On August 14, 2024, the WHO declared the upsurge of Mpox disease in Africa as a Public Health Emergency of International Concern (PHEIC). WHO Director-General Dr. Tedros Adhanom Ghebreyesus made this critical announcement. Notably, this marks the second time Mpox disease has received a PHEIC designation in just two years. The earlier outbreak, which occurred between July 2022 and May 2023, was also classified as a PHEIC. Let’s delve into the seriousness of the Mpox outbreak in Africa. Stick with us as we explore its implications for the continent, and discuss key details such as vaccination efforts and its international significance.
Mpox Disease: the New Global Health Crisis
Mpox disease, previously known as monkeypox, is a serious viral infection caused by the mpox virus (MPXV). Its common symptoms include fever, headache, muscle aches, and pox-like rashes. Although Mpox disease is generally self-limiting, it can tragically be fatal, especially for children and those with weakened immune systems. Since 1970, Mpox primarily affected people in Africa’s endemic regions until the alarming mpox outbreak in Africa in 2022.
There are two types: Clade II, originating in West Africa, is less severe with a 1% fatality rate. In contrast, Clade I, from Central Africa, is far more severe with a 10% fatality rate. This is significantly higher compared to the Omicron variant’s 0.7% fatality rate. Currently, the Democratic Republic of the Congo is grappling with large and deadly epidemics of Clade I Mpox disease.
The 2022 Mpox Outbreak: The Rapid Spread and Impact of Clade 2
In 2022, the grave Mpox disease emerged as a public health emergency, driven by the milder Clade 2 type. This strain alarmingly spread to nearly 100 countries, including parts of Europe and Asia. The outbreak rapidly escalated, leading to over 87,000 cases and 140 tragic deaths, according to WHO. Although Mpox disease can affect anyone, the outbreak predominantly impacted men who engage in physical intimacy with other men. Fortunately, targeted vaccination of vulnerable groups brought this harrowing Mpox outbreak under control.
Africa’s Dire Mpox Surge: The Rise of Clade 1
However, now the deadly Clade 1 of Mpox disease, with a terrifying 10% fatality rate, is surging in Africa. A troubling mutation last September led to the rapid spread of Clade 1b, deemed the most dangerous variant yet.
In 2023, the devastating Mpox outbreak in Africa resulted in 14,626 cases and 654 tragic deaths, with a 4.5% mortality rate, disproportionately affecting children. Most cases and deaths in the Democratic Republic of the Congo involve children, indicating severe non-sexual transmission through close contact. However, a disturbing outbreak in South Kivu revealed sexual transmission, suggesting complex epidemic patterns.
By mid-2024, Mpox disease cases in the country had already surpassed all of 2023, with over 15,600 cases and 537 deaths. Unfortunately, testing capacity remains woefully low, and most cases are unconfirmed. Limited data from Kamituga reveals worrying mutations to Clade 1b, exacerbating the crisis.
From African Borders to a Global Threat
In the past month, the Mpox disease has alarmingly spread to neighboring countries of the Democratic Republic of the Congo. Which includes Rwanda and Burundi. And it has also reached other East African nations like Kenya and Uganda, which had never previously reported Mpox cases.
In our interconnected world, the severe Mpox outbreak in Africa could spread to other continents, as seen in 2018. The alarming spread from Nigeria to the United Kingdom and beyond serves as a stark reminder. And the frightening reality is that travel-related cases between 2018 and 2019 might have fuelled the 2022 clade IIb epidemic.
The Vaccine Crisis
Since Mpox disease and smallpox viruses are related, smallpox vaccines offer crucial protection against Mpox. These vaccines also proved vital in controlling the 2022 clade IIb epidemic. However, most of the world remains vulnerable, lacking immunity to Mpox due to limited vaccination. The newer vaccine, known as Jynneos, Imvamune, or Imvanex, is effective but tragically scarce. The supply of this essential vaccine is particularly dire in the Democratic Republic of the Congo.
Fortunately, WHO’s declaration of the Mpox outbreak in Africa as a public health emergency will urgently mobilize vaccines to where they are critically needed. The Africa Centres for Disease Control had already started negotiations for 200,000 vaccine doses, but this is only a fraction of what is desperately required to contain the outbreak.
India’s Vulnerability: Examining Local Threat
India also reported grievous Mpox disease cases during the 2022 global outbreak, involving the less deadly clade II type. Initially, infections were confined to travelers from Kerala. However, over time, cases emerged in Delhi among those without any international travel history. In total, India reported 27 laboratory-confirmed cases and one death.
Meanwhile, IHR Emergency Committee Chair Professor Dimie Ogoina highlighted that the current mpox outbreak in Africa poses a global emergency. This situation, coupled with the spread of a new sexually transmissible strain, is a grave concern. He stressed the urgent need for decisive action to prevent a repeat of the devastating 2022 global outbreak.
Addressing the Mpox Crisis: Global Awareness and Effective Action
However, a more serious issue is that 20-30% of Mpox patients might also have chickenpox, making initial diagnoses challenging. So, clear communication and combating disinformation are vital. Additionally, spreading awareness about the Mpox disease globally is a critical priority. This urgent action is essential to ensure everyone is informed and prepared.
A serious epidemic anywhere can quickly become a global concern, as we saw with COVID-19. Therefore, it’s crucial to control the outbreak at its source. And WHO’s declaration will help mobilize necessary resources. WHO will lead the global response to Mpox, ensuring fair access to prevention, diagnostics, and vaccines. However, countries must also follow International Health Regulations and carefully handle global emergency protocols. While we may not control an epidemic, we can manage a pandemic. With effective awareness and guidance from WHO, we can prevent a disease from escalating into a serious outbreak or even a global pandemic.
