Understanding Mpox: WHO’s Global Health Emergency Declaration

August 16, 2024

Mpox, a viral illness resurging as a global health emergency, poses significant risks across Africa and beyond, prompting urgent public health responses and renewed international attention.

For the second time since 2022, mpox has been labeled a global health emergency as the virus spreads quickly across Africa and threatens to reach other continents and neighboring countries.

The World Health Organization (WHO) on Wednesday raised its highest alert level for the viral illness, noting that over 14,000 cases and 524 deaths in Africa this year have already surpassed last year’s numbers. This announcement followed the Centers for Disease Control and Prevention (CDC) in Africa declaring mpox a public health emergency just a day earlier, prompting a coordinated public health response and WHO response.

What exactly is mpox?

Mpox is a virus that mainly affects humans and animals. It’s part of the “Orthopoxvirus genus” group, which typically causes pox-like illnesses. These include mpox symptoms like a rash with raised bumps or blisters on the skin. These bumps often contain fluid or pus and eventually scab over and heal.

Mpox is similar to the now-gone smallpox and other pox viruses like cowpox and vaccinia. It was first called “monkeypox” when found in monkeys in 1958. These were research monkeys in Denmark. In 1970, the first human case was reported in a nine-month-old boy in the Democratic Republic of Congo.

In 2022, the WHO suggested changing its name to “mpox” to avoid stigma and links to monkeys, as rodents and humans can also get the disease.

How does the mpox virus spread?

Mpox transmission to humans occurs through close contact with an infected animal or person. Animal-to-human spread usually happens through bites, scratches, or direct contact with an infected animal’s blood, fluids, or wounds. This zoonotic transmission is a key factor in the monkeypox virus spread.

Human-to-human transmission can occur through:

Direct contact with skin sores, body fluids, or breath droplets of an infected person.
Long face-to-face contact with an infected person.
Touching items like bedding or clothes that have touched infectious material, though this is rare. Household transmission is possible in this way.

The monkeypox virus enters the body through broken skin, the breathing system, or moist areas (like eyes, nose, and mouth). Sexual transmission has also been reported in some cases.

What are the signs of mpox?

Monkeypox symptoms include fever, headache, muscle pain, fatigue, and a unique rash that can show up on the face, hands, feet, and other body parts. The rash forms pustules and scabs before healing. Other mpox virus symptoms include respiratory symptoms in some cases.

A pustule – which looks like a big white or yellow pimple – is a small, raised bump on the skin filled with pus.

Swollen lymph nodes, small glands that help fight illness, can also occur as they try to beat the virus. These are found under each arm, and on the sides and back of the neck.

In rare cases, an infection can be fatal. Generally, an infection lasts two to four weeks. After exposure to the virus, symptoms can take three to 21 days to show. However, a person can spread the disease to others one to four days before symptoms appear.

Mpox can be identified by laboratory testing of fluid from the rash. Clinical diagnosis is also possible based on symptoms. Specimen collection and clade-specific testing can help determine the specific strain.

Why has mpox been declared a global emergency?

On Wednesday, the WHO declared mpox a public health emergency of international concern (PHEIC) – its highest alert level due to a new type of mpox being found and cases being reported for the first time in several countries, like Kenya and Rwanda. This clade I MPXV strain appears to have a different epidemiological pattern.

WHO Director-General Tedros Adhanom Ghebreyesus expressed worry about the disease spreading further within Africa and beyond, after a meeting of the United Nations health agency’s emergency team.

An emergency declaration from the WHO aims to prompt donor agencies and countries to take action. “There’s a real effort right now to gather resources, which is partly why WHO called for the public health emergency now,” said Amita Gupta, who leads the Infectious Diseases Division at Johns Hopkins School of Medicine.

The WHO also declared mpox a global health emergency in July 2022, when the virus was first found to spread through sexual contact and was reported in over 70 countries worldwide. Once cases dropped, the WHO lifted the emergency status in May 2023.

Where has mpox spread?

Last week, the Africa CDC reported that mpox has now been found in at least 13 African countries. Compared to the same time last year, the agency said cases are up 160 percent and deaths have increased by 19 percent.

To date, over 96 percent of cases have been reported in Congo, where researchers recently discovered a new strain of the virus causing milder symptoms and genital lesions. This makes detection more challenging, increasing the risk of unknowing mpox transmission.

“The DRC’s limited international travel has kept the spread risk low. However, if it spreads more widely in Africa, global spread becomes a concern,” Gupta explained to Al Jazeera. Surveillance efforts are critical to monitor the monkeypox outbreak.

While the 2022 monkeypox outbreak involved mpox clade II, the current outbreak is driven by clade I, which can be more lethal, according to Otim Patrick Ramadan from WHO’s African regional office.

So far, no cases of the new clade I variant have been reported outside Africa. Travel precautions and risk assessment are important to prevent further spread.

Is there a vaccine available?

Although mild cases may resolve on their own, there are currently no approved monkeypox treatments or mpox vaccines specifically for mpox.

The antiviral drug tecovirimat (TPOXX), initially developed for smallpox, is being evaluated for mpox treatment. The FDA has also approved JYNNEOS (also known as Imvamune or Imvanex), a smallpox vaccine, for severe mpox cases in adults 18 and older. Vaccination recommendations and JYNNEOS vaccine availability are evolving based on CDC guidance.

However, Ramadan notes that about 60 percent of Congo’s cases, the country most affected by mpox, are in people under 18. Mpox vaccine availability remains limited in many affected areas.

The CDC advises getting vaccinated and isolating after exposure to someone with mpox. Infection prevention and isolation precautions are crucial to controlling spread.

Gupta pointed out that while “COVID has taught us much” and global surveillance has improved, quick diagnosis and access to alternative treatment options are lacking in African countries where the virus is spreading.

Source:

Areesha Lodhi (August 14, 2024). What is mpox and why has WHO declared it a global health emergency?. Al Jazeera. https://www.aljazeera.com/news/2024/8/14/what-is-mpox-and-why-has-who-declared-it-global-health-emergency