Health and port authorities around the world are beginning to introduce new rules – mostly notification rules at this point – to control the ongoing spread of Mpox.
Much of the current crackdown appears to have been triggered by the World Health Organization’s declaration of Mpox as a public health emergency of international concern in mid-August.
Known restrictions announced so far
- Chittagong Port Authority has issued rules on notification, shore leave and disembarkation for all crew arriving on maritime vessels, according to the West P&I Club;
- Uruguay has recommended that any seafarers arriving from Africa who are displaying fever symptoms ought to be checked by a physician and ought not be taken offboard, the Japan P&I Club has reported;
- Kandla Port, a multi-cargo and commodity port, and minor ports in India are required in the case of suspected infections to isolate travellers (including seafarers), follow infection control procedures and have samples sent to laboratories, according to circular Q-1/Mpox/2024/504-517 issued by the Ministry of Health & Family Welfare, Government of India;
- Chinese border authorities have announced tighter surveillance measures at ports of entry which will include traveller health self-declarations along with potential sanitizing measures for vehicles, containers and goods from regions where Mpox cases have been reported, according to Xinhua – the official state news agency of China;
- Singapore’s Ministry of Health has put temperature and visual screening in place for inbound travellers and crew arriving on planes, and similar at sea checkpoints for crew and passengers on ships arriving from Mpox-infested countries;
- Brazil – although there are no restrictions on shipping, or the boarding / disembarkation of seafarers or passengers to / from ships, masters must record and report health events; local health authorities have been advised to update and enforce local contingency plans and protocols for responding to the public health emergency at ports of entry with a requirement to report any suspected cases as soon as possible, according to local P&I Correspondents, Proinde.
Spread of Mpox
Mpox appears to be widespread in across the African continent (particularly of the Clade 1 variant), and the current sub-type of Mpox of concern has apparently been found in Sweden, Pakistan, and Thailand according to various sources. One suspected case onboard a vessel that called in Argentina has since been proven by local health officials to be a false alarm, news agency Reuters has reported.
Meanwhile, according to the World Health Organization, since 1 January 2022, cases of Mpox have been reported to the World Health Organization from 19 Member States across Africa. As of 25 August 2024, a total of 6,062 laboratory confirmed cases, including 55 deaths, have been reported since 01 January 2022. In 2024, as of 25 August 2024, 14 countries have reported 3,659 confirmed cases, including 32 deaths. The three countries with the majority of the cases in 2024 are Democratic Republic of the Congo (3,244), Burundi, (231), and Central African Republic (45).
Australia is currently experiencing an ongoing wave of Mpox infections (from an earlier, milder, epidemic (of the Clade 2 variant) “that also started in Africa) and has been since 2022. In 2024 there have so far been 353 confirmed Mpox cases, mostly in NSW and Victoria, but there are other cases scattered across the country, according to data from Australia’s National Communicable Disease Surveillance Dashboard, which is operated by the Australian Federal Department of Health and Aged Care.
Clades, clades, clades
In layman’s terms, a “clade” is a group of organisms that descended from a common ancestor. Humans are within the Great Apes clade, which is itself a clade within “Primates” and so on.
There are effectively outbreaks of different sub-types of Mpox in Africa, and the variant of concern appears to be the Clade 1b type, which might be both more infectious and possibly more dangerous than other types, according to a report in the science-journal “Nature”.
Readers should note that the death rate(s) commonly cited by non-medical sources for the current outbreak might well be very inaccurate. The commonly quoted rate or ratio is the “case fatality rate” which is calculated as the number of people who have been proven to die from the disease divided by the number of people who have been proven to have the disease, and the quotient is then multiplied by 100 to give a percentage i.e. the formula is: (total deaths / total cases)*100. With a widespread outbreak in a lesser developed country, it’s simply not possible to accurately discover all cases and, if there are fewer medical facilities are also less developed, then it is likely that more vulnerable people are more likely to pass away compared to vulnerable people who have easy access to basic treatment. It’s also equally possible that large numbers of people contracted Mpox, but it was pretty mild, so they never sought medical help.
