Mpox Outbreak: The surge in cases of mpox cases has put health authorities across the world on high alert. On Wednesday, Thailand reported an mpox case in a European man who arrived from Africa last week.
According to a report by The Independent, the man is believed to be infected by the Clade 1 variant, which is deadlier and more transmissible. The outbreak was first reported in Africa and the Middle East but now the virus is also spreading to other parts of the world.
Following the rise in mpox cases, the World Health Organization (WHO) declared the ongoing outbreaks a global emergency last week. According to health experts, the outbreaks are fueled by a virulent strain of the disease spread rapidly to 16 countries and several new countries were affected in 10 days.
As per the data from the World Health Organization (WHO), more than 17,000 mpox cases have been reported in Africa since the beginning of 2024. Some of the countries affected are Burundi, Cameroon, Congo, Ghana, Liberia, Nigeria, Rwanda, the Democratic Republic of Congo, South Africa, Uganda and Kenya. As the mpox cases continue to rise, can it turn into pandemic?
Dr Anurag Agrawal, Head, Koita Center for Digital Health at Ashoka Dean, BioSciences and Health Research, Trivedi School of Biosciences, Ashoka University revealed that if the recent announcement by WHO of a Mpox (previously, monkeypox) public health emergency of international concern (PHEIC) is giving you a feeling of déjà vu, you would not be wrong.
“There was a similar warning in 2022 after a global outbreak, which was withdrawn after new cases rapidly fell in 2023. Yet, any feeling of complacency should be quickly discarded since the new warning seems significantly more serious in terms of worst-case scenarios. To understand why, we need to dig a bit deeper. mpox is not new. With some similarities to smallpox, mpox was first detected in humans in 1970, in the Democratic Republic of Congo. The disease was mostly endemic to countries in central and west Africa and two major clades (types) were seen. Clade I, seen in the Congo basin, had less human-to-human spread but led to a higher rate of severe infections and death,” Dr. Anurag Agrawal informed.
Clade II, seen in West Africa, had greater spread but infections were less severe. The large international surge starting July 2022, primarily driven by sexual contact amongst men, was due to Clade IIb, with even lower virulence. The 2022 mpox outbreak was thus mostly a self-limited disease, with low mortality rates. Despite this there were about 200 deaths, mostly in countries that had never reported mpox before, he highlighted.
‘The current outbreak seems different’
According to Dr. Agrawal, the current is different as it is Clade I, with likely higher mortality. “Cases are being reported from multiple countries neighboring DRC and most of the deaths are in children, raising fear of non-sexual human-to-human transmission. While there is no clear evidence of respiratory transmission, there is fear that the virus is evolving. Smallpox could be transmitted via the respiratory route, making it a dreaded pandemic. Every new infection is an opportunity for the virus to evolve, as we learned during the SARS CoV2 pandemic,” he said.
Efforts must thus be directed towards containing the ongoing spread of mpox. Investments into accessible diagnostics and vaccines, as well as general strengthening of the public health surveillance system will be needed, he pointed out.
Gautam Menon, Dean of Research and Professor of Physics and Biology, Head of Centre for Climate Change and Sustainability (3CS) at Ashoka University informed that the WHO has now cautioned that more cases should be expected in Europe. Children seem to be harder hit in the outbreak, especially those in crowded unsanitary conditions, such as in refugee camps.
“As of now, our understanding is that transmission between people requires intimate contact, so it would be harder to have a situation where the numbers of infected can grow explosively. There are also vaccines for mpox as well as anti-viral treatments,” Menon said.
The positives, so far, are that it seems harder for mpox to be transmitted between people as compared to say COVID-19 or influenza, he emphasised. “This implies that we may need to be concerned about localized outbreaks, but perhaps not a true epidemic situation. But our understanding is still evolving and it is crucial that we report transparently and collaborate with international partners to stay at the forefront of what is known,” he added.
Can mpox become the next pandemic?
Based on the available data from the World Health Organization (WHO) and comparisons with COVID-19, it is unlikely that the mpox outbreak will escalate into a pandemic of similar scale, Associate Professor Dr. Vinod Balasubramaniam, Molecular Virologist and Leader, Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine & Health Sciences Monash University Malaysia told Financial Express.com.
