sharon sanders
Editor-in-Chief & President
hat tip @KrutikaKuppalli
Online first
September 10, 2024
The worsening mpox outbreak in Africa: a call to action
Krutika Kuppalli[SUP]a,b[/SUP] krutika.kuppalli@gmail.com ∙ Jake Dunning[SUP]c[/SUP] ∙ Inger Damon[SUP]d[/SUP] ∙ Daniel Mukadi-Bamuleka[SUP]e[/SUP] ∙ Placide Mbala[SUP]f[/SUP] ∙ Dimie Ogoina[SUP]g[/SUP]
Affiliations & NotesArticle Info
snip
By August, 2024, the continent had reported over 18 000 suspected cases (including over 5000 confirmed cases) and over 600 deaths, representing a 160% increase compared with the same period in 2023.[SUP]6,7[/SUP]
DR Congo remains the epicentre of disease, accounting for over 96% of new cases and deaths. The virus has spread across 22 of the 26 provinces, with most confirmed cases reported among children younger than 10 years.[SUP]6[/SUP] In March, 2023, DR Congo reported its first cases of clade I mpox among gay, bisexual, and other men who have sex with men, and between September, 2023, and August, 2024, sustained chains of human-to-human transmission of mpox were reported among sexual networks of adult heterosexuals and female sex workers in North and South Kivu, caused by a newly described variant of the clade I strain, now referred to as clade Ib.[SUP]8,9[/SUP]
In the beginning of July, 2024, due to mobile populations in eastern DR Congo, clade Ib mpox crossed the border, leading to over 300 mpox cases in Burundi, Kenya, Rwanda, and Uganda—countries that had never reported a single case of mpox in the past.[SUP]10[/SUP] Since the beginning of 2024, clade IIb mpox has also resurfaced in South Africa, with 24 confirmed cases and three deaths, with high morbidity and mortality among people with advanced HIV disease.[SUP]10,11[/SUP] More than 100 confirmed mpox cases have been reported across other African countries in 2024, including Côte d'Ivoire, Nigeria, Central African Republic, and Republic of the Congo, among others.[SUP]10,11[/SUP] However, like in DR Congo, these case counts are considered a gross underestimation due to challenges of under-reporting and under-ascertainment.
Addressing the upsurge of mpox in Africa, the shift in transmission dynamics from zoonotic-related disease to sexual transmission and community transmission, the cross-border spread to new countries, and the attendant morbidity and mortality among children and people living with HIV requires urgent understanding and cross-cutting interventions in the most impacted countries with global partnerships.
snip
Surveillance and health education at points of entry is essential for prevention, detection, and containment of further cross-border spread, but this should be done without implementing travel restrictions or instigating stigma. Laboratory capacity requires strengthening and substantial investment to improve PCR testing rates for diagnosis, especially in DR Congo, as well as to enable the development and deployment of cost-effective point-of-care tests and mobile laboratories for ease of mpox diagnosis in remote areas and conflict zones.
snip
Mpox-related medical countermeasures, such as vaccines and therapeutics, are still lacking in all affected African countries, with an estimated need of over 10 million doses while just 2·6–3·6 million doses are available for the continent, mainly through donations from global partners.[SUP]13[/SUP] The recent WHO Emergency Use Listing of mpox vaccines and the regulatory approval of mpox vaccines in Nigeria and DR Congo should hopefully help facilitate access and uptake of vaccines across African countries. However, more financial resources and commitment from vaccine manufacturers are needed to meet the target of 10 million doses by 2025.[SUP]13[/SUP] African leaders must commit local resources to this effort and work to scale up regional manufacturing capacity while simultaneously leveraging global partners to provide the needed support. Vaccination programmes should target the most vulnerable populations and should embed community engagement and clear communication about uncertainties regarding the duration of vaccine protection, among other advocacy-related interventions that promote sustainable population vaccine acceptance. Vaccine rollouts in Africa should necessarily include vaccine effectiveness and efficacy trials for the continent to reveal context-specific vaccination outcomes, if any.
snip
The PALM (Pamoja Tulinde Maisha: Together Let's Save Lives) 007 trial demonstrated that hospitalisation with high-quality supportive care led to a substantially lower mortality rate of 1·7% in participants versus 3·6% as currently reported in DR Congo.[SUP]14[/SUP] The study underscores the critical need for the availability and accessibility of essential medications—such as pain relievers, antipyretics, antimicrobials, supplies to care for skin lesions, and intravenous fluids—to ensure high-quality clinical care. These medications are vital for managing symptoms, reducing complications, and lowering mortality rates in patients with mpox.
Tailored community outreach to educate on disease prevention and control relies on accurate information on disease transmission dynamics. Laboratory and molecular epidemiology may be influential to accurately educate on different transmission modes, clinical presentations, and populations affected compared with the 2022 epidemic. Public health efforts must adapt to local contexts to address mistrust, cultural differences, and misinformation. Involving community leaders, at-risk groups, and survivors is vital. As vaccine campaigns roll out, community engagement will be key to ensuring uptake and controlling the spread of mpox. Prioritising this approach can foster cooperation, reduce stigma, and ultimately improve health outcomes.
