Ali Rogin:
The Africa Centers for Disease Control reports that mpox, originally known as monkeypox, has been detected in 13 African nations, including Kenya, Rwanda and Uganda. More than 96 percent of all cases and deaths have occurred in one country, the Democratic Republic of Congo.
So far there have been more than 14,000 cases registered and 524 deaths in the continent this year alone, surpassing last year's numbers. Experts are asking for more funding, vaccines and a concerted effort to slow the transmission of this virus, which can be spread through infected individuals, sex and contaminated meat.
For more, I'm joined by Anne Rimoin, an epidemiologist at the University of California at Los Angeles who has studied mpox in the Democratic Republic of Congo for two decades.
Anne, thank you so much for being here with us.
What populations are the most vulnerable to mpox?
The World Health Organization has declared mpox a public health emergency of international concern. Cases of mpox previously called monkeypox have been surging in the Democratic Republic of Congo. In recent weeks, cases have appeared in nearby African countries, including several that have never reported mpox cases before.
"What we're seeing is tip of the iceberg" because of weaknesses in the surveillance system, says Dr. Dimie Ogoina, the chair of the emergency committee convened by WHO and an infectious disease physician at Niger Delta University in Nigeria.
"This is something that should concern us all," says WHO's director-general, Tedros Adhanom Ghebreyesus.
WHO has declared seven public health emergencies in the past, including one for mpox in 2022. The type of mpox that is circulating now is known to be more deadly than the type that swept the globe two years ago.
On Tuesday, the Africa Centres for Disease Control and Prevention took a similar step, declaring mpox an emergency.
Africa CDC has never done anything like this before.
"We can no longer be reactive we need to be proactive and aggressive, says Dr. Jean Kaseya, director-general of Africa CDC. "This is a fight for all Africans and we will fight it together."
In the Democratic Republic of Congo (DRC), children make up the majority of the 14,000 reported cases and 511 deaths so far in 2024. Those numbers roughly match the number of cases reported in all of last year in the country and they dwarf the mpox numbers reported in 2022.
"[The declaration] is a wake-up call for the world that urgent action is needed, said Dr. Nicole Lurie, executive director of emergency preparedness and response at the Coalition for Epidemic Preparedness Innovations, headquartered in Norway, in a statement.
Dr. Boghuma Titanji, assistant professor of medicine at Emory University, said in a statement that the declaration is "a crucial step toward enhancing coordination among African countries to address the ongoing mpox outbreak."
In the last couple of weeks, there has been a new and alarming development. Mpox has been detected in countries that have never previously identified cases. About 50 confirmed cases and more suspected cases have been reported in Burundi, Kenya, Rwanda and Uganda, according to World Health Organization officials.
It is with past health emergencies in mind that Africa CDC is trying to move quickly and garner international support."We were abandoned during COVID time, and today we don't want to be again abandoned. We don't want to be dependent. We are taking appropriate action,"says Kaseya, noting that declaring a public health emergency is a new power that the African Union gave to the agency in 2023. Kaseya says that the agency sought input from more than 600 experts and that the scientific committee that was convened to consider the mpox situation unanimously recommended the emergency declaration.
Kaseya says it's particularly concerning that about 70% of cases in the DRC are in children under 18. "This one is a major alarm for the world," he says. "We are losing the youth in Africa."
Experts say the higher number of cases and deaths among children is likely because they don't have protection from the smallpox vaccine which was discontinued after that related virus was eliminated in 1980 and because about 40% of children in the region are malnourished, making it harder for their bodies to fight off the virus.
There's concern about mpox in the U.S. as well. The U.S. Centers for Disease Control and Prevention issued an mpox alert last week. While the risk to the general population in the U.S. remains low, Christina Hutson, senior science adviser at the U.S. CDC, says it's important for clinicians, health departments and travelers to be aware of the virus's spread in Africa and be vigilant about symptoms.
In addition, last week the U.S. pledged nearly $424 million to help with what the U.S. Agency for International Development calls an "ongoing catastrophe" in the DRC, plus $10 million to respond to mpox and 50,000 mpox vaccine doses.
While Japan, the U.S., the European Union and vaccine manufacturers are working on vaccine donations, Africa CDC says the need far outstrips what's in the pipeline.
