South Africa: 2024 Mpox

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Source: https://www.sanews.gov.za/south-afri...keypox-disease


SA records a case of monkeypox disease
Monday, May 13, 2024

The Minister of Health, Dr Joe Phaahla, is urging the public to be vigilant as the country has reported a laboratory-confirmed case of monkeypox disease, also known as Mpox.

The case involves a 35-year-old male, who resides in the Gauteng province and tested positive on 9 May 2024.

The case was first tested by Lancet Laboratory, which was later confirmed by the National Institute for Communicable Diseases (NICD) and immediately notified the department.,,

[Shiloh]

Source: https://www.sanews.gov.za/south-afri...-disease-cases

SA records two more monkeypox disease cases
Thursday, June 6, 2024

The Department of Health is appealing to citizens who have been in close contact with known or suspected patients of monkeypox disease, also known as Mpox, to go to their nearest health facility.

This is after the National Institute for Communicable Diseases (NICD) detected two more cases of Mpox this week at Addington and St Augustine Hospitals in Durban, KwaZulu-Natal.

“The preliminary case finding report has revealed that the two recent cases had contact with the other previously confirmed case in the province, and this suggests that there is a local transmission of the disease, which could potentially lead to a larger outbreak in the province,” the department said in a statement.

This brings the total number of laboratory-confirmed infections in the country to four, with three in KwaZulu-Natal and one in Gauteng...

[Pathfinder]

Minister Joe Phaahla on outbreak of Mpox disease in South Africa and efforts to curb the spread

12 Jun 2024

A global outbreak of Mpox disease, formerly known as Monkey pox, has been ongoing since 2022. Mpox is a notifiable medical condition which the Health Care Workers are required to report all the suspected and confirmed cases. Notifiable Medical Conditions refer to diseases that are of public health importance because they pose significant public health risks that can result in disease outbreaks or disease epidemics with high case fatality rates both nationally and internationally.

The last time South Africa recorded positive cases of Mpox was in 2022 when five cases confirmed in the Western Cape, KwaZulu-Natal, Limpopo and Gauteng, with no cases reported in 2023. According to the World Health Organization multi-country outbreak of mpox published on 31 May 2024, cumulatively from 01 January 2022 through 30 April 2024, a total of 97 208 laboratory confirmed cases of mpox, including 186 deaths from 117 countries in all six WHO regions were reported. A total of 528 new laboratory-confirmed cases were reported in April, which represents a 21.2% decline in the number of new cases reported during the preceding month of March, including retrospectively reported for previous months.

The most affected WHO regions, in order by number of laboratory-confirmed cases, were the Region of the Americas, the African Region, the European Region, the South-East Asia Region, and the Western Pacific Region. In the African Region, the DRC reported the most (99.6%) of the confirmed mpox cases in the reporting month.

The disease is caused by the monkeypox virus (MPXV), an orthopoxvirus that transmits from person to person through close contact, and from unknown animal reservoirs in East, Central, and West Africa. This multi-country Mpox outbreak is characterised by sustained human-to-human transmission via direct skin-to-skin and sexual contact; people living with HIV are disproportionately affected.

South Africa is amongst the countries currently experiencing the outbreak of Mpox, a viral infection which spreads between people and occasionally from the environment to people via objects and surfaces that have been touched by a person with mpox.

South Africa has recorded a total number of 5 laboratory-confirmed cases and one death. Two of these cases were confirmed in Gauteng and three in KwaZulu-Natal. The death that occurred is amongst the two cases reported in Gauteng. The patient passed-on on Monday, 10 June 2024 in Tembisa Hospital. All cases/patients are males aged between 30-39 years without travel history to the countries currently experiencing an outbreak, which suggests there is local transmission of this infectious disease in the country.

All five cases were classified severe cases as per WHO definition requiring hospitalisation. The cases have co-morbidities and have been identified as key populations, Men who have Sex with Men (MSM). Thus, the Department is reaching out to organisations working on HIV programmes and with key populations in addition to other stakeholders to implement targeted communication to intensify awareness about the outbreak and local transmission of the disease.

One patient has been discharged, one discharged for home isolation and follow ups being made. Two cases are still admitted in hospital. Sequencing analysis of three of the cases revealed mpox clade IIb, in keeping with the multi-country mpox outbreak which began in 2022.

