WHO Again Declares Mpox Global Emergency — What Americans Need to Know

of World Health Organization (WHO) declared mpox A Public Health Emergency of International Concern based on the ongoing outbreak in the Democratic Republic of the Congo (DRC), which has spread to at least 13 other African countries, with possible cases in Europe and Asia.¹

According to the Africa CDC, there has been a 160% increase in MPOX cases across the continent and a 19% increase in deaths compared to the same period in 2023.² Overall, the WHO has recorded over 14,000 cases and 524 deaths in Africa by 2024, exceeding the figures for 2023, with over 96% of cases and deaths occurring in the Democratic Republic of Congo alone. The ongoing MPOX epidemic has spread to previously unaffected African countries, including Burundi, Kenya, Rwanda, and Uganda.³ The Africa CDC has confirmed 2,863 cases and 517 deaths across the continent, but there are more than 17,000 suspected cases, a significant increase from 7,146 in 2022 and about 15,000 in 2023.

“This is only the tip of the iceberg, given the many weaknesses in surveillance, testing and contact tracing,” an Africa CDC news release said.

The news comes almost two years later. WHO first declares MPOX In a global emergency, US announcement A public health emergency occurred shortly thereafter.^4,5 The WHO's new announcement comes a week after the U.S. CDC issued a health advisory saying that while the risk of this more severe form of MPOX in the U.S. remains low, clinicians should “increase their suspicion for MPOX” in patients who have recently traveled to affected areas.⁶

Furthermore, the day after WHO announced the global health emergency, Swedish health authorities announced that they had confirmed the first related case in the country after a patient who had returned from travelling to Africa and sought treatment in Stockholm.⁷ The next day, Pakistan's Ministry of National Health Services announced the country's first confirmed case of the virus, saying the patient had arrived from Saudi Arabia and that health authorities were continuing genetic sequencing efforts to identify the specific strain of the virus that infected the patient.

Despite MPOX first being declared a Public Health Emergency of International Concern in 2022, ending in July 2023, Africa did not receive the critical support it needed.¹ While the number of infections has declined around the world, the spread of the virus in Africa has gone largely unnoticed.

“Parts of Africa are currently experiencing a surge in monkeypox virus infections, as well as the spread of a new sexually transmitted strain of the virus. This is an emergency not just for Africa, but for the entire planet,” said Dimier Ogoyina, MBBS, FWACP, FMCP, FACP, FIDSA, Chair of the WHO Emergency Committee on Monkeypox Virus and President of the Infectious Diseases Society of Nigeria. “The monkeypox virus originated in Africa, was ignored there and then led to a global pandemic in 2022. It is time to take decisive action to ensure history does not repeat itself.”

How is this different from the first outbreak?

Mpox viruses are divided into two lineages, clade I and clade II.⁸

Lineage I is responsible for the current outbreak and is endemic in Central Africa, where the outbreak originated, and is thought to be the more infectious of the two lineages, leading to more severe illness and death. This new type of MPOX was described earlier this year, and based on studies in mining towns in the Congo, scientists say the lineage could be fatal in up to 10% of those infected.^9,10

Meanwhile, lineage II is the strain that caused an outbreak in 2022 that infected nearly 100,000 people worldwide, about a third of which occurred in the United States.¹¹ Federal and state health officials continue to track MPOX cases across the country, including in Florida, but so far no link has been confirmed to the highly contagious lineage I strain that is causing outbreaks in Africa, according to the CDC. Lineage II is considered endemic in West Africa, where infections caused by this strain are less severe, with more than 99.9% of people who become infected surviving.¹⁰

“Our experience in 2022 makes it clear that MPOX has the potential to spread far beyond these endemic countries,” Richard Martinello, MD, professor of medicine at Yale University School of Medicine, said in a news advisory.¹² “What's even more concerning is that the current outbreak is driven by a variant called 'clade I.' Infections caused by clade I mpox tend to be more severe than infections caused by clade II mpox, which was responsible for the 2022 pandemic.”

During the global lineage II epidemic, vaccines such as Jynneos helped contain MPOX transmission outside of Africa, but health officials point out that there are shortages of the vaccine in Africa, where the disease remains endemic.¹³ An estimated 10 million doses of vaccine are needed to address the current outbreak in the region, but only the Democratic Republic of the Congo and Nigeria have initiated regulatory measures to access supplies.

In a briefing after the emergency declaration, Tim Nguyen, MPH, head of the WHO's High Impact Events Preparedness Unit, said there are 500,000 doses of Bayer Nordic's MVA-BN vaccine and that an additional 2.4 million doses could be produced by the end of 2024 if orders are placed. A second vaccine, LC16, is stockpiled in Japan but is not commercially available. WHO officials stressed that better data on the spread of the disease is needed to optimize vaccine deployment and called on countries to express interest in donating supplies. WHO also recently invited mpox vaccine manufacturers to express interest in putting their products on the emergency list. One company is expected to submit paperwork this week, another will meet next week, and a WHO advisory group is expected to discuss the listing in mid-September, according to the official.

