Fact sheet: U.S. response to lineage I Mpox outbreaks in African countries

On August 14, 2024, the World Health Organization (WHO) declared a Public Health Emergency of International Concern over the sudden increase in MPOX cases in the Democratic Republic of the Congo (DRC) and African countries. This announcement follows the declaration of a Public Health Emergency of Continental Security by the Africa Centers for Disease Control and Prevention (Africa CDC) on August 13. The significant increase in lineage I MPOX cases threatens the health security of the region as well as countries outside Africa, both in endemic (countries with previous MPOX outbreaks) and non-endemic (countries with no historically reported MPOX outbreaks). In addition, lineage I MPOX has a new sub-lineage called lineage Ib. Both lineage Ia and lineage Ib are circulating in the DRC and have been detected in neighboring countries as well as Sweden and Thailand (one case each linked to travel to Africa with known lineage I cases).

In 2022, a clade IIb mpox pandemic occurred worldwide, with over 95,000 cases in 115 non-endemic countries and continues to occur in the U.S. The Biden-Harris Administration responded by ensuring that the JYNNEOS mpox vaccine is available to at-risk populations in the U.S.

In February, as the outbreak of lineage I mpox in the Democratic Republic of the Congo grew, the Biden-Harris Administration established a federal department and agency-wide incident response posture to ensure a coordinated response and proactively prepare the United States for potential cases of lineage I mpox. Lineage I mpox is associated with a higher number of severe infections and higher mortality rates than lineage IIb mpox. As evidence of clinical outcomes for lineage I mpox is primarily based on data from endemic countries, particularly the Democratic Republic of the Congo, where supportive care is not widespread, it remains to be seen how lineage I mpox will affect Americans, but we expect morbidity and mortality rates to decline in the United States.

Preparedness for the US strain I mpox

The Biden-Harris Administration is closely monitoring the spread of MPOX, particularly lineage I MPOX, and has been working on domestic preparedness since December 2023. The risk to most Americans from lineage I MPOX circulating in Central and East Africa, and from travel-associated cases outside of Africa, is very low, and there are currently no confirmed cases in the U.S. The U.S. stands ready to rapidly detect, contain, and manage lineage I cases if they emerge in the country.

The United States continues to increase its capacity to detect lineage I and IIb cases through existing surveillance systems, including wastewater testing, and by expanding the robust diagnostic testing capacity built during the ongoing IIb lineage outbreak to reliably detect lineage I infections. The ability to rapidly perform such diagnostic tests also aids in rapid detection, particularly for individuals with recent travel to the Democratic Republic of the Congo or neighboring countries. Qualified PersonWe are working to prevent the spread of both strains of MPOX by providing and disseminating recommendations to clinicians, health departments, diagnostic laboratories, and the public.

From August 2022 through August 2024, the Office of Strategic Preparedness and Response (ASPR) under the Department of Health and Human Services (HHS) distributed more than 1 million JYNNEOS vaccines across the United States to reduce the spread and severity of clade II MPOX outbreaks. In addition to the preventive vaccine, partners across the U.S. government are working to better understand the effectiveness of existing treatments for MPOX and to have treatment options available if clade I MPOX is reported in the United States. The U.S. will continue to provide the public with information about MPOX infection, prevention, and treatment. Individuals who have already had clade IIb MPOX or who are fully vaccinated with this vaccine are expected to be protected against clade I MPOX.

The CDC issued an update Health Alert Network Advice for clinicians, public health departments and partners, and the latest Travel Health Noticehas advised travelers to the Democratic Republic of the Congo and neighboring countries to take enhanced precautions. Through the Department of State, our embassies are working to inform U.S. citizens abroad of these updates. At this time, CDC and WHO are not advising against travel to the Democratic Republic of the Congo or anywhere else because of the MPOX outbreak.

U.S. Support for the Global MPOX Epidemic

The U.S. Government has been closely monitoring the spread of lineage I mpox in the Democratic Republic of the Congo and the risk to neighboring countries since 2023 and has been working closely with affected governments and regional and global health partners to mitigate the impact of this outbreak and protect public health. U.S. Government support for the mpox response is: A long-standing partnership with the Democratic Republic of the Congo on global health security and development In health care across Africa, the United States has contributed to combating infectious diseases such as HIV, tuberculosis, and malaria for more than 20 years. In fiscal year 2023, the United States has allocated more than $2.65 billion in bilateral health funding to Central and East African countries, making it the largest health donor in the world.

Beginning in March 2024, USAID and CDC are jointly providing an additional $20 million to support lineage I mpox response activities in Central and East Africa, and on August 20, USAID Announced An additional $35 million in emergency medical assistance to strengthen response efforts is planned, pending notification to Congress, bringing the U.S. Government's total financial assistance to the Democratic Republic of the Congo and other affected countries in the region to more than $55 million.

In addition to direct financial support, the U.S. Government is increasing staff support to support the MPOX response. More than 200 staff, including epidemiologists, laboratory technicians, and risk communication experts, are deployed to support response efforts in the U.S. and Africa. U.S. Government support is focused on a range of critical public health interventions aimed at limiting transmission and reducing MPOX morbidity and mortality. These interventions include surveillance through the deployment of additional local field epidemiologists, risk communication and community engagement, laboratory supplies and diagnostics, infection prevention and control, clinical services, and vaccine planning.

In addition to scaling up surveillance, testing, and treatment of cases, vaccination will be a key component of the response to this outbreak. A successful vaccination campaign will require vaccination of health workers, financial support for the deployment of vaccines and vaccine supplies, and regulatory approval for vaccine use in affected countries. To support this effort, USAID is donating 50,000 doses of the FDA-approved JYNNEOS vaccine to the Democratic Republic of the Congo, as well as financial support for the vaccine deployment. The United States is working with other countries with vaccine stockpiles, WHO, and international partners to support vaccination efforts and encourage additional donations to address vaccine distribution challenges. This includes assessing vaccine demand, supporting country engagement on regulatory pathways, planning vaccine implementation, and providing technical assistance for vaccine distribution.

The United States is working with bilateral, multilateral, and private sector partners to develop and implement coordinated response efforts, including by promoting collaboration on WHO and Africa CDC response plans. Through the Department of State, the United States continues to work to improve African Union member states' capacities to prevent, detect, and respond to health emergencies through the U.S.-Africa CDC Joint Action Plan adopted in November 2023.

The Biden-Harris Administration will continue its whole-of-government response to this evolving epidemic, building on lessons learned from the MPOX response in 2022. For more information about MPOX, signs and symptoms, treatment, and prevention, please visit the CDC website. here.