Neglected for Years, Mpox Now a Public Health Emergency of International Concern

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Kenya has activated all 26 public health emergency operations centers countrywide and prepared laboratories for mpox testing to manage and control an mpox outbreak. Credit: Joyce Chimbi/IPSby Joyce Chimbi (nairobi)Tuesday, August 20, 2024Inter Press Service

NAIROBI, Aug 20 (IPS) - There is a deadly outbreak of a new and graver variant of mpox in the Democratic Republic of Congo (DRC), and at least one case has been confirmed in nearly 12 African countries, including those like Kenya, Burundi, Uganda, and Rwanda that were previously unaffected. Suspected mpox cases across these countries have surpassed 17,000, a significant increase from 7,146 cases in 2022 and 14,957 cases in 2023.

Many of these cases are in the DRC, where, for more than a decade, mpox cases have steadily increased as the disease remained neglected as a rare infection confined to far-flung remote rural areas in tropical Africa. But a recent move by the World Health Organization (WHO) strongly suggests that this is no longer the case as a deadly mpox variant has recently emerged with alarming potential to spread very fast and far.

According to WHO Director-General Dr. Tedros Ghebreyesus, the emergence of "a new Clade of mpox, its rapid spread in the eastern DRC, and the reporting of cases in several neighboring countries are very worrying. On top of outbreaks of other mpox clades in the DRC and other countries in Africa, it's clear that a coordinated international response is needed to stop these outbreaks and save lives."

Dr. Onyango Ouma, a Kenyan-based medical researcher, told IPS there are two endemic types of mpox virus: Clade I, which causes more severe illness and deaths. Some Clade I outbreaks have killed up to 10 percent of the infected and are highly endemic in Central Africa, and Clade II, which caused the 2022 global mpox outbreak, is more endemic in West Africa.

More than 99.9 percent of those with Clade II survive the disease. The new variant has been classified as Clade Ib and can spread through sexual contact. Recently, on August 15, global health officials confirmed the presence of Clade Ib infection in Sweden, signalling that the viral infection had taken on an international dimension.

It is this new and highly contagious Clade Ib mpox, more grave than the deadly and endemic Clade I, that has spread to other African countries that were previously untouched by the viral infection. Kenya is on high alert and has activated all 26 public health emergency operations centers countrywide, prepared laboratories for mpox testing, and deployed 120 trained personnel to manage any potential outbreak.

More than 250,000 people have already been tested thus far since Kenya intensified mpox screening at the beginning of the month. Two Kenyans, in two different parts of the country are currently undergoing testing for presenting with a skin condition akin to the mpox rash.

Although there is only one confirmed case of Clade Ib in Kenya thus far, experts such as Ouma say there are likely to be more cases, especially due to Kenya's position as a hub for travel within the East African community. The mpox case was of a driver travelling from Uganda to the Kenyan coastal city of Mombasa.

Kenya has 35 points of entry and exit or borders with five countries, including Tanzania, Uganda, Ethiopia, Somalia, South Sudan and the Indian Ocean international waters. To avert a public health disaster, Kenya is set to receive what has been labelled an Mpox war kitty assembled by donors to the tune of USD 16 million (Kes 2 billion).

Discovered in captive monkeys in 1958, the first case of monkeypox—renamed mpox by WHO in 2022—was identified in 1970 in DRC and in 2022, mpox spread around the world for the first time. Scientists at the Centers for Disease Control and Prevention say the virus that causes mpox is of the same family as the one that causes smallpox but is not related to chickenpox. As a zoonotic disease, it can spread between animals and people.

Ouma says while mpox is endemic in forested areas in East, Central and West Africa, it is the ongoing unprecedented spread and reach of the deadly Clade Ib variant that has heightened concerns and, elevated mpox as a global health concern worthy of attention from the global community of scientists and public health actors.

Stressing that "not even the more than 517 people who died from mpox, primarily in the DRC this year, raised the disease profile. African researchers rung the bell way before the 2022-2023 mpox outbreak, calling for increased investments from the global public health community to help increase diagnosis, prevention, management and control of the disease without much success."

To put it into perspective, Ouma says WHO declaration that mpox is now a public health emergency of international concern is raising the profile of the disease to the "highest alert level regarding matters that involve a public health risk to other countries, inviting an internationally coordinated response."

WHO Regional Director for Africa, Dr. Matshidiso Moeti, said, "Significant efforts are already underway in close collaboration with communities and governments, with our country teams working on the frontlines to help reinforce measures to curb mpox. With the growing spread of the virus, we're scaling up further through coordinated international action to support countries bring the outbreaks to an end."

Committee Chair Professor Dimie Ogoina said, "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. 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."

Ouma says that while this is a step in the right direction, it is further proof that serious health inequalities and inequities prevail in the prevention and response to disease outbreaks. Since mpox was confined to the African continent and in remote rural areas of the DRC, communities have long been left to grapple with the infectious disease without the much-needed investments in diagnostic, therapeutic and infection prevention.

Stressing that there is a pressing issue around "under-testing and under-reporting as we lack the tools to tackle the disease. Clade I and II are endemic in Africa, but now that the deadly Clade Ib strain can be sexually transmitted, suggesting that it could spread all over the world, we have a flurry of activities to combat the infectious disease as others outside the continent are at risk. This response has taken too long and it seems lessons from COVID-19 have unfortunately faded with time."