Breakdown of the cases

Cases	Confirmation Date	Area/Province	Age	Hospitalised
Case 1	8 May 2024	Sedibeng, GP	35	Yes
Case 2	21 May 2024	eThekwini, KZN	39	Yes
Case 3	31 May 2024	eThekwini, KZN	30	Yes
Case 4	03 June 2024	eThekwini, KZN	33	Yes
Case 5	07 June 2024	Tembisa, GP	37	Yes

All National Health Laboratory Service (NHLS) laboratories have been sensitised to the ongoing outbreak and are referring samples for testing to the NICD. Private sector laboratories are also testing for mpox while NICD serves as the reference laboratory. Since the beginning of 2024, the NICD has received twelve mpox test requests, with three testing positive. The other two cases were diagnosed by private laboratories. Guidelines have been updated and shared widely across networks of healthcare workers using various platform.

Epidemiology and Surveillance

The National Institute for Communicable Diseases (NICD) continues with epidemiological and surveillance activities to identify cases for investigation to estimate the magnitude of disease through systematic data collection and analysis. A total of 38 contacts were identified in KwaZulu-Natal by the outbreak response teams. The contacts include household contacts (16), hospital contacts (10), partners/sexual partners (5) and friends (7). One of the cases indicated to have had sexual contact with multiple partners including both males and females.

Regarding the case notified on the 08 May 2024 in Gauteng, seven (07) contacts have been followed up for 21 days, and none showed any signs and symptoms of mpox. Regarding the case notified on the 07 June 2024, the line list of the identified contacts was developed, they will be monitored for symptoms for a period of 21 days. Attempts will be made to identify other additional contacts.

The provinces have been notifying all the cases that meet the case definition of a suspected mpox case in the Notifiable Medical Condition (NMC) System. Meanwhile, the Outbreak Response Team comprising of experts from the Department, provinces, NICD, WHO and other stakeholders in the health sector have embarked on contact tracing and case finding in the affected provinces.

Treatment

At the current moment, there is no registered treatment for Mpox in South Africa. However, the World Health Organization recommends the use of Tecovirimat (known as TPOXX) for treatment of severe cases, such as in individuals with a CD4 count of less than 350. However, the Department has obtained Tecovirimat via Section 21 SAPHRA approval on compassionate use basis for the five known patients with severe disease.

Three of the five cases had access to Tecovirimat treatment as advocated by the NICD. The drug was obtained via Section 21 and the SAPHRA approval process; and donated by the WHO. SAPHRA has since approved a request for a small stockpile of Tecovirimat which the WHO will support as a donation. Our intention is to obtain a stockpile of Tecovirimat treatment for rapid deployment in case the current situation leads to a wider outbreak. The stock will be donated by the World Health Organization.

As far as the vaccine is concerned, options are being considered as to which population groups should be targeted. South Africa is trying to source vaccine from WHO member countries who have stockpiles that exceed their needs as well as from GAVI. These vaccines will be stored and distributed from our provincial depots.

Additional intervention is being considered, as National Advisory Group for Immunisation (NAGI) Technical Working Group for Mpox vaccines has been appointed and is considering mpox vaccine for both pre and post-exposure administration for high-risk groups, including but not limited to sex workers, men-who-have-sex-with-men, healthcare workers and laboratory workers.

Risk Communications

The Department working together with partner organisations, has intensified both targeted and public awareness using various channels of communications to empower the citizens with crucial information related to Mpox to make well informed health decisions. As part of additional efforts to increase opportunity for engagement, a clinical management webinar has been convened and was attended by five-hundred healthcare workers and public health professionals from across the country.

However, the most important intervention at present remains risk communication and community engagement (RCCE), which is being implemented, including addressing the high-risk population without discriminating to avoid stigma. We are also reaching out to organisations working with the HIV programmes and key populations such as the MSM to reach their members since they fall under the category of people at risk.

Although, the World Health Organization has not recommended any travel restrictions, it is important for travellers to and from endemic countries to alert health officials on the situation to enable them to provide guidance for case detection and management. We can prevent further spread of this infectious disease if those with suspected symptoms or who were in contact with known cases/patients present themselves at health care facilities on time for early diagnosis and effective treatment.

We can disrupt the local transmission by supporting those diagnosed with this disease to take their treatment to prevent infecting others. We can prevent avoidable deaths by cooperating with health officials when they conduct contact tracing and case finding.

One death is too many, especially from a preventable and manageable disease like mpox.

I thank you.

Issued by
Department of Health
...

https://www.gov.za/news/media-statements/minister-joe-phaahla-outbreak-mpox-disease-south-africa

[Shiloh]

Source: https://www.bbc.com/news/articles/clddgx7vg6qo

Second person dies from mpox in South Africa
12 hours ago
By Rafieka Williams, BBC News, Johannesburg

A second person has died from mpox in South Africa, the health minister has announced, less than 24 hours after the country's first death from the virus was reported.

