Mpox outbreaks in Africa declared an international emergency

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This article was originally published by Contagion, a sister publication of dvm360.

The Africa Centers for Disease Control and Prevention (Africa CDC) has officially declared the ongoing outbreak of mpox (formerly monkeypox) a Public Health Emergency of Continental Security (PHECS)—the first such declaration by the agency since its inception in 2017.¹ Similarly, the World Health Organization (WHO) has declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency,² with current pediatric and adult cases confirmed in upward of a dozen countries on the continent, and a new variant of the virus spreading.

“This is something that should concern us all," Tedros Adhanom Ghebreyesus, PhD, MS, the WHO director-general, said in a press briefing.² "The potential for further spread beyond Africa and beyond is very worrying.”

Additionally, WHO says mpox occurs through direct contact with infected animals or humans, spreading via bodily fluids, respiratory droplets, or contaminated objects, causing a rash and flu-like symptoms.

“Today, we declare this PHECS to mobilize our institutions, our collective will, and our resources to act—swiftly and decisively,” Africa CDC Director General Jean Kaseya, MD, said in a statement. “This empowers us to forge new partnerships, strengthen our health systems, educate our communities, and deliver life-saving interventions where they are needed most. There is no need for travel restrictions at this time.”¹

The PHECS declaration, under Article 3, Paragraph F of the Africa CDC Statutes, empowers the organization to lead and coordinate responses to significant health emergencies. The statute mandates Africa CDC to “coordinate and support Member States in health emergency responses, particularly those declared PHECS or Public Health Emergency of International Concern (PHEIC), as well as health promotion and disease prevention through health systems strengthening, addressing communicable and non-communicable diseases, environmental health, and Neglected Tropical Diseases.”¹

According to the African CDC, at least 13 African countries, including previously unaffected nations like Burundi, Kenya, Rwanda, and Uganda, have reported mpox outbreaks. So far in 2024, these countries have confirmed 2863 cases and 517 deaths, primarily in the Democratic Republic of the Congo (DRC). Suspected cases across the continent have surged past 17,000, a significant increase from 7146 cases in 2022 and 14,957 cases in 2023. This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing and contact tracing.¹

US CDC's Recent Warning

The US Department of Health and Human Services (HHS) is collaborating with the Africa CDC and WHO to address the outbreak and has provided over $17 million in recent months for surveillance, community engagement, and vaccination. Also, the US is donating 50,000 doses of the FDA-approved JYNNEOS vaccine to the DRC and working with international partners on vaccine distribution. Although there are no current cases in the US, the country is prepared with surveillance systems and advises high-risk individuals to get vaccinated. The CDC has issued travel and health advisories to manage potential risks from clade I mpox.³

Just last week, the American CDC warned of the virus spreading throughout the continent. Specifically, the federal agency issued a Health Alert Network (HAN) Health Update regarding the ongoing outbreak that has been happening in the Democratic Republic of Congo (DRC) since last year.⁴

What is Being Done

To address the mpox outbreak in Africa, Africa CDC has set up a 25-member Incident Management Team based at the epicenter of the mpox epidemic with mandate to support affected and at-risk countries. Africa CDC has also signed a partnership agreement with the European Commission’s Health Emergency Preparedness and Response Authority (HERA) and Bavarian Nordic to provide over 215,000 doses of the MVA-BN vaccine—the only FDA and EMA-approved mpox vaccine. Africa CDC will oversee the equitable distribution of these vaccines, prioritizing local needs across the affected Member States.¹

Clade I and Clade II mpox

Mpox has 2 distinct genetic clades (subtypes of MPXV), I and II, which are endemic to central and west Africa, respectively. Clade I mpox has previously been observed to be more transmissible and to cause a higher proportion of severe infections than clade II MPXV. The ongoing global mpox outbreak that began in 2022 is caused by clade II MPXV, which is not as deadly as its clade I counterpart, as WHO noted in its May 2024 strategic framework.⁵

"The current mpox clade 1 outbreak in the DRC has already infected over 14,000 persons (mostly women and children under 15) and has caused over 500 deaths," Carlos del Rio, MD, FIDSA, executive associate dean, Emory School of Medicine & Grady Health System, distinguished professor, Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, said in an interview with Contagion. "The outbreak has now spread to other countries in Africa and there is the possibility of spread beyond the continent. Clade 1 is more virulent and has a higher mortality than clade II (which caused the 2022 outbreak mostly among MSM [men who have sex with men]). The available JYNNEOS vaccine is effective in the prevention of mpox clade 1 but the challenge is not having enough vaccine available in countries that need it most."

A major emergence of mpox linked to clade II began in 2017, and since 2022, has spread to all regions of the world. Between July 2022 and May 2023, the outbreak was declared a Public Health Emergency of International Concern. Although that outbreak has largely subsided, cases and deaths continue to be reported, illustrating that low-level transmission continues around the world.

REFERENCES

1. Africa CDC Declares Mpox A Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent. Africa CDC. August 13, 2024. August 14, 2024.
   https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent
2. Cheng M. WHO declares mpox outbreaks in Africa a global health emergency as a new form of the virus spreads. AP News. August 14, 2024. Accessed August 14, 2024. https://apnews.com/article/who-mpox-africa-health-emergency-cc9bdf31b49d06bec5efd44fb55d5e42
3. United States Government’s Response to the Clade I Mpox Outbreak in the Democratic Republic of the Congo and Other Countries in the Region. US Department of Health and Human Services. August 14, 2024. Accessed August 14, 2024. https://www.hhs.gov/about/news/2024/08/14/united-states-governments-response-clade-i-mpox-outbreak-democratic-republic-congo-other-countries-region.html
4. Mpox Caused by Human-to-Human Transmission of Monkeypox Virus in the Democratic Republic of the Congo with Spread to Neighboring Countries CDC. August 7, 2024. Accessed August 14, 2024.
   https://emergency.cdc.gov/han/2024/han00513.asp
5. WHO releases a strategic framework for enhancing prevention and control of mpox. WHO news statement. May 24, 2024. Accessed August 14, 2024.
   https://www.who.int/news/item/24-05-2024-who-releases-a-strategic-framework-for-enhancing-prevention-and-control-of-mpox