Mpox

About the outbreak with the new variant of mpox (clade Ib)

In the past month, a new variant of mpox has spread from the Democratic Republic of Congo, where an outbreak of the new clade has been ongoing since 2023. This variant has now reached several other African countries that have not previously reported cases of mpox. On August 15, 2024, the first case of this new variant was registered in Sweden.

A case outside Africa was to be expected, and as a public health authority, we have established guidelines for healthcare professionals on how to manage individuals suspected of having mpox. While Denmark has experienced a few cases of mpox in recent years, no cases of the new variant have been detected so far.

In collaboration with other national and international health authorities, we are closely monitoring the situation. We are continuously updating our guidelines based on an ongoing evaluation of the need for additional measures in response to this new variant.

Questions and answers about the outbreak with the new variant of mpox (clade Ib), August 2024

How does the Danish Health Authority view the mpox situation in Denmark?

We are closely monitoring the situation. It is anticipated that a few cases of the new variant may occur in Denmark, particularly among individuals who have traveled to or stayed in the affected regions in Africa.

We have established guidelines for the treatment of mpox and are continuously reviewing them to determine if any updates are necessary in response to the new variant. This allows us to be prepared to manage any cases that may occur in Denmark.

How does the Danish Health Authority view the situation in Sweden?

We are aware of the recent case of the new mpox variant in Sweden and are maintaining close communication with other Danish authorities as well as the health care system, to ensure we are prepared should cases also emerge in Denmark. Contingency plans are in place to manage such cases effectively.

What is the risk of mpox cases appearing in Denmark?

It is likely that the new variant will surface in Denmark among people who have traveled to or stayed in the affected areas in Africa.

In recent years, Denmark has experienced a small number of cases mpox, notably during the outbreaks in 2022. It is expected that a small number of cases of the new variant may also occur. Many of those who were at high risk during the previous outbreaks have been vaccinated, and are expected to have a level of protection from the new variant.

Does the Danish Health Authority anticipate changes to the guidelines?

In collaboration with other relevant authorities, we are continually monitoring the situation, adjusting our guidelines as necessary, and evaluating whether additional measures are required in response to the new variant. We closely follow updates in international guidance, including from the European Centre for Disease Prevention and Control (ECDC), and adjust our guidelines taking the national context in Denmark into account.

Will the Danish Health Authority implement a larger effort targeted at risk groups?

At present, there are no plans to launch a broader initiative targeting risk groups. However, we maintain ongoing communication with relevant stakeholders to ensure that developments and relevant recommendations are effectively communicated.

What actions will the authority take if mpox cases are detected in Denmark?

If a case is identified, notification will come from Statens Serum Institut or the Danish Patient Safety Authority. The Danish Health Authority will coordinate the response in collaboration with other relevant authorities, ensuring that the response aligns with current guidelines. Additionally, we will ensure the public is informed about any necessary precautions.

Has mpox been present in Denmark previously?

Yes.

In 2022, there were 192 cases, followed by 6 cases in 2023, and 5 cases in 2024. All of these were cases of the same, original variant.

Is there a vaccine for mpox, and does the Danish Health Authority recommend that more people be vaccinated?

Yes, a vaccine is available that reduces the severity of symptoms from mpox.

Since 2022, individuals at high risk of infection, such as men who have sex with men and have multiple partners, have been eligible for vaccination. Vaccination is still available to these target groups. Many within the target group have already been vaccinated. Additionally, close contacts of infected persons may be vaccinated based on an individual medical assessment.

What should you do if you are concerned about being infected?

If you have symptoms and are concerned about mpox infection—particularly if you belong to a risk group, have traveled to affected areas, or know, that you have been in contact with someone who has tested positive for mpox—you should contact your doctor.

Symptoms of mpox include a skin rash with small blisters that may resemble chickenpox.

Please also refer to the Q&A on this page: "What are the symptoms of mpox, and how does it spread?"

Is it primarily MSM (men who have sex with men) who are at risk?

