No quarantine for residents returning from mpox-affected countries

Singapore residents holidaying in the African continent during the peak safari season from July to September need not worry about having to be quarantined upon their return home.

Despite the new and potentially more deadly clade Ib strain of the mpox virus rapidly spreading in Democratic Republic of the Congo (DRC) and neighbouring countries Burundi, Central African Republic, Rwanda and Uganda, infectious disease specialists say residents and visitors coming from these places do not need to be quarantined if they are not suffering from any symptoms of the disease.

Mpox symptoms include fever, skin rash and swollen lymph nodes.

All travellers are required to report mpox-related symptoms and travel history on the SG Arrival Card, the Ministry of Health (MOH) said.

Mpox, which has been declared a global public health emergency by the World Health Organisation (WHO), “doesn’t seem to spread through casual community contact as Covid-19 did”, said Professor Dale Fisher of the NUS Yong Loo Lin School of Medicine.

He added that quarantine is not necessary at this stage, unless people coming here from African countries have had contact with someone who may have mpox or have been engaging in high-risk behaviour.

Regardless of sexual orientation, persons engaging in high-risk sexual behaviour, such as having multiple or casual sexual partners, are most at risk of infection in the context of the current outbreak.

Dr Barnaby Young, an associate professor at Nanyang Technological University’s Lee Kong Chian School of Medicine, said: “While there are concerning features about the current mpox outbreak – including (the fact that) more than half of the cases in DRC have been among children – mpox transmission is mainly through close, direct contact with infected individuals, which travellers can avoid.”

The disease, formerly known as monkeypox, has been on the rise in DRC and neighbouring African countries. According to the US Centres for Disease Control and Prevention, there have been more than 27,000 cases and over 1,300 deaths since January 2023 in the current outbreak in the DRC. 

This latest surge of mpox has been of the deadlier strain, clade Ib.

On Aug 14, WHO declared mpox a global public health emergency for the second time in two years. However, it stressed that mpox is not the new Covid-19.

International SOS regional medical director for Asia David Teo said each infectious disease has its unique mode of transmission, and “while general plans designed for the prevention of Sars and Covid-19 provide a solid foundation, they must be specifically tailored to address the nuances of new threats like mpox”.

“Sars and Covid-19 primarily spread through respiratory droplets, making measures such as face masks and social distancing highly effective. In contrast, mpox spreads mainly through close contact with bodily fluids, particularly from skin lesions, and through sexual contact, requiring a different approach,” said Dr Teo.

At least four countries outside the African continent have recently reported clade I mpox cases, with Thailand being the most recent to confirm its first case of the more virulent strain on Aug 22.

Ramping up precautions against the import of mpox from abroad, Singapore has enhanced its surveillance capabilities against the infectious viral disease at its borders by carrying out temperature and visual screening at both its air and sea checkpoints from Aug 23.

Those found to have fever, rash and/or symptoms compatible with mpox will be referred for medical assessment.

Medical practitioners are to notify the Ministry of Health of all suspected mpox cases, and they will be isolated in hospital so that they can be further assessed and tested for mpox.

There are no direct flights between Singapore and any country with an mpox outbreak, but there will be temperature and visual screening at Changi and Seletar airports for inbound travellers and crew arriving via flights from places that may be exposed to the risk of mpox outbreaks.

Health advisories have also been put in place at Changi and Seletar airports to remind travellers to take the necessary personal precautions to avoid being infected.

Similar screening measures are in place at sea checkpoints for crew and passengers arriving on ships from mpox-affected areas.

“While thermal screening was widely used during Covid-19, it is less effective for mpox due to its transmission characteristics and the possibility of asymptomatic spread.

“However, it can still play a role in a broader strategy that includes health declarations and targeted testing,” said Dr Teo. 

Professor Paul Tambyah, president of the International Society for Infectious Diseases, believes that people who may have been exposed to mpox are “probably going to be more responsible by coming forward for screening, so their contacts can be protected as appropriate”.

As at Aug 22, there are 13 confirmed cases of mpox detected here in 2024, all of which are of the less severe clade II strain.

MOH also said there are no mpox clade I cases detected in Singapore as at the same date.