Monkeypox is now a global emergency—ignoring it is highly dangerous
MDlinx Aug 24, 2024
The World Health Organization declared mpox a global emergency this month, citing an upsurge in cases and deaths in a growing number of countries in Africa, in the Democratic Republic of the Congo (DRC).
World Health Organization. First meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024. August 19, 2024.
Now, the WHO recommends that impacted countries follow a set of temporary health measures—in addition to already-standing recommendations—to respond to the spread. On a global scale, the WHO is encouraging other countries to help coordinate resources to fight mpox in Africa. While cases from Africa do not appear to have jumped to the US, government agencies are encouraging doctors to keep an eye out for mpox symptoms in travelers and consider testing if deemed necessary.
U.S. Department of Health and Human Services. United States Government’s Response to the Clade I Mpox Outbreak in the Democratic Republic of the Congo and Other Countries in the Region. August 14, 2024.
According to the WHO, there have been 1,854 MPXV cases reported in Africa since the beginning of 2024—36% of the 5,199 cases worldwide.[1] More than 15,000 cases—95% of those reported in Africa—and more than 500 deaths have occurred in the DRC.
The spread appears to contain a mixture of both clade Ia mpox, which has mostly impacted children, clade Ib, a new strain that primarily affects adults and is presumed to be spread through sexual contact. While clade Ib is spreading rapidly, clade Ia has historically caused more severe disease.
In an August 17 statement, President Cyril Ramaphosa of South Africa expressed that he was “deeply concerned by the rapid spread of Mpox across multiple regions within the African Union, with a significant rise in both cases and fatalities, reflecting a concerning shift in the epidemiological pattern.”
Africa Centres for Disease Control and Prevention. Statement by His Excellency President Cyril Ramaphosa, the African Union Champion on Pandemic Prevention, Preparedness, and Response (PPPR) on the situation of Mpox outbreak in Africa. August 17, 2024.
The WHO Director-General also highlighted the gravity of the situation in remarks made on August 14.
World Health Organization. WHO Director-General’s opening remarks at the IHR Emergency Committee meeting regarding the upsurge of mpox 2024 – 14 August 2024. August 14, 2024.
“[W]e are not dealing with one outbreak of one clade – we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk,” he said.
Drawing the line between emergency and pandemic
In light of the WHO’s emergency declaration, representatives from the organization have also clarified that mpox is “not the new COVID,” emphasizing that there are known ways for controlling transmission.
Mpox “not the new COVID,” World Health Organization says after declaring health emergency over Africa cases. CBS News. August 20, 2024.
According to the Centers for Disease Control and Prevention, mpox can be transmitted through close skin-to-skin contact, such as sexual contact with people who have mpox or direct contact with scabs or rashes on a person with mpox. Avoiding skin-to-skin contact with anyone who has an active mpox infection and getting vaccinated against the disease can help keep people safe from transmission.
Not all countries—including impacted areas—however, have sufficient access to mpox vaccinations, and not all modes of mpox transmission are crystal clear.
A call for international support
In his statement on August 17, President Ramaphosa emphasized Africa’s need for international support, which has not always been generously offered.
Africa Centres for Disease Control and Prevention. Statement by His Excellency President Cyril Ramaphosa, the African Union Champion on Pandemic Prevention, Preparedness, and Response (PPPR) on the situation of Mpox outbreak in Africa. August 17, 2024.
“This [Public Health Emergency of International Concern] PHEIC must be different and correct the unfair treatment from the previous one declared in 2022, where vaccines and therapeutics were developed and made available primarily to Western countries, with little support extended to Africa,” Ramaphosa said. “I call upon WHO and all partners to collaborate closely with Africa CDC to ensure that this PHEIC unlocks appropriate support from the international community, guaranteeing equitable access to medical countermeasures, including diagnostics, therapeutics, and vaccines.”
So, while the WHO’s PHEIC is not announcing the next pandemic, it is an important call to action for other countries to fund research on the disease and provide resources to African countries in need. Resources may involve supplies like vaccines or other treatments, should they become available. (Despite vaccines, there is not an mpox-specific drug on the market to treat people with active infections.)
CDC. Mpox in the U.S. August 16, 2024.
Research on infection pathways and potential treatments is also needed.
Education as a public health measure
Amer Aldeen, MD, FACEP, Chief Medical Officer of US Acute Care Solutions, a physician-owned provider of acute care hospital management, says he hopes this emergency declaration will act as a catalyst for more research on mpox.
“It's sort of a silver lining of outbreaks: the outbreak is what causes us to do the research,” Dr. Aldeen says.
“It's so, so much better when tons of people don't have to die in order to do the research,” he adds. “But pulling the trigger early on something like this can help prevent the spread through education, better research trials, and maybe developing an antiviral.”
He adds that stopping mpox spread may not be easy, but he is hopeful that it is possible. Among other prevention methods, avoiding close skin-to-skin contact is key, he says.
“If you can prevent skin-to-skin contact among multiple different people in crowded areas, I think we can contain this outbreak to where it is already endemic and prevent it from spreading internationally,” Dr. Aldeen says. “So as long as we're disciplined about that, I think we can control the spread much better than COVID in 2020.”
Discipline is crucial for people who are infected with mpox; they should not engage in close skin-to-skin contact activities with others, Dr. Aldeen adds. Educating people on the importance of quarantining while sick is also essential so that they know how to take care of themselves and others, he adds.
Since mpox is not reported to spread through respiratory droplets in the same way that COVID-19 does, Dr. Aldeen says, international travelers are likely not particularly vulnerable to catching the disease through travel alone. Still, he recommends not venturing into areas with high case numbers if you don’t have to.
What this means for you
The mpox virus is of international concern, following a global emergency declaration by the WHO. Current outbreaks are concentrated in African countries, and cases do not appear to have entered the US. Doctors and researchers in the US, however, can still play a role in educating people about the virus.
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