The two men, aged 37 and 38, were tested and shown to have died as a result of the virus, said minister Joe Phaahla.

Mr Phaahla said that six cases had now been recorded in the country this year - two in Gauteng, and four in KwaZulu-Natal.

They were all classed as severe and required hospitalisation.

All diagnosed men were aged between 30 and 39, who had not been to other countries experiencing an outbreak - suggesting that the disease was being transmitted locally....

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Source: https://africacdc.org/news-item/mpox...-south-africa/


Mpox Outbreak in South Africa

Addis Ababa, 13 June – On 13 May 2024, the Government of South Africa announced an outbreak of Mpox following the confirmation of a case from Gauteng province with no travel history to countries with an active Mpox outbreak. As of today, a total of 7 laboratory-confirmed cases and two deaths (Case Fatality Ratio – CFR: 28.6%) were reported from Gauteng (3/7), KwaZulu-Natal (3/7), and Western Cape (1/7) provinces. The cases were confirmed at the National Institute for Communicable Diseases (NICD) of South Africa.

All the cases were classified as severe cases of Mpox and required hospitalization. All cases are male, between the ages of 30 and 39 with co-morbidities (HIV-positive), and five of the seven identified as “men who have sex with men.”

Preliminary investigations indicate that all the confirmed cases had no history of travel to countries with ongoing Mpox outbreaks.

Available sequence data from three cases revealed the circulation of Clade IIb in South Africa. Clade IIb led to the largest multi-country Mpox outbreak in 2022.

The Ministry of Health has deployed rapid response teams to support further investigations. Contacts of the confirmed cases are being monitored for 21 days. Additionally, active case search, case management, and risk communication are ongoing in affected communities.

On June 13, 2024, H.E. Dr. Jean Kaseya, Director General of Africa CDC, met with Hon. Joe Phaahla, Minister of Health, and Dr. Sandile Buthelezi, Director General of the National Department of Health, to assess the situation and coordinate the response to this outbreak.

“At Africa CDC, we commend the leadership and efforts of the South African government in managing this outbreak and appreciate the support from partners like WHO. We are committed to supporting South Africa in securing the necessary doses of Mpox vaccines, and building capacity for event-based surveillance focusing on community and health facility. An Mpox outbreak anywhere is a threat everywhere. We call for swift and urgent action to increase access to Mpox diagnostics, vaccines and therapeutics for all affected African countries.” – said Dr. Jean Kaseya, the Director General of the Africa CDC.

Since January 2024, seven African countries have reported Mpox, with a total of 8,401 cases and 412 deaths as of June 14, 2024. Notably, 97% of these cases are from the Democratic Republic of Congo.

In response to this dire situation, Africa CDC held a high-level emergency meeting on Mpox in the DRC in April 2024. The meeting underscored the critical need for timely, accurate, and high-quality data on the Mpox to inform decision-making and program interventions. Ministers of Health from Angola, Benin, Burundi, Cameroon, Central African Republic, Congo, Democratic Republic of Congo, Gabon, Ghana, Liberia, Nigeria, and Uganda, along with partners, emphasized the urgent need to strengthen preparedness and response to Mpox in Africa. They highlighted the necessity for cross-border integrated disease surveillance and a coordinated supply of medical countermeasures like diagnostics, vaccines and therapeutics as part of the Pathogen Access and Benefit Sharing (PABS).

Mpox is a zoonotic viral disease that mainly infects humans and animals (e.g., rodents and primates). Mpox can be transmitted through direct contact (e.g., contact with lesions, body fluids, or contaminated materials) with infected animals or humans or exposure to their respiratory droplets. The Case Fatality Ratio (CFR) of Mpox ranges between 0-11% in the general population.

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Source: https://www.news24.com/news24/southa...ation-20240621

5h ago
Mpox cases rise to 13, as health department receives first batch of disease-specific medication
accreditation
Nicole McCain

South Africa has recorded another six cases of Mpox in Gauteng and KwaZulu-Natal, bringing the total to 13. The death toll remains at two.

Department of Health spokesperson Foster Mohale said: "Seven of the [total number of] cases were confirmed in KwaZulu-Natal, five in Gauteng and one in the Western Cape."

Mohale also said the department had received its first batch of Mpox-specific treatment, Tecovirimat, also known as TPOXX or ST-246, for treating patients who experience severe health complications due to the disease...

