Why a growing mpox outbreak has the world worried again
Global health authorities are sounding an alarm about surging mpox infections in Africa that have left hundreds dead, thousands sick and inflicted suffering in nations previously spared from the viral disease.
Cases in Africa have surpassed 15,000 this year, exceeding the toll in all of 2023. Infections are concentrated in the Democratic Republic of Congo, where mpox has been endemic for decades, reaching record highs and mostly infecting and killing children. The virus has spilled into countries that have never recorded outbreaks, including Kenya and the Ivory Coast.
The Africa Centers for Disease Control and Prevention will probably declare a health emergency next week, officials said Thursday. The leader of the World Health Organization said Wednesday that he would convene a committee to consider declaring another international health emergency. Meanwhile, the U.S. Centers for Disease Control and Prevention released an alert this week warning clinicians to be vigilant for symptoms in travelers from affected countries while stressing that the risk remains low in the United States.
“This is a major alarm for the world. We are losing the youth in Africa,” Jean Kaseya, director general of the Africa CDC, said in a Thursday news briefing. “This new incident demonstrates the need for a collective and collaborative approach in curbing the spread of the disease.”
In 2022, a global mpox outbreak ripped through gay communities in dozens of countries that had rarely encountered the virus and prompted an aggressive public health response and vaccination campaign that were credited with quashing the outbreak.
Recent trends in Congo, where the virus was first detected in 1970, have ignited new concerns. This year, officials have recorded 13,800 suspected and confirmed cases and 450 deaths, with children younger than 15 accounting for 68 percent of cases and 85 percent of deaths, according to the Africa CDC.
Most infections appears to be spreading through contact with infected animals and within households, the usual routes of exposure in endemic regions. But a new form of mpox, known as clade 1b, emerged in eastern parts of Congo, including in sex workers, and has been detected in Kenya, Rwanda and Uganda.
Clade 1b causes more severe illness than the clade 2 version that spread globally in 2022. But the death rate is low, with the new version of mpox killing fewer than 1 percent of people who became infected, according to the CDC.
“That said, it is of concern because it’s spreading sexually so it makes it more of a risk versus in small villages and small households,” said Christina L. Hutson, chief of the CDC’s poxvirus and rabies branch.
Clade 1, the forerunner of the new version, proves more lethal, with a death rate of about 5.5 percent in the Congo province where it predominates, disease experts said. The higher death rate could be explained by that outbreak disproportionately striking vulnerable children in an area with a weak health-care system, the experts cautioned.
While the global outbreak in 2022 was largely driven by male-to-male sexual contact, officials in Africa are identifying spread in heterosexual networks as well, including when male travelers solicit female sex workers in parts of Congo close to other countries.
“Sexual transmission in areas where there is a great deal of population movement is particularly worrisome given the implications for rapid spread,” Anne Rimoin, an epidemiologist who runs a research camp in Congo and has studied the virus there for more than two decades. “Mpox is transmitted very efficiently through sexual contact.”
The virus spreads in Africa in ways not typically seen in the West, including in health-care settings where workers have less access to personal protective equipment while treating patients and inside smaller households where people live in tighter spaces. Outbreaks have also been recorded in displacement camps in conflict-ridden areas.
While the threat to Western countries is considered low, the African countries bearing the brunt of the latest outbreak do not have ample supplies of vaccine and antivirals that helped end the international health emergency last year.
“Let’s be frank: The global south has always faced massive resource limitations, and that is certainly no different here,” said Jason Kindrachuk, an associate professor at the University of Manitoba’s Max Rady College of Medicine who is in Congo assisting the response.
Vaccine distribution presents a logistical nightmare in Congo and other parts of Africa where the health-care system is stretched thin and where some heavily affected rural communities can be reached only by boat. But efforts to expand vaccination are finally gaining steam.
WHO Director General Tedros Adhanom Ghebreyesus said he took steps to accelerate vaccine access in lower-income countries where regulators have yet to approve the vaccine and to allow international aid organizations to buy shots for distribution.
The U.S. CDC is working with Congolese officials to develop a plan for targeting people most at risk for mpox and rolling out shots in phases once the country approves a vaccine. Rimoin said that campaign could start as early as fall.
“An infection anywhere is potentially an infection everywhere, and this is exactly what we saw with mpox in 2022,” said Rimoin, who is also a professor of epidemiology at the UCLA Fielding School of Public Health. “It’s a critical moment to act quickly, to be vigilant and with no time to lose.”
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https://washingtonpost.com/documents/e7296ba2-208b-463e-97b7-af57c9625818.pdf
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