FAQ: What is Singapore doing about mpox?

SINGAPORE: Singapore has developed response measures to mpox after the World Health Organization (WHO) declared it a global public health emergency in August. 
The plan involves vaccinating two groups of people, temperature screening at some places, as well as protocols for dealing with suspected and confirmed cases.
While Singapore has so far not detected any cases of the deadlier clade 1 strain, authorities said they are ready to respond decisively should the situation change.
Here’s what you need to know about the measures in place. 
Mask-wearing is not recommended for people who are well, said the Ministry of Health (MOH).  
This is because current evidence shows that mpox is spread mainly through close physical contact with an infected person, such as through sex, kissing or touching. 
The WHO has said that mpox – whether it is the new or old strain – is not the new COVID-19, and that the risk to the general population is low.
But if there is evidence of significant respiratory transmission, such as outside of households and in public areas, MOH said it will consider implementing wearing masks on public transport and in crowded indoor places.
“I would say the bottom line is this: I think we were right to be worried about mpox clade 1,” Minister for Health Ong Ye Kung said at a press conference on Wednesday (Sep 4). 
“But we think this is likely to be a troublesome virus that we can manage. It will very unlikely lead to the kind of disruption that happened during COVID-19.” 
Clade 1 is the deadlier subtype of mpox. A mutated strain – clade 1b – has driven the recent surge in cases in African countries.
Clade 1b was first detected among sex workers in the eastern Democratic Republic of Congo in September 2023, but it has since spread rapidly beyond those circles, infecting family members in the same household where there is close physical contact.
According to global charity Save the Children, about two-thirds of recent cases in South Kivu – the epicentre of DR Congo’s mpox outbreak – have been children.
The other subtype – clade 2 – gained international prominence back in 2022 when it spread around the world, mostly affecting gay and bisexual men.
Many nations are still recording occasional cases of clade 2b, which appears to mainly spread through sexual intercourse.
Singapore’s position is that population-wide mpox vaccination is not recommended for now. 
This is because the clade 1 virus is “far less transmissible” compared to respiratory viruses such as influenza or COVID-19, said MOH. 
Plus, a significant segment of the population – those 45 years old and above – will have some mpox immunity from the smallpox vaccination, which was a required childhood jab in Singapore until early 1981.
“There is good evidence indicating that smallpox vaccination renders cross-protection against mpox,” MOH said.
So the mpox vaccine, JYNNEOS, will only be offered for free to healthcare workers who are at the highest risk of exposure to the disease, as well as close contacts of confirmed cases.
They can decide if they want to be vaccinated.
For healthcare workers who are younger than 45 years old and have not been vaccinated against smallpox will receive the full regime, or two doses of the vaccine with about 28 days between the first and second dose.
Those above 45 will receive just one dose if they have previously been vaccinated against smallpox.
As for close contacts of confirmed mpox cases, the recommendation is for a single dose of the vaccine within 14 days of exposure. This will be administered while they are in quarantine. 
Singapore’s supply of JYNNEOS is expected to be sufficient for the current vaccination strategy.
The main symptom of mpox is rashes, which can appear in the form of blisters or sores on areas like the face, palms, soles of the feet or genital areas.
Other symptoms include fever, muscle aches, swollen lymph nodes and fatigue. 
Adults with suspected clade 1 mpox will be sent to the National Centre for Infectious Diseases (NCID), while child cases will be taken to KK Women’s and Children’s Hospital for further assessment and treatment. 
Families with both adults and children will be taken to the National University Hospital, said MOH. They will be isolated while waiting for their test results. 
Testing for mpox is conducted at the National Public Health Laboratory through polymerase chain reaction tests on swabs of skin lesions. 
To date, there are no rapid test kits that can diagnose mpox sufficiently accurately. 
People who test positive for clade 1 will continue to be isolated in healthcare facilities until they are no longer infectious. 
Once a clade 1 case is confirmed, MOH will immediately start contact tracing. Close contacts will be quarantined in a designated government facility, where they will be offered a single dose of the vaccine. 
The quarantine period is currently set at 21 days, which is the incubation period observed in Africa.
The treatment of mpox is mainly through supportive care to manage symptoms and prevent complications, said MOH. 
“While there are currently no specific therapeutics approved for the treatment of mpox infection, antivirals such as Tecovirimat will be prescribed for treatment of mpox cases with severe disease,” the ministry said, adding that this is in line with the practices of other public health agencies. 
Tecovirimat is typically used to treat smallpox, mpox and cowpox, which fall under the same family of orthopoxviruses. 
In Singapore’s preschools and schools, existing measures for other infectious diseases such as hand, foot and mouth disease remain relevant. 
Students will be visually screened for symptoms. Outbreak management measures such as isolation, contact tracing, decontamination of premises and temporary closure of specific classes or schools to contain the spread of disease are also in place. 
At migrant worker dormitories and the Onboard Centre where new work permit holders arrive, MOH is conducting wastewater testing with the Ministry of Manpower and the National Environment Agency. 
Newly arrived work permit holders also go through temperature and visual screening at the Onboard Centre. 
If any mpox cases are detected, there are protocols in place for isolation, transporting the suspected cases to hospitals and containment measures to prevent any further spread within the dormitories, said MOH. 
Singapore has stepped up precautionary measures at its borders since Aug 23, by conducting temperature and visual screening at air and sea checkpoints for people arriving from places that may be exposed to the risk of mpox outbreaks. 
While there are no direct flights between Singapore and any mpox outbreak country thus far, there is temperature and visual screening at Changi and Seletar airports for inbound travellers and crew arriving on flights from places where they may have been exposed to clade 1 outbreaks. 
These have also been implemented at sea checkpoints for crew and passengers arriving on ships from mpox-affected areas, said MOH. 
All travellers must report mpox-related symptoms like fever or rash, as well as their travel history, through the SG Arrival Card. 
Travellers who have fever, rash or other mpox symptoms will be assessed by doctors at the borders and referred to hospitals if necessary.