[Shiloh]

Source: https://www.dailymaverick.co.za/arti...ses-confirmed/

South Africa’s mpox outbreak death toll rises to three, 16 cases confirmed
By Naledi Sikhakhane
26 Jun 2024
The number of laboratory-confirmed mpox cases in SA has climbed to 16 since the outbreak of the disease in May and the death toll has risen to three. Eight cases have been recorded in KwaZulu-Natal, seven in Gauteng and one in Western Cape.

The Department of Health gave an update on the mpox outbreak and response efforts on Tuesday evening and confirmed that South Africa had recorded three more positive cases of mpox (formerly known as monkeypox).

One new death was recorded, bringing the number of deaths to three as efforts to curb the spread of the infectious disease are ongoing in affected communities around the country.

The first batch of mpox-specific treatment was received last week. The medicine, Tecovirimat (also known as TPOXX or ST-246), is used to treat patients who experience severe health complications as a result of mpox.

The health department said it was securing more mpox medication, including vaccines, adding that all mild cases would continue to be managed with supportive treatment for complications like fever, pneumonia and skin infections.

“The latest cases/patients include a 40-year-old male from Ladysmith in KwaZulu-Natal who presented with mpox-like symptoms including a rash all over his body and never presented in hospital,” the department said.

The 40-year-old died at home and the results came back positive for mpox on 23 June.

The other two new cases were confirmed in Gauteng, including a 43-year-old man who was diagnosed on 22 June at a private health facility in Johannesburg, and a 29-year-old male diagnosed at a Mamelodi health facility on 21 June...

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Source: https://www.sanews.gov.za/south-afri...ected-increase


Mpox cases rise to 20 with infections expected to increase
Friday, July 5, 2024

Four additional Mpox cases have been reported in KwaZulu-Natal and Gauteng, with infections expected to rise as contact tracing efforts are stepped up.

This pushes the total number of laboratory-confirmed cases of Mpox in South Africa to 20 since the outbreak in May 2024.

According to the Department of Health’s data, all cases involve males aged between 17 to 43 years old.

The recent infections include a 17-year-old man from Hillbrow in Johannesburg, a 37-year-old from Pretoria East, a 29-year-old from West Rand, and a 19-year-old from Durban in KwaZulu-Natal.

Of the 20 cases, 10 were recorded in Gauteng, nine cases in KwaZulu-Natal and one from Western Cape.

Meanwhile, the death toll has remained at three since the outbreak...

[Pathfinder]

Mpox - South Africa

9 July 2024

Situation at a glance

The International Health Regulations (IHR) National Focal Point (NFP) of the Republic of South Africa notified WHO of 20 confirmed mpox cases between 8 May and 2 July 2024, including three deaths (case fatality ratio (CFR) of 15%). These cases were reported in three of nine provinces: Gauteng (10 cases; 1 death), Western Cape (1 case), and KwaZulu-Natal (9 cases; 2 deaths). These are the first cases of mpox reported in South Africa since 2022 when the country had reported five cases, none of which were severe, and no deaths. The persons affected are men aged between 17 and 43 years old, and of the first 16 cases, 11 self-identified as men who have sex with men (MSM). At least 15 cases are living with HIV with unmanaged or only recently diagnosed HIV infection, and have advanced HIV disease (AHD), and one case has diabetes. The type of exposure contact reported by cases is sexual contact. Eighteen of the patients required hospitalization. Several response measures have been put in place by national health authorities with the support of WHO. The sudden appearance of these cases none of whom reported any history of international travel, the extremely high HIV prevalence among confirmed cases, and the high case-fatality ratio suggest that the confirmed cases are only a small proportion of all cases that might have occurred, and that community transmission is ongoing. The risk to human health for the general public remains low in the country. The risk for gay men, bisexual men, other men who have sex with men, trans and gender-diverse people, and sex workers is moderate. There is potential for increased health impact should wider dissemination among these and other vulnerable groups in South Africa and neighbouring countries continue. This event emphasizes that the global mpox outbreak linked to clade IIb monkeypox virus (MPXV) is still ongoing, and the risk of cross-border and international spread persists in all WHO regions.

Description of the situation


The IHR NFP of the Republic of South Africa notified WHO of 20 confirmed mpox (monkeypox) cases between 8 May and 2 July 2024, including three deaths (CFR 15%). These cases were reported in three of nine provinces: Gauteng (10 cases; 1 death), Western Cape (1 case), and KwaZulu-Natal (9 cases; 2 deaths).

