Requirements
Mpox is an infectious disease caused by the virus formerly known as monkeypox, a species of the genus Orthopoxvirus. It typically lasts for 2 to 4 weeks and is similar to smallpox but generally less severe. It has two distinct clades of the virus: clade I (subclasses Ia and Ib) and clade II (subclasses IIa and IIb). The most recent upsurge in cases are the clade I type originating from the Democratic Republic of Congo. However, this clade has now spread to the east and west coasts of Africa and the first case in Europe was reported in Sweden in mid August.
Transmission:
- Human-to-Human: Mpox can spread through close physical contact with someone who has mpox. This includes both direct contact such as touching, including intimate and sexual contact, and indirect contact such as talking or breathing close to someone who has mpox.
- Animal-to-Human: Coming in physical contact with an animal that carries the virus such as a monkey or rodent. Physical contact refers to bits or scratches or eating contaminated meat which is not thoroughly cooked.
Signs and symptoms:
The signs and symptoms of mpox typically develop within 5 to 21 days after exposure and can be divided into two stages:
Initial Symptoms
- Fever: Often the first symptom to appear.
- Headache
- Respiratory Symptoms: Sore throat, nasal congestion, cough.
- Muscle Aches
- Backache
- Swollen Lymph Nodes: A distinguishing feature from smallpox.
- Exhaustion: General feeling of tiredness and weakness.
Rash
- Appearance: Usually starts 1 to 5 days after the initial symptoms.
- Location: Begins on the face and then spreads to other parts of the body, can include the palms of the hands, soles of the feet and genital areas.
- Progression: The rash progresses from raised spots to fluid filled blisters, which eventually scab over and fall off.
Prevention:
- Avoid Close Contact: Avoid close contact with anyone who has a rash resembling mpox.
- Hand Hygiene: Wash your hands frequently with soap and water or use an alcohol-based hand sanitiser.
- Avoid Contaminated Materials: Do not handle clothing, bedding, or other materials that have been in contact with an infected person or animal.
Managing mpox onboard: Treatment Guidelines
Primary treatment is of the mpox rash and pain management. Early and supportive care is important to help manage symptoms and prevent complications. The incubation period of mpox can range from 5 to 21 days. People with mpox are infections until their rash has completely healed. If you suspect that there is a crew member with mpox it is best to invoke isolation precautions as soon as possible. Refer to the Ship’s Captain’s Medical Guide chapter on Communicable Diseases. Report any cases to the local Port Health Authority when approaching port or if discovered whilst in a port area. Vaccines for mpox have been approved, but they are currently being prioritized for individuals in high-risk groups.
Treatment Essentials:
- Isolate, either in crew’s cabin or ship’s hospital depending on the severity.
- Conduct a thorough examination to identify any signs of a rash, ensuring an accurate diagnosis. It is important to distinguish mpox from other illnesses such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies.
- Ensure bed rest and appoint someone to monitor their mpox progress and temperature.
- Give non-alcoholic fluids and provide adequate nutrition.
- Treat symptoms as they arise, including analgesics for pain management.
- Wear disposable face masks and protective clothing such as gloves and gowns when attending the patient. Dispose of items after single use.
- Discourage patient from popping or scratching blisters or shaving areas with sores.
- Advise patient to keep skin dry and uncovered while in isolation.
- When approaching port, send a radio message giving details of the case to the Port Health Authority.
- If the patient is seriously ill and if in any doubt as to the diagnosis contact TELEMEDICINE PROVIDER.
Chittagong Port
An Emergency Circular has been issued by Chittagong Port Authority on 20th August 2024 days after the WHO declares mpox outbreak, formerly called monkeypox, a public health emergency of international concern.
To mitigate the risk of mpox transmission into Bangladesh via maritime routes, all vessels arriving at Chittagong Port must adhere to the following precautionary measures:
- Vessels must submit a declaration of any infected or suspected mpox cases among the crew and report to Port Control before anchoring.
- No officer or crew member shall be granted shore leave without prior approval from the Port Health Officer.
- Disembarking crew members must undergo a health check by the Port Health Officer before receiving clearance at the immigration gate (Gate No. 1) of Chittagong Port.
- Any information regarding symptomatic monkeypox patients on board must be immediately reported to the Port Control Room (Tel: 02333326916, VHF Channel-12) and the Port Health Officer. In such cases, the vessel’s movement and cargo operations will be subject to inspection by the Port Health Officer.
Singapore
From 23 August 2024, there are no direct flights between Singapore and any country experiencing a mpox outbreak.
Temperature and visual screenings are being conducted at Changi and Seletar airports for inbound travellers and crew arriving from regions at risk of mpox outbreaks. Similar screenings are also being implemented at sea checkpoints for crew and passengers arriving on ships from areas affected by mpox.
To help with early detection of mpox cases at Singapore’s borders, the government requires all travellers to report any mpox-related symptoms (e.g., fever or rash) and their travel history via the SG Arrival Card. If suspected clade I mpox cases are detected, the persons will be isolated in hospitals. To prevent spreading, close contacts of confirmed cases will be quarantined and monitored for up to 21 days from their last exposure.
More information can be found on the WHO website or from the Loss Prevention department.