RICHLAND COUNTY, S.C. (WACH) The South Carolina Department of Public Health held a press conference for Immunization Awareness Month on Monday.
The press conference occurred at 10 a.m. in the Warren Derrick Classroom at Prisma Health Children's Hospital-Midlands.
The press conference focused on the importance of immunizations that protect people of all ages from different diseases and certain types of cancer.
It accompanies National Immunization Month, which is celebrated annually toraise awareness about the importance of vaccinations and encourage people to talk to healthcare providers about staying up to date on their vaccinations.
Vaccines are safe and effective at preventing life-threatening diseases in children and adults.
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This years event focused on HPV vaccination, which the Centers for Disease Control and Prevention recommends for all 11- to 12-year-olds.
The HPV vaccine has the potential to prevent more than 90% of HPV-attributable cancers, which is why children must get vaccinated for HPV.
HPV causes more than 9 out of every 10 cases of cervical cancer, as well as many vaginal, vulvar, penile, anal and oropharynx (mouth and throat) cancers.
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South Carolina has increased HPV vaccination coverage in recent years, but coverage remains lower than the national average.
In South Carolina, 70% of 13-17-year-olds have received one dose of the HPV vaccine, compared to 76% across the nation. 54% of South Carolinians aged 13-17 are up-to-date with HPV vaccination compared to 63% of children in the US.
Children who get the vaccine before 15 only need two doses. After turning 15, three doses are needed.
DPH announced that the Medical University of South Carolina's (MUSC) Hollings HPV Vaccination Van was selected by DPH and the S.C. Immunization Coalition as the Association of Immunization Managers 2024 South Carolina Immunization Champion Award during Monday's event.
The vaccination vantravels across South Carolina to make HPV vaccinations accessible to rural and medically underserved communities.
As important as vaccines are for children, adults benefit from vaccines as well.Keeping up-to-date with vaccines for shingles, pneumococcal pneumonia, mpox, flu, COVID-19, RSV and others can also protect your health and those around you.
Talk to your health care provider or your childs pediatrician to stay up to date on shots.
Pfizer and BioNTech have been among the leaders in the race to bring a combined COVID-19 and influenza vaccine to market, but have stumbled in the final straight.
The companies reported mixed results in their phase 3 trial of their mRNA vaccine, which includes antigens for influenza A and B, as well as the SARS-CoV-2 virus that causes COVID-19, and have said they will need to tweak the formulation.
The problem is a lower-than-expected antibody response for influenza B in the 8,000-subject study, which was designed to show non-inferiority to Pfizer and BioNTech's Comirnaty COVID-19 jab, as well as a commercially available flu vaccine, and demonstrate safety.
Last October, the companies reported "robust" antibody and T-cell responses against the viruses, in the same ballpark as approved vaccines, with a safety profile similar to Comirnaty in a phase 1/2 trial that prompted them to start a phase 3 programme.
In a joint statement, Pfizer and BioNTech said they are "evaluating adjustments to the candidate and will discuss next steps with health authorities." It's not clear yet what the delay to the programme could be, but if a new phase 3 trial is needed as seems likely if the constituents of the vaccine need to be modified it could be lengthy.
Pfizer's head of vaccine R&D, Annaliesa Anderson, said the company remains "committed to developing vaccines that will reduce the burden of respiratory diseases and believe that combination vaccines are the most efficient way to do this."
The slip-up hands an opportunity for mRNA vaccine rival Moderna to build a lead in the combined COVID-19/flu vaccine category.
In June, Moderna said its candidate met its objectives in a phase 3 trial, stimulating higher immune responses against influenza and SARS-CoV-2 than the licensed flu and COVID vaccines used as comparators in the study, which the company said could lead to approval in late 2025 or 2026.
Moderna's study looked at the vaccine in adults aged 50 and older, while Pfizer/BioNTech's trial focused on adults aged 18 to 64.
Other rivals, meanwhile, include Sanofi/Novavax, which are developing non-mRNA candidates under the terms of a $1.2 billion alliance agreed in May.
BioNTech's chef executive, Uur ahin, said: "The insights gained from this combination vaccine trial are highly valuable and will play a crucial role in guiding the further development of [] our combination vaccine programme against influenza and COVID-19."
