Since the World Health Organization (WHO) declared mpox a public health emergency of international concern on August 14, the Philippines has recorded new cases of the disease in the country.

The first mpox case in 2024 was made public on August 19.

So far, all of the cases the Department of Health (DOH) has detected do not have any history of travel outside the Philippines.

“We continue to see local transmission of mpox clade II here in the Philippines, in Metro Manila in particular,” Health Secretary Teodoro Herbosa said in a statement on August 26.

As of writing, there have been 14 mpox cases in the country — nine of which have already recovered and the five detected in August 2024 still active.

Mpox and its strains

First off, what is mpox? The WHO describes mpox as an “infectious disease that can cause a painful rash, enlarged lymph nodes, fever, headache, muscle ache, back pain, and low energy.” It has been around for decades.

There are two major groups or “clades” of MPXV. The MPXV Clade I is “more likely to cause severe illnesses and death, especially in the immunocompromised,” the DOH said.

The outbreak in Congo began with the spread of an endemic strain, known as clade I. But a new variant, clade Ib, appears to spread more easily through routine close contact, including sexual contact.

It has spread from Congo to neighboring countries, including Burundi, Kenya, Rwanda and Uganda, triggering the WHO to declare a public health emergency of international concern.

Meanwhile, clade II is considered milder than clade I, with a mortality rate of less than 1% to 4%. It is the strain that caused the mpox outbreak in 2022.

All mpox cases detected in the Philippines so far have been of the milder clade II strain.

“The situation strengthens our health system — we can find, test, and treat mpox,” Herbosa said on August 28. “We will be ready should clade Ib get here.”

Mpox transmission

Health authorities here and overseas have noted that mpox is transmitted mainly through close, skin-to-skin contact. (READ: EXPLAINER: Why is mpox an emergency again, and how worried should I be?)

Johns Hopkins Medicine lists the following as activities that might be risky if a person interacts with someone who is positive for mpox:

• Sharing space in a crowded household
• Prolonged face-to-face contact
• Hugging, massage, and kissing
• Oral, anal, or vaginal sex
• Touching the genitals of a person with mpox

“In rare cases, a person can contract mpox by touching objects, fabrics, and surfaces that were used by a person with mpox but were not disinfected. This can include bedding, clothing, towels, and sex toys,” John Hopkins Medicine said.

Meanwhile, the WHO noted that women who get mpox during pregnancy may pass the virus to the baby, which can also be fatal — leading to stillbirth or complications for the mother, among others.

“Stop it from spreading by washing hands with soap and water or using alcohol sanitizers. Clean surfaces too, and keep skin covered,” Herbosa said in a statement on August 23.

Symptoms

Most of the mpox cases detected in the Philippines have so far started with noticing a “distinct rash,” accompanied by a fever. The WHO lists the following as the other common symptoms of mpox:

• sore throat
• headache
• muscle aches
• back pain
• low energy
• swollen lymph nodes

Mpox rashes look different from chickenpox and measles. “It starts as a flat sore, which develops into a blister filled with liquid that may be itchy or painful. As the rash heals, the lesions dry up, crust over, and fall off,” the WHO said.

The rash begins with the face and can spread throughout the body — from the groin and genital areas to the palms of hands and soles of the feet.

LOOK: The Department of Health releases a public health advisory on mpox (monkeypox) symptoms, comparing it to chickenpox and measles

Health Secretary Teodoro Herbosa said patients with mpox symptoms usually head to dermatologists to get their skin lesions checked @rapplerdotcom pic.twitter.com/dpVXXhIIfX

— Kaycee Valmonte (@kayceevalmonte) August 20, 2024

Those with symptoms are advised to consult a doctor, who will then decide if they should be tested for mpox.

“‘Yung lesion ang kinukuha…. At kadalasan, nagpapatingin ang mga pasyenteng may ganitong karamdaman sa dermatologist (They get the skin lesions…. And usually, patients with these symptoms consult a dermatologist),” Herbosa said on August 19.

Testing is done via PCR at major hospitals, with results taking about four to five days.

