The World Health Organization (WHO) has declared mpox a public health emergency of international concern, after rising cases in the Democratic Republic of the Congo and the potential for further spread.
This now triggers a coordinated international response to an extraordinary event and the mobilisation of resources, such as vaccines and diagnostic testing, to curb the spread of this infectious disease.
But WHO has not declared mpox a pandemic. Rather, the measures it has triggered are designed to prevent it from becoming one.
Mpox, once known as monkeypox, is a viral infection closely related to smallpox. Initial symptoms include a fever, headache, swelling of the lymph nodes and muscle ache. A typical rash follows, mainly on the face, hands and feet.
The spread of mpox through certain African countries led the Africa Centres for Disease Control and Prevention to declare earlier this week mpox a public health emergency of continental security. This is the first time the organisation has issued such an alert since it was established in 2017.
The situation in the Democratic Republic of the Congo in central Africa has been particularly worrying for more than a year.
There are two types or clades of mpox. Clade II, which originates in west Africa, is less severe. It has a fatality rate of up to 1% (in other words, roughly one in 100 are expected to die from it). But clade I, from central Africa, has a fatality rate of up to 10% (up to one in ten die). This compares to a 0.7% fatality rate for the Omicron variant of SARS-CoV-2, the virus that causes COVID. The Democratic Republic of the Congo is seeing large epidemics of the more deadly clade I mpox.
Mpox is endemic in some parts of central and west Africa, where the virus exists in animals and can spread to humans. Outbreaks have been increasing, with more human-to-human spread, since 2017.
This is partly due to very low levels of immunity to the mpox virus, which is related to the virus that causes smallpox. Mass vaccination against smallpox ceased more than 40 years ago globally, resulting in minimal immunity in populations today against mpox.
The WHO designation announced this week relates to the clade I. Not only does this have a higher fatality rate, it has new mutations that enhance spread between people. These changes, and the global lack of immunity to mpox, makes the worlds population vulnerable to the virus.
In 2022, an epidemic of mpox swept through non-endemic countries, including beyond Africa. This was a variant of clade II originating from Nigeria, called clade IIb. This was sexually transmitted, predominantly affecting men who have sex with men, and had a low fatality rate.
That epidemic peaked in 2022, with vaccines made available to people at risk in high-income countries, but there has been an uptick in 2024.
At the same time, large clade I epidemics were occurring in the Democratic Republic of the Congo, but with far less attention.
Vaccines were not available there, even in 2023, when there were 14,626 cases and 654 deaths. Mortality was 4.5%, and higher in children.
In fact, most cases and deaths in the Democratic Republic of the Congo have been children. This means most transmission there is non-sexual and is likely to have occurred through close contact or respiratory aerosols.
However, in 2023 an outbreak in a non-endemic part of the country, South Kivu in the east, appeared to be by sexual transmission, indicating more than one epidemic and different transmission modes in the Democratic Republic of the Congo.
By mid-2024, there were already more cases in the country than all of 2023 more than 15,600 cases and 537 deaths.
Testing capacity is low in the Democratic Republic of the Congo, most cases are not confirmed by lab testing, and the data we have are from a small sample of genomic sequences from the Kamituga region of South Kivu.
This show mutations to the clade I virus around September 2023, to a variant termed clade Ib, which is more readily transmissible between people. We do not have much data to compare these viruses with the viruses causing cases in the rest of the country.
In the past month, the virus has spread to countries that share a border with the Democratic Republic of the Congo Rwanda and Burundi. It has also spread to other east African countries, such as Kenya and Uganda. None of these countries have had mpox cases previously.
In an interconnected, mobile world, cases may spread to other continents, as mpox did in 2018 from Nigeria to the United Kingdom and other countries.
A few travel-related cases between 2018 and 2019 may have led to the large multi-country 2022 clade IIb epidemic.
As the mpox virus and smallpox viruses are related (they are both orthopoxviruses), smallpox vaccines offer protection against mpox. These vaccines were used to control the 2022 clade IIb epidemic.
However, most of the world has never been vaccinated, and has no immunity to mpox.
The newer vaccine (called Jynneos in some countries and Imvamune or Imvanex in others) is effective. However, supplies are limited, and vaccine is scarce in the Democratic Republic of the Congo.