As concerns mount about a type of mpox spreading across Africa thats believed to cause more serious illness, infectious disease experts expressed cautious optimism that this branch of the virus would not spread as broadly in the U.S. or cause health impacts as severe.
The risk of this subtype of mpox to the U.S. could be mitigated by a number of factors, including immunity from vaccination and previous infection from the outbreak of a different variant that began in 2022; the lack of viral circulation in wild animals; and better health care access, living standards and public health.
On Wednesday, the World Health Organization reinstated the status of mpox (formerly monkeypox) as a public health emergency of international concern. This was in response to a large ongoing outbreak of clade I of mpox a clade is an evolutionary branch in the Democratic Republic of Congo, or DRC, that has spread to other African nations.
Sweden announced the first clade I case outside of Africa on Thursday.
It was only a matter of time before we saw this extend beyond the African continent, Dr. Boghuma Titanji, an infectious disease specialist at Emory University, said.
In a statement issued Friday, Dr. Pamela Rendi-Wagner, director of the European Centre for Disease Prevention and Control, said the agency had increased the risk level of clade I to the general European population from very low to low.
Due to the close links between Europe and Africa, Rendi-Wagner said, we must be prepared for more imported clade I cases.
The CDC confirmed on Friday that there have been no reported cases of clade I in the U.S. to date.
Clade I is generally considered more transmissible and more severe than clade II, which drove the global mpox outbreak that peaked in August 2022 and had a death rate of 0.2%. Immunocompromised people, in particular those with untreated, advanced HIV, have been at greatest risk of severe disease, hospitalization and death from clade II. The U.S. continues to see low-level clade II transmission.
Anne Rimoin, an epidemiologist at the University of California, Los Angeles, and a leading mpox expert, said context is key when considering how mpox might behave in Western nations compared with Africa.
I think we have to be very, very cautious about saying that this is more dangerous, Rimoin said of clade I. The data on the severity, associated mortality all of that is scant. There are a lot of questions about whether or not the perceived severity might have more to do with the population that its spreading in, their immune system, the route of transmission, the infectious dose.
The National Institutes of Health on Thursday reported that the antiviral TPOXX did not reduce clade I symptom duration in a DRC clinical trial. But promisingly, just 1.7% of the participants died, compared with a typical clade I death rate in DRC of 3.6% or higher. NIH experts touted the better medical care provided to study participants.
Epidemiologist Dr. Jennifer McQuiston, the lead for the Centers for Disease Control and Preventions mpox clade I response, said the study offered hope that high-quality health care in the U.S. would help minimize deaths from the disease.
Dr. Dan Barouch, a Harvard Medical School virologist, said it was likely the U.S. would see clade I cases. The absolute risk in the U.S. is currently low, he said. Although we need to remain vigilant.
CDC officials first alerted doctors and other health care providers in December to be on the lookout for clade I. The agency updated that advisory on Aug. 7. When U.S. clinics order testing of potential mpox samples from patients with suspected cases, some testing centers directly screen for mpox clade type, while others need to send samples to the CDC to do so. All positive results must be reported to the CDC. Numerous sites throughout the nation also survey wastewater for signs of the infection in the local population.
We are more worried about clade I than we are about clade II, McQuiston said of the CDCs sustained domestic vigilance.
The agency recently reported that receiving both doses of the Jynneos vaccine appears to reduce mpox risk. The CDC expects the vaccine to protect against both clades.
Throughout the now-low-level clade II outbreak, mpox has overwhelmingly spread through sex between men. The CDC continues to urge men with multiple male partners to receive both Jynneos doses. Only an estimated 1 in 4 of those considered at significant risk of mpox in the U.S. have been fully vaccinated.
The DRC outbreak has seen substantial sexual transmission of clade I among both gay men and female sex workers. Children, however, have accounted for two-thirds of the approximately 20,000 suspected cases and three-quarters of the 975 suspected deaths in the DRC since January 2023, according to the CDC.
Its possible that recent documented mutations in the virus may have made it more transmissible. Rimoin said close physical contact whether sexual or nonsexual household contact likely remains largely necessary for transmission.
People in the DRC tend to live in much more cramped quarters than in the U.S., Rimoin said.
We dont hear reports of people getting it at the market, McQuiston said.
McQuiston added: Household spread may be occurring in the DRC due to family members caring for the sick without the ability to protect themselves, and less ability to isolate those who are infected.
