2022–2023 mpox outbreak in asia 2022–2023 mpox outbreak in asia the 2022 mpox outbreak in asia is a part of the ongoing outbreak of human mpox caused by the west african clade of the monkeypox virus. the outbreak was reported in asia on 20 may 2022 when israel reported a suspected case of mpox, which was confirmed on 21 may. as of 10 august 2022, seven west asian, three southeast asian, three east asian and one south asian country, along with russia, have reported confirmed cases. 2022 mpox outbreak in asiaspread of disease in asia as of 29 july 2022 confirmed cases reported diseasempoxvirus strainmonkeypox virus (west african clade)index caseichilov general hospital, tel aviv, israeldate20 may 2022 – ongoing (11 months and 23 days)confirmed cases162suspected cases‡4deaths1territories14‡suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out. as of 10 august 2022, a total of 162 cases were confirmed. most of them were concentrated in the region of west asia, with 141 of the total 156 cases (≈90.38%) being reported in the region. israel alone has reported 114 cases (≈73.07%). israel reported the first community transmission of the disease on 21 june 2022. background these paragraphs are an excerpt from mpox and 2022–2023 mpox outbreak. mpox (pronounced /ˈɛmpɒks/ em-poks, formerly known as monkeypox) is an infectious viral disease that can occur in humans and some other animals. symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. the time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks. there may be mild symptoms, and it may occur without any symptoms being apparent. cases may be severe, especially in children, pregnant women or people with suppressed immune systems. the disease is caused by the monkeypox virus, a zoonotic virus in the genus orthopoxvirus. the variola virus, the causative agent of smallpox, is also in this genus. it may spread from infected animals by handling infected meat or via bites or scratches. human-to-human transmission can occur through exposure to infected body fluids or contaminated objects, by small droplets, and possibly through the airborne route. people can spread the virus from the onset of symptoms until all the lesions have scabbed and fallen off; with some evidence of spread for more than a week after lesions have crusted. diagnosis can be confirmed by testing a lesion for the virus's dna. there is no known cure. a study in 1988 found that the smallpox vaccine was around 85% protective in preventing infection in close contacts and in lessening the severity of the disease. a newer smallpox and mpox vaccine based on modified vaccinia ankara has been approved, but with limited availability. other measures include regular hand washing and avoiding sick people and animals. antiviral drugs, cidofovir and tecovirimat, vaccinia immune globulin and the smallpox vaccine may be used during outbreaks. the illness is usually mild and most of those infected will recover within a few weeks without treatment. estimates of the risk of death vary from 1% to 10%, although few deaths as a consequence of mpox have been recorded since 2017. an outbreak of mpox, a viral disease then commonly known as "monkeypox", was confirmed in may 2022. the initial cluster of cases was found in the united kingdom, where the first case was detected in london on 6 may 2022 in a patient with a recent travel history from nigeria (where the disease is endemic). on 16 may, the uk health security agency (ukhsa) confirmed four new cases with no link to travel to a country where mpox is endemic. all four cases appeared to have been infected in london. from 18 may 2022 until may 2023, cases were reported from several countries and regions, predominantly in europe and in the americas but also in asia, in africa, and in oceania. the outbreak marked the first time mpox had spread widely outside central and west africa. on 23 july, the director-general of the world health organization (who), tedros adhanom ghebreyesus, declared the outbreak a public health emergency of international concern (pheic). as of 18 march 2023, there had been a total of 86,516 confirmed cases in over 113 countries.in may 2023, the world health organization declared an end to the global health emergency declared in response to the worldwide outbreak of mpox virus. transmission stages of lesion development. a large portion of those infected were believed to have not recently traveled to areas of africa where mpox is normally found, such as nigeria, the democratic republic of the congo as well as central and western africa. it is believed to be transmitted by close contact with sick people, with extra caution for those individuals with lesions on their skin or genitals, along with their bedding and clothing. the cdc has also stated that individuals should avoid contact and consumption of dead animals such as rats, squirrels, monkeys and apes along with wild game or lotions derived from animals in africa. in addition to more common symptoms, such as fever, headache, swollen lymph nodes, and rashes or lesions, some patients have also experienced proctitis, an inflammation of the rectum lining. cdc has also warned clinicians to not rule out mpox in patients with sexually transmitted infections since there have been reports of co-infections with syphilis, gonorrhea, chlamydia, and herpes. history imported cases before the outbreak according to the world health organization, imported cases of mpox from nigeria was detected in israel and singapore in september 2018 and may 2019, respectively. in 2018, an imported case was detected in israel. a 38-year-old man came from rivers state, nigeria in late september. he showed the symptoms of the disease on that month. later on october the patient sought medical attention at shaare-zedek medical center in jerusalem. he was confirmed to be infected with the west african clade of monkeypox virus that month. all of the patient's contacts were traced and followed up but no virus transmission were detected. arrival ichilov general hospital (in the middle) in tel aviv sourasky medical center, where the first case was isolated as the outbreak was