The spread of a new sexually transmissible strain of the MPXV and new clades and virus variants may be explained by inadequate infection surveillance during 2022 and 2023. Now, mpox infection should be regarded as an emergency for Africa and the rest of the world.
The mpox (formerly monkeypox) is a self-limited disease that is unlikely to disrupt economic activities but continues to spread rapidly around the world. There have been more than 87,039 cases, with 119 deaths recently reported within 100 countries and territories. The virus has emerged several times since the 1970s, including the 2017 outbreak in Nigeria that had more than 200 confirmed cases and the deadlier version in Central Africa with a mortality rate of 10%.
The mpox is transmitted to humans through close contact with infected animals, persons, or any material contaminated with the virus. Skin lesions, body fluids, respiratory droplets, and bedding also serve as the medium of transmission.
Although the current risk of contracting mpox is low, the virus is an emerging public health threat. Potential public health impacts exist because anyone can get infected and spread the virus regardless of sex, race, gender, and region. The reporting of 87,039 cases in 110 countries on 18 April 2023 is a clear indication. It is challenging to determine who is at risk, and the general population is already worried due to the scary reminder of the COVID-19 pandemic. The growth in cases and the geographical spread has been rapid and relentless, and experts are racing to curb the virus believing the virus cannot be contained. The virus is hitting a part of the population where people have been in close contact with each other and human transmission is quite feasible.
Health ministry ‘ill-equipped’ to detect Mpox infection
This situation also makes it difficult for public health authorities to effectively communicate specific safety protocols. Confusion, panic, and a tricky balance in clearly communicating about the mpox prevail due to the risk of stigmatization, which could undermine our capacity and trust to respond effectively to outbreaks. Vaccines, therapeutics, testing centers, point of vaccination, and contact testing are not readily or adequately available yet and this is a major public concern.
The overall public health risk is moderate but could be high if the virus exploits this opportunity, especially when smallpox vaccination, also effective in protecting people against mpox, was stopped being administered routinely more than 40 years ago. The general population will become gradually vulnerable to the mpox if not promptly managed with testing, treatment, and vaccination. The virus cannot die out on its own unless aggressive containment measures are deployed to prevent it becoming endemic in more countries. This suggests that the mpox is undoubtedly serious with an enormous public health impact.
On August 14, 2024, the Director General of the World Health Organization (WHO) declared that the increasing outbreaks of mpox should be regarded as an international public health emergency due to the growing number of cases in endemic and non-endemic geographical areas, and increasing disease severity. Two years ago, outbreaks of mpox became so high that on July 23, 2022, the WHO declared mpox as a Public Health Emergency of International Concern (PHEIC). However, almost a year later, on May 11, 2023, the WHO declared the end of the global public health emergency for mpox.
The mpox virus (MPXV), or Orthopoxvirus monkeypox, is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family, which also includes several animal poxviruses, cowpox virus, vaccinia virus, and variolavirus. Infection with MPXV causes a disease similar to smallpox. MPXV consists of two genetically distinct clades, clade I (formerly the Congo Basin/Central African clade), and clade II (formerly the West African clade). The genetic differences between the genomes of the two MPXV clades and the ongoing development of new variants could explain the recent increase in spread, epidemiology, and pathogenesis, as Clade I is associated with more severe disease, with increased mortality rates .
An important feature in the pathogenesis of viruses of the genus Orthopoxvirus is their known long-lasting stability in the environment. Viable MPXV can be detected on surfaces for at least 15 days after contamination and are less sensitive to organic disinfectants when compared to other enveloped viruses.
The latest update from the WHO and the alerts given regarding the PHEIC status of mpox follows an upsurge of mpox in the Democratic Republic of the Congo (DRC) and an increasing number of African countries, spreading to other continents and countries. The spread of a new sexually transmissible strain of the MPXV and new clades and virus variants may be explained by inadequate infection surveillance during 2022 and 2023. Now, mpox infection should be regarded as an emergency for Africa and the rest of the world.
Although mpox has been endemic in West and Central Africa it came to the attention of the World Health Organization in 2022 when laboratory-confirmed cases were reported in 50 non-endemic countries, mainly in adults, and mainly in Europe. In the US, the Center for Disease Control and Prevention (CDC) identified an outbreak of mpox in May 2022, with 99% of cases in adult men, 94% reported cases being due to male-to-male sexual contact or intimate contact three weeks before symptoms of infection. Also, in 2022, 46% of infected patients reported one or more genital lesions, and in the US, 41% of adult patients also had HIV infection. Therefore, initial public health measures in the US aimed to prioritize specific adult male demographic groups for infection prevention and testing. By August 4, 2022, the Department of Health and Human Services (HHS) declared the mpox outbreak a public health emergency in the US. On August 22, 2022, the European Centre for Disease Prevention and Control (ECDC) rapidly published a factsheet for health professionals on the prevention and management of mpox .
Because MPXV is crossing geographical boundaries and has varied and unpredictable transmission patterns, it is urgently needed to contain this infection before it reaches pandemic status. Public health measures require infection surveillance, rapid diagnosis, contact tracing, patient isolation and management, and vaccination. The three main approved MPXV vaccines are ACAM2000, MVA-BN, and LC16, all recommended by the WHO. The WHO has now provided vaccination guidance for those in contact with infected people or those in current non-endemic areas who may be at risk for contracting mpox when traveling. However, mass vaccination is still not currently recommended, and in many countries, vaccine availability is limited.
The current status of the global spread of MPXV and the increasing number and severity of cases of mpox in African countries has occurred due to a lack of infection surveillance and control and a lack of availability of approved vaccines. Urgent public health measures are required to prevent the spread of pox and prevent it from reaching pandemic status. The mpox meets the criteria for being declared as a PHEIC. A PHEIC declaration will rekindle the global community to scale up efforts to prevent further spread of the virus. Extraordinary resources can be mobilized by the international community to respond to this public health risk that can cross the border and threaten people worldwide. It is better we overreact than underreact.
