AND OTHER EMERGENCIES
Week 9: 24 February - 2 March 2025
Data as reported by: 17:00; 2 March 2025
...
South Africa
Mpox
3 cases
0 Deaths
0.0% CFR
EVENT DESCRIPTION
The outbreaks of mpox in the African Region continue,
with new cases reported from South Africa. On 24
February 2025, the Government of South Africa notified
WHO of a new cluster of three mpox cases in Ekurhuleni
Metropolitan Municipality, Gauteng Province, following
laboratory confirmation.
The index case is a 30-year-old male resident of Brakpen
Township, Ekurhuleni District, Gauteng Province who
initially sought out-patient care from a general practitioner
in the same district on 27 January 2025 following onset
of illness on 24 January 2025. The initial symptoms for
which he sought care included painful lesions on the
face, body, and genital areas. On 4 February 2025
following worsening condition, he was admitted to
a private hospital, having presented with signs and
symptoms of headache, fatigue, and blister-like lesions
on his face, arms, and genital area. Attending clinicians
initially treated for herpes infection with antibiotics
and acyclovir, an antiviral medication used for herpes
virus infection. He did not improve with this treatment;
hence, he sought care from another general practitioner
who referred him to a dermatologist. By this time, the
patient had deveoped painful genital sores, painful
groin and scrotal pain, headaches, and pustules on his
face, palms, and soles. The dermatologist swabbed
the lesions for mpox testing at Lancet Laboratories on 6
February 2025 and prescribed analgesics, antibiotics,
and acyclovir before discharging the patient the same
day. Compassionate treatment with Tecovirimat was not
considered since the clinical presentation of the illness
was not severe. Test results returned on 21 February
2025, as positive for mpox virus infection by real-time
polymerase chain reaction (RT-PCR). Further testing of
the sample at the National Institute of Communicable
Disease (NICD) confirmed mpox infection, with genomic
sequencing identifying the strain as clade 1b mpox virus
(MPXV). The case-patient reportedly had recent travel
to a country in the African Region from 11 – 18 January
2025, where an ongoing outbreak of clade 1b MPXV has
been reported.
Following contact tracing by the Gauteng Provincial
Department of Health, seven (7) contacts were listed of
whom two were symptomatic with lesions on their bodies.
Samples collected from the symptomatic individuals
tested positive for mpox virus infection on 22 February
2025 at the NICD Laboratory. One is a 27-year-old
female, the partner of the index case, and the other is a
30-year-old male, a friend of the index case.
As of 24 February 2025, a total of three new cases
of mpox have been confirmed in Gauteng Province,
South Africa as of 24 February 2025. All patients are
undergoing treatment at home. This marks the first
documented cases of clade 1b MPXV in South Africa,
with the index case likely exposed during travel outside
of South Africa, where this strain is currently circulating.
South Africa previously reported an mpox outbreak in
2022, involving five cases, and another in 2024, with 25
cases and three deaths, with the last case reported on 6
September 2024 from Western Cape Province. Genomic
sequencing identified clade IIb MPXV as the circulating
viral strain in the previous outbreaks.
PUBLIC HEALTH ACTIONS
The health authorities in South Africa are responding to
the event through the provincial and district response
teams.
Enhanced surveillance and contact tracing activities are
ongoing. Standard case definitions are in place, with
reminders issued to health workers across the country
to heighten surveillance and enhance early detection
and treatment of mpox cases. Mpox remains among the
notifiable medical conditions in South Africa.
Visual health screening and symptom monitoring
continue at airports, seaports, and land crossings to
identify travelers who may have mpox.
Advanced capacities for diagnostic and genomic
sequencing of MPXV are in place across a network
of clinical laboratories and at the National Institute of
Communicable Disease.
Clinical care is being provided to the case-patients
according to the national treatment protocol.
Healthcare facilities have dedicated wards for isolation
and treatment of mpox cases and standardized infection
prevention protocols for effective clinical management.
SITUATION INTERPRETATION
The detection of a new mpox outbreak in South Africa,
likely due to the index case’s exposure outside the
country, highlights the persistent risk of transnational
spread due to global interconnection and population
mobility amid ongoing outbreaks across the African
region, emphasizing the need for global collaboration
in containment efforts. While South Africa has
demonstrated strong surveillance, laboratory, and
clinical management capacities, as evidenced by rapid
genomic sequencing and contact tracing activities,
gaps remain in early clinical recognition and diagnostic
turnaround time. The delayed confirmation of the index
case and initial misdiagnosis as herpes underscore the need for investment in training and sensitization of clinicians
and surveillance officers, particularly with the introduction of Clade 1 MPXV, which has historically been associated
with more severe disease. To prevent further spread, the country must enhance surveillance, including identification of
all contacts of the cases, improve early detection in healthcare settings, and strengthen risk communication provide
awareness, promote preventive practices, and encourage health-seeking behaviour.
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