#18,213
While it isn't getting the attention it deserves, for the better part of a year we've been watching the rapid spread of a new, and arguably more dangerous, Mpox clade (Ib) which was first detected in the DRC in 2023 (see WHO Reports 1st Confirmed Cluster Of Sexually Transmitted MPXV Clade 1 in the DRC).
Meanwhile the milder clade IIb virus - which began its world tour in 2022 - continues to cause sporadic outbreaks around the globe (see WHO DON Mpox - South Africa).
That study revealed a novel clade I sub-linage had emerged - most likely from a zoonotic introduction - which included changes that may render current CDC tests unreliable.
In April, in Preprint: Sustained Human Outbreak of a New MPXV Clade I Lineage in Eastern Democratic Republic of the Congo, we saw a further analysis, which called for this new lineage to be named Clade Ib, and warned of its potential to spread globally.
While that hasn't happened yet, the Mpox epidemic in the DRC continues to worsen, and neighboring nations are on heightened alert. In recent weeks Mpox cases have been reported in Burundi, and given limited surveillance, other cases may be flying under the radar.
Yesterday the 8-nation EAC (East African Community) released the following statement:
EAC calls for heightened public awareness to combat spread of MonkeypoxEast African Community Headquarters, Arusha, Tanzania, 29th July, 2024: The East African Community (EAC) Secretariat has called on EAC Partner States to educate their citizens on how to protect themselves and prevent the spread of Monkeypox (Mpox).
This follows reports from the World Health Organization (WHO) that Burundi and the Democratic Republic of Congo (DRC) are experiencing an outbreak of the viral Mpox disease.
Burundi has confirmed three (3) cases of Mpox in Bujumbura and Isare, verified by national laboratories and the WHO. The Burundian health ministry has assured the public that measures are in place to manage the disease, with patients currently receiving treatment and showing improvement.
Since 2022, the DRC has reported over 21,000 cases and more than 1,000 deaths, according to WHO. In 2023, there were 14,626 cases and 654 deaths, and by the end of May 2024, 7,851 cases and 384 deaths had been reported. Many of those infected are children under five (39%), and nearly two-thirds (62%) of the deaths are also among children. Health experts have identified a new strain of the virus in one part of the country.
Burundi borders DRC, Rwanda and Tanzania while the DRC borders five EAC Partner States: Tanzania, Burundi, Rwanda, Uganda and South Sudan.
The EAC Deputy Secretary General in charge of Infrastructure, Productive, Social and Political Sectors, Hon. Andrea Aguer Ariik Malueth, emphasised the importance of taking preventive measures to minimise the spread of Mpox.
Amid this growing concern, yesterday the ECDC released the following statement reassuring - at least for now - that the risk of seeing this new clade Ib spreading to Europe remains `very low'.
Risk to EU/EEA from variant mpox virus ‘very low’
News
29 Jul 2024
The European Centre for Disease Prevention and Control (ECDC) is working closely with Africa CDC, and local and international partners to monitor and respond to a worsening mpox outbreak in the Democratic Republic of the Congo (DRC) where a new variant of the mpox virus has emerged.
While the risk to the EU/EEA remains very low, more than 11 000 suspected cases of mpox including around 450 deaths have been reported in DRC since the beginning of 2024. Adding to concerns about the outbreak is the emergence of a new variant of the clade I mpox virus which is thought to cause more severe disease and higher mortality than the clade II variant that has circulated globally since 2022.
“I would like to stress that the risk to the EU/EEA population from the new mpox variant identified in DRC remains very low. ECDC is engaging with our partners in Africa in their efforts to contain this outbreak for the benefit of all those affected, prevent this new variant from spreading any further and reinforce future preparedness and response capabilities,” says Pamela Rendi-Wagner, Director of ECDC.
Despite concerns about the new clade I variant, current vaccines and treatments are expected to remain effective. There is no evidence that the clade I variant is circulating outside central Africa.
Experts from across ECDC have been working closely with their partners at Africa CDC to support the response to the outbreak. Through the ‘ECDC and Africa CDC partnership project’, ECDC experts are contributing to a rapid literature review to help identify gaps in the knowledge of the clade I mpox variant and guide future research. They are also supporting an in-action review of the mpox outbreak response in DRC to inform preparedness and response activities.
In addition, ECDC is preparing for an EU Health Task Force (EUHTF) deployment to DRC, enabled by the Global Outbreak Alert and Response Network (GOARN), as part of wider, proactive efforts to support global health and strengthen Europe's defences against infectious disease.
The EUHTF deployment will see an ECDC epidemiologist join colleagues from Africa CDC and the World Health Organization (WHO) on the ground in DRC to contribute to the DRC Ministry of Public Health-led outbreak response. EU Health Task Force efforts in DRC will focus on surveillance, field investigation and research projects.
Since 2022, 22 592 cases of mpox have been detected in the EU/EEA in an unrelated outbreak of the less severe clade II variant. Cases have declined steadily since their peak in July 2022. Nine EU/EEA countries reported a total of 98 cases in the four weeks up to July 5, 2024 – the most recent data available.
In the EU/EEA, the risk of infection from mpox clade II remains low for the general population and moderate among higher risk groups such as people who have multiple sexual partners and some men who have sex with men.
ECDC continues to support EU/EEA Member States in responding to the ongoing mpox clade II outbreak, issuing public health guidance, risk communication and community engagement resources and regular joint surveillance bulletins with the WHO Regional Office for Europe. ECDC assesses the overall risk from the ongoing clade II mpox outbreak in Europe as moderate for men who have sex with men and low for the broader population.
The caveat of course is that up until mid-May of 2022, the risk of Mpox Clade II spreading internationally was considered equally low. The Mpox virus was only belatedly discovered to be spreading in multiple non-endemic nations, leading to the declaration of a PHEIC (Public Health Emergency of International Concern) the following July.
As we've seen with COVID, H5N1, and other infectious disease reporting around the globe, surveillance and reporting on Mpox is often limited, or sometimes missing entirely. The WHO described this situation in their last monthly Mpox update #34:
WHO continues to encourage all countries to ensure that mpox is a notifiable disease and to report mpox cases, including reporting when no cases have been detected (known as ‘zero-reporting’, as outlined in the Standing Recommendations on mpox issued by the WHO Director General).
This report does not highlight non-reporting countries. Therefore, it should be noted that an absence of reported cases from a country may be due to the country not reporting, rather than having no cases. Reporting to WHO has been declining, therefore, the decline in reported cases should be interpreted with caution.
A reminder that an absence of evidence is not necessarily evidence of absence.