"We need to have vaccines. Today, we are just talking about almost 200,000 doses [becoming] available. We need at least 10 million doses," says Kaseya. "The vaccine is so expensive we can put it around $100 per dose. There are not so many countries in Africa that can afford the cost of this vaccine."
The type of mpox spreading in the DRC's east particularly among sex workers and other adults and into some of the neighboring countries is a subtype called clade Ib. (Clade is the term used for mpox variants.) This is a new type of mpox that has kept scientists on their toes, discovering new information that is both good and bad.
It's harder for diagnostic tests to pick it up because of a genetic change in the virus, says Hutson of the U.S. CDC. It's also the first time clade Ib has been spread through sexual transmission. However, it also seems less fatal than the original clade I circulating elsewhere in the DRC. The number of people who have died has dropped below 1%. At least that, she says, is a glimmer of good news.
In an update, the WHO said that an outbreak of mpox was declared in Burundi on 25 July at around the same time that Kenya, Rwanda and Uganda also confirmed their own cases.
The UN health agency noted that all of these infections, where patients symptoms included fever, joint pain and a widespread rash, were linked to the expanding outbreak in East and Central Africa.
Later in the day, the Africa Centres for Disease Control and Prevention (Africa CDC) officially declared the situation a public health emergency voicing concern over the speed of its spread in the past few weeks.
Every infection was identified after genetic sequencing as clade 1b, one of three recognised variants of the virus, explained WHO, which added that 934 new laboratory-confirmed cases of mpox and four deaths had been reported to the UN health agency from 26 countries in June.
This indicated continuing transmission of mpox across the world, WHO noted.
Mpox been circulating in the Democratic Republic of the Congo (DRC) for years, according to the UN health agency, which said that there has been an unprecedented increase in the number of countries in Africa reporting mpox, which is mainly spread through sexual contact.
Within the African region, WHO said the DRC reported 96 per cent of the confirmed mpox cases in June. But, with limited access to testing in rural areas, less than one quarter of suspected cases there have been tested, so it is very likely that the disease burden is higher than initial estimates.
Data indicates that the DRC has been experiencing a severe outbreak of mpox since the beginning of the year, with more than 14,000 cases and 511 deaths reported, the UN health agency said.
In a related development, WHO said Cte dIvoire is also experiencing an outbreak of mpox, clade 2, the variant that was responsible for the global mpox outbreak in 2022, the UN health agency said, adding that South Africa has reported two more confirmed cases.
Mpox, formerly monkeypox, is endemic in Central and West Africa.It can be transmitted through physical contact with an infected person, animal or contaminated materials. Symptoms include skin rash or lesions accompanied by fever, headache, muscle aches, back pain, low energy and swollen lymph nodes.
Globally, the most affected region in June was Africa, with 567 cases of infection, followed by the Americas (175 cases), Europe, excluding the Eastern Mediterranean region (100 cases), Western Pacific (81 cases) and Southeast Asia (11 cases).
From 1 January 2022 to 30 June 2024, a total of 99,176 laboratory-confirmed cases of mpox, including 208 deaths, have been reported to the UN health agency from 116 countries in all WHO regions. Apart from Africa, the outbreak continues at a low level of transmission globally, WHO said.
Data for June indicated that 16 out of 26 reporting countries showed an increase in cases compared to May. DR Congo reported the highest increase in Africa, with 543 cases in June compared to 459 a month earlier (up 62 per cent), while Spain saw the highest increase in Europe (54 cases, up from 38 in May), Colombia reported the highest increase in the Americas, with 11 cases in June and none in May, and Australia had the highest increase in the Western Pacific (from 33 cases in May to 64 in June). No country reported an increase in Southeast Asia.
The rapid spread of mpox, formerly called monkeypox, in African countries constitutes a global health emergency, the World Health Organization declared on Wednesday.
This is the second time in three years that the W.H.O. has designated an mpox epidemic as a global emergency. It previously did so in July 2022. That outbreak went on to affect nearly 100,000 people, primarily gay and bisexual men, in 116 countries, and killed about 200 people.
The threat this time is deadlier. Since the beginning of this year, the Democratic Republic of Congo alone has reported 15,600 mpox cases and 537 deaths. Those most at risk include women and children under 15.
