Joe McConnell
The World Health Organization’s declaration of a public health emergency for mpox is the second such alert for the infectious disease in just two years; experts fear this one will be even more serious.
The latest outbreak, centered in the Democratic Republic of Congo and identified in about a dozen African countries, is driven by the most severe type of the virus, clade 1. This week, Sweden reported its first clade 1 case outside Africa.
On Friday, WHO prepared to host an emergency meeting to discuss equitable access to tests, treatments and vaccines.
The warning about mpox was a “stark reminder of the vital importance of early intervention when infectious diseases are still geographically contained,” said Boghuma Titanji, associate professor of medicine at Emory University in the United States.
What is mpox and what triggered the emergency?
Mpox, formerly known as monkeypox, is a viral disease that causes skin rashes and mucosal lesions such as canker sores. In severe forms, it can lead to brain inflammation, sepsis, and even death.
This is an example of a so-called zoonotic disease. These have been transmitted from animals to humans and are a major public health concern as possible triggers of pandemics.
Mpox virus was discovered in 1958 in captive monkeys and the first human case was reported in the Democratic Republic of Congo in 1970.
The pathogen, similar to the one that causes smallpox, is spread through contact with infected animals, people or materials. It can be transmitted during prolonged, intimate face-to-face interactions, such as talking or breathing, according to the U.S. Centers for Disease Control and Prevention.
The health emergencies announced by the WHO and the Africa Centers for Disease Control and Prevention are a consequence of the increase in cases on the continent.
At least 12 countries have reported outbreaks. More than 17,000 suspected cases and 500 deaths have been recorded so far, the Africa CDC said, adding that this is likely a large underestimate.
What’s different from the last Mpox emergency?
The previous international mpox emergency in 2022-23 was caused by the clade 2 virus type. This time, it is the more dangerous clade 1 version, specifically a strain known as clade 1b, which has spread rapidly in the DRC.
Clade 1b appears to be transmitted in the DRC primarily through sexual activity, the WHO said. Swedish authorities said the clade 1 case they reported involved a person who had visited an infected area in an African country.
The role of the clade 1 virus is of concern because it is associated with more severe disease and higher mortality rates than clade 2. There is also some evidence that the clade 1 pathogen is more transmissible between humans.
How should people protect themselves?
To prevent the spread of the MPox virus, preventive measures other than vaccination can be taken, such as avoiding proximity to infected individuals or objects used by them, such as bed sheets.
WHO advises people to isolate themselves to prevent the spread of the virus. People are contagious until all their lesions have crusted over, the scabs have fallen off, and a layer of skin has formed underneath, according to the health body’s guidelines.
The clade 1 case in Sweden is the first sign of what scientists see as an inevitable international spread. Pakistan has also confirmed a case of mpox from a traveler arriving from the Middle East, but has not said whether the case is related to clade 1.
What is being done to control the epidemic?
WHO is working closely with the Africa CDC, affected countries and non-governmental organizations to curb the spread of the disease, Director-General Tedros Adhanom Ghebreyesus said Wednesday.
Among them, field teams collected blood samples and performed genomic sequencing, conducted contact tracing and supported health workers through training.
Scientists say more data are needed on the transmissibility and impact of the clade 1b virus.
To support surveillance efforts, WHO has allocated $1.45 million from its emergency funding and said it needs at least $15 million in immediate additional funding from donors.
But monitoring and patient care are very difficult in areas such as eastern Democratic Republic of Congo, where there is a protracted conflict between armed rebels and the government.
Experts have called for vaccines to cover those most at risk and prepare for future outbreaks, but few supply deals have been signed. The Africa CDC has said 10 million doses will be needed.
Two mpox vaccines are recommended by the WHO Advisory Group on Immunization. DRC and Nigeria have recently approved both.
Bavarian Nordic, one of the vaccine makers, has said it could supply 10 million doses by the end of 2025 if donors place enough orders. The EU said this week it will send more than 215,000 shots from the Danish manufacturer to the Africa CDC.
“If we want a long-term solution, we need to consider wider vaccination of the entire population in areas where mpox outbreaks occur, to avoid the risk of future outbreaks becoming so large,” said Michael Marks, professor at the London School of Hygiene & Tropical Medicine.
Could this turn into the next pandemic?
The European Centre for Disease Prevention and Control warned on Friday that more imported cases were expected to be reported in Europe, but said the spread of mpox should be containable.
“The likelihood of sustained transmission in Europe is very low, provided that imported cases are diagnosed rapidly and control measures are implemented,” ECDC said. There is no evidence that mpox spreads as easily as Covid, via respiratory droplets and airborne particles.
Nigeria, Africa’s most populous country, said this week that travellers arriving in the country at airports in the capital Abuja and Lagos, its economic hub, will be required to fill out Mpox health declaration forms online.
As during the Covid-19 pandemic, one of the biggest challenges is ensuring that the most affected countries receive adequate resources, especially if their health systems are already underfunded or under pressure.
In war-torn eastern Democratic Republic of Congo, health care is already strained by malnutrition, measles and cholera.
Most MPOX cases in the country are among children under 15, and children are more likely to die from the virus than adults, said Greg Ramm, national director of the charity Save the Children.
“Adding to the mix a deadly new virus that aggressively attacks children is a cruel twist of fate,” he said.
Additional reporting by Aanu Adeoye in Lagos and Andrew Schipani in Nairobi
