Why is the latest mpox outbreak a ‘global public health emergency’?

On August 14, 2024, the World Health Organization (WHO) declared mpox a global public health emergency for the second time in two years.

The declaration comes after the sudden surge of cases from the Democratic Republic of Congo (DRC) that has now spread to other countries.

In the latest development, Sweden reported its first mpox case, becoming the first country outside the African continent to report the more contagious strain of mpox virus.

More than 15,600 cases and 537 deaths have been reported so far this year alone in Africa.

Mpox, previously known as monkeypox, is a self-limiting viral infection caused by mpox virus (MPXV). Mpox was discovered in 1958 in captive monkeys, and the first human case was identified in 1970.

The disease is primarily spread through close contact with an infected person or animal. The symptoms of mpox usually appear within 5 to 21 days after exposure and can include fever, headache, back pain, fatigue, and swollen lymph nodes, along with pox-like rashes that last for two to three weeks.

Even though it is a self-limiting disease, it can lead to death, especially among children and those with weak immune systems. The current concern stems from the spread of clade 1b of the MPXV is predominantly transmitted through sexual contact.

While the infection has been reported in humans since 1970, it mostly affected people in the endemic regions in Africa till 2022. Hence, Mpox was largely neglected by the scientific and public health communities and regarded as an uncommon infection in remote rural areas in tropical Africa without relevance for the rest of the world.

The new clade 1b viral strain, which first emerged in September 2023, has for the first time been detected outside DRC with over 100 cases of infections reported in Burundi, Kenya, Rwanda, and Uganda. The numbers are likely to be higher, as many with symptoms might not have been tested. The case now reported in Sweden shows the contagious spread of mpox virus outside Africa and the urgent need for action.

There are at least two vaccines currently in use for mpox, which have been recommended by the WHO’s Strategic Advisory Group of Experts on Immunization. But getting these vaccines to those in need requires political commitment and financial investments. Meanwhile, equitable access to diagnostic tests, and antiviral treatments remains a priority.

Mpox’s recent history is yet another reminder that an infectious disease in one corner of the world should not be regarded as someone else’s problem, as it can suddenly start to spread fast and far.