Africa CDC Declares First-Ever Public Health Emergency Amid Escalating Mpox Outbreak

A concerning strain of the monkeypox (mpox) virus is spreading quickly across Central Africa. This surge led the Africa Centres for Disease Control and Prevention (Africa CDC) to issue its first public health emergency on August 13. The World Health Organization (WHO) will meet on August 14 to consider a global emergency declaration.

These developments underscore the growing concern among scientists that this mpox outbreak, caused by the monkeypox virus, might escalate into a widespread epidemic. The virus has emerged not only in rural areas but also in densely populated urban centers.

The Africa CDC Declares an Emergency Amid Rising mpox Cases in Multiple Nations 

Mpox cases have surged in Central Africa over the past month, including in Bukavu, a city in the Democratic Republic of the Congo (DRC) with over one million residents. Four countries in the region have reported their first-ever mpox infections, likely linked to an outbreak that started in South Kivu province in late 2023. Violent conflict has devastated this region, complicating efforts to control the virus.

“With a heavy heart but with an unyielding commitment to our people, to our African citizens, we declare mpox as a public health emergency of continental security,” Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC), stated during an online media briefing.

He continued, “Mpox has now crossed borders, affecting thousands across our continent, families have been torn apart and the pain and suffering have touched every corner of our continent.” According to CDC data, by August 4, Africa had recorded 38,465 mpox cases and 1,456 deaths since January 2022.

Historical data suggests the viral strain circulating in Central Africa is more lethal than the one responsible for the 2022 global mpox outbreak, which infected over 95,000 people and caused more than 180 deaths.

Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who has studied mpox outbreaks in the DRC since 2002, emphasizes the global threat. “An infection anywhere is potentially an infection everywhere,” she says, highlighting the need for vigilance. “I hope we’ve moved beyond the idea that something happening far away can’t affect us,” she said, a nod to the widespread impact and devastating ripple effects revealed by the global COVID-19 pandemic.

Increased Vulnerability in Adolescents, Clade I & II Strain Differentiation

In 2024, African countries have reported more confirmed and suspected mpox cases than in the entire year of 2023, with 17,500 cases this year compared to about 15,000 last year. Children are particularly at risk, with around two-thirds of infections in the DRC occurring in individuals under the age of 15.

Recent data links many of these infections to clade II, the strain responsible for the 2022 outbreak. However, a growing number of cases are now attributed to clade I, which has historically caused limited outbreaks in Central Africa. Researchers in April identified a variant called clade Ib in samples from South Kivu, noting its efficient person-to-person transmission, including through sexual contact. This variant has spread rapidly, likely carried by mobile populations such as sex workers, into densely populated areas and neighboring countries. The ongoing humanitarian crisis in South Kivu further hampers efforts to track and treat infections, while the DRC also battles other diseases like cholera.

In the past month, Burundi, Kenya, Rwanda, and Uganda reported their first mpox cases. In early August alone, the DRC recorded nearly 2,400 suspected infections and 56 deaths. These alarming figures led Jean Kaseya, director-general of the Africa CDC, to declare a public health emergency, a power granted by the African Union in 2023.

The outbreak’s severity has prompted the WHO to consider whether this situation warrants a global emergency declaration, potentially requiring international coordination to control the virus’s spread.

Uncertainty Surrounding Clade Ib

Mpox causes painful, fluid-filled skin lesions and, in severe cases, death. The specific symptoms and dangers of the clade Ib strain, compared to clade II, remain unclear. “That’s the million-dollar question,” Rimoin says, noting the higher death rate associated with clade I.

Espoir Bwenge Malembaka, an infectious-disease epidemiologist at the Catholic University of Bukavu, points out that clade I’s higher mortality rate may not solely stem from its virulence. Poor access to healthcare in rural areas where clade I typically occurs could contribute to its lethality. Enhanced surveillance and cooperation among affected countries will be crucial for controlling the outbreak. However, treatments and vaccines, which were widely used in high-income countries during the 2022 outbreak, remain largely unavailable in Africa.

Vaccine Shortage and Global Response

The Africa CDC is negotiating with Bavarian Nordic, a Danish biotechnology company, to secure 200,000 doses of its two-dose mpox vaccine. However, this falls short of the 10 million doses that the Africa CDC estimates are needed to control the outbreak. Even if these negotiations succeed, delivering vaccines to regions with weak public-health infrastructure and to high-risk, stigmatized populations, such as sex workers and men who have sex with men, will be challenging. The vaccine’s effectiveness against clade Ib is still uncertain, but given the urgent situation, Rimoin insists this should not delay vaccine acquisition.

Rimoin also stresses the importance of avoiding vaccine stockpiling in high-income countries, as seen during the COVID-19 pandemic and the 2022 mpox outbreak. “It’s critically important to remember that our best bet to control outbreaks is to provide the countries at greatest risk for emergence and spread outward to have the tools needed to control outbreaks at the source,” she concludes. 

Author

Bernice Lottering