New cases reported

Here are details that authorities have shared with the public on the new mpox cases:

• Mpox case 10: 33-year-old male from Metro Manila reported having a fever and a “distinct rash” on the face, back nape, trunk, groin, palms, and soles. He visited Infinity Spa in Quezon City on August 11, where he availed the services of a ​​masseur and had a sexual encounter with another client. Four days later, he consulted a dermatologist in Quezon City after noting his symptoms.
  His positive test result for mpox was reported to the DOH on August 18. He was recovering in a government hospital as of August 25. Authorities have identified 41 close contacts.
• Mpox case 11: 37-year-old male from Metro Manila noticed rashes on August 20 around his face, arms, legs, thorax, palms, and soles. The patient does not know of any exposure to anyone with symptoms, but noted he had “close, intimate, skin-to-skin contact” with someone 21 days before his symptoms showed.
  He was admitted to a government hospital on August 22 and was tested for mpox.
• Mpox case 12: A 32-year-old male noticed symptoms — skin lesions at his groin area — beginning August 14, which was then followed by fever days later. He had contact with one sexual partner. His case was initially thought to be a bacterial infection, but he sought consultation at a DOH hospital on August 23 after getting “pimple-like lesions” on his face, forehead, and scalp.
  As of August 26, the DOH said the patient was in home isolation.
• Mpox case 13: A 26-year-old from Metro Manila who noticed her symptoms, which included rashes on her face and back, accompanied by fever, on August 20. She was advised to undergo home isolation a day later by an outpatient clinic. However, she followed up on August 23 after noting more rashes on her pubic area, arms, and trunk, as well as getting a sore throat and swollen neck lymph nodes.
  She is currently in home isolation. Meanwhile, authorities have notified two close contacts who, as of August 28, had no symptoms.
• Mpox case 14: A 12-year-old boy from Calabarzon whose symptoms started with fever on August 10 and later got rashes on his face, legs, trunk and pubic area, among others. The DOH noted that the boy also had a cough and swollen lymph nodes in his groin area.
  The boy’s skin sample was collected on August 23 and was recovering at home.

The DOH did not name the specific cities or province of the identified mpox cases, but said that their local government units (LGUs) have been notified of their status.

LGUs have the power to share more details of the case and their respective response systems, the department noted. For instance, it was the Quezon City LGU that shared more details about mpox case 10, despite the patient not being a resident of the city.

Treatment

The DOH has repeatedly said that mpox is “treated with supportive care,” so it is all about managing the symptoms.

Patients without other health concerns or illnesses can isolate at home.

The rashes that come with mpox usually last around two to four weeks before scabs start falling off.

“Pag nag-fall off na ‘yung scabs mo, ‘yung mga peklat galing dun sa vesicles, hindi ka na infectious. Pero habang may lesion ka na may lamang vesicle at tubig, maraming mikrobyo doon or virus (When your scabs fall off, the scares from the vesicles, you’re no longer infectious. But while you still have lesions with vesicle and a water, there’s a lot of microbes there or the virus itself),” Herbosa said on August 19.

According to the WHO, there is “no proven effective antiviral treatment” for mpox yet. For now, the WHO advises those who test positive for the viral infection to:

• Contact their healthcare provider for advice
• Stay at home in their own, well-ventilated room, if possible
• Wash hands often with soap and water or sanitizer, especially before or after touching sores
• If not yet healed, wear a mask and cover lesions when around other people
• Keep skin dry and uncovered
• Avoid touching items in shared spaces
• Disinfect shared spaces frequently
• Use saltwater for rinsing sores in the mouth
• Take warm baths with baking soda or epsom salts for body sores
• Take over-the-counter medications for pain (paracetamol or ibuprofen)
• Avoid scratching, shaving, touching sores

The DOH has been responding to cases and updating the public quickly since the first case in 2024. Local health authorities are also monitoring the patients with mpox.

Meanwhile, Quezon City has activated its health response protocol after finding out that mpox case 10 visited two establishments in the city. — with reports from Reuters / Rappler.com