The vaccine remains woefully scarce in the DRC. In the U.S., where there is adequate supply, household contacts of infected people can seek the vaccine prophylactically.
People in rural DRC also likely contract mpox from an unknown wild animal host, perhaps a rodent. No animals in the U.S. are believed to carry the virus.
Differences in sexual behavior between gay men and heterosexuals in the U.S. might continue to limit mpoxs spread among the wider American population, Dr. Jeffrey Klausner, an infectious disease expert at the University of Southern California, said in an interview.
Unlike with heterosexuals, the overall population of gay and bisexual men has within it a smaller group that engages in behaviors that can sustain an mpox outbreak outside of Africa, Klausner wrote in a commentary in The Lancet Microbe on Aug. 7.
Klausner argued that infectious disease researchers have underestimated the rate of natural immunity from previous infection. For now, a combination of natural and vaccine-induced immunity, he argued, is sufficient among those engaging in sexual behavior patterns most likely to transmit mpox to largely prevent a substantial outbreak.
However, while research suggests that natural immunity from the 2022 outbreak has persisted, it may ultimately wane and mpox may mutate to evade such defenses.
Whats more, Dr. Chloe Orkin, an infectious disease expert at Queen Mary University of London, said, The extent to which immunity from clade II virus will protect people from infection or severe disease from clade I virus is unknown.
Emorys Titanji added another wrinkle, saying of clade I: I dont want people to get into a complacency and think that we cannot see this in a heterosexual network in the U.S.
Since January 2023, the Democratic Republic of the Congo (DRC) has reportedmore than 22,000 suspect mpox cases and more than 1,200 deaths.
There are two types of mpox, clade I and clade II. Clade I usually causes a higher percentage of people with mpox to get severely sick or die compared to clade II.
Clade I mpox occurs regularly, or is endemic, in DRC. The current outbreak is more widespread than any previous DRC outbreak, and clade I mpox has spread to some neighboring countries, including Burundi, Central African Republic, Republic of the Congo, Rwanda, and Uganda. These countries are all reporting cases of clade I mpox, and some of them have links to DRC. On August 14, 2024, the World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern (PHEIC). This is the WHOs highest level of global alert, and the decision recognizes the potential threat this virus poses to countries around the world. The declaration focuses international attention on acute public health risks that require coordinated mobilization of extraordinary resources by the international community for prevention and response.
No cases of clade I mpox have been reported outside central and eastern Africa at this time, including the United States.
The risk to the general public in the United States from the type of mpox circulating in the DRC is very low.
CDC has made this assessment due to the limited number of travelers and no direct commercial flights from DRC or its neighboring countries to the United States. The risk might change as more information becomes available, or if cases appear outside central and eastern Africa.
People in the United States who have already had mpox or are fully vaccinated should be protected against the type of mpox spreading in DRC and neighboring countries. Mpox needs close or intimate contact to spread, so casual contact like you might have during travel is not likely to cause the disease to spread. The best protection against mpox is two doses of the JYNNEOS vaccine if youre eligible, People can also protect themselves by:
There are several outbreaks happening at the same time in DRC, with cases reported throughout the country, in the capital city of Kinshasa, and in some other large cities. In DRC, different provinces have outbreaks with different features. In some provinces, patients have acquired infection through contact with infected dead or live wild animals, household transmission, or patient care (transmitted when appropriate PPE wasnt used or available); a high proportion of cases have been reported in children younger than 15 years of age. In other provinces, the cases are associated with sexual contact among men who have sex with men and female sex workers and their contacts. These are first reported cases of sexual transmission with clade I mpox.
CDC has been supporting DRC mpox research and response for more than 20 years. CDC and other U.S. government agencies are on the ground in DRC helping partners in the country with disease surveillance, laboratory capacity including testing materials, strengthening workforce capacity, case investigation, case management, infection prevention and control, border health, and risk communication and community engagement. DRC has approved the use of vaccines in-country, so CDC is working with other U.S. government agencies and partners on a strategy for vaccination in DRC.
