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The ECDC has published an updated risk assessment on Mpox Clade I for its EU/EA members, and is urging enhanced preparedness as more imported cases are considered highly likely. First, the press release, followed by the Risk Assessment Summary and link.
ECDC recommends enhancing preparedness as more imported cases of clade I mpox highly likely
Press release
16 Aug 2024
In a new risk assessment, the European Centre for Disease Prevention and Control (ECDC) has said that it is highly likely that the EU/EEA will see more imported cases of mpox caused by the clade I virus currently circulating in Africa. However, the likelihood of sustained transmission in Europe is very low provided that imported cases are diagnosed quickly and control measures are implemented.
Due to frequent and close travel links between the EU/EEA and Africa, ECDC recommends that EU/EEA Member States issue travel advice for people visiting or returning from areas affected by the outbreak. The likelihood of infection for people from the EU/EEA travelling to affected areas who have close contact with affected communities is high. Additionally, there is a moderate risk for close contacts of possible or confirmed imported cases into the EU/EEA.“As a result of the rapid spread of this outbreak in Africa, ECDC has increased the level of risk for the general population in the EU/EEA and travellers to affected areas. Due to the close links between Europe and Africa, we must be prepared for more imported clade I cases,” says Pamela Rendi-Wagner, Director of ECDC.
Through strengthened surveillance and preparedness activities as well as the robust healthcare and response capacity in EU/EEA Member States, ECDC predicts that the impact on the EU/EEA from MPXV clade I will be low.
ECDC recommends that public health authorities in the EU/EEA maintain high levels of preparedness planning and awareness raising activities to enable rapid detection and response of any further MPXV clade I cases that may reach Europe. Ensuring effective surveillance, laboratory testing, epidemiological investigation and contact tracing capacities will be vital to detecting cases of MPXV clade I on the continent and activating any response.
Raising awareness among clinicians and establishing effective case management processes once a suspected case is identified will be crucial to detecting any further cases of MPXV clade I in the EU/EEA and preventing any secondary infections. If a clade I infection is detected, the event should be promptly communicated at the EU level via EpiPulse or EWRS. ECDC recommends travellers to epidemic areas consult their healthcare provider or travel health clinic regarding eligibility for vaccination against mpox.
The new risk assessment follows Africa CDC’s declaration of a Public Health Emergency of Continental Security and the declaration of a Public Health Emergency of International Concern by the World Health Organization. ECDC continues to work with local and international partners to help control the spread of mpox on the African continent.
The outbreak in Africa is distinct from the global MPXV clade IIb outbreak that occurred in 2022 and which continues to circulate at low levels in Europe and globally.
Risk assessment for the EU/EEA of the mpox epidemic caused by monkeypox virus clade I in affected African countries
Risk assessment
16 Aug 2024
The monkeypox virus (MPXV) clade I epidemic that has been affecting the Democratic Republic of the Congo (DRC) since November 2023 has recently spread to several other African countries including Burundi, Rwanda, Uganda and Kenya. The size of these outbreaks could be larger than reported due to under-ascertainment and under-reporting.
Epidemiological situation
On 15 August 2024, one case of MPXV clade Ib was reported in the EU/EEA and more imported MPXV clade I cases will likely occur. It is therefore important for European countries to be prepared to handle such imported cases and prevent secondary transmission.
In countries reporting clade I cases, human-to-human transmission through close physical contact and through both sexual and non-sexual transmission has been documented. Although all age groups are represented among cases infected with MPXV clade I, preliminary data show that infections by clade Ib virus concern mostly the adult population, whereas infections by clade Ia concern mostly children. To date, there are still significant uncertainties about the main transmission routes, transmissibility, severity, and natural disease history, and whether these differ between the two circulating subclades of clade I MPXV.
Mpox symptoms usually appear 6–13 days (up to 21 days) after infection. The clinical manifestation of the disease includes general febrile symptoms, a distinct rash (papules) on the skin and sores on the mucosa, back pain and muscle aches. The rash may spread quickly throughout the body within three days of experiencing the initial symptoms. Most people experience mild to moderate symptoms that usually last two to four weeks, followed by a full recovery.
Risk assessment
In the affected areas in the African continent:
The likelihood of infection with MPXV clade I for EU/EEA citizens travelling to or living in the affected areas and having close contact with affected communities is high, while the likelihood of infection is low when contacts with affected communities are avoided. The severity of the disease is expected to be low. Overall, the risk for these populations is moderate and low, respectively.
In the EU/EEA:
The overall risk for the EU/EEA general population is currently assessed as low, based on a very low likelihood and a low impact. The likelihood of infection with MPXV clade I for close contacts of possible or confirmed imported cases is high, yet the severity of the disease is expected to be low. However, in this same group, the severity of the disease is considered moderate amongst those with underlying conditions, particularly individuals who are immunocompromised. Overall, the risk for these populations is moderate and high, respectively.
The likelihood of infection for people with multiple sexual partners who were not previously infected with MPXV clade IIb or were not vaccinated in the 2022 outbreak is considered moderate. This assessment is based on the difficulty of controlling the spread of infection during the clade II outbreak in 2022/23 in this risk group. Although the severity of the disease would in most instances be low, people who are immunocompromised and those with an untreated HIV infection could experience moderate clinical severity. Overall, the risk for these populations is moderate.
Recommendations
To contain any possible outbreak in the EU/EEA, detecting cases and preventing secondary transmission is vital. This can be achieved through:
- Raising awareness among clinicians and other health professionals about possible travel-associated mpox cases caused by MPXV clade I, including the possibility of different clinical presentations, transmission through sexual and non-sexual routes and different groups affected than in previous outbreaks.
- Ensuring effective surveillance, laboratory testing (including molecular clade identification), epidemiological investigation and contact tracing capacities. Importation of MPXV clade I infections, or notable mpox events (outbreaks related to mass gathering events or other specific settings, re-infections among cases, rise in cases among women, children or other risk groups) should be promptly reported via EpiPulse and/or EWRS. All mpox cases should be reported to the European Surveillance System (TESSy).
- Providing advice to travellers to affected areas on national guidance for vaccination against mpox prior to travelling.
- Rapidly isolating any suspected cases until proven negative and, if positive, until symptom resolution.
- Implementing contact tracing and testing close contacts of confirmed cases following ECDC testing protocols.
- Providing travel advice to people visiting or returning from countries with confirmed MPXV clade I outbreaks.
- Continuing risk communication activities and working with civil society organisations to engage population groups at higher risk of infection.
Risk assessment for the EU/EEA of the mpox epidemic caused by monkeypox virus clade I in affected African countries
Open file in new window - EN - [PDF-521.87 KB]
It should be noted that risk assessments have a limited shelf life, as they are based on what we currently think we know, and that can change considerably over time.
Much also depends on how thorough, and proactive, individual nations are in detecting cases and in preventing secondary transmission.
It should be noted that the ECDC can only only present non-binding recommendations to member states. What they decide to do with it is something we'll have to wait to see.
