The ongoing outbreak of the mpox virus, formerly known as monkeypox, in Central and West Africa has prompted the World Health Organization (WHO) to declare a public health emergency of international concern. This is the second time in two years that such a declaration has been made due to the spread of the disease. Swedish health officials recently confirmed a case of mpox outside of Africa, marking the first known infection of its kind.
### Understanding mpox
Mpox is an infectious disease caused by a virus that belongs to the same family as the one that causes smallpox. The virus primarily spreads among animals in Central and West Africa, such as rodents and monkeys, but can occasionally jump to humans, resulting in small outbreaks. There are two distinct lineages of mpox – clade I and clade II. Clade I is associated with more severe disease and a higher risk of death. The current outbreak is being driven by a subtype of clade Ib, which falls under clade I. On the other hand, the global mpox outbreak in 2022 and 2023 was spurred by a subtype of clade II.
Jonas Albarnaz, a researcher at The Pirbright Institute in the UK, stated that there is no evidence to suggest that clade Ib is more dangerous than the original clade I strain.
### Latest Data on mpox Cases
As of 13 August, the Africa Centres for Disease Control and Prevention reported over 17,000 suspected cases of mpox across the continent. However, this number is believed to be just the tip of the iceberg due to weaknesses in surveillance, laboratory testing, and contact tracing. In the Democratic Republic of the Congo alone, there have been 15,664 reported cases and 537 deaths, surpassing the total seen in 2023.
Tedros Adhanom Ghebreyesus, the Director-General of the WHO, confirmed the rise in cases and fatalities on 15 August. The current outbreak originated in a small mining town in the Democratic Republic of the Congo and has since spread to at least 11 other African countries. Surprisingly, four of these countries had never reported cases of mpox before – Kenya, Rwanda, Burundi, and Uganda. Additionally, one case has been detected in Sweden, marking the first known infection outside of Africa.
### Symptoms and Survival Rate
The survival rate for mpox varies depending on the lineage of the virus. While more than 99.9% of individuals infected with clade II survive, outbreaks of clade I have resulted in up to 10% mortality. Children, as well as individuals who are immunocompromised or pregnant, are particularly vulnerable to severe disease.
Symptoms of mpox typically begin with a rash that starts as a flat sore and progresses into a blister. The rash usually starts on the face before spreading to other parts of the body, including the hands and feet. Other symptoms may include fever, headache, muscle aches, back pain, fatigue, and swollen lymph nodes. These symptoms typically appear within a week of exposure but can manifest anywhere from one to 21 days after coming into contact with the virus. It is worth noting that some individuals may contract the virus without experiencing any symptoms at all.
### Transmission and Prevention
Mpox is primarily spread through close contact with infected individuals. This can occur through skin-to-skin contact, respiratory droplets, or contact with contaminated materials such as bedding or sharp objects. The virus can also be transmitted through contact with infected animals, particularly through bites or scratches. Young adults and children have been the most affected by the current outbreak, with children under 15 accounting for a significant percentage of suspected cases in some provinces of the DRC.
To prevent the spread of mpox, infected individuals should self-isolate, wear a mask, and avoid scratching sores to prevent secondary infections. Individuals are considered infectious until all sores have healed. While there is no specific treatment for mpox, managing symptoms and preventing complications are essential. Antivirals that were originally developed for treating smallpox have been used in the past, but their effectiveness against the clade I virus remains uncertain.
### Vaccination Efforts
There is an mpox vaccine available that provides optimal protection after two doses. Additionally, smallpox vaccines have been found to offer some level of protection against mpox. However, it is unclear if these vaccines will be effective against the new variant of the virus. Vaccination is recommended for individuals at high risk of contracting mpox, while the risk remains low for those not in affected areas.
Currently, countries in Africa are facing challenges in accessing an adequate supply of vaccines. Estimates suggest that the region needs 10 million doses to combat the outbreak effectively. Jimmy Whitworth from the London School of Hygiene & Tropical Medicine highlighted the urgent need for vaccine supplies in the affected regions.
In conclusion, the ongoing mpox outbreak in Central and West Africa poses a significant public health concern. Understanding the transmission, symptoms, and prevention strategies is crucial in controlling the spread of the virus. Vaccination efforts and access to adequate healthcare resources are essential in mitigating the impact of the outbreak and preventing further fatalities. Collaboration between international health organizations and affected countries is key to effectively addressing the mpox crisis and safeguarding public health worldwide.