The Republic of the Congo (ROC), which borders DRC to the west, declared a clade I mpox outbreak in April 2024.There have also been confirmed clade I cases in Central African Republic (CAR), which borders DRC to the north.Clade I mpox is endemic to ROC and CAR, but the new cases appear to be linked to spread from DRC.In late July 2024, Burundi, Rwanda, and Uganda, which sit on the eastern border of DRC, reported confirmed cases of mpox.Clade I mpox has not been known to be endemic in these countries.Although contact tracing is ongoing, some cases have links to DRC.Rwanda and Uganda have confirmed these cases are clade I MPXV. In Burundi, clade-specific testing is underway, but cases are presumed to be clade I because of DRC and Rwandas shared borders with Burundi. Person-to-person transmission has occurred during this outbreak, including through sexual contact, household contact, and within the healthcare setting. People have also gotten mpox through contact with infected wild animals.
CDC is working with Ministries of Health and in-country partners across the region on disease surveillance, laboratory capacity including testing materials, strengthening workforce capacity, case investigation, case management, infection prevention and control, border health, and risk communication and community engagement.
[Originally published: July 11, 2022. Updated: Aug. 14, 2024.]
Mpox (formerly known as monkeypox), an infectious disease typically found in parts of Central and Western Africa, has again been labeled a global health emergency by the World Health Organization (WHO).
Mpox became a global concern in 2022 when a type of the virus spread to other countries. That outbreak led to more than 90,000 cases worldwide, including more than 32,000 in the United States.
In 2023, the WHO declared an end to the global health emergency based on a decline in new cases and steady progress in controlling the spread of the disease, even though it continued to circulate in the community.
Now, public health officials around the world are concerned about a new strain of the virus that has driven up the number of cases and deaths in the Democratic Republic of Congo and other African countries. No cases have been reported in U.S.
Although it can affect anyone, most mpox cases from the 2022 outbreak were sexually transmitted and reported in men who have sex with men (MSM). The 2022 outbreak was caused by a strain called Clade IIb. The current outbreak is caused by Clade I, a strain that can also be sexually transmitted, cause more severe illness, and lead to death in up to 10% of those infected.
For reasons not yet known, the virus, since 2022, is behaving in ways never before seen, with cases occurring in countries that dont normally see it. Before this, mpox was also not known to spread easily among people or to infect large groups at once. Now, it can spread through close contact.
We talked with Marwan Azar, MD, a Yale Medicine infectious diseases specialist about what we know so far about this new strain of mpox.
Faced once again with a rapidly spreading epidemic of mpox, the World Health Organization on Wednesday declared a global health emergency. The last time the W.H.O. made that call was in 2022, when the disease was still called monkeypox.
Ultimately the outbreak affected nearly 100,000 people worldwide, primarily gay and bisexual men, including more than 32,000 in the United States.
The W.H.O.s decision this time was prompted by an escalating crisis of mpox concentrated in the Democratic Republic of Congo. It recently spread to a dozen other African countries. If it is not contained, the virus again may rampage all over the world, experts warned.
On Thursday, Sweden reported the first case of a deadlier form of mpox outside Africa, in a person who had traveled to the continent. Occasional imported cases like the current one may continue to occur, the countrys public health agency warned.
Theres a need for concerted effort by all stakeholders, not only in Africa, but everywhere else, Dr. Dimie Ogoina, a Nigerian scientist and chair of the W.H.O.s mpox emergency committee, said on Wednesday.
Congo alone has reported 15,600 mpox cases and 537 deaths, most of them among children under 15, indicating that the nature of the disease and its mode of spread may have changed.
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The announcement that a new version of mpox had been discovered in Sweden this week was the first indication that the disease had slipped out of Africa, where it has caused an escalating crisis in the Democratic Republic of Congo.
The announcement on Thursday about the disease formerly known as monkeypox came just a day after the World Health Organization declared a global health emergency, and it confirmed fears that a further spread was inevitable.
The person with the disease in Sweden had traveled to an area affected by the disease.
The European Center for Disease Prevention and Control said it was highly likely that more imported cases would be confirmed, in large part because of frequent travel between Europe and Africa. The center advised member countries to increase preparedness and to issue travel advisories recommending that people traveling to affected areas see if they are eligible for vaccination.
Pamela Rendi-Wagner, the E.C.D.C. director, warned that as long as the outbreak in Africa was not under control, cases would continue to appear in Europe and North America too.
We have to be concerned, even outside Africa, because with the increasing number and the fast spread, the likelihood of the introduction of cases in Europe and the U.S. will increase, Dr. Rendi-Wagner said in an interview on Friday.
