WHO Declares Another Mpox Global Emergency—What Americans Should Know

The World Health Organization (WHO) has declared mpox a public health emergency of international concern based on the ongoing outbreak in the Democratic Republic of Congo (DRC) that has spread to at least 13 other African countries, with possible cases in Europe and Asia.¹

According to the Africa CDC, mpox cases across the continent are up 160% and deaths are up 19% compared with the same period in 2023.² In general, WHO has recorded more than 14,000 cases and 524 deaths in Africa in 2024 so far, exceeding figures from 2023 with more than 96% of cases and deaths in the DRC alone. The ongoing mpox outbreak has now reached previously unaffected African nations such as Burundi, Kenya, Rwanda, and Uganda.³ The Africa CDC has confirmed 2863 cases and 517 deaths across the continent, but suspected cases have passed 17,000—a significant jump from 7146 cases in 2022 and almost 15,000 in 2023.

“This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing and contact tracing,” said an Africa CDC news release.

This news comes almost exactly 2 years after WHO first declared mpox a global emergency, with the US announcing a public health emergency soon after.^4,5 A week before the new WHO announcement, the US CDC issued a health advisory stating that, although the risk of this more severe form of mpox in the US remains low, doctors should maintain a “heightened index of suspicion for mpox” in patients who have recently traveled to affected regions.⁶

WHO has declared mpox a public health emergency of international concern | Image credit: hectorchristiaen – stock.adobe.com

Additionally, the day after WHO announced the global health emergency, Swedish health officials said they identified the first related case in their country after a patient sought care in Stockholm after returning from travel in Africa.⁷ The following day, Pakistan’s Ministry of National Health Services announced its first confirmed case of the virus, stating that the individual had arrived from Saudi Arabia and that health officials are still working on sequencing to identify the specific strain of the virus the individual was infected with.

Despite the initial declaration of mpox as a public health emergency of international concern in 2022—which ended in July 2023—Africa did not receive the critical support it needed.¹ While global cases decreased, the growing outbreak in Africa was mostly overlooked.

“The current upsurge of mpox in parts of Africa, along with the spread of a new sexually transmissible strain of the monkeypox virus, is an emergency, not only for Africa, but for the entire globe,” said Dimie Ogoina, MBBS, FWACP, FMCP, FACP, FIDSA, chair of WHO's mpox emergency committee and president of the Nigeria Infectious Diseases Society. “Mpox, originating in Africa, was neglected there, and later caused a global outbreak in 2022. It is time to act decisively to prevent history from repeating itself."

How Is This Different From the First Outbreak?

The mpox virus is classified into 2 strains: clade I and clade II.⁸

Clade I is responsible for the current outbreak and is endemic to Central Africa—where the outbreak is now stemming from—and is deemed the more contagious version of the 2 strains, leading to more severe illness and death. This new form of mpox was reported on earlier this year, with scientists saying this strain can kill up to 10% of those infected based on research in a Congolese mining town.^9,10

Meanwhile, clade II was the strain responsible for the 2022 outbreak that led to nearly 100,000 global cases, with about a third being from the US.¹¹ Federal and state health officials are continuing to track mpox cases in the country, including in Florida, but so far none have been linked to the more contagious clade I strain driving the surge in Africa, according to the CDC. Clade II is considered endemic to West Africa, and infections from this strain are less severe, with more than 99.9% of people surviving infection.¹⁰

"From experiences in 2022, it has become clear that mpox can spread well beyond these countries where mpox is endemic," Richard Martinello, MD, professor of medicine at Yale School of Medicine, said in a news advisory.¹² "Further concerning, the current outbreak is due to a variant known as 'clade I'. Infections due to clade I mpox tend to be more severe compared with infections due to clade II mpox, which was responsible for the 2022 global outbreak."

Although vaccines like Jynneos have helped curb mpox transmission outside of Africa during the global clade II outbreak, health officials have highlighted the lack of vaccines available for Africa, where the disease remains endemic.¹³ An estimated 10 million doses are needed to address current outbreaks in the region, yet only the DRC and Nigeria have initiated regulatory steps to access supplies.

At a briefing following the public emergency announcement, Tim Nguyen, MPH, head of WHO's High Impact Events Preparedness unit, noted there are 500,000 doses of the Bavarian Nordic MVA-BN vaccine available, with the potential to produce an additional 2.4 million doses by the end of 2024 if orders are placed. A second vaccine, LC16, is stockpiled in Japan but is not commercially available. WHO officials emphasized the need for better data on the disease’s spread to optimize vaccine deployment and urged countries to signal interest in donating supplies. WHO also recently invited mpox vaccine manufacturers to express interest in having their products emergency-listed. Officials noted that 1 company plans to submit paperwork this week, with another set to meet next week, and WHO’s advisory group is expected to discuss the listings in mid-September.

