What do we know about the ‘alarming’ mpox outbreak in Africa?

What is mpox?

Mpox, formerly known as monkeypox, is an infectious disease caused by a virus. Flu-like symptoms, including fever, chills, and muscle aches, are usually followed by a skin rash that begins as raised spots, which turn into blisters filled with fluid. These eventually crust over.

There are roughly two different types, known as “clades.” Clade I was once known as the Congo Basin clade, and clade II as the West African clade. Both can be fatal, although clade I was historically a higher mortality rates.

Where do infections occur?

A briefing from the Africa Centres for Disease Control and Prevention (Africa CDC) reported that 34 countries in Africa are reporting infections or are considered “high risk.”

The Democratic Republic of Congo is experiencing a serious outbreak, with more than 14,000 reported cases and 511 deaths since the beginning of 2024. Outbreaks in the DRC are not uncommon, but this year’s figure already matches the total for all of 2023 and includes cases in previously unaffected provinces.

Infections are also being reported in Burundi, Kenya, Rwanda and Uganda, countries neighboring the Democratic Republic of Congo where no cases have previously been reported.

Why is the number of cases increasing now?

A new offshoot of clade I, clade Ib, has been discovered in eastern DRC and confirmed in Kenya, Rwanda and Uganda. Scientists believe this variant plays a role in the spread.

Clade I was historically spread mostly by people eating contaminated bushmeat. Clade Ib spreads from person to person, often through sexual contact, but also through other physical and face-to-face contact, or via contaminated bedding or towels. Dr Rosamund Lewis, the World Health Organization (WHO) lead for mpox, said: “We don’t know if it’s more infectious, but it’s being transmitted efficiently.”

Other forms of the virus continue to circulate. The DRC is also recording cases of clade Ia, as is the Central African Republic. Clade II has been reported in Cameroon, Côte d’Ivoire, Liberia, Nigeria and South Africa, the WHO said.

The rise comes amid high levels of insecurity in the region and the climate crisis is bringing humans into closer contact with nature. These are also factors according to Dr. Jean Kaseya, head of Africa CDC.

How concerned should people be?

The situation is “alarming,” Kaseya said. He plans to declare the outbreak a “continental public health emergency” next week — the first time Africa CDC has made such a declaration. This will allow for better coordination between countries as they respond, and will require more information sharing among member states.

WHO Director-General Dr Tedros Adhanom Ghebreyesus is convening experts to decide whether the MPOX outbreak represents a “public health emergency of international concern” – a definition that included the Covid-19 pandemic and the 2022 MPOX outbreak first detected in Europe.

How does it spread and who gets infected?

The virus is crossing borders and infected people are on the move. Kenyan Authorities diagnosed mpox in a long-distance truck driver who had also traveled to Rwanda, Tanzania and Uganda.

Mpox also spreads through sexual networks. Sex workers originally formed a large part of those infected.

In the DRC, more than 70% of cases are under the age of 18. Experts say this could reflect differences in their immune systems, with high rates of malnutrition making children vulnerable to infection. While older people in the region may have had a smallpox vaccination, which offers some protection, this is not the case for younger generations.

Do we have vaccines?

Vaccines exist, but access is a problem. Africa CDC says 10 million doses are needed, but only 200,000 are available. A lack of treatments and diagnostics is hampering the response.

Plans for vaccination programs are still being reviewed, but will likely include tracing and vaccinating contacts of cases, and targeting groups such as people living with HIV who appear to be at higher risk of severe disease.

The WHO has issued emergency status for two vaccines, allowing organizations such as Gavi and Unicef ​​to procure them for distribution.

What happened during the last major outbreak?

In 2022, the outbreak spread from Europe to the world, mainly affecting men who have sex with men.

The WHO declared a public health emergency in July of that year, and contact tracing programs and mass vaccination were initiated. The emergency was lifted in May 2023 after about 90,000 infections.