WHOs declaration of mpox as a public health emergency of international concern will help mobilise vaccines to where they are needed. The Africa Centres for Disease Control had already begun negotiations to secure 200,000 doses of vaccine, which is a fraction of what is required to control the epidemic in the Democratic Republic of the Congo.
Ultimately, a serious epidemic anywhere in the world is a concern for all of us, as it can spread globally through travel, as we saw with the COVID pandemic.
Controlling it at the source is the best measure, and WHOs latest declaration will help mobilise the required resources.
Surveillance for spread of this more serious version of mpox is also essential, bearing in mind that many countries do not have the capacity for widespread testing. So well have to rely on suspected cases, based on a clinical definition, to keep track of the epidemic.
Open-source epidemic intelligence such as using AI to monitor trends in rash and fever illness can also be used as an early warning system in countries with weak health systems or delayed reporting of cases.
A further complication is that 20-30% of people with mpox may simultaneously have chickenpox, an unrelated infection that also causes a rash. So an initial diagnosis of chickenpox (which is easier to test for) does not rule out mpox.
Effective communication and tackling push-back against public health measures and disinformation is also key. We saw how important this was during the COVID pandemic.
Now, WHO will coordinate the global mpox response, focusing on equity in disease prevention and access to diagnostics and vaccines. It is up to individual countries to do their best to comply with the International Health Regulations, and the protocols for how such a global emergency are managed.
The World Health Organization has more information about mpox, including symptoms and treatment. For information about vaccine access and availability, contact your local health department or doctor, as this varies from country to country.
Geneva, 15 August 2024 Gavi, the Vaccine Alliance continues to be deeply concerned about the escalating mpox emergency on the African continent. We welcome recently announced measures by our partners at the African Centres for Disease Control and Prevention (Africa CDC) and World Health Organization (WHO) which will help create an enabling environment in support of a comprehensive region-led response, and join partners in emphasizing the importance of international coordination following a declaration of a Public Health Emergency of Continental Security by Africa CDC and a Public Health Emergency of International Concern by WHO.
Working in collaboration with countries and partners, Gavi has been closely monitoring the mpox situation since 2022. As a result, considerations related to mpox have helped inform both the design of Gavis new innovative health security mechanisms, aimed at addressing systemic gaps exposed during the COVID-19 vaccine response, as well as Gavis next five-year strategy. When the assessment process for Gavis next five-year Vaccine Investment Strategy (VIS) began in 2023, mpox vaccines were included for consideration. Special sessions of the VIS Steering Committee were convened in Q1 2024 to ensure the approach took into account developments in the Democratic Republic of the Congo (DRC), where the outbreak has spread rapidly, primarily impacting children (in terms of both morbidity and mortality), and resulting in a high case fatality ratio.
As a result, in June 2024 the Gavi Board approved the following measures related to mpox:
Gavi has been monitoring the mpox situation daily for the past several weeks, and is currently engaging closely with countries, Africa CDC, WHO, UNICEF, donors, and manufacturers to support the response to mpox. Our actions include:
People should get vaccinated against mpox if travelling to an African country affected by the latest outbreak, the EU's public health body has said.
The European Centre for Disease Prevention and Control (ECDC) has updated its advice after the World Health Organization (WHO) declared a global emergency following the detection of a more contagious strain of the virus in 16 African countries.
The outbreak of the strain - called clade 1b - was first detected in the Democratic Republic of Congo. The endemic form of the virus, clade 1, has also been spreading throughout Africa.
More than 17,000 mpox cases and at least 571 deaths have been confirmed in Africa this year, officials have said. The figures exceed last year's totals.
The UK has been preparing for cases after a person in Sweden was found to have the clade 1b strain of mpox.
The disease, previously known as monkeypox, is a viral infection that causes pus-filled lesions and flu-like symptoms. It is usually mild but can kill.
It is passed on through close physical contact and symptoms include a high temperature, headache, muscle aches, backache, and a rash.
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Following its latest risk assessment, the ECDC said it is "highly likely" Europe will have "more imported cases of mpox caused by the clade I virus currently circulating in Africa".
It therefore increased its risk level assessment from "low" to "moderate" in relation to the chance of sporadic cases appearing in EU countries.
