The World Health Organization (WHO) declared the ongoing mpox outbreak in Africa a global health emergency on Wednesday, marking it as the highest alert level under international health law. This follows a similar public health emergency declaration made by the Africa Centres for Disease Control and Prevention the day before.
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A more lethal strain of the virus, clade Ib, is spreading rapidly in the Democratic Republic of Congo and has already reached at least four other African countries previously unaffected. WHO Director-General Tedros Adhanom Ghebreyesus expressed concern over the risk of further international spread, describing the situation as "very worrying."
“The consensus was that the current mpox outbreak is an extraordinary event,” said Dimie Ogoina, chair of WHO’s emergency committee. “What we are seeing in Africa is just the tip of the iceberg. We don't yet fully understand the extent of the mpox burden.”
Global experts are closely monitoring the situation, although the immediate risk to the United States is currently considered low. Here's what you need to know.
What is Mpox?
Mpox, formerly known as monkeypox, is a viral disease closely related to the smallpox virus, which has been eradicated. The virus spreads through close contact, such as touching, kissing, or sexual activity, as well as through contaminated materials like clothing, sheets, and needles, according to the WHO.
Initial symptoms are usually similar to the flu, including fever, chills, fatigue, headaches, and muscle weakness, followed by a painful or itchy rash with raised lesions that eventually scab over and heal within weeks.
What Makes This Outbreak Different?
Mpox is categorized into two genetic clades, I and II, which are groups of viruses that have evolved distinct genetic and clinical traits over time.
Clade II caused a global outbreak that was also declared a global health emergency from July 2022 to May 2023. However, the current outbreak is being driven by clade I, which tends to cause more severe illness. The subtype behind most of the ongoing spread, clade Ib, is relatively new.
“Clade Ib has emerged as a new mutation that is more adapted to humans,” said Dr. Daniel Bausch, senior adviser for global health security at FIND, a global health equity nonprofit.
While clade I is new and concerning, the current situation is complicated by several overlapping outbreaks in different countries, each with varying modes of transmission and levels of risk, said Tedros.
How Dangerous Is It?
Outbreaks of clade I mpox have seen fatality rates as high as 10%, although more recent outbreaks have shown lower death rates, according to the U.S. Centers for Disease Control and Prevention (CDC). The death rate for clade II is less than 0.2%.
Certain groups, including infants, people with severely weakened immune systems, and pregnant women, are more likely to experience severe infections. However, surveillance of mpox is incomplete, meaning there is still much to learn about its transmissibility and fatality rates, Bausch said.
“This virus is found in the environment and likely maintained in small mammals in Africa, and we lack proper diagnostic tools,” he said. “Diagnosing mpox isn’t difficult when you have access to a nearby lab with skilled workers and technology, but most cases occur in rural areas where getting a sample to a lab is challenging.”
Where Is Mpox Found?
For decades, mpox was primarily found in Central and West Africa, with the majority of clade I cases in Central Africa and the Democratic Republic of Congo, and clade II cases in Nigeria.
In 2022, concerns grew as cases began spreading in Europe and North America. The current outbreak, however, is spreading to more African countries that had previously been unaffected. While most cases are still concentrated in the DRC, at least 13 African countries have reported cases, according to the Africa Centres for Disease Control and Prevention. Recently, Sweden confirmed its first case of clade I mpox, marking the first time it has been detected outside of Africa.
How Can the Spread Be Contained?
Vaccines are available to protect against mpox, but they are not widely accessible in Africa. Although no clade I mpox cases have been identified in the United States, the CDC recommended last week that individuals in the U.S. who are exposed to or at high risk of contracting mpox should get vaccinated.
The Vaccine Alliance, known as Gavi, has allocated up to $500 million to supply mpox vaccines to affected countries, including the DRC and surrounding nations. Starting in 2026, Gavi will establish a global stockpile of mpox vaccines, similar to those it has for cholera, Ebola, meningitis, and yellow fever.
WHO emphasized that vaccines are just one part of the response. Containing the spread will also require enhanced surveillance, diagnostics, and research to fill existing gaps in understanding.
The organization has approved the Emergency Use Listing process for mpox vaccines and developed a regional response plan requiring $15 million. Half a million doses of the vaccine are currently in stock, with an additional 2.4 million potentially available by year-end. The DRC and Nigeria will be the first recipients of these vaccines.
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