-As it Prepares To Combat MonkeypoxVirus
On August 14, 2024, the National Public Health Institute of Liberia (NPHIL) alerted that it was informed of an outbreak of the Monkeypox virus (Mpox) in several countries of the WHO African Region, mainly in Central and West Africa.
This Mpox outbreak has been determined by the WHO to be a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). Since the beginning of this year 2024, Liberia has accounted for 5 confirmed cases in 3 counties. In recent times, new cases have been confirmed in neighboring countries like Nigeria and Cote d’Ivoire in the region.
Mpox is the disease caused by the Monkeypox virus which belongs to the same family as the virus that causes smallpox. It is transmitted through various modes that include direct skin-to-skin contact, sexual contact with bodily fluids or lesions found around the anus, rectum, or vagina from a Mpox-infected person, and respiratory secretions and droplets, among others.
Symptoms include fever, chills, headache, swollen lymph nodes, muscle aches, among others.Noting the nature of this outbreak and its rapid spread over several countries, the National Public Health Institute of Liberia (NPHIL) will heighten its surveillance system, strengthen its outbreak preparedness plan, and work in collaboration with the Ministry of Health to activate measures and specific response mechanism to address any impending outbreak of Mpox in Liberia.
Meanwhile, the public is strongly advised to take the following preventive measures such as constant hand-washing, avoiding sex with persons suspected of having Mpox symptoms, avoiding close contact with persons suspected of Mpox symptoms, avoiding animal contact, and reporting to the nearest medical facility should you experience or observe any of the Mpoxsymptoms listed above.
However, the World Health Organization give the a data statistics on Monkey pox, in June 2024 (latest complete monthly disease surveillance data available), a total of 934 new laboratory confirmed cases of mpox and four deaths were reported to WHO from 26 countries, illustrating continuing transmission of mpox across the world. The most affected WHO regions, ordered by number of laboratory-confirmed cases, were the African Region (567 cases), the Region of the Americas (175 cases), the European Region (100 cases), the Western Pacific Region (81 cases) and the South-East Asia Region (11 cases). The Eastern Mediterranean region did not report cases in June 2024. As reporting from countries to WHO has been declining, the current reported global data most likely underestimate the actual number of mpox cases.
Within the African Region, the Democratic Republic of the Congo reported most (96%) of the confirmed,mpox cases in the reporting month. With limited access to testing in rural areas, 24% of clinically compatible (reported as suspected) cases in the country have been tested in 2024, with a positivity of around 65% at the national level. The confirmed case counts are, therefore, underestimates of the true burden.
This issue also features an update on the geographic expansion of mpox in the WHO African Region from July – August 2024, not yet captured in global surveillance data by 30 June 2024. Four new countries in Eastern Africa (Burundi, Kenya, Rwanda, and Uganda) reported their first mpox cases. All cases are linked to the expanding outbreak in East and Central Africa and all cases sequenced to date from these countries are clade I. Separately, Côte d’Ivoire is experiencing an outbreak of mpoxlinked to clade II MPXV and South Africa has reported two more confirmed cases.
From 1 January 2022 through 30 June 2024, a cumulative total of 99 176 laboratory-confirmed cases of mpox, including 208 deaths, were reported to WHO from 1162 countries/territories/areas (hereafter ‘countries’) in all six WHO Regions (Table 1). A total of 934 new cases were reported in June 2024, comparable to the number of new cases reported for May 2024, including some cases retrospectively reported for previous months. For the second month in a row, most cases in June 2024 were reported from the African Region (61%), followed by the Region of the Americas (19%), and the European Region (11%). The African Region reported a rise in case counts in June 2024 compared to May 2024 (n = 567 vs465), despite some delays in reporting typical of all regions.
No case was reported by the Eastern Mediterranean Region. Reporting to WHO has been declining, therefore, the recent trends in reported cases should be interpreted with caution. WHO continues to encourage all countries to ensure that mpoxis a notifiable disease and to report mpox cases, including reporting when no cases have been detected (known as ‘zero-reporting’). This report does not highlight non-reporting countries. Therefore, it should be noted that an absence of reported cases from a country may be due to the country not reporting, rather than having no cases.