The cases are all male, aged between 17 and 43 years, and almost all self-identified as men who have sex with men (MSM). Most are persons living with HIV, with unmanaged or only recently diagnosed HIV infection and advanced HIV disease (AHD), and one has diabetes. All cases were symptomatic, with extensive skin lesions and 18 required hospitalization. None of the confirmed cases reported a history of international travel and none reported attending high-risk social gatherings. The type of exposure reported by cases is sexual contact.

For the first 16 cases overall, 44 contacts were identified in KwaZulu-Natal, 39 contacts in Western Cape, and 55 in Gauteng province. While three of the four initial cases in KwaZulu-Natal were epidemiologically linked through contact tracing, at least the initial seven in Gauteng province were not found to be epidemiologically linked, suggesting community transmission is underway. Individual contact tracing for recent cases is ongoing. In addition, limited information suggests that some affected persons have attended and been exposed to mpox at parties or clubs where sexual activity occurs.

Genomic sequencing, available for five confirmed cases has identified sub-clade IIb MPXV, the clade linked to the multi-country mpox outbreak.

During the ongoing 2022-2024 multi-country outbreak, five mpox cases had previously been confirmed in South Africa, during the peak in June-August 2022, and all had reported travel abroad. None of the cases were severe. No cases were reported in 2023.

Figure 1. Geographic distribution of reported mpox cases and deaths, South Africa, 8 May to 2 July 2024 (n=20)

Epidemiology


Mpox is an infectious disease caused by the monkeypox virus (MPXV). There are two known clades of MPXV: clade I, previously called the Congo Basin clade; and clade II, previously called the West African clade, which includes subclades IIa and IIb. MPXV transmits between humans through close contact with lesions, body fluids, respiratory droplets or contaminated materials, or from animals to humans through contact with live animals or consumption of contaminated bushmeat. Mpox causes signs and symptoms which usually begin within a week of exposure but can start 1–21 days later. Symptoms typically last 2–4 weeks but may last longer in someone with a weakened immune system. Fever, muscle aches and sore throat appear first, followed by skin and mucosal rash. Lymphadenopathy (swollen lymph nodes) is also a typical feature of mpox, present in most cases. Children, pregnant women and people with weak immune systems are at risk of developing complications and death from mpox.

It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also concurrently have another sexually transmissible infection such as herpes. Alternatively, a child or adult with suspected mpox may have chickenpox. For these reasons, laboratory testing of skin specimens obtained by swabbing is important for confirmation of mpox, particularly for the first cases in an outbreak or new geographic area, and implementation of public health and social measures to curb transmission.

Treatment is based primarily on managing clinical symptoms, ensuring skin care, reducing pain, and preventing and managing complications. Where available through emergency or compassionate use programmes, specific antiviral medications such as tecovirimat can also be used in the treatment of mpox, particularly for severe cases or individuals at higher risk of complications.

Public health response


Coordination

• Establishment of a national mpox Incident Management Team (IMT), with biweekly multisectoral coordination meetings with provincial mpox response coordination.
• Mapping of implementing partners and non-governmental organizations at national, provincial, district and sub-district levels for coordination of response activities.
• Ministerial press briefing on mpox held on 12 June 2024.
• The National Department of Health issues regular mpox media statements emphasizing prevention measures and addressing stigma.

Surveillance

• Outbreak response teams deployed and supporting outbreak investigations.
• Ongoing contact tracing and active case search.
• Generation of weekly national mpox situation reports.

Laboratory:

• Mpox clinical specimen collection and processing guidelines updated and disseminated to health facilities.
• All public health facilities refer samples through the National Health Laboratory Service (NHLS) network to the National Institute for Communicable Disease (NICD) for testing.
• Private health facilities can test for mpox and send specimens for sequencing to the NICD.
• Target turnaround time for testing and reporting on results for suspected cases and symptomatic contacts is within 24 hours.
• Increasing testing capacity through decentralizing testing to include private laboratories.
• Preparations are underway to roll out mpox environmental surveillance leveraging established wastewater surveillance sites.

Case management:

• Implementation of immediate isolation of suspected and confirmed cases in a hospital or, for non-severe disease, at home, to prevent transmission.
• Fast tracking approval of national clinical guidelines and circulation to all public and private healthcare facilities.
• Ongoing capacity building for health and care workers, including a clinical management webinar attended by over 500 health professionals, to update clinicians on mpox case detection, clinical care, and infection prevention and control; provinces conducting training for healthcare workers.
• Supplemental clinical care, including mental health and psychological support for health workers, patients and their relatives prioritized for inclusion in case management guidelines, plans, and trainings.
• The Department of Health obtained authorization for use of tecovirimat from the South Africa Health Products Regulatory Authority (SAHPRA).
• Tecovirimat application through Section 21 (SAHPRA) and 15 courses of tecovirimat provided to South Africa by WHO.

