#18,237
Over the weekend the Director General of the WHO Dr. Tedros announced (see below) that he would be convening an Emergency Committee Meeting of the IHR this week to consider whether the new emerging Mpox Clade Ib virus in central Africa constitutes a public health emergency of international concern (PHEIC).
We've been following this upsurge since last November, and saw the identification of a new clade (Ib) last March (see Preprint: Sustained Human Outbreak of a New MPXV Clade I Lineage in Eastern Democratic Republic of the Congo).
So far, Clade I has not been identified outside of Africa, but current laboratory tests have encountered challenges identifying the new clade Ib virus (see Predicted failure of common Mpox PCR testing on a recent DRC clade I variant).Unlike the clade II Mpox virus, which began its world tour in the spring of 2022, clade I & Ib Mpox cause far more severe illness, and carry a significantly higher fatality rate.
Clade Ib appears to be spreading far more efficiently in the DRC than previous strains, and is disproportionately affecting (and killing) children. In recent weeks clade Ib has been detected in three new countries (Rwanda, Uganda and Kenya), and testing is ongoing in a 4th (Burundi).
Add in the fact that many countries are lax in looking for, or reporting cases (see WHO statement below), and it becomes difficult to say with absolute certainty how widespread clade I has become.
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.
Clade II Mpox was obviously spreading internationally - but under the radar - for months before the first cases were identified in the UK & Portugal in May of 2022 (see EID Journal: Monkeypox Virus Evolution before 2022 Outbreak).
Within 30 days, the United States was detecting 50-60 new cases a day, climbing to > 440 a day by August 1st, 2022. While cases began to decline after that, clade II cases are rising once again (see NYC HAN Advisory: `Substantial' Increases In Mpox Infections Over Past Few Months).
Between that, and the potential spread of clade I outside of Africa, and we've seen a sudden surge of risk assessments and epidemiological alerts on Mpox. Late last week, PAHO (the Pan American Health Organization) issued their own epidemiological alert, calling for enhanced surveillance.
First excerpts from the PAHO News release, followed by a link and some excerpts, from the PAHO Alert.
Countries of the Americas should strengthen Mpox surveillance in light of potential spread of new variant detected in African region, PAHO says
Washington D.C. 9 August 2024 (PAHO/WHO) – In an epidemiological alert released on 8 August, the Pan American Health Organization (PAHO) has called on countries of the Americas to strengthen surveillance, including laboratory detection and genomic sequencing of confirmed cases, following the identification of a new variant of mpox virus, Clade I (Clade Ib), in the sub-Saharan African Region. While the new variant has not been reported in the Americas, countries should remain alert to possible imported cases.
The new variant is associated with sustained transmission, as well as the occurrence of cases in a wider range of age groups than during previous outbreaks, including children. It is estimated to have emerged in the Democratic Republic of the Congo in September 2023 and is associated with a significant increase of cases in the country.
Mpox is a viral illness caused by the monkeypox virus, a species of the genus Orthopoxvirus. Two different clades exist: clade I and clade II. Symptoms include fever, intense headache, muscle aches, back pain, low energy, swollen lymph nodes, and a skin rash or mucosal lesions. The rash tends to be concentrated on the face, palms of the hands, and soles of the feet, but can also be found on the mouth, anogenital region, and eyes. Symptoms typically last between 2 to 4 weeks and go away on their own without treatment.
Since the beginning of 2024 (to 26 July 2024), the Democratic Republic of Congo Ministry of Health reported 14,479 cases of mpox, and 455 deaths. According to the report, “the number of cases reported in the first six months of this year match the number reported in all of last year.” Children under the age of 15 accounted for 66% of cases and 82% of deaths. Cases of the new variant have also been reported in Rwanda, Uganda and Kenya. Testing is also underway in Burundi to determine whether reported cases in that country are also due to the new variant.
As a result of the hike in cases, on 7 August the World Health Organization (WHO) Director General, Dr. Tedros Adhanom Ghebreyesus announced that he will convene a panel of experts to advise him on whether the expanding outbreak constitutes a global health emergency.
(Continue . . . )
Given the circulation of the variant of clade I of mpox virus (MPXV) in the African Region, which is associated in the African Region with sustained transmission and the occurrence of cases in a wider range of age groups, including children, the Pan American Health Organization/World Health Organization (PAHO/WHO) encourages Member States to remain vigilant to the possibility of introduction of this variant in the Americas, and to continue their surveillance efforts, including genomic sequencing of detected cases, with special emphasis on high-risk groups.
(Excerpt)
In December 2022, the Democratic Republic of the Congo declared a nationwide outbreak of mpox and since September 2023 the outbreak that affected South Kivu province has spread and affected several provinces. As part of the outbreak investigation, a new variant of mpox virus clade I (MPXV) was identified and is estimated to have emerged around mid- September. The variant was associated with the significant increase in cases of mpox in that country, and sexual transmission was the main mode of infection in most of the reported cases (8).
The clade I variant contains predominantly APOBEC3-type mutations, indicating an adaptation of the virus due to intense circulation in humans (8). Person-to-person transmission has been continuous since its detection, and this is the first time that sustained community transmission of the virus has been described in the country (8).
Since the beginning of 2024, as of the last report on 26 July 2024, the Democratic Republic of the Congo Ministry of Health reported 14,479 cases of mpox (2,715 confirmed; 11,764 suspected) and 455 deaths (case fatality rate: 3.1%), affecting 25 of the country's 26 provinces. Children under 15 years of age accounted for 66% of cases and 82% of deaths. Of the confirmed cases, 73% were males (9).
Exactly what that would look like is impossible to say, since the virus continues to evolve. Past performance has never been a reliable guarantee of future results.
About the only thing we can say is, the longer we wait to acknowledge a problem, the harder is becomes to effectively deal with it.
And the warning lights have been flashing with Mpox for quite some time.