In June 2024, 16 of 26 (62%) reporting countries showed an increase in cases compared to May 2024. The Democratic Republic of the Congo reported the highest relative increase in the African Region (n = 543 vs 459), Spain (n = 54 vs 38) reported the highest increase in the European Region, Colombia (n = 11 vs zero) reported the highest increase in the Region of the Americas, Australia (n = 64 vs 33) reported the highest increase in the Western Pacific Region, and no country reported an increase in the South-East Asia Region.
From 1 January 2022 to 30 June 2024, the ten countries that reported the highest cumulative number of confirmed cases globally are the United States of America (n = 33 191), Brazil (n = 11 212), Spain (n = 8 084), France (n = 4 272), Colombia (n = 4 249), Mexico (n = 4 124), the United Kingdom (n = 3 952), Peru (n = 3 875), Germany (n = 3 857), and the Democratic Republic of the Congo (2 999). This marks the first time the Democratic Republic of the Congo has featured among the top ten countries that have reported the highest cumulative number of confirmed cases globally. Together, these ten countries account for 81% of the cases reported globally.
In recent weeks, there has been an unprecedented increase in the number of countries in the WHO African Region reporting mpox cases and outbreaks. Burundi, Kenya, Rwanda, and Uganda have each reported their first mpox cases.
The presence of clade Ib monkeypox virus (MPXV) has been confirmed in each country. For several cases, travel to eastern parts of the Democratic Republic of the Congo, or one or more of the four newly affected countries, was also reported. Other countries in the African region are also reporting re-emerging outbreaks. This includes Côte d’Ivoire, that had reported no cases since the start of the multi-country outbreak in 2022, where clade II MPXV has again been detected. A detailed description of the cases in these countries is provided below.
East Africa, on 25 July 2024, the Ministry of Health of Burundi declared an outbreak of mpox following the confirmation of three cases by the National Reference Laboratory of the National Institute of Public Health. These cases were identified on 22 July 2024, one each from Kamenge University Hospital and Kamenge Military Hospital, and the third case from IsareHealth District. They presented with symptoms including fever, joint pain, and a widespread rash. Samples collected during a multidisciplinary investigation tested positive for MPXV on 25 July 2024. These are the first confirmed mpox cases ever identified in Burundi. Since then, the Ministry of Health has received several alerts of possible mpox cases and investigated suspected cases, of which 61 cases distributed across several districts had been confirmed by 9 August 2024. Genomic sequencing analysis has identified clade Ib. No deaths had been documented at the time of reporting.
On 29 July 2024, the Ministry of Health, Kenya confirmed a case of mpox in Taita Taveta County (on Kenya-Tanzania border). The patient is a 42-year-old Kenyan male, a long-distance truck driver who travelled from Kampala, Uganda to Mombasa, Kenya on 12 July 2024. At the time of identification, the patient was travelling to Rwanda through Tanzania via the Taveta One Stop Border Point. This is the first mpox case ever identified in Kenya, and genomic sequencing analysis has identified clade Ib. No deaths had been reported as of 8 August 2024.
On 24 July 2024, Rwanda notified WHO of two laboratory-confirmed mpox cases in the country, and on 27 July, the Ministry of Health declared an outbreak of mpox. The cases included a 33-year-old woman trader (case 1) who frequently travels to the Democratic Republic of the Congo, and a 34-year-old man (case 2) with recent travel
to the Democratic Republic of the Congo. Case 1 was identified at a point of entry (PoE) and case 2 was identified at a health facility. Both cases were reported to be in stable condition and under continuous medical follow-up.
These are the first ever confirmed mpox cases identified in Rwanda. As of 7 August 2024, four confirmed mpox cases and zero deaths had cumulatively been reported by the country Genomic sequencing analysis has identified clade Ib. In June and early July 2024, Kasese District enhanced surveillance for mpox disease along the border with the neighboring Democratic Republic of the Congo. This was done in light of reported increasing cases in the Democratic Republic of the Congo.
Following the orientation of screeners at the Bwera Point ofEntry and Bwera Hospital, suspected cases were identified, from whom samples were collected for laboratory testing, two of which tested positive for clade I MPXV. Of the confirmed cases, one is a 37-year-old woman married to a national of the Democratic Republic of Congo and the second is a 22-year-old woman from the Democratic Republic of the Congo. These are the first ever confirmed mpox cases identified in Rwanda.