However, the ECDC has said "strengthened surveillance and preparedness activities" as well as "robust healthcare" across Europe means the impact of mpox on the continent "will be low".
As part of measures to try and prevent the spread of the virus, the public health body is also advising travellers to "epidemic areas" to "consult their healthcare provider or travel health clinic regarding eligibility for vaccination against mpox".
Pamela Rendi-Wagner, director of ECDC, said: "As a result of the rapid spread of this outbreak in Africa, ECDC has increased the level of risk for the general population in the EU/EEA and travellers to affected areas. Due to the close links between Europe and Africa, we must be prepared for more imported clade I cases."
Read more: How does mpox spread and what is the risk to the world?
Mpox is a viral disease that occurs mostly in central and western Africa. It was first identified in laboratory monkeys, according to the US Centers for Disease Control and Prevention (CDC).
Common symptoms of mpox are a skin rash or pus-filled lesions which can last two to four weeks. It also can cause fever, headaches, muscle aches, back pain, low energy and swollen lymph nodes.
A human can contract it through physical contact with someone who is infectious or with infected animals.
Currently there is no treatment approved specifically for mpox virus infections, according to the CDC.
However, a two-dose vaccine has been developed to protect against the virus.
The CDC says that for most patients with mpox who have intact immune systems and dont have a skin disease, supportive care and pain control will help them recover without medical treatment.
Meanwhile, the WHO is due to host an emergency meeting to discuss ways to ensure fair global access to tests, treatments, and vaccines for the virus.
It comes as a Red Cross and Red Crescent official said far more diagnostic kits, treatments and vaccines need to be shipped to Africa to respond adequately to the outbreak of the new strain of mpox there.
Shares in pharmaceutical companies producing and developing mpox vaccines rose on Friday.
Dr Jean Kaseya, the director general of Africa Centres for Diseases Control and Prevention, told Sky News there are cases in 16 countries in Africa, including DR Congo, where the outbreak was first spotted.
"For the first time, we have countries like Ivory Coast, Kenya, Rwanda and Uganda reporting cases," he said.
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Burundi, Central Africa Republic, South Africa, and Nigeria have also detected cases, the WHO said.
Meanwhile, Pakistan confirmed on Friday a case of the mpox virus in a patient who had returned from a Gulf country.
It is not clear whether it was of the new variant or of the clade that has been spreading globally since 2022.
China said earlier on Friday it plans to monitor people and goods entering the country for mpox for the next six months.
The mpox outbreak in Africa is yet another example of how infectious diseases perceived to be someone elses problem, and affecting mainly poor, developing countries, may suddenly pose unexpected global threats.
Other examples of neglected diseases include the West Nile, Zika and Chikungunya viruses.
Mpox was discovered in 1958 (in captive monkeys, hence the original misnomer monkeypox) and the first human case was identified in 1970. Then for decades it was largely neglected by the scientific and public health communities, regarded as an uncommon infection in remote rural areas in tropical Africa without relevance for the rest of the world.
When a massive mpox outbreak hit developed countries in 2022, increased research funding led to a surge in scientific studies. On just one medical search engine, theres been more research produced since April 2022 than in the preceding 60 years.
The 2022-23 global mpox outbreak happened despite repeated calls from African researchers for increased global investment in diagnostic, therapeutic and infection prevention tools for mpox.
The WHO has now declared the current upsurge of mpox in central Africa a public health emergency of international concern.
This is the highest alert level for events that constitute a public health risk to other countries and requires a coordinated international response.
We are infectious disease researchers who have worked on HIV, SARS-CoV-2 and other viral infections.
Mpoxs recent history is yet another reminder that an infectious disease in one corner of the world should not be regarded as someone elses problem, as it can suddenly start to spread fast and far.
It also highlights global inequities in resource allocation and access to vaccines, diagnostics and treatments. These were made available in many industrialised countries and helped curb the global outbreak, but are still largely lacking in most of Africa.
Read more: Mpox: what to watch out for, treatment and what to worry about
The disease has been renamed mpox but the name of the virus, for now, remains monkeypox (MPXV). It is closely related to the smallpox virus.
MPXV was considered a zoonotic disease endemic in parts of central and west Africa. It was acquired mainly through close contact with wild mammals, especially handling bush meat, but there was no sustained human-to-human transmission.