The detection and rapid spread of a new clade of mpox in eastern D.R.C., its detection in neighboring countries that had not previously reported mpox, and the potential for further spread within Africa and beyond is very worrying, said Dr. Tedros Adhanom Ghebreyesus, the W.H.O.s director general.
The outbreak has spread through 13 countries in Africa, including a few that had never reported mpox cases before. On Tuesday, the Africa Centers for Disease Control and Prevention declared a public health emergency of continental security, the first time the organization has taken that step since the African Union granted it the power to do so last year.
Its in the interests of the countries, of the continent and of the world to get our arms around this and stop transmission as soon as we can, said Dr. Nicole Lurie, the executive director for preparedness and response at the Coalition for Epidemic Preparedness Innovations, a nonprofit that finances vaccine development.
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Mpox (formerly monkeypox) has officially been declared a public health emergency by the Africa Centers for Disease Control and Prevention (CDC).
The African agency reported an increase in the disease throughout the continent and warned that the virus could spread across international borders, The Associated Press reported.
More than 96% of all mpox cases and deaths have taken place in Congo, even though mpox has been detected in 13 African countries.
MPOX DECLARED PUBLIC HEALTH EMERGENCY IN AFRICA AS AUTHORITIES BATTLE MULTIPLE VARIANTS
The Africa CDC confirmed that overall cases are up 160%, and deaths increased by 19% compared to last year, according to AP.
Additionally, Swedish health authorities just announced the first case of the highly infectious mpox as well. "In this case, a person was infected during a stay in the part of Africa where there is a major outbreak of [the more infectious mpox formerly known as monkeypox]," the Public Health Agency of Sweden said on Thursday.
The backs of the hands of a patient with mpox showing a characteristic rash during his recovery phase. (CDC/IMAGE POINT FR/BSIP/Universal Images Group via Getty Images)
Unlike in the 2022 epidemic, when mpox was typically spread through close contact (including sex) between gay and bisexual men, patterns in Africa show that children under 15 years old are making up more than 70% of cases and 85% of deaths in Congo.
Dr. Boghuma Titanji, an infectious diseases expert at Emory University, told AP that it is "unclear" why children are "disproportionately hit" in Congo right now.
She hypothesized that it could be due to children being more susceptible to the virus, overcrowding in social situations or exposure to parents who have mpox.
A new form of mpox that can kill up to 10% of people and may spread more easily has also been detected in Congo, AP reported, which has scientists concerned about transmission.
MPOX OUTBREAK THAT IS RAPIDLY SPREADING THROUGH CONGO MAY BE A NEW FORM OF THE DISEASE
This is because, unlike traditional mpox, which causes lesions on the chest, hands and feet, the new strain causes milder symptoms with lesions on genitalia, according to AP, making it harder to spot.
Earlier this month, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus considered declaring mpox a global emergency given the increasing numbers in Africa.
A child affected by mpox sits on his father's legs while receiving treatment at the center of the International medical NGO Doctors Without Borders in Zomea Kaka, in the Lobaya region in the Central African Republic, on Oct. 18, 2018. (CHARLES BOUESSEL/AFP via Getty Images)
The WHO head decided to convene with independent experts to come to a pending decision.
Meantime, the WHO reported the release of $1.45 million from its emergency fund to support mpox response in Africa.
Congo is reportedly in communication with donors about vaccine donations and has received financial aid from Britain and the U.S., AP reported.
MONKEYPOX: WHAT YOU MUST KNOW ABOUT THE VIRUS AND HOW TO PROTECT YOURSELF
The U.N. health agency said there have been more than 14,000 cases and 524 deaths in 2024 already blowing past last years numbers.
Kyle Planck, 26, who has recovered from mpox, shows scars from rashes on his skin during an interview in New York on July 19, 2022. (YUKI IWAMURA/AFP via Getty Images)
In May 2023, the WHO declared that mpox was no longer an international emergency following the 2022 outbreak, as cases declined by 90% for three consecutive months.
Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center and Fox News senior medical analyst, said he credited the vaccine for helping to end that outbreak.
WHO ASKS EXPERTS TO HELP DECIDE IF MPOX OUTBREAK IN AFRICA IS GLOBAL EMERGENCY
"The use of ring vaccination, where those who were close to monkeypox cases are vaccinated, played a role," he told Fox News Digital last year.
