The World Health Organization (WHO) has declared mpox (formerly monkeypox) a public health emergency of international concern (PHEIC) for the second time. This declaration comes in response to a resurgence of cases, primarily in Africa, and the emergence of a new, more lethal variant. This renewed threat underscores the importance of global vigilance and coordinated action.
Resurgence of Mpox and a New Variant
Mpox, a viral disease closely related to smallpox, has historically been considered a zoonotic disease, primarily spreading from animals to humans. However, in 2022, widespread human-to-human transmission occurred globally, leading to over 90,000 cases and a PHEIC declaration. This declaration was lifted in May 2023 as cases declined.
This year, however, over 14,000 suspected or confirmed mpox cases and 524 deaths have been reported across 13 countries, mostly concentrated in the Democratic Republic of the Congo. While initial outbreaks involved an established lineage of the virus (clade I), a new, more lethal variant (clade Ib) is now spreading, with a mortality rate of 3-4%. The initial spread appears to have been primarily through sexual contact, mirroring the 2022 outbreaks. However, concerningly, cases are now increasing among younger children, healthcare workers, and within households, suggesting potential transmission through other forms of direct contact.
Symptoms and Transmission
Mpox typically presents with flu-like symptoms, headaches, and distinctive bumpy rashes or lesions across the body. Symptoms usually appear within 21 days of exposure. The virus can spread several days before symptoms appear and remains contagious until the rash fully heals (2-4 weeks). While any direct contact can potentially transmit the virus, the 2022 outbreaks saw predominantly sexual transmission among gay and bisexual men.
Global Response and Challenges
Following a public health emergency declaration by the Africa Centers for Disease Control and Prevention last week, the WHO’s PHEIC declaration highlights the global risk. WHO Director-General Tedros Adhanom Ghebreyesus emphasized the need for international collaboration to contain the outbreak and prevent further loss of life.
Although the U.S. has replenished its supply of the Jynneos vaccine, countries currently facing outbreaks lack sufficient access. Experts predict vaccine supplies will fall short of the planned 3 million doses for Africa by year-end. The WHO is expediting emergency vaccine approvals in lower-income countries and has allocated $1.45 million in emergency funding. Efforts are underway to coordinate vaccine donations from other countries and pharmaceutical companies, but more is needed. The WHO estimates $15 million is immediately required to fund surveillance, preparedness, and response activities and plans to appeal for further funding.
Conclusion: The Need for Continued Vigilance
The re-emergence of mpox as a global health emergency highlights the ongoing threat posed by this evolving virus. The emergence of a new, more lethal variant, coupled with increasing cases in vulnerable populations, necessitates a swift and coordinated international response. Increased funding, vaccine access, and public health measures are crucial to contain the outbreak and prevent further spread.