Only very occasionally were cases seen outside the endemic areas, due to infected travellers or import of infected small mammals.
This changed abruptly in 2022: a massive, rapidly evolving global outbreak caused over 99,000 laboratory-confirmed cases in 116 countries. At its peak in August 2022, over 6,000 cases were reported each week.
This outbreak came as a total surprise: most cases were reported from non-endemic countries, mostly in men who have sex with men who had become infected during recent sexual encounters.
Even though most cases were clinically not particularly severe and the death toll stands at just over 200, the global outbreak was declared a public health emergency of international concern by the World Health Organization on 23 July 2022.
Fortunately, case numbers soon plummeted due to a combination of behavioural changes and vaccination in at-risk groups.
Modern vaccines and antiviral drugs with activity against mpox were made available in many affected high-income countries.
These had been developed and stockpiled in the US and Europe, mostly in preparation for a potential bioweapon attack using a poxvirus.
The global outbreak in 2022 was caused by clade II of MPXV, which is endemic in west Africa and not as virulent as clade I MPXV, which so far has only been seen in the Congo Basin.
That first mpox public health emergency of international concern was declared over in May 2023.
Clade II MPXV infections are still occurring globally, but the worst seems over for now.
Complacency would be misguided, as illustrated by the current mpox outbreak that is gathering steam.
The African region is experiencing an upsurge in mpox cases which started in 2023.
As the continent which includes the areas where mpox has been endemic for a long time, Africa now presents a complex mosaic:
cases arising from the endemic, largely zoonotic, pattern that used to be predominant in the past
cases linked to the 2022 global outbreak, for example in South Africa
most worryingly, ever increasing numbers of MPXV clade Ib infections reported from the Democratic Republic of Congo.
Read more: Mpox cases are soaring in Africa -- what must be done to prevent a global pandemic
The current clade I MPXV (formerly called Congo Basin strain) is more virulent than the clade II (west African) strain, resulting in a higher case fatality rate.
The ongoing outbreak has its epicentre in South Kivu province, eastern DRC, and has the potential to fuel a large pandemic.
It has a distinct epidemiological pattern with sustained chains of human-to-human transmission, often via the sexual route.
It may have increased transmissibility (we dont know yet).
The virus which causes it is the newly defined clade Ib lineage. It displays mutations that are the hallmark of human-to-human spread that is estimated to have been happening since September 2023.
Case numbers are rising rapidly, even though many suspected cases are likely not tested and thus not counted as confirmed. Complicating matters, a commonly used test was found to miss infections with this lineage of the virus.
It affects mostly adults.
The case fatality rate is higher than it was in the 2022 global outbreak.
Already, this outbreak has resulted in mpox cases occurring in several neighbouring countries, including some (like Kenya) with no previous record of mpox.
The challenge is enormous. The eastern DRC is an area beset by multiple problems. This includes natural disasters, violence and infectious diseases including measles, cholera and poliomyelitis for the DRC.
In recent years the second-largest Ebola outbreak ever took place in the wider area and, despite the availability of vaccines and treatments, posed considerable challenges.
A recent article we co-authored in The Lancet Global Health outlines what needs to be done to contain this outbreak and prevent it from turning into an epidemic, possibly even a pandemic.
Equitable access to diagnostic tests, vaccines and antiviral treatments requires political commitment and financial investments.
Scientific investigations are needed to learn more about exposure settings, transmission routes and clinical presentations.
Its important to find the best ways to make these interventions.
We have proposed the establishment of an African-led, multidisciplinary, multi-country Mpox Research Consortium (MpoxReC) in Africa.
It should conduct research towards the elimination of mpox as a public health problem.
There is no doubt that a disease in one corner of the world can suddenly become a global heath threat. Its time the global health system woke up to this reality.
Swedish health authorities announced the first case of the highly infectious mpox just a day after the World Health Organization (WHO) declared a global emergency for the outbreaks in Africa.
"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 announced on Thursday.
Magnus Gisslen, a state epidemiologist with the Swedish health agency, said the person had been treated and given "rules of conduct."