Public education and awareness of risk factors have also been critical, he said.
Those who contracted the disease two years ago were hit with jarring symptoms.
Siegel told Fox News Digital during the first outbreak that the disease causes a "painful" rash that can lead to scarring.
MONKEYPOX: WHO SAYS NO LONGER GLOBAL HEALTH EMERGENCY
The virus is part of the same family that causes smallpox but is not related to chickenpox, said the CDC.
Blood samples are drawn from a boy who did not display any sign of mpox, even as his family was contaminated, at a quarantine area of the center of the International medical NGO Doctors Without Borders in Zomea Kaka, in the Lobaya region in the Central African Republic, on Oct. 18, 2018. (CHARLES BOUESSEL/AFP via Getty Images)
Mpox patients often develop a rash that moves through several stages and can develop within one to three days, the agency said.
Symptoms can also include headache, muscle aches, exhaustion, fever, backache, swollen lymph nodes and chills.
Mpox is classified as a "zoonotic disease," meaning it can be spread between animals and people and can be found in small rodents, monkeys and other mammals living in locations where the virus is endemic.
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To prevent mpox spread, the CDC recommends avoiding close, skin-to-skin contact with people who appear to have a mpox rash or animals that may carry it.
The public should also be aware of preventative measures to avoid contracting the virus through sex, social gatherings or contaminated materials.
A doctor shows a vial of the Jynneos mpox vaccine by Danish vaccine developer Bavarian Nordic in Montpellier, southern France on Aug. 23, 2022. (PASCAL GUYOT/AFP via Getty Images)
People with severely weakened immune systems, children under 1-year-old, people with a history of eczema and people who are pregnant have the highest risk of severe disease, the CDC notes.
A two-dose vaccine, called JYNNEOS, is available for protection against mpox and smallpox.
For more Health articles, visit www.foxnews/health
The CDC recommends vaccinations against mpox if patients have known or suspected exposure to someone with mpox, had a sexual partner who was diagnosed with mpox in the last two weeks, are men having sex with other men or are individuals in other related, high-risk scenarios.
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Fox News Digitals Melissa Rudy and Sarah Rumph-Whitten, as well as Deirdre Reilly and The Associated Press, contributed to this report.
Angelica Stabile is a lifestyle reporter for Fox News Digital.
In May 2023, the World Health Organization released a statement declaring the end of mpoxformerly known as monkeypoxas a public health emergency. Just over a year later, the agency has been forced to backtrack, with a far more serious epidemic brewing across much of sub-Saharan Africa.
Statistics show that more than 15,000 mpox cases and 461 deaths have been reported on the African continent since January, spreading out of countries such as the Democratic Republic of Congo (DRC), where mpox has long been endemic, to 13 other African nations: countries like Rwanda, Kenya, Burundi, and Uganda, where the disease has never previously made an impact.
In the eyes of scientists like Boghuma Titanji, an associate professor in infectious diseases at Emory University who studies mpox outbreaks, this new, deadlier outbreak represents the consequence of the worlds health watchdogs failing to do enough last time round.
It was the summer of 2022 when the spread of mpox first set alarm bells ringing. Suddenly a virus which had always been predominantly contained within parts of West and Central Africa was suddenly going worldwide. Between early 2022 and December 2023, there were 92,783 confirmed cases of mpox across 116 countries, leading to 171 deaths.
Despite these numbers, its perception as a public health threat swiftly faded. Ninety-five percent of the cases during the 2022 outbreak were among men who have sex with men, reporting exposure through sexual or close contact with another infected person, says Titanji. It was an outbreak that was very focused, which allowed vaccinations to be prioritized among that network.
Countries in the global north successfully scrambled to suppress the outbreak within their own borders. Meanwhile, Titanji says, ramping up viral surveillance among the African nations who had been battling a steady rise in mpox cases for the past four decades soon slipped down the priority list, allowing a potentially more problematic variant to emerge undetected.
Mpox exists in two main subtypes, clade 1 and clade 2. Between them, clade 1 is believed to be up to 10 times more deadly, particularly among population groups with weakened or developing immune systems such as children under the age of 5, pregnant women, and immunocompromised people. Thats the viral strain behind this new outbreak, and why infectious disease scientists are so alarmed. (A separate outbreak spreading in South Africa among people living with HIV is thought to be linked to clade 2.)