What should Americans know?

HHS has been closely monitoring the spread of lineage I mpox in Africa and has announced in recent months that it has provided $17 million in preparedness and response support. Additionally, the United States will donate 50,000 doses of the Jynneos vaccine to the Democratic Republic of Congo.

In the United States, most cases of MPOX are generally not life-threatening, but certain people are at higher risk for severe illness, including those with severely weakened immune systems, those with a history of eczema, pregnant women, and infants under the age of 1.¹⁰

Both types of the virus can be transmitted through direct contact with infected animals, close contact (including intimate contact) with a person infected with MPOX, and contact with contaminated objects or surfaces. CDC said that to protect themselves and others from MPOX, Americans should avoid close skin contact with people who have a rash similar to MPOX or animals that may carry the virus. Patients can also take precautions to reduce their risk when socializing or engaging in sexual activity, or talk to their health care provider about whether the MPOX vaccine is recommended.

Martinello said there are currently few MPOX outbreaks in the U.S., but Americans should be aware of outbreaks.¹²

“It's important for people to be aware, because the situation could change quickly, as it does in 2022,” Martinello said. “It appears that transmission of MPOX requires close skin-to-skin contact, so this is not a situation where you would need to change how you use public transportation, for example.”

Americans can also track MPOX detection levels in wastewater across the country.¹⁴ Detections have been low in the US over the past 4 weeks, with most sites not detecting MPOX. Detections may be intermittent in some areas of California and Illinois (1%-80% of samples positive), but CDC reports a lack of recent data.

References

1. WHO Director-General declares MPOX outbreak a Public Health Emergency of International Concern. News release. WHO. 14 August 2024. Accessed 19 August 2024. https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
2. Cheng M. An emerging global health emergency: What is MPOX, where is it occurring, and how will the virus spread? Associated Press. Updated August 15, 2024. Accessed August 19, 2024. https://apnews.com/article/what-is-mpox-monkey-pox-congo-emergency-415d11f9e62d104b4c40dd8fe8e80b47
3. Africa CDC declares mpox a continental safety public health emergency and is mobilizing resources across the continent. News release. Africa CDC. 13 August 2024. Accessed 19 August 2024. https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent/
4. AJMC Staff. Currently reading: Monkeypox declared a global emergency, Amazon-One Medical deal raises concerns, White House COVID-19 response. AJMC®. July 25, 2022. Accessed August 19, 2024. https://www.ajmc.com/view/what-we-re-reading-monkeypox-declared-global-emergency-amazon-one-medical-deal-raises-concerns-white-house-covid-19-efforts
5. Gavidia M. United States declares monkeypox a public health emergency. AJMC. August 4, 2022. Accessed August 19, 2024. https://www.ajmc.com/view/us-declares-monkeypox-a-public-health-emergency
6. Human-to-human transmission of monkeypox virus leads to monkeypox outbreak in Democratic Republic of Congo and spread to neighboring countries. News release. CDC. August 7, 2024. Accessed August 19, 2024. https://emergency.cdc.gov/han/2024/han00513.asp
7. Bendix A. MPOX Stock Spreading Now Isn't the Same as It Was in 2022. Here's What You Need to Know. NBC News. August 16, 2024. Accessed August 19, 2024. https://www.nbcnews.com/health/health-news/mpox-virus-outbreak-symptoms-2024-spread-rcna166778
8. Marchante M. New MPOX Outbreak Declared Global Emergency. What to Know in Florida. Miami HeraldLast updated on August 19, 2024. Accessed August 19, 2024. https://www.miamiherald.com/news/health-care/article291081815.html
9. Cheng M, Malkia C. New form of MPOX that may spread more easily discovered in Congo's largest outbreak. Associated Press. Updated May 2, 2024. Accessed August 19, 2024. https://apnews.com/article/mpox-congo-outbreak-who-fda17cea128f46e48110ad7adcd9e5de
10. About Mpox. CDC. Updated April 18, 2024. Accessed August 19, 2024. https://www.cdc.gov/poxvirus/mpox/about/index.html
11. Ongoing 2022 pandemic cases and data. CDC. Updated March 5, 2024. Accessed August 19, 2024. https://www.cdc.gov/poxvirus/mpox/response/2022/index.html
12. Yale School of Medicine Professor Consults on MPOX Emergencies. Yale School of Medicine. August 16, 2024. Accessed August 19, 2024. https://d.newswise.com/articles/view/815695/?sc=mwhr&xy=10050189
13. Schnirring L. WHO declares global public health emergency due to MPOX surge in Africa. CIDRAP. August 14, 2024. Accessed August 19, 2024. https://www.cidrap.umn.edu/mpox/who-declares-global-public-health-emergency-mpox-surge-africa
14. U.S. mpox wastewater data. CDC. Updated August 14, 2024. Accessed August 19, 2024. https://www.cdc.gov/nwss/wastewater-surveillance/mpox-data.html