MPOX DECLARED PUBLIC HEALTH EMERGENCY IN AFRICA AS AUTHORITIES BATTLE MULTIPLE VARIANTS
"The fact that a patient with mpox is treated in the country does not affect the risk to the general population," Swedish officials said.
Swedish state epidemiologist Magnus Gissln speaks during a press conference regarding mpox in Stockholm on Thursday. (Fredrik Sandberg/TT News Agency via AP)
The announcement of an infected resident in the Scandinavian country comes just a day after WHO declared the mpox outbreak a global emergency.
The U.N. health agency said there have been more than 14,000 cases and 524 deaths this year, which already exceed last year's figures.
So far, more than 96% of all cases and deaths are in Congo.
Mpox on a child in Nigeria. (Nigeria Centre for Disease Control via WHO)
Mpox, also known as monkeypox, was first identified by scientists in 1958 when there were outbreaks of a "pox-like" disease in monkeys. Until recently, most human cases were seen in people in Central and West Africa who had close contact with infected animals.
In 2022, the virus was confirmed to spread via sex for the first time and triggered outbreaks in more than 70 countries that had not previously reported mpox.
'ZIKA-LIKE' MOSQUITO-BORNE VIRUS HAS SPREAD INTO EUROPE, HEALTH OFFICIALS WARN
Mpox belongs to the same family of viruses as smallpox but causes milder symptoms like fever, chills and body aches. People with more serious cases can develop lesions on the face, hands, chest and genitals.
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Earlier this year, scientists identified a highly contagious form of mpox, which can kill up to 10% of people.
Mpox is transmittable and highly contagious. (Reuters/Dado Ruvic/Illustration)
Scientists in Europe have maintained that although mpox is transmittable and highly contagious, advanced health care in Sweden and other rich countries can stop the transmission before it becomes an epidemic.
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The Associated Press contributed to this report.
Sarah Rumpf-Whitten is a breaking news writer for Fox News Digital and Fox Business.
Story tips and ideas can be sent to sarah.rumpf@fox.com and on X: @s_rumpfwhitten.
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ATLANTA The numbers at the Northeast Georgia Health System dont lie. The COVID-19 summer surge is here.
COVID has become part of our lives, but we never took our eyes off it, said infectious disease physician Supriya Mannepalli.
Since the pandemic's beginning in 2020, the Northeast Georgia Health System has administered COVID-19 tests to patients across all settings, including outpatient and long-term care facilities, to monitor transmission rates. As recently as April, roughly 2% of the tests came back positive.
Now, were at 22% positivity, and this trend is going up, Mannepalli said. There is definitely a surge going on.
The Centers for Disease Control and Prevention no longer tracks COVID-19 case numbers but estimates the trend of the virus spread based on emergency room visits. According to the CDC, in the week that ended July 13, Georgia reported 1.1% of emergency room visits were diagnosed as COVID-19, a 40% increase from the previous week a high percentage that reflects a rise in the small number of emergency department cases. Nationally, 1.6% of all emergency visits were due to COVID-19, up 16% from the previous week.
Even President Joe Biden couldnt dodge the outbreak. The president returned to the White House Wednesday after several days of isolation at his Delaware home following a diagnosis last week of COVID-19. The White House reported last week that his symptoms were mild and that he responded quickly to the antiviral Paxlovid.
The virus seems to be causing fewer emergency visits this summer than last year. During last summers peak, 2.5% of emergency department patients were diagnosed with COVID-19. It accounted for 3.5% of emergency patients in 2022, and 7% during summer 2021.
A summertime COVID-19 outbreak has become the norm since the pandemic, tied to people enjoying holiday travel and gathering indoors where its cooler. The virus has shown a seasonal surge twice each year, spiking in July and August, and again in December and January.
The CDC tracks a sample of over 300 hospitals in 13 states to estimate COVID-19 activity. For the week ended July 13, the agency reports a rate of 2 hospitalizations per 100,000 people. The highest rate of hospitalizations this year was reported for the week ended Jan. 6, when 7.6 hospitalizations per 100,000 people was reported.
Health experts and doctors have said they expect this summers COVID-19 illnesses to be milder than some past versions, but the latest iterations of the ever-evolving coronavirus seem to be more contagious.