The 2022 global outbreak was clade 2, and mortality was less than 1 percent, says Jean Nachega, a Congolese infectious disease doctor and an associate professor of medicine at the University of Pittsburgh. Now were talking about a strain which can have up to 10 percent mortality.
While the previous outbreak predominantly affected homosexual populations, data indicates that the new strain is also being transmitted far more broadly, perhaps initially through sexual networks and then being passed on to family members. Last month, Nachega and others published a paper in the journal Nature Medicine demonstrating how an outbreak of mpox began in the small mining town of Kamituga in eastern DRC through sex workers before being transmitted to nearby Rwanda, Uganda, and Burundi as the infected individuals returned home to visit their families.
Outbreaks in DR Congo have affected children as well as adults
The World Health Organization (WHO) has declared the mpox outbreaks in parts of Africa a public health emergency of international concern.
The highly contagious disease - formerly known as monkeypox - has killed at least 450 people in the Democratic Republic of Congo.
Mpox is caused by a virus in the same family as smallpox but is usually much less harmful.
It was originally transmitted from animals to humans but now also passes between humans.
Initial symptoms include fever, headaches, swellings, back pain and aching muscles.
Once the fever breaks, a rash can develop. It often begins on the face before spreading to other parts of the body, most commonly the palms of the hands and soles of the feet.
The rash, which can be extremely itchy or painful, changes and goes through different stages before finally forming a scab, which later falls off. It can cause scarring.
The infection can clear up on its own and lasts between 14 and 21 days.
But in some cases it is fatal, particularly for vulnerable groups including small children.
Serious cases can see lesions attack the whole of the body, especially the mouth, eyes and genitals.
Mpox is most common in remote villages in the tropical rainforests of West and Central Africa, in countries such as the Democratic Republic of Congo (DR Congo), where it has been seen for many years.
In these regions, there are thousands of infections and hundreds of deaths from the disease annually, with children under 15 worst affected.
There are currently a number of different outbreaks happening simultaneously - mainly in the DRC and neighbouring countries.
The disease has recently been seen in Burundi, Rwanda, Uganda and Kenya, where it is not normally endemic.
There are broadly two main types of mpox - Clade 1, which is often more serious, and Clade 2.
The Clade 1 virus - that has for decades caused sporadic outbreaks in DRC - is spreading.
Some forms of Clade 1 seem to be affecting children more than adults.
There is also real concern because many people infected in the last year have had a relatively new and more severe type of mpox known as Clade 1b.
Experts say there is a lot to learn about the Clade 1b but it may be spreading more easily, causing more serious disease.
The Africa Centres for Disease Control and Prevention (CDC) says there were more than 14,500 mpox infections and over 450 deaths from mpox between the start of 2024 and the end of July. That is a 160% increase in infections and a 19% increase in deaths compared with the same period in 2023.
A previous mpox public health emergency, declared in 2022, was caused by the relatively mild Clade 2.
It spread to nearly 100 countries which do not normally see the virus, including some in Europe and Asia, but was brought under control by vaccinating vulnerable groups.
Mpox spreads from person to person through close contact with someone who is infected - including through sex, skin-to-skin contact and talking or breathing close to the ill person.
The virus can enter the body through broken skin, the respiratory tract or through the eyes, nose or mouth.
It can also be spread through touching objects which have been contaminated by the virus, such as bedding, clothing and towels.
Close contact with infected animals, such as monkeys, rats and squirrels, is another route.
During the global outbreak in 2022, the virus spread mostly through sexual contact.
The current outbreaks in DR Congo are being driven by sexual contact and by other forms of close contact.
It has been found in other vulnerable communities, including young children.
Anyone who has close contact with someone with symptoms can catch the virus, including health workers and family members.
Sexual contact between infected adults is thought to be one of the reasons cases are rising.
Experts are studying the situation to understand more about who is most at risk.
Young children may be among groups who are particularly vulnerable because their immune systems are still developing and many in the region have poor nutrition, making it harder to fight off disease.
Some experts suggest younger children may be at risk because of the way they play and interact with each other closely.
They will also not have had access to the smallpox vaccine, discontinued more than four decades ago, that may offer older people some protection.
Anyone with a weakened immune system may also be more prone to the disease and there is concern pregnant women may be at greater risk.