The E.C.D.C. on Friday raised the risk of people in the European Union contracting the new version from very low to low, but emphasized that people traveling to and from the affected areas in Africa need to take precautions and are at a high risk.
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The World Health Organizations decision to declare mpox a global public health emergency for the second time in two years may seem like dj vu but there are key differences between the strain thats causing international concern now and the one that spread in 2022.
Mpox, formerly known as monkeypox, is a viral infection characterized by painful lesions. Its spread by direct contact with an infected person, animal or contaminated items like clothing or bedding.
The virus is classified into two distinct groups: clade I and clade II.
Clade II was responsible for the 2022 outbreak, which has led to around 100,000 cases worldwide.
But now, a version of clade I has spread internationally. The outbreak started in January 2023 in the Democratic Republic of Congo, and has since reached 12 other countries in the region.
On Thursday, Sweden confirmed the first known infection of clade I outside Africa, though Swedish health officials said the person was infected while spending time in Africa. Health authorities in Pakistan also confirmed a case of mpox on Friday but have not identified the strain yet.
Clade I is more transmissible than clade II and capable of being more severe, so infectious disease experts are concerned about further international spread.
We should have learned a lesson from 2022 that an infection anywhere is potentially an infection everywhere, said Anne Rimoin, an epidemiology professor at the University of California, Los Angeles Fielding School of Public Health.
Mpox has historically spread in a few ways. The first is through close, personal contact with an infected person, such as skin-to-skin contact with rashes or with saliva or mucus. The second is via contact with contaminated materials. And the third is contact with infected animals: hunting, trapping or cooking them, touching sick rodents or getting bitten or scratched.
In 2022, the version of clade II that spread globally, dubbed clade IIb, was passed primarily through sexual contact, particularly among men who have sex with men.
In the Democratic Republic of Congo recently, clade Ib has also been spreading through sexual contact among female sex workers and men who have sex with men. Research that hasnt yet been published or peer reviewed linked an outbreak in an eastern mining town in Congo to professional sex work in bars.
But thats not the only way the virus is being transmitted. Dr. Stuart Isaacs, an associate professor of medicine at the University of Pennsylvania, said much of the spread of clade I could be due to exposure to animals and transmission within households, but limited surveillance in the regions where the virus is make it difficult to know for sure.
Isaacs said theres early evidence that clade Ib has certain properties that are allowing it to spread more readily person to person.
In the past, outbreaks of clade I have been deadlier than clade 2, killing up to 10% of people who got sick. But more recent outbreaks have had lower death rates. Out of an estimated 22,000 cases in this outbreak in Congo, more than 1,200 people have died which puts the fatality rate at just above 5%.
By comparison, clade II outbreaks in Africa have generally had a mortality rate of around 1%, and just 0.2% of cases linked to the 2022 global outbreak were fatal.
Rimoin said the diseases severity can have less to do with the actual clade and more to do with route of transmission, the immune system of the individual, the source of the infection.
The threat in the U.S. could be milder than in Africa, according to Marc Siegel, an associate professor of medicine at the George Washington School of Medicine and Health Sciences.
The underlying health conditions of the population in the DRC are probably contributing to the current case fatality rate, he said, using the acronym for the Democratic Republic of Congo. With less malnutrition and better access to health care resources, I would imagine that the case fatality rate will not be as high as were seeing in the DRC.
Vaccines for mpox are also widely available in the U.S., following a major rollout effort in 2022. Two doses of the mpox vaccine or a previous clade II infection should protect against severe illness from clade I, the Department of Health and Human Service said Wednesday.
Symptoms of the two mpox clades can be difficult to distinguish from each other.
The illness generally starts with a rash that progresses to small bumps on the skin, followed by blisters that fill with whitish fluid a hallmark of the disease and eventually scab over. People may also experience a fever, headache, muscle aches, back pain, low energy and swollen lymph nodes.
These symptoms often disappear on their own within a few weeks. But in severe cases, people may develop larger, more widespread lesions, secondary bacterial infections, pneumonia, heart inflammation or swelling of the brain. Immunocompromised people may develop atypical symptoms and have a greater risk of hospitalization and death.