Mpox is transmitted through close physical contact. While anyone can contract mpox, most cases of the "old variant" were seen among men who have sex with men and have multiple partners. Transmission typically occurs through sexual or close physical contact.

The new variant appears to be slightly more contagious. It is still unknown what the impact may be in a Danish context.

Is mpox a dangerous disease in Denmark?

For persons in Denmark, there no need to worry at the moment. The risk of infection and severe illness remains very low.

About the disease

Mpox spreads through close physical contact, such as kissing or sexual activity, and only when symptoms are present. The typical symptoms include a skin rash with small blisters and flu-like symptoms. Vaccination is available for close contacts and individuals at high risk of infection.

Transmission usually occurs through direct contact with the small blisters on the skin. Even a single blister can be sufficient to transmit the virus. Transmission rarely occurs through casual social interaction but typically happens during close physical contact, such as during sexual activity or sharing a bed.

In most cases, the disease is mild and resolves on its own within 2-4 weeks. However, the condition can be painful, particularly if the rash is located in and around the rectum. Scarring may also occur as the blisters heal.

It is important to avoid sexual activity and close physical contact if you suspect you are infected or if you have tested positive for mpox.

What is mpox?

Mpox is a viral disease that can be transmitted from person to person through close physical contact, such as with people you live with or have sexual contact with. Mpox is classified as a zoonotic disease, because it originates in certain animals and can be transmitted to humans.

What are the symptoms of mpox, and how does it spread?

Symptoms of mpox include a skin rash with small blisters that may resemble chickenpox. The blisters often appear around the genitals and rectum and may spread to other parts of the body, including the mouth and throat, during the course of the illness. Some individuals develop many blisters, while others may have few (fewer than 10). Flu-like symptoms, such as chills, headaches, muscle aches, fatigue, and swollen lymph nodes, may also occur before the rash develops.

Mpox can be contagious from the onset of symptoms until all scabs have fallen off the blisters and the skin is fully healed. The virus spreads through contact with fluid from skin blisters or sores. Even with very few blisters, you can transmit the infection. Human-to-human transmission typically occurs through close physical contact, such as kissing, sexual activity, or sharing a bed. Mpox is not highly contagious without close physical contact with an infected person.

In rare instances, the virus can be transmitted through respiratory droplets if you are in close proximity to an infected person who is coughing or speaking loudly. It can also be transmitted through objects contaminated with the virus.

The incubation period, or the time from infection to the onset of symptoms, typically ranges from 6-16 days but can be as short as a few days or as long as 21 days.

The disease usually lasts around 2-4 weeks and resolves on its own for most people. However, the rash can be painful, especially if it is located in and around the rectum. Scarring may also occur where the blisters were present. Over-the-counter pain medication can be used to manage symptoms.

Is mpox a sexually transmitted disease?

There is a risk of transmission during sexual activity with someone infected with mpox. While using a condom reduces the risk, it does not eliminate it. Mpox can also be transmitted through objects that have come into contact with the virus, such as sex toys, bedding, or other items.

If you have sexual contact with multiple partners, pay attention to symptoms such as a skin rash, sores, or blisters in yourself and your partners. It is a good idea to exchange contact information with sexual partners, as this can assist with contact tracing if one of you is later diagnosed with mpox.

If you develop symptoms of mpox, do not engage in sexual activity until you know for sure whether you have mpox and until you have fully recovered. We also recommend using condoms or dental dams until 12 weeks after the rash has healed.

What should I do if I suspect I am infected?

If you suspect you may be infected with mpox, contact your doctor without going to the clinic in person. When speaking with your doctor, describe your symptoms and where you think you may have been exposed to the virus. If your doctor determines that you may be at risk of infection, they will arrange for testing. If you need to visit a healthcare facility for testing, we recommend maintaining physical distance, wearing a face mask, and covering any blisters with clothing. Avoid using public transportation, such as buses, metros, or trains, if possible.

If you have symptoms of mpox, avoid sexual activity and close physical contact with others. It is also recommended that you avoid contact with individuals with weakened immune systems, pregnant women, and children under 12 years old.

