Mpox an emergency of international concern, says WHO

The World Health Organization has declared the rising case numbers of mpox in the Democratic Republic of the Congo, and several other African countries, a public health emergency of international concern (PHEIC).

Mpox, which had a global outbreak in 2022, is caused by a virus related to the smallpox virus. The disease can be fatal, but there are 2 approved vaccines that can prevent infection and spread.

The outbreak in the DRC is a new variant of the virus.

“The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighbouring countries are very worrying,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus while declaring the PHEIC.

“On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.”

The global outbreak in 2022 was caused by a type of mpox, which was in a strain of the virus called “clade 2”. The new variant is a “clade 1” type, and has been called “clade 1b”.

“Although both cause mpox illness (a flu-like illness with a rash), there had traditionally been some differences with clade 1 being associated with more severe disease and higher death rates,” says Associate Professor Sanjaya Senanayake, an infectious disease specialist at the Australian National University.

“This is one concern with the new outbreak. The large number of cases has been another concern with the Africa Centres for Disease Control finding a 160% rise in reported cases compared to 2023-24.

“Also, another worrying feature with this new outbreak is that most cases and most deaths have occurred in children under 15, compared to the 2022 outbreak, which is mainly affecting adult males.”

Mpox is less transmissible than COVID or smallpox, but can be spread between humans by contact with bodily fluids and respiratory droplets, usually during prolonged face-to-face contact. It can also spread from animals to humans.

“Two doses of a vaccine are very effective in preventing the infection, although this usually applies to adults rather than children,” says Senanayake.

“The risk remains low for Australia as an island nation; however, maintaining vigilant surveillance is crucial to preventing any potential outbreak,” says Associate Professor Oyelola Adegboye, from the Menzies School of Health Research at Charles Darwin University.

Adegboye says that there is an “urgent need” to address disparities in vaccine availability for African nations.

“Unfortunately, a repeat of the mistakes seen during the COVID-19 pandemic is evident, as countries begin stockpiling vaccines while the most needed communities in Africa are left wanting,” says Adegboye.

“Enhanced surveillance, public health education, and vaccination are crucial in controlling the spread of mpox, particularly in non-endemic regions like Australia, where monitoring for potential cases is essential to prevent outbreaks,” says Associate Professor Vinod Balasubramaniam, a molecular virologist at Monash University Malaysia.

“Australians should remain vigilant, as the potential for mpox to enter the country exists, particularly through international travel.

“Monitoring can be enhanced through robust surveillance systems, public health campaigns to educate about transmission risks, and vaccination strategies for at-risk populations.”

Balasubramaniam says that both approved vaccines have been shown to be effective against currently circulating mpox strains.

“However, it is important to note that the vaccines may have reduced efficacy against the more virulent Central African clade,” he says.

The new variant of mpox is sexually transmissible.

Professor Jaya Dantas, a researcher in international health at Curtin University, says that it’s important information be provided about the disease in a “non-stigmatising manner”.

“Specific actions include prioritising two vaccines available currently as a matter of urgency for those most at risk and targeting public health messaging,” says Dantas.

“Actions individuals can take include maintaining contact details of sexual partners, avoiding sex if you have a rash until you get tested, considering avoiding skin to skin contact in large gatherings, if diagnosed with monkeypox, avoiding close physical contact, including sexual contact, with other people for the duration of the illness.”

Professor Andrew Grulich, an epidemiologist at the University of New South Wales’ Kirby Institute, says that the PHEIC declaration is the “best opportunity we have to prevent the global establishment of mpox”.

“All infectious disease pandemics are different, but they are also the same,” says Grulich.

“The key similarity is that early highly targeted action using effective tools can prevent global spread and the global establishment of endemicity.”