Mpox vaccine to be offered to healthcare workers at highest risk and close contacts of confirmed cases

SINGAPORE: Singapore will offer the mpox vaccine to healthcare workers who are at the highest risk of exposure to the disease, as well as close contacts of confirmed cases.
There is no need for mask-wearing measures for people who are well, based on current evidence on how mpox is spread.
These were announced at a press conference on Wednesday (Sep 4) against the backdrop of growing concern about the clade 1 strain, which prompted the World Health Organization to declare mpox a global public health emergency for the second time in two years. 
“We do not have full information on the characteristics of this virus, but we have good information on how it behaves, the key characteristics, which allow us to develop a response plan,” Health Minister Ong Ye Kung said. 
Singapore’s measures may have to adapt over time, he added, as the situation evolves and as the world understands the virus better.
Clade 1 is the deadlier subtype of mpox.
A mutated strain – clade 1b – emerged in September 2023 and was first detected among sex workers in the Democratic Republic of Congo. It has driven the recent surge in cases in African countries.
Singapore has not detected any clade 1 infection to date. All 14 mpox cases in the country so far this year have been of the less severe clade 2 subtype.
“I would say the bottom line is this: I think we were right to be worried about mpox clade 1,” said Mr Ong.
“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.” 
The vaccine JYNNEOS, which has been used in Singapore for protection against mpox and smallpox, will be offered for free to two groups of people.  
Healthcare workers who are at the highest risk of exposure to mpox, such as those working at the National Centre for Infectious Diseases (NCID), can get vaccinated for additional protection, on top of infection control protocols and wearing protective equipment.
As for close contacts of confirmed mpox cases, the Expert Committee on Immunisation has recommended a single dose of the vaccine within 14 days of exposure. This will be administered while they are in quarantine. 
The quarantine period is currently set at 21 days, which is the incubation period observed in Africa.
Singapore’s current supply of JYNNEOS is expected to be sufficient for the current vaccination strategy.
Population-wide mpox vaccination is not recommended for now, as the clade 1 virus is “far less transmissible” compared to respiratory viruses such as influenza or COVID-19, the ministry said.
In addition, given that smallpox vaccination was required in Singapore until early 1981, there will be some mpox immunity among a “significant” segment of the population, or those who are 45 years old and above, MOH noted.
“There is good evidence indicating that smallpox vaccination renders cross-protection against mpox,” it added.
Out of 100 infected cases in the Democratic Republic of the Congo, about three to four die, Mr Ong noted, describing it as quite a high and worrying number. Many of the infections and fatalities involve children below 15.
Although the actual statistics for developed nations like Singapore are likely to be lower, Mr Ong said the country needs to pay attention to more vulnerable groups like older people who are immunocompromised, as well as children.
“We should not resort to draconian and very disruptive measures like what we did during COVID-19. No countries are doing that now,” he added. 
“The best way is to suppress the spread of the virus, provide proper treatment to those who are infected, and have a very effective vaccine strategy.” 
Explaining why mask-wearing is not recommended for people who are well, MOH noted that current evidence shows that mpox is spread mainly through close physical contact.
However if there is evidence of significant respiratory transmission, such as outside of households and in public areas, the health ministry will consider implementing wearing masks on public transport and in crowded indoor places.
Symptoms of mpox include intense headaches, fever or rash. It is mainly spread from human to human through close contact with an infected person. This can include sex, kissing or just merely touching. 
“What makes clade 1 different from clade 2 is that the global outbreak of clade 2 is mostly among men who have sexual relationships with men, within those circuits,” Mr Ong said.
However, clade 1 in the Democratic Republic of Congo does not spread primarily through “just sexual networks”, but also through family members living in the same household where there is some close and physical contact, he noted.
In Singapore’s preschools and schools, existing measures for other infectious diseases remain relevant, said MOH, noting that students will be visually screened for symptoms. 
Together with the Ministry of Manpower and the National Environment Agency, MOH is conducting wastewater testing at migrant worker dormitories and the Onboard Centre. 
Newly arrived work permit holders also go through temperature and visual screening.
If there are any suspected adult and paediatric clade 1 cases identified by primary care providers, they will be taken to NCID and KK Women’s and Children’s Hospital respectively. Families with both adults and children will be taken to the National University Hospital, said MOH. 
Once a clade 1 case is confirmed, MOH will immediately start contact tracing. Close contacts will be quarantined in a designated government facility. 
Clade 1 cases will continue to be isolated in healthcare facilities until they are no longer infectious to prevent further exposure to the community.
Singapore has stepped up precautionary measures at its borders since Aug 23, by conducting temperature and visual screening at air and sea checkpoints for travellers and crew arriving from places that may be exposed to the risk of mpox outbreaks. 
All travellers must report mpox-related symptoms like fever or rash, as well as their travel history, through the SG Arrival Card, MOH said previously.
The WHO has said that more than 18,000 suspected mpox cases and about 630 deaths have been recorded in the Democratic Republic of Congo this year.
That figure includes over 5,000 cases and 31 deaths in regions where the new, deadlier clade 1b has been spreading.
Sweden on Aug 15 announced the first case of the clade 1b strain outside Africa.
On Aug 22, Thailand confirmed Asia’s first known case of the clade 1b strain. A 66-year-old European man landed in Bangkok from Africa on Aug 14 and was taken to hospital with mpox symptoms.