MOH says low risk of severe mpox variant spreading to S’pore
SINGAPORE – Despite the World Health Organization (WHO) declaring mpox a global public health emergency on August 14, Singapore’s Ministry of Health (MOH) has assessed the immediate public health risk of the outbreak in Africa to Singapore as low.
The MOH clarified on August 15 that although there is a cross-border spread of the more severe mpox clade I in parts of Central and East Africa, the outbreak has so far been confined to the African continent, with no reported cases of clade I being exported outside of Africa.
Since January 2024, Singapore has reported 10 cases of mpox, all of which were from the milder form of the virus, known as clade II. The country saw 32 cases in 2023 and 18 cases in 2022, following the initiation of disease reporting in June 2022. Notably, all mpox infections detected in Singapore have been of the milder clade II strain, predominantly during the global outbreak between 2022 and 2023.
Mpox, formerly known as monkeypox, is a viral disease that causes flu-like symptoms and pus-filled lesions on the skin. The emergence of a new and deadlier Ib sub-variant of clade I, which spreads more easily through close contact, including sexual contact, has alarmed global health experts. This development led the WHO to declare mpox a global public health emergency for the second time in two years.
According to the WHO's recent report, there has been an unprecedented increase in the number of mpox cases and outbreaks in several countries within the WHO African region. While the Democratic Republic of the Congo (DRC) remains the epicenter, neighboring countries such as Burundi, Kenya, Rwanda, and Uganda have reported their first cases, linked to clade Ib.
Children account for over 70% of mpox cases and 85% of deaths in the DRC, where malnutrition exacerbates vulnerability to infections. An emergency committee convened on August 14 to advise WHO Director-General Tedros Adhanom Ghebreyesus on whether the outbreak qualifies as a public health emergency of international concern (PHEIC). A PHEIC declaration is WHO’s highest alert level, intended to expedite research, funding, and international cooperation to contain the disease.
Professor Dale Fisher from the NUS Yong Loo Lin School of Medicine noted that there is minimal movement between the DRC and Singapore for business or tourism, keeping the risk low at this stage. However, he emphasized the importance of continued vigilance to prevent the spread of clade I and Ib in Singapore. “We should maintain current practices, such as seeking medical attention for skin vesicles and ensuring they are swabbed,” said Prof Fisher, who also directs the NUS Centre for Infectious Disease Emergency Response. “Infection prevention measures remain crucial to stopping the spread.”
MOH assured that Singapore’s healthcare system is well-equipped to diagnose and manage mpox infections. The ministry has instructed all medical practitioners and healthcare institutions to stay alert for potential mpox cases, including those suspected to involve clade I infections.
To enhance early detection at Singapore’s borders, travelers are required to report any mpox-related symptoms, such as fever or rash, and provide their travel history via the SG Arrival Card. Suspected clade I cases will be isolated in hospitals, and close contacts of confirmed cases will be quarantined and monitored for up to 21 days from the date of last exposure.
Dr. Leong Hoe Nam, an infectious diseases specialist from Rophi Clinic, highlighted that unlike the earlier clade, which primarily spread through sexual contact, there is now an increase in infections among children. “This suggests that the virus is spreading through more frequent and varied contact, not just among adult sexual partners,” he said. Dr. Leong advised healthcare workers to take appropriate barrier precautions during consultations and to monitor for both clades.
Singapore’s first mpox case was identified in 2019 when a Nigerian business traveler presented with fever, chills, muscle pain, and pus-filled bumps, likely due to consuming contaminated bushmeat. His close contacts were quarantined and vaccinated with the smallpox vaccine, preventing local transmission. Singapore did not see further local cases until the 2022 outbreak, at which point mpox was made a notifiable disease following its global spread to non-endemic regions.