Investigations revealed that transmission occurred outside Uganda and no secondary transmission had been linked to the two cases as of 2 August 2024. By the same date, nine contacts were under follow up. No deaths have been reported as of 8 August 2024.
Central African Republic (CAR)
On 17 July 2024, the Ministry of Health and Population was alerted by the Pasteur Institute of Bangui about confirmed mpoxcases detected in the health district of Bangui 2, in Health Region No. 7, in the country’s capital. This brought the cumulative number of mpox cases detected in the country in 2024 to 28 cases. Following this, the Central African Republic (CAR) declared an mpox outbreak on 26 July 2024.
West Africa, In July 2024, Côte d’Ivoire confirmed two non-fatal cases of mpox. The first case is a 46-year-old patient who consulted a doctor on 1 July 2024 with a fever, headache and skin rash, in Tabou district, San Pedro region, on the border with Liberia. Mpox was confirmed by the Institute Pasteur de Côte d’Ivoire (IPCI) laboratory on 3 July 2024 and again by quality control on 14 July 2024 by the Institute Pasteur in Dakar. The second case is a 20-yearold patient, in the Koumassi health district in Abidjan, who presented with skin rash and oral mucosal lesions on 14 July 2024. No epidemiological link between these first two cases has been identified.
As of 2 August 2024, six mpox cases had been confirmed in three health districts: Tabou, Koumassi, YopougonOuest-Songon. Genomic sequencing analysis has identified clade II MPXV. The country has previously reported mpox, but no cases had been notified since the start of the multi-country outbreak in 2022.
South Africa recently reported two additional confirmed cases of mpox, one in Gauteng province and another in KwaZulu-Natal province, bringing the total number of cases reported since 8 May 2024 to 24 cases (12 cases in Gauteng, 11 cases in KwaZulu-Natal, and one case in the Western Cape). The recent cases were reported 26 days
since the last cases reported in South Africa. One of these recently detected cases reported a history of international travel to Peru in South America. It is uncertain if exposure occurred in Peru or South Africa. Of the 22 cases recorded between 8 May and 6 July, 19 cases have fully recovered, and three cases had died. In addition to these confirmed outbreaks, suspected cases are being investigated in several other countries.
WHO stated that these events represent a rapid escalation in the geographic areas affected by mpox. Considering these recent developments and the risk this expansion of mpox represents for the continent and more broadly the world: WHO has regardedthe global mpox multi-country event to an acute grade 3 emergency in accordance with the WHO Emergency Response Framework and issued an information posting to WHO Member States.
The WHO Director-General’s Standing Recommendations for mpox issued on 21 Aug 2023 are being extended for another year; The WHO Director-General has triggered the process towards Emergency Use Listing for mpox vaccines; Funds are being released from the WHO Contingency Fund for Emergencies (CFE) to scale up the response in the African Region.
The Director-General is convening an Emergency Committee under the International Health Regulations (IHR) (2005) to advise on whether the evolving mpox situation constitutes a Public Health Emergency of International Concern (PHEIC). In a press briefing on 7 August 2024, the Director-General of the WHO addressed the mpox situation and outlined key, high-level actions taken by WHO. The press briefing statement can be found here and the recording here.
At the national level, WHO Member States and partners are reminded to strengthen surveillance and response and to ensure early outbreak detection and control, regardless of origin. In light of the continuing public health threat from mpox in all countries and notably in the African region, WHO is calling on national and local health authorities, health workers, civil society and partners to continue to collaborate with national and global partners to develop strategies to increase access to diagnostics, improve clinical care and access to vaccines, ensure stigma-free risk communication and community engagement, and bolster global preparedness and response efforts to effectively contain mpox both locally and globally.
As outlined in the WHO Strategic Framework for enhancing prevention and control of mpox, it is essential to continue to adapt these classic public health interventions to the local context, for groups at risk and in line with local modes of transmission. Continuing partnership with the national HIV/AIDS control programmes, humanitarian actors and immunization teams will greatly strengthen capacity to integrate response with ongoing interventions to reach those most at risk and to prepare for mpox vaccine introduction for outbreak prevention.