Advice is to avoid close contact with anyone with mpox and clean your hands with soap and water if the virus is in your community.
Those who have mpox should isolate from others until all their lesions have disappeared.
Condoms should be used as a precaution when having sex for 12 weeks after recovery, the WHO says.
Vaccines exist but only people at risk or who have been in close contact with an infected person are usually able to have it.
There is real worry that there is not enough funding for vaccines to reach all those in need.
The WHO has recently asked drug manufacturers to put forward their mpox vaccines for emergency use, even if those vaccines have not been formally approved.
Now that the Africa CDC has declared a continent-wide public health emergency, it is hoped that governments will be better able to co-ordinate their response and potentially increase the flow of medical supplies and aid into affected areas.
Without global action there is real concern the current outbreak could spread beyond the continent.
A nurse takes a sample from a child thought to have mpox.Credit: Arlette Bashizi/Reuters
Update: The World Health Organization (WHO) announced on 14 August that it is declaring mpox a public health emergency of international concern just 15 months after the end of the WHOs previous mpox emergency. The declaration asks the world's countries to work together and to provide resources to improve surveillance, treat those who are infected and stop the outbreak.
A concerning strain of the monkeypox virus has spread rapidly across Central Africa in the past few months. The outbreak prompted the Africa Centres for Disease Control and Prevention (Africa CDC) to declare its first-ever public-health emergency on 13 August, and the World Health Organization (WHO) is meeting on 14 August to consider a global declaration.
The moves reflect scientists deep worry that the outbreak of mpox, the disease caused by the monkeypox virus, could evolve into an epidemic that spreads across the continent and possibly beyond. They note that the virus is making an alarming appearance not just in rural regions, but also in densely populated areas.
Monkeypox in Africa: the science the world ignored
During the past month, mpox infections have surged in Central Africa, affecting locations including Bukavu, a city in the Democratic Republic of the Congo (DRC) that has more than one million residents, and four countries in the region have reported mpox infections for the first time. These infections are probably connected to an outbreak that began in late 2023 in South Kivu province, a region of the DRC that has been ravaged by violent conflict.
Evidence from past outbreaks indicates that the viral strain spreading in Central Africa is more lethal than the strain that sparked the 2022 global mpox outbreak, which has since infected more than 95,000 people and killed more than 180.
I hope that weve long gotten over the idea that something that is happening somewhere far away cant affect us, says Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who has worked on mpox outbreaks in the DRC since 2002. An infection anywhere is potentially an infection everywhere, and weve seen this idea come to bear many times.
African countries have already reported more confirmed and suspected mpox infections in 2024 than in all of 2023: 17,500 this year, compared with about 15,000 in 2023. Children are particularly vulnerable: around two-thirds of infections in the DRC are in people under the age of 15.
Some of these infections have been traced to a strain called clade II, which caused the 2022 outbreak. But over the past few months, an increasing proportion of reported infections have been attributed to a strain called clade I. Clade I has for decades caused small outbreaks in Central Africa, often limited to a few households or communities.
How does monkeypox spread? What scientists know
In April, researchers who analysed samples collected in South Kivu in late 2023 and early 2024 revealed that they had identified1 a clade I variant, called clade Ib, that seems to spread effectively between people through means including sexual contact. Since then, the virus has spread to densely populated areas, presumably carried by highly mobile populations such as sex workers, and to neighbouring countries. South Kivu is also confronting a humanitarian crisis that makes it harder to track and treat infected people, and the DRC is grappling with the aggressive spread of other diseases, such as cholera.
Burundi, Kenya, Rwanda and Uganda have all reported their first-ever mpox infections in the past month, and in a single week in early August, the DRC reported nearly 2,400 suspected infections and 56 deaths. These developments prompted Jean Kaseya, director-general of the Africa CDC in Addis Ababa, to use the power, newly bestowed by the African Union in 2023, to declare a public-health emergency.
The outbreak has also prompted the WHO to call a meeting to discuss whether the outbreak merits a global emergency declaration, which signals to countries worldwide that coordination and preparation might be necessary to control the virus.
Mpox causes fluid-filled skin lesions, which can be painful, and, in severe cases, death. It is still unclear whether the symptoms of the clade Ib virus differ from those of the clade II virus that caused the 2022 outbreak, as well as precisely how dangerous and transmissible it is. Thats the million-dollar question, Rimoin says.