spreading in europe in the middle of may 2022, the israeli health ministry reported a suspected mpox case in the country on 20 may. the case was confirmed by testing on 21 may, becoming the first case in israel during the outbreak, which also became the first in asia. the 30-year-old man returned from western europe and contracted the disease from there. the ministry reported that he was in isolation in the ichilov general hospital in tel aviv. cases transited through asia in may and june 2022, two australians tested positive for mpox in australia, but before that they stayed in transit in airports for some hours in southeast asia. on 30 may, thai health authorities confirmed that an australian who stayed in transit in suvarnabhumi airport for two hours that week had tested positive for mpox in australia. on 6 june, the singaporean ministry of health announced that a mpox case in new south wales in australia stayed in transit in singapore on 2 june. 13 people who had casual contact were isolated. wastewater surveillance a study from the faculty of medicine, chulalongkorn university, thailand lead by dr dhammika leshan wannigama reported multiple traces of monkeypox virus were detected in non-sewered wastewater with sparse sampling collected from both the bangkok, thailand with increasing concentrations from june to august 2022. this is the first dataset related to monkeypox viral dna in wastewater in bangkok. monkeypox viral dna was first detected in wastewater in the second week of june 2022. from the first week of july, the number of viral dna copies increased. sanger sequencing confirmed the identification of the monkeypox virus and its relation to the 2022–2023 mpox outbreak. timeline of first confirmed cases by country or territory first confirmed mpox cases by country or territory date countries / territories 21 may 2022 israel 24 may 2022 united arab emirates 15 june 2022 georgia 20 june 2022 lebanon • singapore 22 june 2022 south korea 24 june 2022 taiwan 30 june 2022 turkey 12 july 2022 russia 14 july 2022 india • saudi arabia 20 july 2022 qatar 21 july 2022 thailand 25 july 2022 japan 29 july 2022 philippines 2 august 2022 cyprus 16 august 2022 iran 19 august 2022 indonesia 6 september 2022 hong kong 16 september 2022 china • jordan • bahrain 3 october 2022 vietnam 4 november 2022 sri lanka timeline of suspected cases by country or territory countries listed below had only suspected cases at the time of reporting. some countries reported confirmed cases after reporting suspected cases (i.e. turkey). countries listed several times reported suspected cases again after they discarded suspected cases before. timeline of suspected mpox cases by country or territory date countries / territories 20 may 2022 israel (confirmed on 21 may) 27 may 2022 iran (discounted on 4 june) 28 may 2022 malaysia (discounted on 31 may) 29 may 2022 afghanistan (discounted between 30 may and 5 june) 1 june 2022 cambodia (discounted on 2 june) 3 june 2022 india (discounted on 7 june) 4 june 2022 turkey (discounted on 5 june) 5 june 2022 georgia (confirmed on 15 june) 7 june 2022 bangladesh (discounted on 9 june) 9 june 2022 bangladesh (discounted on 12 june) 16 june 2022 nepal (discounted on 17 june) 21 june 2022 south korea (confirmed on 22 june) 8 july 2022 india (discounted on 9 july) 14 july 2022 india (confirmed on 14 july) responses several countries have responded to the outbreak. the responses of some of them are listed below. bangladesh: on 22 may, the directorate general of health services (dghs) issued warnings at every port in the country to prevent the spread of mpox. the directorate spokesperson nazmul islam said that the dghs has asked all air, land and sea ports to be alert. suspected cases are instructed to be sent to an infectious disease hospital and kept in isolation. china: on 2 june, the chinese cdc issued a notice quoting the who's document with a translation of the original, "stigmatising people because of a disease is never okay. anyone can get or pass on mpox, regardless of their sexuality." india: on 21 may, union health minister mansukh mandaviya directed the national centre for disease control and the icmr to keep a close watch and monitor the situation. the union health ministry has also directed airport and port health officers to be vigilant, according to official sources. they have been instructed to isolate and send samples to the national institute of virology of any sick passenger with a travel history to infected countries. indonesia: indonesian health authorities were put on alert when cases of mpox were reported in australia in may 2022. mohammad syahril, ministry spokesperson, urged medical personnel and the country's population to be alert and aware of the symptoms of the disease. malaysia: on 27 may 2022, the malaysian ministry of health reactivated the mysejahtera app to provide information and surveillance on mpox. philippines: health secretary francisco duque iii said that the philippines was intensifying its border control measures amid the threat of mpox. the health department stated it is exploring potential sources of mpox vaccines and antivirals. saudi arabia: on may 21, the saudi ministry of health stated that they are ready to monitor and investigate cases of mpox, if any occurs. they added that it also has an integrated preventive plan to deal with such cases if they appear, including identifying suspected and confirmed cases. taiwan: on 30 may, the taiwan centers for disease control officially listed mpox as a notifiable infectious disease, and on june 23, mpox was officially upgraded to a second-class notifiable infectious disease, which means that confirmed cases must be notified within 24 hours, and if necessary, isolation treatment may be implemented in designated isolation treatment institutions. thailand: on 24 may 2022, the department of disease control (ddc) started screening all overseas passengers from central african countries and other outbreak countries at international airports. on 26 may 2022, the ddc set up an emergency operations center to monitor the outbreak situation and plan for a possible outbreak in