Historically, mpox lesions have tended to appear on the face, chest, palms of the hands and the soles of the feet. But during the 2022 outbreak, people frequently developed lesions around the genital and anal region or inside the mouth and throat, presumably because of how the virus was spreading at the time. The lesions were also fewer in number and less pronounced overall.
Some cases of this nature have also been detected in the current outbreak in Congo.
There is talk that there are more people that have lesions around the genitals this time around than previous clade I outbreaks, said Amira Albert Roess, a professor of global health and epidemiology at George Mason University. Its going to take us some time to really understand what may be going on here.
We developed an agent-based model to simulate sexual mpox transmission among MSM. We adapted a previous model that assessed clade II transmission in MSM networks, adding new data on U.S. sexual network structures and exploring transmission parameters to represent clade I mpox.
We produced simulations for 13 counties among 50 jurisdictions in the Ending the HIV Epidemic (EHE) Initiative. The 50 EHE jurisdictions account for more than half of all new HIV diagnoses, and many represent urban areas across the United States with large MSM populations. We chose 13 counties that represent a range of mpox population immunity levels (11%-88%) across the 50 non-state EHE jurisdictions, prioritizing counties that are hubs for international travel and large events. For each of the 13 counties, we established baseline population-level immunity based on vaccination and case reporting to DCIPHER as of February 2024. We assumed that prior infection with clade II mpox provides full protection against both mpox clades, and that vaccination with the JYNNEOS vaccine provides partial but strong immunity (75.2% and 85.9% for one dose and two doses, respectively).
We then generated sexual networks with sizesequivalent to the estimated MSM population for each county. The sexual behavior within the networks was estimated from an online survey of cisgender MSM from across the United States. We assumed that the distribution of type and frequency of sexual behavior is the same across all counties as data does not exist to estimate these parameters at a local level. Finally, we also modeled short-term behavioral adaptations as a reduction in the frequency of spontaneous or one-time sexual encounters, assuming a level of behavioral adaptation in our analyses similar to what occurred in the District of Columbia in 2022 based on previous modeling work and documentedacross the United States.
The cumulative number of infections and proportion of simulation runs with infections remaining one year after introduction of the virus were compared across three transmission scenarios. Transmission scenarios included the following: 1) baseline, parameterized for clade II (74.5%); 2) clade I, assumed 10% more transmissible than clade II (81.9%); and 3) clade I, assumed 20% more transmissible than clade II (89.4%). For each simulation, we assumed that five MSM with the highest levels of sexual activity (defined as having one or more spontaneous/one-time sexual partners per week in addition to any main or casual partners) were exposed to mpox and ran the simulation for one year. We summarized results across 1,000 simulation runs for each county and scenario combination.
The updated model was fit to sexual network data that was collected more recently (2017-2019), representing MSM across the United States rather than a single geographic region. Furthermore, we added data on oral sex partnerships in addition to anal sex partnerships and recalibrated sexual activity group strata to better characterize the range of sexual activity reported in the data. We also calibrated the clade II transmissibility parameter using clade II mpox case data from early in the 2022 outbreak. This parameter has a calibrated distribution of (4.24, 1.45), with mean equal to 74.5% probability of transmission per contact.
We also added additional transmission parameters to explore possible clade I scenarios. While there are no studies that estimate the exact difference in per-contact transmissibility between the globally circulating clade II virus and clade I in humans, there is evidencethat rash intensity and detectable viral loads are greater for clade I relative to clade II in traditional zoonotic and household transmission settings, and a small mammal model demonstrated that virulence of clade I is greater than clade II. We generalized these lines of evidence, assuming a 10% increase relative to clade II (81.9% per-contact transmissibility) and a 20% increase (89.4% per-contact transmissibility).
Lastly, previous work modeled a range of immunity to mpox using a single population size, where in this work we modeled county-specific MSM population size and composition of population-level immunity. This generates more variance in our results, but both approaches come to similar conclusions about the overall level of population-level immunity that is protective against prolonged transmission of mpox.
Population-level immunity was calculated as the total number of immune people in each county divided by the estimated size of the MSM population with increased risk of mpox exposure in that county. Total number of immune people included everyone reported to have received one or two doses of the JYNNEOS vaccine through January 2024, all people with diagnosed mpox through March 2024, and an estimate of the number of undiagnosed mpox infections based on previous modeling work. We estimated the size of the MSM population with increased risk of mpox exposure in each county using county-level estimates from survey data reduced by 40% to reflect the smaller proportion of MSM considered higher activity based on national survey data.