At the Northeast Georgia Health System, Mannepalli said milder infections are the norm, with people presenting flu-like symptoms including coughing, runny nose, muscle aches, fever and sometimes sore throat. In more severe cases, shortness of breath can also be an issue.
COVID-19s greater transmissibility is a product of the new, more contagious strains of the virus.
There are new variants that keep evolving every few months. And as the new variants evolve, they (become) easily transmissible. Thats the way the virus tries to survive, Mannepalli said.
The FDA has announced a new COVID-19 booster shot is expected to arrive in August or September and will better target the more recent variants.
For many people who have already had COVID-19, a reinfection is often milder. But those who are 65 and older, pregnant or immunocompromised remain at higher risk of serious complications from COVID-19.
Protocols for whether to isolate and wear a mask changed in March, when the CDC released new guidelines for people with COVID-19. They now recommend those with the infection treat it the same as the flu and RSV staying home while they have symptoms and fever. The agencys latest recommendation is that people can return to normal activities 24 hours after their fever has resolved and symptoms have improved.
The CDC encourages people recovering from COVID-19 or any other respiratory illness to wear a mask as part of an overall strategy to reduce transmission, but masks are not mandated. The CDC said the new guidelines are intended to make it easier for people to know how to protect others and take into account that other people might not know which virus they have.
Mannepalli said vaccination remains the number one precaution people can take, even as she allows that everyone gets confused whenever they hear about a new vaccine for COVID.
While newer vaccines might be more effective at blocking the variants now in circulation, Mannepalli recommends staying up to date with currently available vaccines rather than waiting for new boosters.
Especially if somebodys high risk of getting severe COVID or having complications from COVID, its so important that they stay up to date with the vaccination instead of delaying it, she said.
For those seeking to minimize their exposure to COVID-19, Mannepalli says masks are advisable, especially in crowded indoor settings with poor ventilation. And if somebody has symptoms, they should source a test, so they can take steps to avoid passing the virus onto others if a COVID-19 infection is confirmed.
I think the most important thing if somebody tests positive for COVID is to reach out to their primary care physician and talk to them, she said, so they can evaluate and see if they need to be started on antiviral medication.
2024 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.
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Updated 4 hours ago
Peaty missed out on a third consecutive gold medal by 0.02 seconds on Sunday and afterwards said he had been slightly unwell with a little bit on my throat.
A Team GB statement said the 29-year-olds condition worsened overnight and he has now tested positive for coronavirus.
Unlike the last Games in Tokyo, there are no strict protocols around the disease in Paris which could prevent him from competing.
It is viewed as a general illness by organisers, although Team GB have straightforward protocols including hand hygiene and keeping space from other competitors.
Peaty was expected be part of the British relay teams later in the Olympics, with a possible return to action as soon as Friday. Team GB said he is hopeful to be back in competition.
As in any case of illness, the situation is being managed appropriately, with all usual precautions being taken to keep the wider delegation healthy, the statement added.
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Peaty could compete in either the men's or mixed 4x100m medley relay competitions in Paris, and was part of the squad that won gold in the mixed event in Tokyo.
Their title defence begins on Friday morning in the heats with a potential final, should Britain qualify, on Saturday evening.
The men's medley relay begins on Saturday morning, with the heats on Sunday night.
Following his positive Covid test, Peaty said: "Ill now be focusing on a fast, full recovery to give my best in the team relays later in the week.
"Ive had so many messages and Ill get back to you all, thank you for your support as it has truly been an unforgettable journey."
The Team GB coaches would pick Peaty for whichever event they viewed as the best chance of a medal, possibly both if he felt fit enough, and he would be crucial to their hopes.
There are other breaststrokers in the GB squad who could take his place if required.
Peaty was targeting a third consecutive 100m Olympic title on Sunday, which would have meant he joined Michael Phelps as the only man to have won the same Olympic swimming event three times in a row.
He was well placed in the final 25m but Italian Nicolo Martinenghi came through to win gold.
Peaty gave emotional interviews afterwards when he discussed his difficulties since his last gold in Tokyo, which included problems with alcohol and his mental health.
He almost walked away from the sport before returning last year.
The Englishman is not the first aquatics athlete at these Games to test positive for Covid-19.
Five members of Australia's water polo squad, which takes place at a different venue to the swimming, contracted the disease days before the Games.
