Risk Factors of Transmission and Being Infected by Monkeypox Virus

Mr Zhulkarnain Abdul Rahim asked the Minister for Health whether the Ministry has any data on the risk factors of transmitting or being infected by the monkeypox virus, such as age, demographics or lifestyle choice.

This will collectively address the PQs for oral answer No. 41 and 42 in the order paper, and also oral PQs filed by Dr Lim Wee Kiak, Ms Joan Pereira and Dr Wan Rizal for the sitting on and after 5 July.

On 22 June 2022, the World Health Organization (WHO) reported that since 1 January 2022, over 3,400 laboratory confirmed cases of monkeypox had been detected from 49 countries globally, including one imported case in Singapore. This global spread of monkeypox is driven mainly by person to person transmission. However monkeypox is unlikely to become a global pandemic like COVID-19, as transmission requires close or prolonged physical contact with infectious persons or contaminated material. WHO had also determined that this outbreak does not constitute a Public Health Emergency of International Concern (PHEIC) as of 23 June 2022.

Monkeypox is typically a self-limiting illness where patients recover within 2 to 4 weeks. A small percentage of those infected can fall seriously ill or even die. Those particularly vulnerable to complications are young children, pregnant women or immunocompromised individuals. Data from the current multi-country outbreak indicated that in Europe, where the majority of recent cases were reported, 99% of the cases were men, and many have self-identified as men who have sex with men. Given that sexual contact with infected individuals appeared to be the main driver of the current monkeypox outbreak, and that transmission requires close physical or prolonged contact, the risk to the general public remains low.

The Ministry of Health (MOH) has developed protocols and processes to manage monkeypox. These have been applied to the recent imported case reported on 21 June. Similar to the management of other emerging infectious diseases, the key to controlling the spread of monkeypox is early diagnosis and isolation of the case, contact tracing and monitoring of close contacts, and if necessary placing them in quarantine.

We require travellers to declare relevant symptoms using the electronic Health Declaration Card on arrival for early detection of cases. Individuals with symptoms will be referred for further assessment. We have also disseminated information on monkeypox, including symptoms and precautionary measures for the public to adopt. We urge individuals to see a doctor promptly when they develop symptoms, and to isolate themselves from others.

To reduce spread, cases are isolated in hospital, and their close contacts quarantined for up to 21 days from the last date of exposure, for monitoring, and offered smallpox vaccines as post-exposure prophylaxis to reduce their risk of infection or severe symptoms. MOH has also provided regular updates to all medical practitioners and healthcare institutions on the monkeypox situation, including guidance and protocols on the criteria for identifying suspect cases as well as the subsequent management of confirmed cases.

Unlike COVID-19 vaccination, mass population-wide vaccination with the smallpox vaccine is not recommended as a preventive strategy for monkeypox, in line with international recommendations and the global response thus far. Although the smallpox vaccine is up to 85% effective at preventing monkeypox, it has potentially severe side effects. For the general population, the risks of complications outweigh the benefits, because they are at low risk of being infected. Exercising personal responsibility to avoid high risk activities, especially when symptomatic, and practicing good personal hygiene remain effective at reducing the risk of transmission in the general population.

For certain healthcare and laboratory personnel who are at higher risk of occupational exposure, such as those who will directly and frequently work with infectious monkeypox cases or specimens, the proper use of personal protective equipment, and infection control practices, are effective at reducing risk of transmission. For this group, MOH is also evaluating vaccination for protection before potential exposures on a case by case basis.

MOH will continue to monitor the monkeypox situation closely and calibrate our preparedness and response measures as needed. Members of the public are encouraged to keep up to date with the Government’s advisories. They should exercise personal responsibility to monitor their personal health and maintain good hygiene, especially during travel. They should also avoid close contact with other individuals known or suspected to be ill with monkeypox infection.