The spread in Africa of a new, apparently more lethal variant of monkeypox (renamed mpox) has led the World Health Organization (WHO) on Wednesday to declare a public health emergency of international concern. It is the second time that the organization has activated the highest level of alert provided for in the International Health Regulations for this disease and the eighth in history.
The decision was unanimous among the members of the WHO Emergency Committee. “The detection and rapid spread of a new clade [variante] “The recent outbreak of mpox in eastern Democratic Republic of the Congo (DRC), its detection in neighbouring countries that had not previously reported it, and the potential for further spread within Africa and beyond is of great concern,” WHO Director-General Adhanom Tedros Ghebreyesus said at a press briefing. “Coming alongside other outbreaks of other mpox clades elsewhere in Africa, it is clear that a coordinated international response is essential to stop these outbreaks and save lives.”
According to Dimie Ogoina, director of this committee, the requirements of the international health regulations are met to declare this international emergency. “Although we have known about the disease for years, we are facing the largest outbreak we have seen, and there are vulnerable populations, such as children and pregnant women, who are being affected. It is spreading beyond RCD, and we believe there is a risk of international expansion beyond Africa,” he listed, and justified the need for the emergency to promote “global action” to improve “surveillance and the public health response to this challenge.”
The WHO is taking this measure just one day after the African Centres for Disease Control and Prevention declared an alert on the continent (the first time this has happened), after having recorded 15,000 cases and 461 deaths from this virus so far this year. The number of infections detected is much higher (160%) than last time around this time and is most likely only a small fraction of those that have actually occurred. Most of these cases are concentrated in the Democratic Republic of the Congo, although the virus is already spreading to other countries such as Uganda, Kenya and Rwanda.
The viruses analysed belong to a different clade than the one that caused the international alert that the WHO declared in 2022 and ended in May 2023. Experts point out that it may be more lethal than the previous one. In Africa, around 3% of those who test positive are dying, although it must be taken into account that the diagnosis levels on the continent are deficient and its health capacities, regarding treatment, are much more deficient than in developed countries.
The first clade of mpox was transmitted mainly through sexual relations, through very intimate contacts. The specific transmission mechanisms of the new variant are still not entirely clear, but it seems to be more easily transmitted. In this wave of transmission in RCD, children are being the main victims: 70% of positive cases are under 15 years of age, and 39% are under five years of age, who account for 62% of deaths.
The status of an international health emergency does not imply any kind of obligation for countries, but it allows for better coordinated action between states, greater agility when purchasing vaccines, and African governments can skip some bureaucratic processes that slow down the process. According to Madhu Pai, a member of the McGill School of Global Health in Canada, on the social network X, 10 million injections would be needed in Africa, when only about 200,000 are available.
Maria Van Kerkhove, from the WHO’s Emergencies Programme, has pointed out that much better knowledge is needed about the epidemiology of the virus, how it is being transmitted and where in order to target vaccines to the population that is really most at risk.
Vaccines were one of the keys to stopping the spread of MPOX in the West. Transmissions were mainly concentrated in men who had sex with men with risky behaviour, a group on which vaccination campaigns and recommendations have been focused.
The Spanish Ministry of Health counted 40,610 immunized people and Last week he warned that only half of them had received the second dose, calling on the others to go to their medical centres to request them. Since April 2022, when the first cases were detected, 8,100 cases of mpox infection have been reported, of which 260 have been reported in 2024.
According to the latest assessment by the European Centre for Disease Control The ECDC (ECDC) has assessed the risk posed by the new variant in Europe as “very low”. In a statement dated 29 July, its director, Pamela Rendi-Wagner, said: “I would like to emphasise that the risk to the European population remains very low. ECDC is working with our partners in Africa in their efforts to contain this outbreak for the benefit of all those affected, to prevent this new variant from spreading further and to strengthen future preparedness and response capacities.” However, the agency is preparing another risk assessment which will be published in the coming days.
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