Can a smallpox drug treat monkeypox? Heres what scientists know
Although the death rate for clade I mpox is known to be higher than that of clade II mpox, it is hard to pin down the reason, says Espoir Bwenge Malembaka, an infectious-disease epidemiologist at the Catholic University of Bukavu. Beyond the viruss inherent virulence, many factors could be responsible for clade Is high death rate: for example, clade I has historically been reported in rural parts of the country with poor access to health care, which could make it more lethal, he says.
Rapidly ramping up surveillance and cooperation between affected countries will be key to bringing the outbreak under control, Bwenge Malembaka says. But treatments and vaccines against mpox, which many high-income countries deployed in the 2022 global outbreak, continue to be almost totally unavailable to African nations.
This might soon change: the Africa CDC is in negotiations with Bavarian Nordic, a biotechnology firm based in Hellerup, Denmark, to obtain 200,000 doses of the companys two-dose mpox vaccine, Kaseya announced at a briefing on 8 August. But thats a far cry from the ten million doses that the Africa CDC estimates are needed to stop the current outbreak, Kaseya added.
If and when these negotiations are finalized, much work will still remain to be done: it will be difficult to deliver these doses to regions with poor public-health infrastructure, and to stigmatized populations that are at high risk of contracting mpox, such as sex workers and men who have sex with men, Rimoin says. In addition, the vaccines effectiveness against clade Ib is unclear but, given the dire situation in Central Africa, Rimoin says that shouldnt delay plans to obtain doses.
Rimoin adds that she hopes that any emergency declaration is not followed by the stockpiling of vaccines and treatments in high-income countries, as occurred during the COVID-19 pandemic and the 2022 mpox outbreak. Its critically important to remember that our best bet to control outbreaks is to provide the countries at greatest risk for emergence and spread outward to have the tools needed to control outbreaks at the source, she says.
News Release
Thursday, August 15, 2024
NIH-cosponsored study examined tecovirimat in mpox-endemic country.
The antiviral drug tecovirimat did not reduce the duration of mpox lesions among children and adults with clade I mpox in the Democratic Republic of the Congo (DRC), based on an initial analysis of data from a randomized, placebo-controlled trial. However, the studys 1.7% overall mortality among enrollees, regardless of whether they received the drug or not, was much lower than the mpox mortality of 3.6% or higher reported among all cases in the DRC. This shows that better outcomes among people with mpox can be achieved when they are hospitalized and provided high-quality supportive care. The trial is sponsored by the National Institutes of Healths (NIH) National Institute of Allergy and Infectious Diseases (NIAID) and co-led through a government-to-government partnership with the DRCs Institut National de Recherche Biomdicale (INRB). Further analyses and detailed results will be released through scientific channels.
These findings are disappointing, but they give us essential information and reinforce the need to identify other therapeutic candidates for mpox while we continue research on tecovirimat use in other populations with mpox, said NIAID Director Jeanne Marrazzo, M.D., M.P.H. We remain committed to developing safe and effective interventions, including treatments and vaccines, that can ease the devastating mpox burden in Central Africa and address the milder form of the virus that is circulating globally.
Mpox has occurred in West, Central and East Africa for decades, with the first human case identified in 1970. Two types of the virus that causes mpox have been identified. Clade I, studied in this trial, is endemic in Central Africa and can cause severe illness. Clade II, endemic in West Africa, tends to result in milder illness. A clade II subtype virus caused a global mpox outbreak in 2022. People with compromised immune systems, children, and people who are pregnant are especially vulnerable to severe mpox regardless of the virus clade.
Reports of clade I mpox are increasing in Central African countries, particularly in the DRC. A recent report from the Centers for Disease Control and Prevention (CDC) indicated that 67% of suspected DRC mpox cases and 78% of suspected mpox deaths have occurred in people aged 15 years and younger. Tecovirimat, also known as TPOXX, was initially developed and approved by the Food and Drug Administration to treat smallpox a virus closely related to, but far more serious than, mpoxbut the drugs safety and efficacy as an mpox treatment have not been established. It is currently available for mpox treatment in the United States as part of a separate NIAID-sponsored trial called STOMP and through a CDC expanded access Investigational New Drug (EA-IND) request process. Tecovirimat is authorized in Europe and the United Kingdom for the treatment of smallpox, mpox, and other indications.