Risk Communication and Community Engagement (RCCE):

• Messages developed to support risk communication and community engagement, which integrates aspects of sexual transmission of mpox.
• Risk communication messages translated into local languages and aligned with context.
• Sensitization of affected communities initiated in KwaZulu-Natal and Gauteng provinces; training for Health Promoters and other stakeholders conducted in Gauteng.
• Health promoters conducting health promotion talks at clinics and community settings on mpox as part of routine health promotion activities.
• Public awareness event at Braamfontein, Johannesburg conducted mid-June 2024, in conjunction with non-governmental organizations (NGOs).
• Engagement with relevant National Department of Health (NDoH) programmes to support RCCE activities (e.g., STI, HIV, TB etc.).
• Identified and engaged NGOs working with key populations (e.g., MSM).
• Partners engaged in awareness building during the Pride event in Durban.
• Regular online updates through the NICD webpage. Link

Vaccination strategies and research initiatives:

• National Advisory Group on Immunization (NAGI) Technical Working Group mpox vaccine recommendations for South Africa endorsed by the National Department of Health.
• Risk groups for pre-exposure vaccination include men who have sex with men, health workers and laboratory personnel while sexual, household, and health facility contacts will be offered post-exposure vaccination.
• Discussions are underway regarding options for vaccine procurement.
• WHO and partners supporting the development of vaccination strategies for emergency response and discussions regarding clinical vaccine studies for vaccines and therapeutics.

Infection Prevention and Control (IPC)

• Reviewing IPC action plans for health facilities and the community.
• Refresher training conducted for IPC staff.
• Guidelines on the safe management of human remains and burial updated and distributed, including training for undertakers.

Continuity of essential health services (CEHS)

• The affected provinces are conducting health facility readiness assessment to identify gaps.
• The mpox IMT is working to integrate prevention, screening and management of mpox into HIV and STI care in the Key Populations programme of the National Department of Health.

Equipment and resources:

• Logistics support was provided for the collection, transport, and examination of samples from suspected cases.
• Equity Pharma working with NDoH- Affordable Medicine Directorate (AMD) regarding access to therapeutics.

WHO risk assessment


The sudden appearance of unlinked cases of mpox in South Africa without a history of international travel, the high HIV prevalence among confirmed cases, and the high case fatality ratio suggest that community transmission is underway, and the cases detected to date represent a small proportion of all mpox cases that might be occurring in the community; it is unknown how long the virus may have been circulating. This may in part be due to the lack of early clinical recognition of an infection with which South Africa previously gained little experience during the ongoing global outbreak, potential pauci-symptomatic manifestation of the disease, or delays in care-seeking behaviour due to limited access to care or fear of stigma.

At present, most of the transmission in the initial cases is linked to recent sexual contacts among men, similar to the spread in newly affected countries during the 2022-2024 multi-country outbreak. For most confirmed cases, no epidemiological link has been established, possibly due in part to incomplete contact identification. This suggests that undetected community transmission is occurring and that further cases can be expected as surveillance is strengthened. The current risk to human health for the general public remains low in the country. The risk for gay men, bisexual men, other men who have sex with men, trans and gender diverse people, and sex workers is moderate, as currently assessed for the global outbreak. The higher risk assessment is consistent with ongoing transmission among recognized risk groups due mainly to exposure through sexual contact, and the higher prevalence of undetected or uncontrolled HIV infection in the country which also puts people at risk of severe disease. There is potential for increased health impact should wider dissemination continue in vulnerable groups in South Africa or neighbouring countries. Data from ongoing mpox outbreaks show that the risk of severe disease and death is higher among children, immunocompromised individuals including persons with poorly controlled HIV, and pregnant women.

The most recent Joint United Nations Programme on HIV/AIDS (UNAIDS) data estimate HIV prevalence among men who have sex with men in South Africa to be around 30%, only 44% of whom are on antiretroviral therapy. This makes this group extremely vulnerable to severe mpox disease and death. There is also a hazard to health workers if they are not appropriately using personal protective equipment (PPE) when caring for patients with mpox.

Prior to 2022, the CFR for clade II MPXV in West Africa was estimated to be 3.6% (95% CI: 1.7%, 6.8%). Case fatality in the ongoing multi-country outbreak (0.2%) is the lowest recorded for MPXV clade II. In contrast, the CFR among cases reported in South Africa in 2024 is extremely high (15%), as most detected cases are among persons who are immunocompromised with uncontrolled HIV and other co-morbidities. Persons with less severe mpox are less likely to recognize the condition or seek diagnosis and care; therefore, such cases may remain undetected and unreported.