Illustration of the mpox virus
Getty Images/Science Photo Library
The World Health Organization (WHO) has declared a public health emergency of international concern over an ongoing outbreak of mpox formerly known as monkeypox in Central and West Africa. This is the second time in two years that the disease has spread enough to prompt such a declaration from the WHO. On 15 August, Swedish health officials confirmed a case as the first known infection outside of Africa with the mpox strain that is currently driving the outbreak.
Mpox is an infectious disease caused by a virus that belongs to the same family as that which causes smallpox. It regularly spreads among animals in Central and West Africa such as rodents and monkeys, but occasionally jumps to people, causing small outbreaks.
There are two distinct lineages of mpox: clade I and clade II. Clade I is associated with more severe disease and higher risk of death. A subtype of clade I, called clade Ib, is driving the current outbreak, while the global mpox outbreak in 2022 and 2023 was spurred by a subtype of clade II.
So far, there is no evidence to suggest that clade Ib is more dangerous than the original clade I strain, said Jonas Albarnaz at The Pirbright Institute in the UK in a statement.
The Africa Centres for Disease Control and Prevention reported on 13 August that there have been more than 17,000 suspected cases across the continent. This is just the tip of the iceberg when we consider the many weaknesses in surveillance, laboratory testing and contact tracing, the agency said in the statement.
There have been 15,664 reported cases and 537 deaths so far in the Democratic Republic of the Congo alone, according to the WHO. This exceeds the total seen in 2023, according to a statement by Tedros Adhanom Ghebreyesus at the WHO on 15 August.
The current outbreak originated in a small mining town in the Democratic Republic of the Congo (DRC). The mpox variant has now spread to at least 11 other African countries, including four that had previously never reported mpox: Kenya, Rwanda, Burundi and Uganda. Mpox has also been detected in one person in Sweden.
While more than 99.9 per cent of people who fall ill with clade II survive, mpox outbreaks of clade I have killed up to 10 per cent of people who become sick. Children and people who are immunocompromised or pregnant are especially vulnerable to severe disease.
The first mpox symptom is usually a rash, which begins as a flat sore and then develops into a blister that may be itchy or painful. The rash tends to start on the face before spreading across the body and extending to hands and feet. People can also get lesions in their mouth or on the genitals or anus.
The rash and lesions usually last between two and four weeks and are often accompanied by other symptoms such as fever, headache, muscle aches, back pain, fatigue and swollen lymph nodes.Symptoms usually begin within a week of contracting the virus but can start anywhere from one to 21 days after exposure. However, some people can contract the virus without experiencing symptoms.
Mpox is spread through close contact with people who have the illness. Usually this is through skin-to-skin contact, such as sex, kissing or touching. The virus can also spread through respiratory droplets and contact with contaminated materials such as bedsheets, other linens or sharp objects like needles. People remain infectious until all of their sores heal.
Mpox can also spread through contact with infected animals such as through bites or scratches, or when people hunt or eat them.
Young adults and children have been most affected by the current outbreak, a trend that was not seen in the 2022-2023 outbreak. In some provinces of the DRC, children under 15 account for up to 69 per cent of suspected cases.
Treatment primarily consists of managing symptoms and preventing complications like secondary infections. Some antivirals that were originally developed for treating smallpox have also been used to treat mpox in the past. However, results from a recent trial of the antiviral drug tecovirimat, which was used in the previous outbreak, found that it was not effective against the clade I virus. People who have mpox should self-isolate and wear a mask. They should also avoid scratching sores, which can prevent them from healing, increase the risk of secondary infections and cause them to spread to other parts of the body.
There is an mpox vaccine, which provides the best protection after two doses. Smallpox vaccines have also been found to protect against mpox, though it isnt clear if any of these vaccines will be effective against the new mpox variant.
People are recommended to get vaccinated only if they are at high risk of contracting mpox. For people who arent in areas affected by the current outbreak, the risk remains very low.
Countries in Africa currently have minimal to no vaccine supplies, though estimates suggest the region needs 10 million doses, said Jimmy Whitworth at the London School of Hygiene & Tropical Medicine in a statement.
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