The recent upsurge of mpox in Africa was declared a PHEIC by WHO because of the risk of international spread and the need for a coordinated global effort. The recent detection of travel-associated clade I cases in Sweden and Thailand, the first reports outside Africa, is indicative of the potential for clade I mpox to spread from Africa to the rest of the world, reminiscent of the 2022 global clade II outbreak.[SUP]15,16[/SUP] The time for global solidarity and partnership is now.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00577-2/fulltext
Online first
September 10, 2024
The worsening mpox outbreak in Africa: a call to action
Krutika Kuppalli[SUP]a,b[/SUP] krutika.kuppalli@gmail.com ∙ Jake Dunning[SUP]c[/SUP] ∙ Inger Damon[SUP]d[/SUP] ∙ Daniel Mukadi-Bamuleka[SUP]e[/SUP] ∙ Placide Mbala[SUP]f[/SUP] ∙ Dimie Ogoina[SUP]g[/SUP]
Affiliations & NotesArticle Info
snip
By August, 2024, the continent had reported over 18 000 suspected cases (including over 5000 confirmed cases) and over 600 deaths, representing a 160% increase compared with the same period in 2023.[SUP]6,7[/SUP]
DR Congo remains the epicentre of disease, accounting for over 96% of new cases and deaths. The virus has spread across 22 of the 26 provinces, with most confirmed cases reported among children younger than 10 years.[SUP]6[/SUP] In March, 2023, DR Congo reported its first cases of clade I mpox among gay, bisexual, and other men who have sex with men, and between September, 2023, and August, 2024, sustained chains of human-to-human transmission of mpox were reported among sexual networks of adult heterosexuals and female sex workers in North and South Kivu, caused by a newly described variant of the clade I strain, now referred to as clade Ib.[SUP]8,9[/SUP]
In the beginning of July, 2024, due to mobile populations in eastern DR Congo, clade Ib mpox crossed the border, leading to over 300 mpox cases in Burundi, Kenya, Rwanda, and Uganda—countries that had never reported a single case of mpox in the past.[SUP]10[/SUP] Since the beginning of 2024, clade IIb mpox has also resurfaced in South Africa, with 24 confirmed cases and three deaths, with high morbidity and mortality among people with advanced HIV disease.[SUP]10,11[/SUP] More than 100 confirmed mpox cases have been reported across other African countries in 2024, including Côte d'Ivoire, Nigeria, Central African Republic, and Republic of the Congo, among others.[SUP]10,11[/SUP] However, like in DR Congo, these case counts are considered a gross underestimation due to challenges of under-reporting and under-ascertainment.
Addressing the upsurge of mpox in Africa, the shift in transmission dynamics from zoonotic-related disease to sexual transmission and community transmission, the cross-border spread to new countries, and the attendant morbidity and mortality among children and people living with HIV requires urgent understanding and cross-cutting interventions in the most impacted countries with global partnerships.
snip
Surveillance and health education at points of entry is essential for prevention, detection, and containment of further cross-border spread, but this should be done without implementing travel restrictions or instigating stigma. Laboratory capacity requires strengthening and substantial investment to improve PCR testing rates for diagnosis, especially in DR Congo, as well as to enable the development and deployment of cost-effective point-of-care tests and mobile laboratories for ease of mpox diagnosis in remote areas and conflict zones.
snip
Mpox-related medical countermeasures, such as vaccines and therapeutics, are still lacking in all affected African countries, with an estimated need of over 10 million doses while just 2·6–3·6 million doses are available for the continent, mainly through donations from global partners.[SUP]13[/SUP] The recent WHO Emergency Use Listing of mpox vaccines and the regulatory approval of mpox vaccines in Nigeria and DR Congo should hopefully help facilitate access and uptake of vaccines across African countries. However, more financial resources and commitment from vaccine manufacturers are needed to meet the target of 10 million doses by 2025.[SUP]13[/SUP] African leaders must commit local resources to this effort and work to scale up regional manufacturing capacity while simultaneously leveraging global partners to provide the needed support. Vaccination programmes should target the most vulnerable populations and should embed community engagement and clear communication about uncertainties regarding the duration of vaccine protection, among other advocacy-related interventions that promote sustainable population vaccine acceptance. Vaccine rollouts in Africa should necessarily include vaccine effectiveness and efficacy trials for the continent to reveal context-specific vaccination outcomes, if any.
snip
The PALM (Pamoja Tulinde Maisha: Together Let's Save Lives) 007 trial demonstrated that hospitalisation with high-quality supportive care led to a substantially lower mortality rate of 1·7% in participants versus 3·6% as currently reported in DR Congo.[SUP]14[/SUP] The study underscores the critical need for the availability and accessibility of essential medications—such as pain relievers, antipyretics, antimicrobials, supplies to care for skin lesions, and intravenous fluids—to ensure high-quality clinical care. These medications are vital for managing symptoms, reducing complications, and lowering mortality rates in patients with mpox.
Tailored community outreach to educate on disease prevention and control relies on accurate information on disease transmission dynamics. Laboratory and molecular epidemiology may be influential to accurately educate on different transmission modes, clinical presentations, and populations affected compared with the 2022 epidemic. Public health efforts must adapt to local contexts to address mistrust, cultural differences, and misinformation. Involving community leaders, at-risk groups, and survivors is vital. As vaccine campaigns roll out, community engagement will be key to ensuring uptake and controlling the spread of mpox. Prioritising this approach can foster cooperation, reduce stigma, and ultimately improve health outcomes.
The recent upsurge of mpox in Africa was declared a PHEIC by WHO because of the risk of international spread and the need for a coordinated global effort. The recent detection of travel-associated clade I cases in Sweden and Thailand, the first reports outside Africa, is indicative of the potential for clade I mpox to spread from Africa to the rest of the world, reminiscent of the 2022 global clade II outbreak.[SUP]15,16[/SUP] The time for global solidarity and partnership is now.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00577-2/fulltext