In October 2022, NIAID and INRB launched the PALM007 trial to examine the safety and efficacy of tecovirimat for mpox treatment in adults and children. The study enrolled 597 people with laboratory-confirmed mpox at two sites in the DRC. Study participants were randomly assigned to receive tecovirimat or placebo and were admitted to a hospital for at least 14 days, where they were monitored closely for safety and resolution of mpox lesions. All participants received supportive care including nutrition, hydration, and treatment for secondary infections.
Tecovirimat was well-tolerated with no drug-related serious adverse events. Overall, mortality was lower, and lesions resolved faster than anticipated regardless of whether participants received tecovirimat or placebo. Study participants are being notified of the initial results and offered the opportunity to participate in an ongoing extension study providing further supportive medical care. Additional analyses are planned to better understand outcomes observed in the study, including whether there were any significant differences in clinical outcomes by days of symptoms prior to enrollment, severity of clinical disease, participant characteristics, or the genetic variant of mpox being treated.
This study delivered urgently needed evidence to guide the mpox response in Central Africa said co-principal investigator Jean-Jacques Muyembe-Tamfum, M.D., Ph.D., director-general of INRB and professor of microbiology at Kinshasa University Medical School in Kinshasa, DRC. Although not what we had hoped for, the results show that study clinicians provided exceptional supportive care to all participants, which is a testament to the knowledge and skill that Congolese clinicians have acquired on managing mpox-related disease.
The PALM007 study demonstrated the importance and value of testing investigational mpox treatments through robust clinical trials in the DRCs endemic setting, said Lori Dodd, Ph.D., NIAIDs PALM project lead for the DRC. Well continue to evaluate the trial data to determine whether additional studies of tecovirimat in patient subgroups are warranted.
The PALM007 trial is led by co-principal investigators Professor Muyembe-Tamfum and Placide Mbala, M.D., Ph.D., operations manager of the PALM clinical research partnership, and head of the Epidemiology and Global Health Department and the Pathogen Genomic Laboratory at INRB. NIAIDs Veronique Nussenblatt, M.D. and Olivier Tshiani, M.D. of Leidos Biomedical Research were protocol co-chairs. The trial was implemented in Tunda (Maniema province) and Kole (Sankuru province) with support from Congolese staff, the Mitchell Group and the NIHs Frederick National Laboratory for Cancer Research. Collaborating institutions include the U.S. CDC, the Institute of Tropical Medicine Antwerp (ITM), the aid organization Alliance for International Medical Action (ALIMA) and the World Health Organization (WHO). The U.S. Embassy in the DRC and DRC-based U.S. CDC staff supported logistics and operations for shipments, travel and regional security. SIGA Technologies, Inc., based in New York, provided tecovirimat for the study.
The Pamoja Tulinde Maisha or PALM clinical research partnership was established in response to the 2018 Ebola outbreak in DRC. The collaboration has continued as a multilateral clinical research program composed of NIAID, the DRC Ministry of Health, INRB and INRBs partners.
NIAID and the INRB thank the extraordinary team of individuals who carried out this study in remote regions of the DRC, the members of the independent study Data and Safety Monitoring Board, and most importantly, the study participants and their families. For more information about PALM007, please visit ClinicalTrials.gov using the study identifier NCT05559099.
Given the differences in populations affected by the two mpox clades, the types of clinical disease that are appearing and the ongoing spread of both clades, its very important that we continue with the STOMP trial and other related studies, so that we can develop treatments that benefit all people with mpox, said Dr. Marrazzo.
The international STOMP trial is examining the safety and efficacy of tecovirimat against clade II mpox. For more information about the STOMP trial, please visit ClinicalTrials.gov using the study identifier NCT05534984. An additional study, UNITY, sponsored by ANRS Emerging Infectious Disease, is evaluating tecovirimat with a similar study design to STOMP in Argentina, Brazil and Switzerland. More information about the UNITY study can also be found on ClinicalTrials.gov using the identifier NCT05597735. Both studies will continue to enroll participants and work in close collaboration.
NIAID conducts and supports researchat NIH, throughout the United States, and worldwideto study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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