Vaccination with mpox vaccines has been shown to be effective against mpox. The last case of smallpox in South Africa was reported in 1972, and smallpox vaccination stopped shortly after the global eradication of the disease in 1980. Thus, any immunity from prior smallpox vaccination (which is cross-protective for mpox) will at best now only be present in some persons over the age of 44 years. The median age of mpox cases in the current global outbreak is 34 years (IQR: 29 - 41) and within South Africa, reported cases are aged between 17-43 years.

The limited awareness of mpox and lack of knowledge about practices for prevention among health workers and among key populations such as sex workers or men who have sex with men in the country exacerbates their risk for mpox. Anyone suffering from disfiguring skin conditions, including mpox, may experience fear and stigma, which can be further compounded for key populations.

There is concern that the mpox outbreak in South Africa will continue to evolve given:

• The high likelihood of under-detection and under-reporting of local transmission, given that reported cases have to date almost exclusively affected the most vulnerable.
• Currently, all detected cases have presented with severe disease and extensive skin lesions, which could lead to more viral transmission and risks poor outcomes for the patients.
• While the government and partners are mobilized to introduce treatment for affected patients and vaccines for people at risk, these countermeasures are not yet widely available in the country.
• Public awareness of mpox and information about modes of transmission or possible amplifying events or risk of exposure in sex-on-premises venues remains limited in South Africa.
• Concurrent outbreaks of mpox are occurring in Africa and elsewhere, increasing the risk of further transmission.

WHO advice


General

Health authorities and clinicians/health and care workers of all countries should be aware that the global mpox outbreak linked to clade IIb MPXV is ongoing in all WHO regions and the risk of cross-border and international spread exists. National reporting to WHO is less complete and timely in recent months, and the number of cases continues to be underestimated globally.

WHO strongly advises that countries continue to follow the Standing Recommendations issued by the Director-General in August 2023, particularly concerning the epidemiological surveillance of mpox.

Countries should continue to strengthen the availability of and access to laboratory diagnostics in line with updated WHO interim guidance, including genomic sequencing of viruses. Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. However, while a positive result of oropharyngeal, anal or rectal sample confirms mpox, a negative result is not enough to rule out MPXV infection. Testing of blood is not recommended. Serology does not distinguish between different orthopoxviruses and is therefore restricted to reference laboratories where antibody detection methods may be applied for retrospective case classification or in special studies.

There must be sustained implementation of risk communication and community engagement appropriate to each context, maintenance or initiation of vaccination for persons at risk, optimal case management, adherence to infection control measures, strengthening research to better appreciate modes of transmission in different contexts, and sustained support for the development of rapid diagnostic methods and treatments adapted to the needs of patients.

Health authorities should strive to achieve the elimination of human-to-human transmission of mpox and ensure the maintenance of capacity for outbreak response. Anyone with a clinical or laboratory-confirmed diagnosis of mpox should follow the instructions of health authorities according to the local context, including isolation during the infectious period. Contacts of a confirmed case are asked to limit their movements (and advised to abstain from sexual relations) for 21 days, the monitoring period for the appearance of possible symptoms.

Vaccination against mpox is recommended for people possibly at risk of contracting the disease. Specific antiviral treatments are currently being assessed for efficacy against mpox, such as tecovirimat. Access to tecovirimat is possible through national application for use under the WHO MEURI protocol or request to WHO for access to the reserve for compassionate use.

It is essential to deepen knowledge in different contexts on optimal case management in the event of mpox and HIV co-infection, especially for patients who must initiate antiretroviral treatment.

In the community

Risk communication and community engagement activities are vital in motivating affected communities to become aware of the risks and protective behaviours, and to understand, prevent and combat stigma and discrimination. In this outbreak, there is continuing risk of exposure to mpox in the community through sexual activity in high-risk settings where multiple sexual contacts may occur.

Key audiences should be identified and advice provided to health professionals, community organizations, managers of events and sex-on-premises venues, key populations including commercial sex workers, men who have sex with men, trans and gender-diverse individuals, people working at or attending venues and events where sexual activity takes place, and people at risk of more serious illness (including persons living with untreated or poorly controlled HIV infection). To keep venues safe, a risk-based approach is recommended, including risk evaluation, risk mitigation and risk communication for personnel and clients, accompanied by rigorous environmental infection prevention and control practices.

