Fears undetected mpox cases will hinder plans to tackle outbreak

Major testing programme required ahead of vaccine programme to suppress source of infections

A health worker at an mpox treatment centre in Munigi, eastern Congo. The World Health Organization recently declared mpox outbreaks in Africa a global emergency. AP

Mpox cases are going undetected due to a shortage of testing kits and poor community surveillance in Central Africa, a leading charity has said.

As a major vaccination programme is to be introduced in the Democratic Republic of Congo – the centre of the latest mpox outbreak – tackling the virus at source is viewed as critical in bringing it under control.

Cases have so far also been confirmed in Burundi, South Africa, Kenya, Rwanda, Uganda, Central African Republic, Republic of the Congo, Cameroon, Nigeria, Ivory Coast and Liberia.

The virus, formerly known as monkeypox, has also been recently reported in Sweden, Pakistan and the Philippines.

Aid workers issued a rallying call for international support and urged people to avoid panic as community prevention programmes in the regions most affected aim to curb further spreads.

“Many of the cases in Burundi and DRC are among children and youth,” said Gwen Eamer, senior officer for public health emergencies at the International Federation of Red Cross and Red Crescent Societies.

“We know for sure there are many more cases than have been counted or identified.

“Categorically we know in many of the countries where this is circulating the capacity of those health systems to detect and test all of those cases is lacking due to chronic underinvestment.”

New variant

The more dangerous and contagious Clade 1b variant of mpox emerged last September.

It is passed on through basic human contact rather than the sexual transmission that contributed to the majority of previous cases of the Clade 2 variant.

More children are now being found with mpox, due to physical contact from family members and friends, with charities calling on improved education and surveillance at source to prevent a wider outbreak.

So far, the Democratic Republic of Congo has reported the highest number of cases this year, with 17,794 of the 18,910 confirmed and 535 of the 541 deaths.

“While transmission was initially based in sexual networks, we're seeing a lot of transmission beyond simply sexual activity,” Ms Eamer told The National.

“That's really important to understand in terms of who is at risk.

“This recent increase is unlike anything we had seen prior to a few years ago, as it is infecting many more people than we have seen in previous epidemics. That is also cause for concern.”

Symptoms include fever, painful rash and lesions, headache, muscle pain and swollen lymph nodes.

More than 1,400 cases have been reported across Africa in recent weeks, raising the continent’s tally for the year to almost 19,000 – a 160 per cent increase on 2023 figures, according to the Africa Centres for Disease Control and Prevention.

“Mpox is something that has never happened to many of these communities before,” said Ms Eamer.

“This is not like chickenpox where for many generations parents knew what that looked like.

“It is something that is totally novel to these communities where if something is happening to them that they don't understand, or know what the risk factors are or how to prevent it, that is a challenge.

“Thankfully, this is very different from Covid. It's really important that we use this public health emergency declaration as a rallying call and not as an inducement of panic.”

Vaccines

A shortage of vaccines will be the greatest challenge facing health authorities in the countries experiencing mpox cases.

There are currently two vaccines that are part of the fast-tracked WHO Emergency Use Listing process announced last week – BVN-MN and LC16.

While existing smallpox vaccines are effective against the virus, about 200,000 approved mpox vaccines made by Danish drug company Bavarian Nordic are due to be administered in the region.

The company said it could step up manufacturing of the Jynneos vaccine, supplying 2 million doses this year and another 8 million in 2025.

Meanwhile, an international response has seen the US commit 50,000 vaccines, while France has pledged a further 100,000 doses.

Gavi, the vaccine alliance, works with the WHO, Unicef, the World Bank and the Bill & Melinda Gates Foundation to vaccinate more than 1 billion children in 78 lower income nations against numerous childhood infections and viruses.

It is offering operational support in affected areas and is working with the WHO and Africa CDC to understand how many mpox doses are needed across affected countries.

“It is clear that DRC, at the epicentre of the outbreak and the appearance of the concerning Clade 1b – with spread to neighbouring non-endemic countries, large number of cases, high case fatality ratio, and new populations impacted – will be a priority area of focus,” a Gavi representative said.

“The top priority is to build an accurate picture of demand and supply.

“In the meantime, however, it’s important that this process does not hold up the response: if some vaccines are available immediately, and countries are ready for them, we have made sure that funding is available to support countries’ rollout.”

No cases of mpox have been reported in the UAE by government health authorities.

There is also no travel guidance from national airlines on those booked on flights to affected areas, although some international airports have introduced preflight screening.

Dr Alaa Zedan, a specialist of internal medicine at Burjeel Hospital, Dubai, said anyone planning a trip to affected regions of Africa should look to delay their journey.

“If someone is still planning to go, it's better to get the vaccine,” he said.

“There is another way to help prevent the spread of mpox, such as avoiding contact with infected animals, especially sick or dead animals, and avoiding contact with the bedding and other materials contaminated with the virus.

“It is important to thoroughly cook all foods that contain animal meat, and frequently wash hands with soap and water.

“Avoiding contact with people who may be infected with the virus and wearing a mask that covers the mouth and nose when around others is also important.”