Mpox Virus Outbreak: Amid the concerning rise of mpox cases in Africa, the World Health Organization (WHO) is considering whether to declare an international public health emergency as a deadlier strain of mpox spreads in the continent. According to experts, some of the cases have been caused “clade 1b,” a new mpox lineage identified in the DRC last year.
Reportedly, it is highly transmissible and has a higher CFR than clade 2, which swept across the globe in 2022 among men who have sex with men in a sexual transmission pattern. The CFR for clade 2 is less than 1 percent, while 1b’s CFR is roughly 6 percent.
There is evidence in the DRC that clade 1b is spreading both through household transmission and sexual transmission, with clade 1b and clade 2 outbreaks occurring simultaneously.
In a report released last week, the Africa Centers for Disease Control and Prevention (Africa CDC) said mpox cases have risen by 160% on the continent this year compared with 2023.
While 96 percent of cases have been recorded in the Democratic Republic of the Congo (DRC), several other African countries have reported new outbreaks, including Kenya, Cote d’Ivoire, and the Central African Republic (CAR).
As of July 28, 2024, a total of 14,250 cases (2,745 confirmed; 11,505 suspected) and 456 deaths have been recorded in 10 African nations, including Burundi, Cameroon, CAR, Congo, DRC, Ghana, Liberia, Nigeria, Rwanda, and South Africa, CIDRAP reported.
“While mpox is moderately transmissible and usually self-limiting, the case fatality rate has been much higher on the African continent compared to the rest of the world,” the Africa CDC said.
Meanwhile, the European Centre for Disease Prevention and Control (ECDC) issued a statement announcing that, for now, the risk of clade 1b spread to Europe remains low.
It is noteworthy that safe and effective mpox vaccines and antivirals are widely available in the United States and Europe, it is not widely used in Africa.
Last month, the Coalition for Epidemic Preparedness Innovations (CEPI) announced it would launch a clinical trial of the Bavarian Nordic mpox vaccine in the DRC to see if the vaccine protects against infection prophylactically.
According to a report by Science, WHO experts fear that this outbreak can cause a new mpox epidemic, just 2 years after a milder strain spread worldwide. Reportedly, the DRC has for decades had outbreaks of mpox but this year nearly 14,000 cases and 450 deaths have been reported in the country, and for the first time sexual transmission in adults has been a major driver.
The virus also spread in urban areas and has reached Goma, a city of more than 2 million people in the DRC’s North Kivu province, which borders Rwanda, Science reported. Infection levels are especially high in women who are commercial sex workers and men who are clients.
What is mpox?
It is an infectious disease that causes painful skin lesions but can also be lethal, especially in people with weakened immune systems. In the past, most cases occurred in children in remote villages, who caught the disease primarily from rodents. The mpox virus found in the DRC, known as clade 1, has killed about 3% of those infected in the past year. According to the WHO, the disease mpox (formerly monkeypox) is caused by the monkeypox virus (commonly abbreviated as MPXV), an enveloped double-stranded DNA virus of the Orthopoxvirus genus in the Poxviridae family, which includes variola, cowpox, vaccinia and other viruses.
According to a report by Science, the milder variety of mpox, clade 2, erupted from Nigeria in May 2022, infecting nearly 100,000 people in 116 countries to date and spreading mainly among men who have sex with men (MSM). Only 208 deaths have been reported, a case fatality rate of 0.2 percent. A rollout of mpox vaccines and aggressive disease surveillance in MSM communities has helped slow that spread.
Africa CDC says there have been 37,583 cases of mpox and 1451 deaths in 15 African countries between January 2022 and the end of last month.
Who can get mpox?
Anyone can get mpox. It spreads from contact with infected:
- persons, through touch, kissing, or sex
- animals, when hunting, skinning, or cooking them
- materials, such as contaminated sheets, clothes or needles
- pregnant persons, who may pass the virus on to their unborn baby.
If you have mpox:
- Tell anyone you have been close to recently
- Stay at home until all scabs fall off and a new layer of skin forms
- Cover lesions and wear a well-fitting mask when around other people
- Avoid physical contact.
How mpox is transmitted?
Person-to-person transmission of mpox can occur through direct contact with infectious skin or other lesions such as in the mouth or on genitals; this includes contact which is
- face-to-face (talking or breathing)
- skin-to-skin (touching or vaginal/anal sex)
- mouth-to-mouth (kissing)
- mouth-to-skin contact (oral sex or kissing the skin)
- respiratory droplets or short-range aerosols from prolonged close contact
According to WHO, the virus then enters the body through broken skin, mucosal surfaces (e g oral, pharyngeal, ocular, genital, anorectal), or via the respiratory tract. Mpox can spread to other members of the household and to sex partners. People with multiple sexual partners are at higher risk.
What are the signs and symptoms of mpox?
Mpox causes signs and symptoms which usually begin within a week but can start 1–21 days after exposure. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system.
Common symptoms of mpox are:
- rash
- fever
- sore throat
- headache
- muscle aches
- back pain
- low energy
- swollen lymph nodes.
For some people, the first symptom of mpox is a rash, while others may have different symptoms first.
How mpox is treated?
Taking care of rash manage pain and prevent complications. Early and supportive care is important to help manage symptoms and avoid further problems. According to WHO, getting an mpox vaccine can help prevent infection. The vaccine should be given within 4 days of contact with someone who has mpox (or within up to 14 days if there are no symptoms).
It is recommended for people at high risk to get vaccinated to prevent infection with mpox, especially during an outbreak, WHO stated.