Non-exanthematous mpox and the implications on response measures during outbreaks

Area of Science:

• Epidemiology
• Public Health
• Infectious Diseases

Background:

• Mpox (formerly monkeypox) was declared a public health emergency in 2024, prompting response measures.
• Rashless mpox presentations, though previously noted, are poorly understood in outbreak dynamics.
• A newer clade 1b is responsible for the current mpox upsurge, with no prevalence studies on rashless cases.

Purpose of the Study:

• To reflect on the implications of rashless mpox presentations.
• To discuss strategies for addressing mpox outbreaks considering atypical symptoms.
• To highlight gaps in current mpox surveillance and reporting.

Main Methods:

• Perspective piece based on experiences and existing literature.
• Analysis of diagnostic challenges and reporting limitations.
• Examination of potential implications for surveillance and control.

Main Results:

• Diagnostic expectations focused on rash can delay mpox detection and response.
• Current mpox reports lack symptom profile disaggregation, obscuring the true disease burden.
• Undetected spread due to rashless cases may impact surveillance and vaccination strategies.

Conclusions:

• Timely detection and reporting of mpox require considering non-exanthematous cases.
• Improved data disaggregation and surveillance are crucial for understanding mpox epidemiology.
• Addressing rashless mpox is vital for effective control and breaking transmission chains.