Patients without severe disease who can isolate at home should be given advice on how to care for themselves. This includes advice for taking care of the rash (don't scratch, clean your hands before and after touching lesions, keep your rash clean with sterilized water/antiseptic etc.) and supporting the patient’s mental health (keep hydrated, eat well, get enough sleep, use medication for pain and fever if needed, do things you find relaxing/enjoyable etc.) Mental health and psychosocial support are essential for patients with mpox in all settings regardless of context. The details on public health advice on recovering from mpox at home are accessible in this link.

Health and care workers who provide care to patients in the community and/or household settings should refer to WHO Interim Rapid Response Guidance on case management and infection prevention and control for mpox for guidance on the IPC measures recommended. It is vital that infection control measures be implemented to prevent and stop transmission of mpox in household and community settings that may amplify risk.

In healthcare settings

Implementing IPC measures in health care settings is necessary to prevent and stop the transmission of mpox. It is important to train staff on mpox and the appropriate control measures, such as standard and transmission-based precautions. Staff should also have access to and appropriately wear personal protective equipment, adhere to the WHO 5 Moments for hand hygiene, ensure frequent cleaning and disinfection of the patient environment, and implement appropriate patient placement and isolation. For further guidance on IPC measures required when caring for patients with mpox, please refer to WHO interim guidance Clinical Management and Infection Prevention and Control for monkeypox.

While protecting themselves with recommended measures, health and care workers should also ensure that stigmatization of patients with mpox is avoided and that psychological support is provided to patients and their families.

At points of entry

It is recommended to encourage authorities, health and care workers and community groups to provide travellers with relevant information to protect themselves and others before, during and after travel to events or gatherings where mpox may present a risk. WHO advises against any travel and trade restrictions based on available information on the current outbreak.

As not all viral genomes from these cases have yet been sequenced, and there is known extensive commercial and professional exchange between South Africa and central Africa, it is also critical to remain vigilant regarding the possibility of importation of clade I strains to South Africa.

...

https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON525

[Shiloh]

Source: https://www.sanews.gov.za/south-afri...ol-says-health


Mpox outbreak remains under control, says Health
Thursday, July 18, 2024

The Department of Health has reassured South Africa that the current Monkeypox, or Mpox, disease outbreak remains under control.

This is despite several suspected cases reported across the country due to heightened awareness and surveillance activities, the department said on Thursday.

The Gauteng Department of Education retracted a statement this morning after it said a case of the infectious disease was reported at a Hammanskraal school in Gauteng.

The provincial department admitted that it may have “acted prematurely” in confirming the case without verification from the National Institute for Communicable Diseases (NICD) and apologised for the confusion.

According to the Department of Health, there have been 22 positive cases reported since May of this year. This includes 16 recoveries, three deaths and three active cases...

[Shiloh]

Source: https://www.sowetanlive.co.za/news/s...-hammanskraal/


First Mpox case at Gauteng school reported in Hammanskraal
18 July 2024 - 11:25
Koena Mashale Journalist

The first case of Mpox at a Gauteng school was reported at a primary school in Hammanskraal, north of Pretoria.

This was after a grade 1 pupil from Iketleng Primary School was diagnosed with the infectious disease after displaying the symptoms.

According to the Gauteng department of education, this was confirmed by the pupil's parents on Tuesday after taking the child to hospital.

Spokesperson Steve Mabona said the child visited relatives in Boplaas, Northern Cape, this past weekend, where it’s alleged some of the relatives were displaying symptoms of Mpox.

“Upon returning home, the learner reportedly had itchy sores and was taken to hospital on Monday where the diagnosis was reported as Mpox...,
+++++++++++++++

Source: https://www.news24.com/citypress/new...eport-20240718

18 Jul
Mpox scare at Hammanskraal school: Gauteng education department retracts premature confirmation
accreditation
Thapelo Lekabe and Zamokuhle Ndawonde

The Gauteng department of education caused a stir among parents on Thursday after announcing and then retracting a statement confirming the first case of Mpox (formerly known as monkeypox) at a public school in Hammanskraal, north of Pretoria...

[sharon sanders]

In 2024 so far -

24 cases, 3 deaths - ALL clade IIb

all are males, immune comprised and sex transmission

via WHO mpox media event August 28, 2024

[sharon sanders]

Mia Malan
@miamalan
·
3h


JUST IN: SA has 1 more #mpox case, bringing total nr to 25. All cases = clade 2B - the (relatively) new strain, 1B, has not been found in SA yet: - New case = male, 38, Cape Town, not hospitalised, diagnosed = 6 Sep - 25 cases: GP = 12; KZN = 11; WC = 2 - deaths = 3