Perhaps even more concerning, more than 12,000 cases (almost certainly an under-count) of Mpox Clade I - which is far more dangerous - were reported in the DRC in 2023.
While no international spread of Mpox Clade I has been detected thus far (see EID Journal Letter: No Evidence for Clade I Monkeypox Virus Circulation, Belgium), the quality and quantity of testing, surveillance, and reporting varies greatly around the globe.
Even without the added threat of the clade I virus, there is a chance for an international resurgence of Mpox clade IIb, given its continued evolution and spread.
And just as we've seen with COVID, MERS-CoV, and (presumably) novel viruses, reporting of Mpox cases by member nations has decreased substantially. The following caveat appears on the WHO's 2022-23 Mpox (Monkeypox) Outbreak: Global Trends website.
This past week the ECDC-WHO released a quarterly epidemiological update on Mpox in Europe, and while not every country reported cases (make of that what you will), Spain and Germany reported the highest number of cases.
This may be more indicative of their willingness to test and report cases than anything else. But it does remind us that the threat hasn't gone away.
I've posted the link and the surveillance summary below. Follow the link to review the data more thoroughly. I'll have a bit more after the break.
Surveillance summary
A total of 26,703 cases of mpox (formerly named monkeypox) have been identified through IHR mechanisms, official public sources and TESSy up to 14 January 2024, 14:00, from 45 countries and areas throughout the European Region. Since the last report, in the last three months, 472 cases have been reported from 19 countries and areas. Over the past 4 weeks, 138 cases of mpox have been identified from 11 countries and areas.
Case-based data were reported for 26,568 cases from 41 countries and areas to ECDC and the WHO Regional Office for Europe through The European Surveillance System (TESSy), up to 14 January 2024, 10:00.
Of the 26,568 cases reported in TESSy, 26,386 were laboratory confirmed. Furthermore, where sequencing was available, 495 were confirmed to belong to Clade II, formerly known as the West African clade. No cases of Clade I have been reported in the Region. The earliest known case has a specimen date of 07 March 2022 and was identified through retrospective testing of a residual sample. The earliest date of symptom onset was reported as 17 April 2022.
The majority of cases were between 31 and 40 years-old (10,463/26,536 - 39%) and male (26,063/26,501 - 98%). Of the 11,643 male cases with known sexual orientation, 96% self-identified as men who have sex with men. Among cases with known HIV status, 38% (4,212/11,096) were HIV-positive. The majority of cases presented with a rash (15,865/16,637 - 95%) and systemic symptoms such as fever, fatigue, muscle pain, chills, or headache (11,233/16,637 - 68%). There were 855 cases hospitalised (7%), of which 288 cases required clinical care. Eight cases were admitted to ICU, and seven cases of mpox were reported to have died.
An overview of the global situation can be found here: https://worldhealthorg.shinyapps.io/mpx_global/.
Presumably Clade I cases would present with distinctively more severe symptoms, but this is an area which could stand some improvement.
More concerning is the growing lack of commitment to surveillance, testing, and timely reporting of infectious disease cases around the world. While there were certainly gaps in infectious disease reporting before COVID, the situation appears to be getting worse since the pandemic.
Some of this may be due to a genuine lack of resources (see Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries), but for some countries - political, economic, or societal factors appear to be driving policies.
Knowing what is coming might not be enough to stop the next global health crisis, but it might give us some extra time to prepare for it.
But for the past year or so, rather than donning face masks, the world much prefers wearing blinders.
