Close contacts of any confirmed mpox Clade I cases will be quarantined for 21 days under new public health preparedness measures in Singapore. This was announced by the Ministry of Health (MOH) at a press conference on 4 September. Mpox, formerly known as monkeypox, is a viral disease caused by two distinct clades of the monkeypox virus (MPXV), known as Clade I and II.
## Background
Mpox was declared a “public health emergency” by the World Health Organisation (WHO) on 18 August. This came after more than 15,600 cases and 537 deaths were reported in the Democratic Republic of the Congo (DRC) in 2024. In the past month, over 100 laboratory-confirmed cases of the virus were detected in Burundi, Kenya, Rwanda, and Uganda. The disease was primarily reported in parts of Central (Clade I) and West Africa (Clade II) before 2022, with almost all cases occurring outside of Africa being linked to international travel to endemic regions or through imported animals. MOH said on 22 August that there are no direct flights between Singapore and any mpox outbreak country. Temperature and visual screening have been placed for inbound travellers and crew arriving on flights from places with potential outbreak risks at Changi and Seletar airports. Similar screening measures will be implemented at sea checkpoints for crew and passengers arriving on ships from mpox-affected areas.
## All suspected mpox cases to be reported to MOH
MOH stated on 4 September that all medical practitioners and healthcare institutions have been instructed to be vigilant in detecting and reporting all pox cases to MOH immediately, including suspected Clade I infections. The most common symptoms of mpox are blister-like rashes and fever, where serious complications or death can occur in medically vulnerable individuals. If necessary, suspected cases will be transferred to hospitals for further assessment and treatment. As of 3 September, Singapore has 14 confirmed cases of mpox, all of which are of the less severe Clade II infections. No cases of the more severe mpox Clade I have been detected in Singapore to date.
## Close contacts of Clade I cases to be quarantined
Upon confirmation of a Clade I case, MOH will immediately initiate contact tracing. Close contacts of the case will be quarantined in a designated government quarantine facility. This quarantine period is currently set at 21 days, the same as the incubation period observed in Africa. “We are monitoring the situation closely with our international counterparts, and are ready to respond decisively should the situation change,” MOH said in a press release.
## Suspected Clade I cases to be sent to hospital
All suspected Clade I cases will be conveyed to designated hospitals for further assessment and testing. Adult cases will be conveyed to the National Centre for Infectious Diseases (NCI) while paediatric cases will be conveyed to KK Women’s and Children’s Hospital. Adult-child family dyads will be sent to the National University Hospital (NUH). Testing for mpox will be conducted through polymerase chain reaction tests on swabs of skin lesions. While awaiting test results, cases will be isolated. Those confirmed to test positive for Clade I will continue to be isolated in healthcare facilities until they are no longer infectious. MOH noted that there are currently no specific treatments approved for mpox infections, but supportive care will be provided to help manage symptoms and prevent complications. Antivirals such as Tecovirimat will be prescribed for treatment of mpox cases with severe disease. MOH said it will continue to monitor new developments and assess the safety, efficacy, and suitability of emerging mpox therapeutics in meeting the needs of the population.
## TraceTogether not needed
Health Minister Ong Ye Kung said that mpox is mainly transmitted through close physical contact with infectious persons, such as during sex, or from skin or mouth contact. Ong disclosed that mpox Clade I is classified as R1.3, meaning that for every 10 infected persons, the disease can spread to about 13 persons. According to MOH, every person infected with mpox spreads the disease to an average of 1.3 other persons. Comparatively, without measures, each case of Covid-19 and its subsequent variants spreads to an average of two to five persons. Ong noted that due to the disease’s characteristics, TraceTogether will not be required for mpox contact tracing, unlike during the pandemic. “TraceTogether was useful during Covid-19, because Covid-19 had spread far and wide. In a room like that, a person talking can spread to everybody and therefore TraceTogether became a very efficient, effective way of rounding up contacts,” Ong said. “In this case, we are looking at very close contacts, skin-to-skin, mouth-to-mouth…and therefore TraceTogether will not be necessary.”
## Additional measures and future implications
Anyone in close contact with a person with mpox can get it and should take steps to protect themselves, especially through vaccination. At this time, data suggest that gay, bisexual, and other men who have sex with men make up the majority of cases in the mpox outbreak that began in 2022. Travellers who plan to attend gatherings that may place them in close, skin-to-skin contact with someone who has mpox should be particularly cautious. If personal, partner, or household travel to the DRC within the past 21 days is reported by an individual being tested for mpox, additional clade-specific testing may be indicated. Specimens collected from suspected Clade I MPXV cases should be processed accordingly. The United States has also been actively supporting the response to the Clade I mpox outbreak in several African countries. Since March 2024, USAID and CDC together have provided an additional $20 million USD to support clade I mpox response efforts in Central and Eastern Africa. On 20 August, USAID announced up to an additional $35 million in emergency health assistance, pending Congressional Notification, bringing the proposed total U.S. government financial support for DRC and other affected countries in the region to more than $55 million.
