The World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) on August 14th due to the rapid spread of an epidemic of smallpox, formerly known as “monkeypox” (mpox), in African countries
This marks the second time in three years that WHO has declared an emergency over mpox. The previous declaration was in July 2022 when a mpox outbreak affected over 100,000 people in 116 countries, primarily among gay and bisexual men.
“The detection and rapid spread of a new clade of mpox in eastern D.R.C., its detection in neighboring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond is very worrying,” saidDr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general.
What is mpox, and what are its symptoms?
The mpox virus was first identified in laboratory monkeys in Denmark in 1958, with the first human case reported in a nine-month-old boy in the DRC in 1970. Until 2022, it was known as “monkeypox,” but WHO renamed it “mpox” to avoid racism and discrimination.
Mpox is caused by a virus from the same family as smallpox, but it is generally less dangerous. Initially, the virus was transmitted from animals to humans, but it now spreads among people as well. Early symptoms include fever, headaches, swelling, back and muscle pain. Once the fever subsides, a rash may appear, often starting on the face and then spreading to other parts of the body, especially the palms and soles.
The rash, which can be very itchy or painful, goes through several stages before forming a scab that eventually falls off, potentially leaving scars. The infection can resolve on its own, lasting 14 to 21 days. However, in some cases, the virus can be fatal, especially among vulnerable groups such as young children. Severe cases can affect the entire body, particularly the mouth, eyes, and genitals.
Which countries are affected by mpox?
Mpox is most commonly found in remote villages and tropical forests in West and Central Africa, where it has been present for many years. Thousands of infections and hundreds of deaths are reported annually in these regions, with children under 15 being the most affected.
Currently, there are multiple outbreaks occurring simultaneously, primarily in the DRC and neighboring countries. Recently, the virus has been detected in Burundi, Rwanda, Uganda, and Kenya, where it is not usually endemic.
There are two genetic clades (groups of organisms with a common ancestor) of mpox—Clade 1, which is often more severe, and Clade 2. Concerns have grown after a new and more serious Clade 1b was identified in infected individuals last year. Experts say there is still much to learn about Clade 1b, but it may spread more easily and cause more severe illness.
The previous public health emergency related to mpox in 2022 was caused by the relatively mild Clade 2 strain, which spread to nearly 100 countries where the virus was not typically found, including parts of Europe and Asia. It was controlled through vaccination of vulnerable groups.
How does mpox spread?
The virus is transmitted from person to person primarily through bodily contact, including talking, breathing, and sexual contact. It can enter the body through broken skin, the respiratory tract, eyes, nose, and mouth. Infection can also occur through contact with items contaminated with the virus, such as bedding, clothing, and towels.
Another route of transmission is close contact with infected animals, such as monkeys, rats, and squirrels.
During the global outbreak in 2022, the virus primarily spread through sexual contact. The current outbreaks in the DRC are linked to other forms of close contact, and the virus has also been found in other vulnerable groups, including young children.
Who is at risk?
Anyone in close contact with an infected person, including healthcare workers and family members, can contract the virus. Young children may be particularly vulnerable due to their underdeveloped immune systems, and many residents in the region suffer from poor nutrition, making it harder to fight off infections.
Some experts believe that young children may be at higher risk due to close interactions during play. Anyone with a weakened immune system may also be more susceptible, and there are concerns that pregnant women could also be at greater risk.
Those infected with mpox should isolate until all lesions have healed. WHO also recommends using condoms as a precaution during sexual activity for 12 weeks after recovery.
Is there a vaccine for mpox?
Vaccines are available, but are typically only offered to those at high risk or who have been in close contact with an infected person. There are concerns that funding for vaccines is insufficient to cover all those in need.
Recently, WHO has urged pharmaceutical companies to submit mpox vaccines for emergency use, even if they are not yet officially approved.
Now that the Africa CDC has declared a public health emergency across the continent, there is hope that governments will better coordinate their efforts and potentially increase the supply of medical resources and aid to affected areas. Without global action, there are real concerns that the current outbreak could spread beyond the continent.
The U.S. Centers for Disease Control and Prevention (CDC) advises doctors to screen anyone suspected of having mpox, either due to recent travel to affected areas in Africa or contact with someone who has recently been to Africa. Symptoms include fever, headache, rash, and painful sores.
Existing mpox tests are designed to detect orthopoxviruses, the group of viruses that includes mpox and smallpox, but they cannot determine whether the infection is Clade 1 or 2. Some tests available in certain laboratories can detect Clade 2 viruses, and therefore exclude Clade 1 mpox. To confirm the type of virus, the CDC conducts additional genetic analysis of positive orthopoxvirus samples sent from U.S. laboratories.
The U.S. Department of Health and Human Services (HHS) states that the risk to the U.S. population from Clade 1, circulating in the DRC, is currently very low, with no known cases in the country. Thanks to efforts over the past nine months, the United States is well-prepared to quickly detect, contain, and treat cases of Clade 1 if they are identified domestically.
“We continue to encourage those at high risk to get vaccinated with the JYNNEOS mpox vaccine, which has been demonstrated to be safe and highly effective at preventing severe disease from mpox. Those who have already had clade 2 mpox or are fully vaccinated against mpox are expected to be protected against severe illness from clade 1 mpox,” the statement reads.
