Mpox Outbreak in Africa

Mpox Outbreak Status

The Democratic Republic of the Congo (DRC) accounts for over 90% of reported mpox cases in Africa, with a new variant emerging in September 2023 and circulating in its eastern region [1]. This variant has also been detected in neighboring countries, including Rwanda, Uganda, and Kenya [2]. The outbreak has seen a 160% increase compared to the same period last year, with 887 newly confirmed and suspected cases reported in just one week [3]. As of August 2024, the total number of cases for the year has reached 15,132, with 461 fatalities attributed to the disease [1].

Countries Affected by Mpox

Burundi, Kenya, Rwanda, and Uganda have reported their first mpox cases since mid-July 2024, expanding the list of affected countries [1]. These nations join the Democratic Republic of the Congo (DRC) and other previously affected countries, bringing the total to 16 nations reporting instances of the disease [2]. The spread of the new variant (clade 1b) has been observed in the eastern DRC, with cases also confirmed in neighboring Rwanda, Uganda, and Kenya [2]. South Africa has reported cases primarily among men who have sex with men, while transmission in West and Central Africa is associated with the 2022 global outbreak [2].

Transmission and Symptoms

Mpox spreads through direct contact with infectious skin lesions, bodily fluids, respiratory droplets, or contaminated objects. Symptoms typically appear within 2-19 days after exposure and include a painful rash, fever, sore throat, headache, muscle aches, back pain, fatigue, and swollen lymph nodes [1] [2]. The rash progresses from flat, red bumps to pus-filled blisters that eventually crust over and fall off, a process lasting 2-4 weeks [2]. Some individuals may experience severe manifestations such as ocular infections, neurologic complications, or myopericarditis [3].

Response and Prevention Measures

Health authorities are implementing a multi-faceted approach to combat the mpox outbreak. The WHO is working through country teams and deployed experts to support national authorities in strengthening key response areas, including disease surveillance, diagnostic testing, and clinical care [1]. Vaccination is recommended for high-risk groups, including health workers, men who have sex with men, and individuals with multiple sexual partners [2]. However, Africa faces a significant challenge due to severe vaccine shortages, with only 200,000 doses available compared to the needed 10 million [3]. The African Union has authorized an emergency fund of $10.4 million to support the Africa CDC's initiatives in combating the outbreak [3].

Long-term Strategies for Mpox Control

The UK and other countries are developing long-term strategies to control and potentially eliminate mpox transmission. Key elements of these strategies include:

• Aim for eventual elimination of person-to-person mpox transmission, defined as absence of indigenously acquired cases for at least 3 months [1].
• Reduce harm from mpox, including hospitalizations, complications, severe illness, and stigma [1].
• Suppress current domestic transmission and minimize transmission from imported cases [1].
• Contribute to reducing the global burden through international collaboration and knowledge sharing [1].
• Establish clinical pathways for rapid and accurate case finding [1].
• Deploy targeted vaccination programs for high-risk groups [2].
• Encourage behavior changes like partner reduction among affected populations [2].
• Update policies, plans and resources to support long-term control efforts [1].
• Conduct research on long-term sequelae and impacts of mpox infection [1].

These strategies recognize that complete elimination may take time due to ongoing global transmission, but aim to maintain low levels of domestic cases in the interim [1].

Vaccine Development and Distribution

Several pharmaceutical companies and research institutions are actively developing and distributing vaccines to combat the mpox outbreak in Africa. Here's an overview of the current vaccine development and distribution efforts:

Company/Institution	Vaccine	Development Stage	Key Information
BioNTech	BNT166	Phase 1/2 clinical trial	mRNA-based vaccine; CEPI funding up to $90 million [1].
Bavarian Nordic	MVA-BN	Phase 2 clinical trial	Non-replicating vaccine; CEPI funding of $6.5 million for pediatric study in Africa [2].
China National Biotec Group	VGPox 1-3	Preclinical	mRNA vaccines encoding mpox proteins M1R and A35R [3].
Sun Yat-sen University	Unnamed	Preclinical	mRNA-LNP vaccine targeting A27, A33, B5, and L1 antigens [3].

Despite these developments, Africa faces significant vaccine shortages, with only 200,000 doses available compared to the estimated 10 million needed [4]. The African Union has authorized an emergency fund of $10.4 million to support the Africa CDC's initiatives in combating the outbreak, including vaccine distribution efforts.

Conclusion and Outlook

The mpox outbreak in Africa presents a significant public health challenge, with cases rising dramatically across the continent. While the Democratic Republic of Congo remains the epicenter, new countries are reporting their first cases, indicating a concerning spread of the virus [1] [2]. The emergence of a new, potentially more transmissible variant has further complicated control efforts [2]. Despite ongoing response measures, including surveillance, testing, and clinical care improvements, Africa faces critical shortages in vaccines and resources [3] [3]. The African Union and international partners are mobilizing funds and support, but the situation remains precarious, potentially warranting a continent-wide public health emergency declaration [3]. As the outbreak evolves, continued collaboration, resource mobilization, and targeted interventions will be crucial in curbing the spread of mpox across Africa.