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In 2022, while the world was still grappling with the uncontrolled spread of COVID-19, outbreaks of monkeypox began to emerge globally. Although primarily transmitted from primates to humans, the initial strains of the virus mainly caused skin lesions, and despite a few fatalities, the virus did not garner significant global attention. However, as of August 2024, there are rising concerns that monkeypox may be making a dangerous comeback.
On August 13, 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared the first public health emergency of the year due to the resurgence of monkeypox. In response, the World Health Organization (WHO) is closely monitoring the situation. The current outbreak, which began in rural areas of Africa, is now spreading to densely populated urban centers. Over the past month, Central Africa has seen a significant surge in monkeypox infections, with some data indicating that this outbreak could be more deadly than previous ones.
As of 2024, the number of confirmed and suspected monkeypox cases in African countries has already surpassed the total cases reported in 2023. Alarmingly, this strain appears particularly harmful to children. In the Democratic Republic of the Congo (DRC), nearly two-thirds of those infected are under the age of 15, marking a stark difference from the 2022 outbreak.
Reports indicate that the current strain of the virus is not identical to the one responsible for the 2022 outbreak. The majority of cases in this outbreak are linked to Clade I of the monkeypox virus, whereas previous outbreaks were primarily associated with Clade II. While past transmission of monkeypox was predominantly through sexual contact, researchers believe that the current outbreak involves additional modes of human-to-human transmission. The rapid spread might be attributed to the high mobility of sex workers, but the significant increase in pediatric cases suggests other factors may be at play.
In the DRC, a country plagued by violent conflict and humanitarian crises, other infectious diseases are also rampant. Monkeypox, until recently, had not been a primary concern. However, in the past week alone, the DRC has reported nearly 2,400 suspected cases and 56 deaths. The mortality rate in this outbreak far exceeds that of the 2022 outbreak, which saw 87,000 infections and 140 deaths. Due to the high fatality rate and the severe threat to children's health, along with the escalating outbreaks in various African nations, Jean Kaseya, the Director General of the Africa CDC, has invoked the emergency powers granted by the African Union in 2023 to declare a public health emergency. The WHO is expected to convene soon to discuss whether this outbreak warrants a global emergency declaration.
The 2022 monkeypox outbreak was characterized by severe skin lesions and excruciating pain. Given that this outbreak is occurring in impoverished regions of Africa with limited healthcare infrastructure, researchers have not yet been able to fully assess whether the symptoms of Clade I differ from those caused by Clade II, or whether the higher mortality rate is solely due to differences in the virus strains. Experts are calling for enhanced surveillance and collaboration with affected countries. They also suggest that the treatments and vaccines used in high-income countries during the 2022 outbreak should be made available to African nations.
However, the feasibility of this approach remains uncertain. Many African nations are impoverished and face ongoing armed conflicts, making it challenging to implement treatment protocols and vaccine distribution. Although the Africa CDC is negotiating with developed nations for vaccine access, the current offer of 200,000 doses falls far short of the estimated 10 million doses needed. The situation remains under close watch, and individuals planning to travel to or work in affected areas are advised to get vaccinated and take necessary precautions.
Reference:
Vakaniaki, E. H. et al. Preprint at medRxiv https://doi.org/10.1101/2024.04.12.24305195 (2024).
https://africacdc.org/news-item/speech-of-the-director-general-africa-cdc-on-the-declaration-of-mpox-as-a-public-health-emergency-of-continental-security-phecs/
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