Mpox remains a public health emergency of international concern, according to the World Health Organization (WHO), as its cases and geographic spread are on the rise.
The outbreak, initially reported in the Democratic Republic of Congo (DRC), has escalated significantly. Mpox cases caused by clade Ib of the virus are now present in over six WHO regions, with hotspots in the DRC, Burundi, Uganda, Kenya and Rwanda.
WHO data highlighted 2,083 cases in Burundi and 582 in Uganda, with smaller clusters in Kenya and Rwanda. Travel-related infections have surfaced in eight countries across Africa, Europe, Asia and the Americas, amplifying international risk. Fatalities, though limited, have been reported in Burundi, Uganda, and Kenya, with children under five years facing the highest mortality rates.
Since January 2024, 21,401 infections have been reported across 80 countries.
Urban centres like Kinshasa and Bujumbura report sustained community transmission, including among children, a shift from earlier patterns of adult infections linked to sexual networks.
The International Health Regulations (2005) Emergency Committee, in a closed session on November 28, 2024, said the latest upsurge of mpox cases was “extraordinary” for multiple reasons. One of them is that clade Ib of the virus, which has one of the highest death rates, went from being circulated among individuals in commercial sexual networks to broader units of populations such as households and entire communities.
This resulted in the infection spreading to a larger number of age groups or to vulnerable population groups, or, co-infection and co-circulation with other clades and / or pathogens, the Committee noted. “This could have generated uncertainties and unknowns in terms of morbidity and mortality, and, consequently, led to new response challenges, including regarding clinical care.”
Further, during sustained community transmission, there is higher risk of mutations of the clade Ib, resulting in new transmission dynamics or morbidity and mortality patterns, it added.
The ongoing prevalence of clade Ia infections in DRC, with new foci of sexual network disease transmission in the capital Kinshasa, also indicates a complication in understanding the disease spread.
The Committee underscored the urgent need for coordinated global action to curb the spread of the disease.
Efforts to control mpox face significant challenges. Inadequate local response measures, including delayed testing, insufficient contact tracing, and limited public education, have hampered progress.
Vaccination coverage remains patchy, with logistical hurdles and vaccine hesitancy further complicating distribution. Although over 1.1 million vaccine doses have been allocated, their effectiveness in children and immunocompromised individuals remains uncertain.
Compounding the crisis, concurrent health emergencies and resource constraints in affected countries limit the prioritisation of mpox. The WHO’s deputy director-general emphasised the necessity for political commitment to scale up interventions at local levels.
WHO and Africa Centres for Disease Control and Prevention have implemented a joint response plan, focusing on surveillance, equitable vaccine allocation and regional collaboration. However, of the $87.4 million needed for WHO’s mpox emergency response, only $40.6 million has been secured, reflecting a critical funding gap.
To address the multifaceted dynamics of transmission, the WHO has recommended intensified local efforts, strengthened international partnerships, and the integration of predictive modelling to anticipate future outbreaks. Strategies also include expanding vaccination to hotspots and combating misinformation about the disease and its prevention.