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The World Health Organization (WHO) today published its 42nd situation report for the multi-country outbreak of mpox, which provides an update on the epidemiological situation of mpox in the WHO African Region and countries in the WHO Eastern Mediterranean Region.
The number of mpox cases in Africa is generally rising, driven mainly by cases reported from the Democratic Republic of the Congo (DRC).
As of November 11, 2024, the WHO confirmed Clade Ib monkeypox virus (MPXV) had been detected in six provinces in the DRC: South Kivu, North Kivu, Kinshasa, Kasai, Tshopo, and Tanganyika. Additionally, 11 other African countries have also reported clade Ib MPXV cases.
Since the last WHO situation report, three countries outside of Africa have confirmed travel-related cases of clade Ib MPXV,
For the first time, local transmission of clade Ib MPXV in the United Kingdom of Great Britain and Northern Ireland, where three (all) household members of the initial case (who had traveled to affected East African countries with clade Ib) were confirmed to have mpox.
Most impacted countries offer access to Bavarian Nordic's JYNNEOS® (MVA-BN®) vaccine to prevent mpox infections. The first round of mpox vaccination has concluded in the DRC, with around 51 500 people vaccinated across six provinces.
Furthermore, the clade 2 outbreak that began in May 2022 continues in numerous countries, including the United States.
The European CDC recently reported there have been no significant changes in the global circulation of monkeypox virus (MPXV) clade I and clade II during the past week.
In 2024, over 34,000 confirmed and suspected mpox cases due to MPXV clade I and clade II, including over 850 deaths, have been reported from Africa.
To slow the spreading of clade I, the Democratic Republic of the Congo (DRC) announced today vaccination efforts to halt the spread of mpox disease.
The DRC received 265,000 doses of the MVA-BN (Bavarian Nordic A/S, JYNNEOS®) vaccine donated by the European CCommission'sHealth Emergency Preparedness and Response Authority, Gavi, the Vaccine Alliance, and the United States Government.
Vaccinations will be launched in the eastern North Kivu province on October 5, 2024, and will prioritize health workers and frontline responders, contacts of confirmed cases, contacts of those contacts, and other at-risk groups.
Subsequently, the vaccination will be rolled out in eleven of the most affected health zones in Equateur, North Kivu, Sankuru, South Kivu, Sud-Ubangi, and Tshopo provinces.
With a population of about 100 million and assuming two doses per person, 130,000, or 1% of the people in the DRC, can be better protected from mpox.
"The rollout of the vaccine marks an important step in limiting the spread of the virus and ensuring the safety of families and communities,” said Dr. Matshidiso Moeti, WHO Regional Director for Africa, in a WHO press release.
Person-to-person transmission of the MPXV has occurred during this outbreak, including through sexual contact, day-to-day household contact, and within the healthcare setting.
Mpox vaccination is now recommended for most people visiting outbreak areas, says the ECDC. There are now several Mpox vaccines available worldwide.
The U.S. Centers for Disease Control and Prevention (CDC) today issued Health Alert Network Health Update (CDCHAN-00516) to provide additional information about the ongoing outbreak of clade I monkeypox virus (MPXV), the virus that causes mpox.
As of September 23, 2024, no cases of clade I mpox have been identified in the U.S.
This mpox strain is more severe than the clade 2 strain circulating in the U.S. since May 2022.
The CDC urges travelers to vaccinate against mpox if they are heading to Eastern and Central African countries where clade 1 MPXV has been spreading.
Furthermore, healthcare providers and travel vaccine experts should recommend vaccination to those whose activities place them at risk.
This is essential advice since clade 1 mpox cases have recently been confirmed in international travelers.
For example, The Mint reported a man from Malappuram district in Kerala, India, has been detected with Mpox clad I. The patient had returned from the United Arab Emirates.
According to the CDC, two doses of JYNNEOS® (MVA-BN®, IMVAMUNE®, IMVANEX®) should be given at least six weeks before traveling abroad. This U.S. FDA-approved vaccine is available at clinics and pharmacies in the U.S.
According to an analysis from the U.S. Centers for Disease Control and Prevention (CDC) and published by NEJM Evidence on September 13, 2024, SIGA Technologies, Inc. mpox treatment tecovirimat (TPOXX®) safety and effectiveness against the monkeypox virus clade 2 virus can't be determined from data.
CDC researchers evaluated data from over 7,100 patients prescribed tecovirimat, a virostatic antiviral drug, from May 29, 2022, through July 10, 2023.
They wrote, 'Although relatively few serious adverse events (SAEs) were reported, because of the passive nature of reporting, we cannot definitively conclude that tecovirimat treatment was always safe. Similar to data from case reports and other published observational studies, our data, in the absence of comparison data from untreated patients, cannot be used to infer clinical effectiveness, or lack thereof, of tecovirimat treatment.'
Overall, 223 SAEs and 40 deaths were reported. Most events were among patients who were severely immunocompromised.
Despite the inclusion of many patients with severe disease for whom the CDC was consulted, outcomes were favorable for most of the treated patients in this cohort.
This analysis did not review the current mpox clade 1 outbreak impacting countries in Africa.
The World Health Organization (WHO) today announced temporary (one-year) recommendations for States Parties experiencing the upsurge of monkeypox virus (MPXV) clade 1 detections, including, but not limited to, the Democratic Republic of the Congo (DRC), Burundi, Kenya, Rwanda, and Uganda.
The upsurge of mpox cases in the DRC in 2024 and its neighboring countries is driven by outbreaks associated with two sub-clades of clade I MPXV: clade Ia and clade Ib.
These WHO recommendations include establishing or strengthening cross-border collaboration arrangements for surveillance and management of suspect mpox cases and providing information to travelers and conveyance operators without resorting to general travel and trade restrictions unnecessarily impacting local, regional, or national economies.
As of August 19, 2024, the WHO Committee considered the event “extraordinary” because of the increase in mpox clade I disease occurrence in the DRC and the emergence of the new MPXV clade Ib.
Clade I mpox was classically described in studies conducted by WHO in the 1980s to have a mortality rate of approximately 10%, with most deaths occurring in children.
MPXV clade Ia is endemic in the DRC. The disease primarily affects children. Data available for 2024 show an aggregated case fatality rate of 3.6%, and the spread is likely sustained through multiple modes of transmission, including person-to-person transmission following zoonotic introduction in a community.
MPXV clade Ib is a new strain of MPXV that emerged in the DRC. It is transmitted between people, presumed via sexual contact, which has been spreading in the eastern part of the country.
Although first characterized in 2024, estimates suggest it emerged around September 2023.
The outbreak associated with clade Ib in the DRC primarily affects adults and is spreading rapidly, sustained largely, but not exclusively, through transmission linked to sexual contact and amplified in networks associated with commercial sex and sex workers.
Furthermore, these African countries are to initiate plans to advance mpox vaccination activities targeting people at high risk of infection. As of August 19, 2024, various reports indicate that (10 million) mpox vaccines are being produced to meet potential outbreak demand.
In early August 2024, the U.S. CDC issued a Level 2 - Practice Enhanced Precautions, Travel Health Advice, recommending various mpox protection tactics, including (JYNNEOS) vaccination.
These new WHO recommendations are intended to be implemented by those States Parties in addition to the current standing recommendations for mpox, which will be extended until August 20, 2025.