Cover all blisters on your body, arms, and legs with clothing. Depending on your symptoms, you may need to self-isolate. While awaiting test results, you should self-isolate regardless of whether you have symptoms.

What should I do if I test positive for mpox?

If you test positive for mpox, whether you need to self-isolate depends on your symptoms.

However, everyone who tests positive for mpox should avoid close physical contact with others, including refraining from sexual activity, until all scabs have fallen off the blisters and the skin is fully healed.

You should self-isolate if you have blisters or a rash that cannot be covered with clothing when around others, such as blisters on your face, hands, or in your mouth.

You should also self-isolate if you feel unwell with flu-like symptoms such as headaches, fever, muscle aches, and/or chills.

If you can completely cover your blisters or rash with clothing, self-isolation may not be necessary. However, it is important pay attention to new blisters that may appear. If new blisters appear in areas that cannot be covered, such as your face, hands, or mouth, you should self-isolate. Additionally, it is important to wash or disinfect your hands frequently and avoid close physical contact with others.

As a general rule, you should avoid contact with individuals who are at risk of severe mpox if they become infected. If your job involves close physical contact with others or working with children under 12 years old, pregnant women, or individuals with weakened immune systems, you should stay home from work until all blisters have scabbed over and the skin is fully healed.

Vaccination

Who is recommended to get vaccinated against mpox?

The Danish Health Authority recommends preventive vaccination for specific high-risk groups. The Danish Health Authority also advises that close contacts of confirmed mpox cases be offered vaccination to protect against severe illness if they are at high risk.

Vaccination against mpox provides strong protection against the disease, but it does not guarantee immunity or prevent transmission. Therefore, it is crucial to pay attention to whether you are developing symptoms of mpox. If you have symptoms, you should avoid close physical contact with others until you have been diagnosed and fully recovered.

Vaccination for individuals at increased risk of infection (PrEP vaccination)

In Denmark, mpox cases have primarily been observed among men who have sex with men and have multiple partners. A significant proportion of people who have been infected with mpox are also on preventive PrEP treatment for HIV or are HIV-positive.

You are recommended to get vaccinated if you:

• Are receiving PrEP for HIV.
• Are a man who has sex with men and has had anal intercourse with at least two male partners within the last 12 weeks, regardless of whether you used condoms. A steady partner does not count. Using a condom does not guarantee protection against infection or transmission.
• Are a man who has sex with men and has had syphilis within the last 24 weeks.
• Are a man who has sex with men and has had chlamydia or gonorrhea within the last 24 weeks.

The vaccine can also be offered to women, non-binary people, and transgender people who are in close contact with people in the above groups and are therefore at higher risk of infection. A doctor will assess your eligibility for vaccination.

If you have already been infected with mpox, you do not need to be vaccinated. This also applies if you become a close contact of an infected person after having mpox.

Where can you get vaccinated?

Vaccination against mpox is managed by the five Danish regions, and you can find more information about where and how to get vaccinated on the regional websites.

Here’s where to find information about vaccination in your region (in Danish):

• Region Hovedstaden
• Region Sjælland
• Region Syddanmark
• Region Midtjylland
• Region Nordjylland

If you contract mpox after receiving the first dose of the vaccine, a second dose is not required.

Does the smallpox vaccine also protect against mpox?

People who have been vaccinated against smallpox are expected to have some immunity against severe mpox, although the exact level of protection is unknown.

Smallpox vaccination ceased in Denmark in 1977, and smallpox was declared eradicated by the WHO in 1980.

Even if you have been vaccinated against smallpox, it is still advisable to get vaccinated against mpox if you belong to a high-risk group. For more information, see 'Vaccination for individuals at increased risk of infection (PrEP vaccination).'

5 tips to prevent mpox

Here are our 5 tips to prevent mpox:

1. Be aware of symptoms.
2. Protect yourself and your partners: Postpone sexual activity if you have symptoms or suspect infection.
3. Contact your doctor if you have symptoms.
4. Get vaccinated if you are at high risk – but remember, vaccination is not a guarantee against infection.
5. Call AIDS-Fondet’s hotline for LGBT+ individuals.