#18,311
In mid-August the WHO declared the Mpox outbreak in Central Africa to constitute a PHEIC (Public Health Emergency of International Concern) after reports that a recently emerged clade (Ib) of the virus had begun to spread outside of the DRC (see More African Nations Reporting Mpox - Africa CDC Mpox Update (Jul 30th)).
Until now only clade IIb Mpox have made serious inroads outside of Africa (> 100,000 cases). There are at least 4 known distinct clades (Ia, Ib, IIa, IIb) of Mpox circulating in Africa (see map below), with Clade II (a & b) considered the mildest, while Clade Ia and Ib are considered more severe.
Nearly every WHO DON or disease Situation Report contains diplomatic reminders to member nations of their `duty to report' these cases under the IHR 2005 agreement, but compliance remains spotty at best.
Although the situation in Africa is currently the greatest concern, the number of global cases (clade II) is also rising, with Europe and the Western Pacific region reporting large increases in August (see chart below).
While there are efforts underway to send badly needed Mpox vaccine to the hardest hit regions, supplies are quite limited, and several recent studies suggest its duration of protection may be limited, particularly among those aged < 50 who never received the smallpox vaccine.
Last month an NIH Clinical trial found Tecovirimat (TPOXX) Mpox Antiviral to be ineffective against clade I mpox in an NIH Trial, further limiting pharmaceutical options against the virus.
Over the weekend the WHO released their 2nd SitRep (#37) since the declaration of a PHEIC (see below). Which includes the following risk assessment:
Based oninformation available at the time, the mpox risk was assessed as follows:
• In the eastern Democratic Republic of the Congo and neighbouring countries: high.
• In areas of the Democratic Republic of the Congo where mpox is endemic: high.
• In Nigeria and other countries of West, Central and East Africa where mpox is endemic: moderate.
• In all other countries in Africa and around the world: moderate.
The highlights from this 18-page document follow, but you'll want to download and read the full report. I'll have a brief postscript when you return.
Multi-country external situation report n. 37, published 22 September 2024
Highlights
• This situation report provides an update of the weekly mpox epidemiological situation in Africa, and the monthly global epidemiological situation.
• While the global outbreak linked to clade II MPXV is ongoing in most affected countries outside of Africa, outbreaks of clade I MPXV continue to occur in areas known to be endemic for mpox and cases linked to clade Ib MPXV continue to be reported in the eastern provinces of the Democratic Republic of the Congo and in an expanding outbreak in Burundi.
• Stockouts of tests in recent weeks hinder the confirmation of mpox cases in the Democratic Republic of the Congo.
• As of the end of August 2024, 2082 confirmed mpox cases were reported globally, marking the highest number of monthly cases globally since November 2022. Rising trends have been reported in the WHO African, European and Western Pacific regions. Meanwhile, the Region of the Americas has seen a decrease in cases in August 2024 compared to the previous month.
• In the past month, one new country, Gabon, reported their first mpox case.
• Five countries in Africa (Burundi, the Democratic Republic of the Congo, Kenya, Rwanda and Uganda) and two countries outside of Africa (Sweden and Thailand) have reported clade Ib monkeypox virus (MPXV). Available information suggests that sustained community transmission of this strain is ongoing in the Democratic Republic of the Congo and Burundi.
• The report provides operational updates about the WHO global mpox response as of 15 September 2024.
• The special focus of this edition provides an overview of a WHO mpox transmission protocol with aims to investigate mpox outbreaks in a standardized manner, enhancing control efforts and addressing critical knowledge gaps.
Since the global eradication of smallpox in the 1970s, there is a general feeling that poxviruses - much like polio and the plague - are relics of the first half of the last century; something you only read about in history books.
But our collective immunity to poxviruses has greatly diminished since smallpox vaccination was halted in the 1970s.
While the smallpox virus may be gone, its relatives are still out there, and we increasingly provide them with a target rich environment.
