Mpox declares public health emergency in Africa as authorities battle multiple variants

• The Africa Centers for Disease Control and Prevention has declared the growing spread of mpox a public health emergency and warned that the virus could spread across international borders.
• A new form of mpox has been detected in the Congo, which can kill up to 10% of people and spread more easily. The new form is harder to detect.
• The director-general of the World Health Organization said authorities were dealing with multiple outbreaks of mpox in several countries with “different modes of transmission and different levels of risk.”

The Africa Centers for Disease Control and Prevention this week declared the growing spread of mpox on the continent a public health emergency and warned that the virus could eventually cross international borders.

On Wednesday, the World Health Organization will convene its own meeting of experts to consider making a similar emergency declaration over the coronavirus. The U.N. health agency said there have been more than 14,000 cases and 524 deaths this year, already exceeding last year's figures.

So far, more than 96% of all cases and deaths have occurred in a single country: Congo. Scientists are concerned about the spread of a new version of the disease there that could be transmitted more easily between people.

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Here's what we know about mpox and what could be done to contain it:

What is mpox?

Mpox, also known as monkeypox, was first identified by scientists in 1958, when outbreaks of a “smallpox-like” disease occurred in monkeys. Until recently, most human cases were seen in people in central and western Africa who had close contact with infected animals.

In 2022, the virus was confirmed to be spread through sexual contact for the first time, triggering outbreaks in more than 70 countries that had previously not reported mpox.

Mpox belongs to the same family of viruses as smallpox, but causes milder symptoms, such as fever, chills and body aches. People with more severe cases may develop lesions on the face, hands, chest and genitals.

What is happening in Africa that is causing all this concern?

The number of cases has risen sharply. Last week, the Africa CDC reported that mpox has been detected in at least 13 African countries. Compared to the same period last year, the agency said cases were up 160% and deaths were up 19%.

Earlier this year, scientists reported the emergence of a new form of mpox in a Congolese mining town that can kill up to 10% of people and may spread more easily.

Unlike previous mpox outbreaks, in which lesions were seen primarily on the chest, hands and feet, the new form of mpox causes milder symptoms and lesions on the genitals. That makes it harder to detect, meaning people can also make others sick without knowing they are infected.

The WHO said the human papillomavirus was recently identified for the first time in four East African countries: Burundi, Kenya, Rwanda and Uganda. All of these outbreaks were linked to the Congo epidemic.

In Ivory Coast and South Africa, health authorities have reported outbreaks of a different, less dangerous version of mpox that spread around the world in 2022.

What does an mpox emergency declaration mean?

CDC Director General for Africa Dr. Jean Kaseya said the agency's declaration of a public health emergency was aimed at “mobilizing our institutions, our collective will and our resources to act quickly and decisively.” He appealed to Africa's international partners for help and said the rising number of cases in Africa had been largely ignored.

“It's clear that current control strategies are not working and there's a clear need for more resources,” said Michael Marks, a professor of medicine at the London School of Hygiene and Tropical Medicine. “If a (global emergency declaration) is the mechanism to unlock these things, then it's justified,” he said.

What is different about the current outbreak in Africa compared to the epidemic in 2022?

During the 2022 global MPOX outbreak, gay and bisexual men made up the vast majority of cases and the virus spread primarily through close contact, including sexual intercourse.

Although some similar patterns have been observed in Africa, children under 15 years of age now account for more than 70% of mpox cases and 85% of deaths in the Congo.

Ahead of its emergency meeting on mpox, WHO Director-General Tedros Adhanom Ghebreyesus said authorities were dealing with multiple mpox outbreaks in several countries with “different modes of transmission and different levels of risk.”

“Stopping these outbreaks will require a comprehensive, tailored response,” he said.

Greg Ramm, Save the Children's country director in Congo, said the organisation was particularly concerned about the spread of the virus in crowded refugee camps in the east of the country, noting that there were 345,000 children “crammed into tents in unsanitary conditions”. He added that the country's health system was already “collapsing” under the pressure of malnutrition, measles and cholera.

Dr. Boghuma Titanji, an infectious disease expert at Emory University, said it was unclear why children were so disproportionately affected by mpox in Congo. She said it could be because children are more susceptible to the virus, or that social factors, such as overcrowding and exposure to parents who contracted the disease, could explain it.

How could mpox be stopped?

The 2022 mpox outbreak in dozens of countries was largely contained by the use of vaccines and treatments in rich countries, as well as by convincing people to avoid risky behavior. But in Africa, there are hardly any vaccines or treatments available.

Marks, of the London School of Hygiene and Tropical Medicine, said immunisation would probably help, including inoculation against smallpox, a related virus.

“We need a large supply of vaccines to be able to vaccinate the most at-risk populations,” he said, adding that would mean sex workers, children and adults living in outbreak regions.

Congo has said it is in talks with donors about possible vaccine donations and has received financial help from Britain and the United States.

The WHO said it had released $1.45 million from its emergency fund to support the mpox response in Africa.