What Should Americans Know?

HHS announced that it is closely monitoring the spread of clade I mpox in Africa and has provided $17 million in preparedness and response support in recent months. Additionally, the US plans to donate 50,000 doses of the Jynneos vaccine to the DRC.

While most cases of mpox are generally not life-threatening in the US, certain people are at higher risk of severe illness, including those with severely weakened immune systems, those with a history of eczema, those who are pregnant, and infants younger than 1 year.¹⁰

Both types of the virus can spread through direct contact with infected animals, close contact—including intimate contact—with someone who has mpox, and contact with contaminated objects or surfaces. To protect themselves and others from mpox, the CDC said Americans should avoid close, skin-to-skin contact with people who have a rash that resembles mpox and with animals that may carry the virus. Patients can also take precautions to reduce their risk during social gatherings or sexual activity, and can consult their health care provider to see whether the mpox vaccine is recommended for them.

According to Martinello, there is very little mpox circulating in the US at the moment, but Americans should be aware of the outbreak.¹²

"This could quickly change as it did in 2022, so it is important for people to be aware," Martinello said "Transmission of mpox does seem to require close skin-to-skin contact, so this is not a situation where persons need to change how they use, for example, public transportation."

Americans can also track mpox detection levels in wastewater across the country.¹⁴ In the past 4 weeks, detection has been low in the US with most sites not measuring any mpox. While some areas in California and Illinois may have intermittent detection (1% to 80% of samples positive), the CDC reported a lack of recent data.

References

1. WHO Director-General declares mpox outbreak a public health emergency of international concern. News release. WHO. August 14, 2024. Accessed August 19, 2024. https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
2. Cheng M. A new global health emergency: what is mpox, where are the outbreaks and will the virus spread? Associated Press. Updated August 15, 2024. Accessed August 19, 2024. https://apnews.com/article/what-is-mpox-monkey-pox-congo-emergency-415d11f9e62d104b4c40dd8fe8e80b47
3. Africa CDC declares mpox a public health emergency of continental security, mobilizing resources across the continent. News release. Africa CDC. August 13, 2024. Accessed August 19, 2024. https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent/
4. AJMC Staff. What we’re reading: monkeypox declared global emergency; Amazon, One Medical deal raises concerns; White House COVID-19 efforts. AJMC®. July 25, 2022. Accessed August 19, 2024. https://www.ajmc.com/view/what-we-re-reading-monkeypox-declared-global-emergency-amazon-one-medical-deal-raises-concerns-white-house-covid-19-efforts
5. Gavidia M. US declares monkeypox a public health emergency. AJMC. August 4, 2022. Accessed August 19, 2024. https://www.ajmc.com/view/us-declares-monkeypox-a-public-health-emergency
6. Mpox caused by human-to-human transmission of monkeypox virus in the Democratic Republic of the Congo with spread to neighboring countries. News release. CDC. August 7, 2024. Accessed August 19, 2024. https://emergency.cdc.gov/han/2024/han00513.asp
7. Bendix A. The mpox strain spreading now is different from the one in 2022: Here's what to know. NBC News. August 16, 2024. Accessed August 19, 2024. https://www.nbcnews.com/health/health-news/mpox-virus-outbreak-symptoms-2024-spread-rcna166778
8. Marchante M. Global emergency declared over a new mpox outbreak. What to know in Florida. Miami Herald. Updated August 19, 2024. Accessed August 19, 2024. https://www.miamiherald.com/news/health-care/article291081815.html
9. Cheng M, Malkia C. A new form of mpox that may spread more easily found in Congo’s biggest outbreak. Associated Press. Updated May 2, 2024. Accessed August 19, 2024. https://apnews.com/article/mpox-congo-outbreak-who-fda17cea128f46e48110ad7adcd9e5de
10. About Mpox. CDC. Updated April 18, 2024. Accessed August 19, 2024. https://www.cdc.gov/poxvirus/mpox/about/index.html
11. Ongoing 2022 global outbreak cases and data. CDC. Updated March 5, 2024. Accessed August 19, 2024. https://www.cdc.gov/poxvirus/mpox/response/2022/index.html
12. Yale School of Medicine professor available to discuss mpox emergency. Yale School of Medicine. August 16, 2024. Accessed August 19, 2024. https://d.newswise.com/articles/view/815695/?sc=mwhr&xy=10050189
13. Schnirring L. WHO declares global public health emergency for mpox surge in Africa. CIDRAP. August 14, 2024. Accessed August 19, 2024. https://www.cidrap.umn.edu/mpox/who-declares-global-public-health-emergency-mpox-surge-africa
14. U.S. mpox wastewater data. CDC. Updated August 14, 2024. Accessed August 19, 2024. https://www.cdc.gov/nwss/wastewater-surveillance/mpox-data.html