There’s another commonly used rate called the “infection fatality rate”, which is the number of people who have been confirmed to die from the disease divided by the best guess at the total number of cases of the disease (which includes no-symptom cases and the best guess at the number of people who contracted the disease but aren’t recorded anywhere (e.g. they didn’t go to the doctor). Meanwhile, remember that both the case and infection fatality rates will change over time. Readers should be somewhat sceptical of very high death rates based on data from lesser developed countries until, or if, these are confirmed in countries with a health surveillance network.
That said, the significance of Clade 1b Mpox shouldn’t be downplayed either, given that the World Health Organization has declared it as a public health emergency and the Director-General Dr Tedros Adhanom Ghebreyesus has stated that: “the emergence of a new clade of Mpox, its rapid spread in eastern DRC [Democratic Republic of Congo], and the reporting of cases in several neighbouring countries are very worrying. On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.”
About Mpox and its symptoms
Mpox is a virus, and it has historically spread to humans from animals. Since the earlier 2022 outbreak, there are examples of it spreading between humans. While Mpox can, potentially, be fatal, it is normally a mild disease. According to the Australian Federal Department of health, symptoms can include a distinctive rash and blisters, swollen lymph nodes, fever, headache, muscle ache, joint pain, back pain, chills and exhaustion. Mpox can also be present without any symptoms at all, and the rate of asymptomatic infection is not well understood, according to the WHO. Mpox symptoms can look like a range of other skin diseases, so the best way to determine an infection is through laboratory testing.
Mpox spreads mainly through close contact with someone who is already infected. “Close contact” includes skin-to-skin contact (such as during sex), especially if the skin is broken (and this breakage might not be visible to the naked eye), through mouth-to-mouth contact, or being face-to-face for some time, such as talking or breathing close to each other. Mpox can also be spread via contaminated objects (such as clothing or linen), through needle injuries, and tattoo parlours. The virus can also be passed on to unborn children.
A person is generally thought to be infectious with Mpox from the time they develop symptoms to the time that the scabs heal and a fresh layer of skin forms, according to the Australian Department of Health.
Prevention of infection and treatment
Avoid being in close contact with infected people who should, in any case, be isolating themselves, using private bathrooms etc. Patients should wear facemasks if they are unavoidable around other people. Avoid being in contact with clothes, linens, towels etc of infected persons. Careful hand and respiratory hygiene are recommended for patients and for everyone in the household.
There is a globally limited supply of vaccines and high international demand. Although Australia has secured a supply of vaccines and is working with the manufacturer to acquire more, until then supply is limited. Access is being prioritised to support outbreak management by, for example, being target at at-risk populations such as medical workers who may be working with Mpox patients or Mpox samples, or to people who live with Mpox patients.
Two doses of vaccine are required for optimal protection. No vaccine is 100% effective and Mpox may occur even in vaccinated people.
Shipping Australia comments
Shipping Australia CEO, Capt Melwyn Noronha, commented: “although we strongly emphasise that we do not any have reason to envisage any widespread restrictions on the general population, nor do we envisage a repeat of the COVID lockdowns, it is with the benefit of hindsight from the COVID experience that we can see that seafarers were poorly, unfairly, and unjustly mistreated.
“Given that there have already been some restrictions imposed on shipping and seafarers, we urge that that a humanitarian approach be adopted toward the health, well-being and welfare of seafarers as the authorities roll-out measures to protect the public health”.
Resources for shipping companies
The International Chamber of Shipping publishes a guide: “Global Health Emergency Guide: Helping Shipping Companies and Crew Prepare, Act and Recover”, which draws on lessons learned both from COVID and from the ongoing Mpox emergencies.
Mpox – World Health Organization
International Health Regulations (2005) Third Edition – WHO
Mpox (monkeypox) – Australian Government Department of Health & Aged Care
