WHO Director-General Dr Tedros has determined that the upsurge of mpox (formerly monkeypox) in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR). The PHEIC will help to take further coordinated international action to support countries in combating disease outbreaks.
This PHEIC determination is the second in two years relating to mpox. Mpox was first detected in humans in 1970, in the DRC. The viral disease is caused by the Monkeypox virus (MPXV), which is present in the wildlife (in certain small mammals) and the disease is considered endemic in countries in central and west Africa. In July 2022, the multi-country outbreak of mpox was declared a PHEIC after an outbreak occurred in Europe and spread rapidly via sexual contact across a range of countries where the virus had not been seen before. That PHEIC was declared over in May 2023 after there had been a sustained decline in global cases.
Since November 2023, the Democratic Republic of the Congo (DRC) has seen a significant increase in mpox cases and the emergence of a new mpox clade I. The country has reported over 16’000 new cases and more than 500 deaths in 2024. Mpox outbreaks are caused by different clades, clades 1 and 2. Historically, clade 1 has been associated with a higher percentage of people with mpox developing severe illness or dying, compared to clade 2. The clades are now subdivided into clade 1a, 1b and clade 2a, 2b.
- Clade 1a is the clade endemic in DRC and other central and East African countries (e.g. the Central African Republic and the Republic of Congo) for decades, it affects mostly children and is spreading through multiple mode of transmission (including animal-to human transmission, close nonsexual contact, sexual contact).
- Clade 1b, identified since September 2023, is currently causing the outbreak in eastern DRC and neighboring countries (Burundi, Rwanda, Kenya, and Uganda; and more recently in a returning traveler from Burundi to Sweden), it affects mostly adults of both sex and is spreading predominantly through intimal contact (sexual networks). Nonsexual transmission is also happening to a lesser extent. At present, there is no evidence that it is more transmissible or more severe than the clade 1a.
- Clade 2a is endemic in various countries of West Africa for decades with low incidence and is spreading through multiple modes of transmission like clade 1a.
- Clade 2b is the clade at the origin of the 2022/2023 global outbreak (116 countries), it affects mostly men (>96%) and is spreading primarily through sexual contact (particularly men having sex with men). It is still ongoing and could affect people with risk factors in all countries around the world, including African countries.
Details to Mpox, see LINKs of Swiss FOPH, Robert Koch-Institute Germany, ECDC, CDC.
Countries where mpox virus clade I and/or clade II have been detected:
Follow local media and local health authority advice.
The following prevention measures should be followed during a stay in countries where mpox is endemic/epidemic:
General precautions:
- Refrain from sexual or other close contact with people who are sick with signs and symptoms of mpox, including those with skin lesions or genital lesions.
- Avoid contact with wild animals (alive or dead) in areas where mpox regularly occurs.
- Avoiding contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
- Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
- Avoid sex with sick persons and use of condoms for up to 12 weeks after the convalescence of the sexual partner.
A vaccination against mpox is available (Jynneos®, manufacture Bavarian Nordic). There is an increased demand worldwide with risk of vaccine shortage. The Swiss Expert for Travel Medicine recommends vaccination against mpox in following situations, status 16 August 2024 (the recommendation will be updated regularly depending on the development of the outbreak):
1. People staying or travelling to Eastern D.R. Congo and Burundi in case of:
- Clinical or research or laboratory work
- Working with animals
2. People staying outside of Eastern D.R. Congo and Burundi (worldwide) in case of:
- Increase risk (e.g. laboratory workers handling mpox virus, men who have sex with men or trans-persons with multiple sexual partners), see Swiss recommendations: see Link.
At the present time, it is assumed that the available vaccine (Jynneos®) is also effective against the new clade I. This vaccine is considered safe and highly effective in preventing severe Mpox disease.
In case of symptoms:
- Please stay at home (isolate) until your mpox rash has healed and a new layer of skin has formed. Staying away from other people and not sharing things you have touched with others will help prevent the spread of mpox. People with mpox should clean and disinfect the spaces they occupy regularly to limit household contamination.
- Wash hands often with soap and water or an alcohol-based hand sanitiser containing at least 60% alcohol.
- You should not have sex while symptomatic and while lesions are present. Use condoms for 12 weeks after infection. This is a precaution to reduce the risk of spreading the virus to a partner.
- Further information on what do if you are sick, see CDC LINK.
For clinicians:
- Consider mpox as a possible diagnosis in patients with epidemiologic characteristics and lesions or other clinical signs and symptoms consistent with mpox. This includes persons who have been in DRC or, due to the demonstrated risks of regional spread, any of its neighboring countries (ROC, CAR, Rwanda, Burundi, Uganda, Zambia, Angola, Tanzania, and South Sudan) in the previous 21 days.
- Further information on Evaluation and Diagnosis: see CDC LINK.
The European Center for Disease Control (ECDC) has issued a risk assessment on 16 August 2024 with specific advice, for details see LINK.