“Unlike COVID-19, which is caused by the novel SARS-CoV-2 virus that spreads efficiently through respiratory droplets and was initially met with no pre-existing immunity or vaccines, Mpox is caused by a virus that is not new, allowing for more established knowledge about its transmission and treatment. mpox primarily spreads through close contact, making it less transmissible than COVID-19, and while there has been an increase in cases, particularly with the emergence of a new, more contagious variant (clade 1b), the general risk to the public remains low,” Dr. Balasubramaniam revealed.
He also said that the current outbreak has led to over 15,600 cases and at least 500 deaths in 2024, predominantly in the Democratic Republic of the Congo, but this is still significantly lower than the global impact of COVID-19, which has seen hundreds of millions of cases.
Additionally, effective vaccines for mpox are already available, which were not the case at the onset of the COVID-19 pandemic, he pointed out. “Therefore, while vigilance is necessary, the characteristics of mpox suggest that it is not poised to become the next pandemic on the scale of COVID-19,” he added.
Meanwhile, Dr. Vikram Vora, Medical Director, International SOS emphasised that while mpox poses a significant health risk, large-scale transmission is not expected as long as surveillance, contact tracing, and isolation of cases are diligently followed. “Countries must continue their preparedness efforts, including screening at international borders, and ensure that vaccines and diagnostic tools are readily available,” he told Financial Express.com.
How current Mpox outbreak in different from 2022 outbreak?
The current mpox outbreak in 2024 differs from the 2022 outbreak in several key aspects, particularly regarding the strain of the virus, transmission patterns, and clinical manifestations.
According to Dr. Balasubramaniam, the 2022 outbreak was predominantly linked to clade II, which resulted in approximately 100,000 cases globally and was primarily transmitted through sexual contact, especially among men who have sex with men. In contrast, the ongoing outbreak has seen the emergence of a more virulent strain, clade I, which is more easily transmitted and potentially more severe.
“This new variant has been associated with higher mortality rates, estimated between 1-10%, compared to clade II, which typically has a mortality rate of less than 1%. In terms of clinical manifestations, while both clades present with similar symptoms such as fever, muscle aches, and characteristic rashes, the 2024 outbreak has reported an increase in lesions around the genital and anal regions, possibly due to its transmission dynamics. This is a notable shift from the 2022 outbreak, where lesions were more commonly found on the face, chest, and extremities,” he explained.
Additionally, Dr. Vora said that this strain has a higher risk of severe outcomes compared to the 2022 outbreak strain, Clade II.
The current outbreak has been characterized by a higher incidence of severe cases among immunocompromised individuals, particularly those with uncontrolled HIV, leading to atypical presentations and increased hospitalization rates.
Geographically, the 2024 outbreak has expanded beyond the DRC to include new cases in neighboring countries like Burundi, Kenya, and Rwanda, indicating a broader regional threat.
Overall, while both outbreaks share similarities, the differences in viral strain, transmission methods, and clinical outcomes underscore the evolving nature of Mpox as a public health challenge, he said.
‘Robust public health responses are necessary’
The world must adopt a comprehensive and proactive approach to treat and react to the current mpox outbreak, particularly as it continues to evolve and affect various regions, Dr. Balasubramaniam explained.
“The World Health Organization (WHO) emphasizes the importance of vaccination for individuals at risk, as well as the need for antiviral treatments like tecovirimat, which are being assessed for efficacy against mpox. Risk communication and community engagement are crucial in educating populations about transmission routes, particularly in high-risk settings where sexual activity may facilitate the spread of the virus. Targeted outreach to key populations, including men who have sex with men, commercial sex workers, and individuals with compromised immune systems, is essential to mitigate stigma and promote protective behaviors.” he told Financial Express.com.
In addition to vaccination and treatment, robust public health responses are necessary. He also emphasised that countries should establish incident management teams to coordinate outbreak responses, enhance surveillance systems, and implement active case searches and contact tracing.
“The focus should also be on mental health support for affected individuals, as the psychological impact of the outbreak can be significant. As we navigate this outbreak, it is crucial to acknowledge that we are indeed in an age of viruses, where emerging infectious diseases pose ongoing threats to global health. The the interconnectedness of our world means that viruses can spread rapidly across borders, necessitating international cooperation in surveillance, research, and response efforts,” he informed.
Public health education is crucial to prevent fear and ensure quick identification and isolation of cases. Continuous global collaboration is key to ensuring Mpox remains a manageable outbreak and does not escalate into a pandemic, Dr. Vora said.