Mpox has been around for decades, but a new strand is spreading rapidly.
You may have questions, and we have answers:
➡️ How is this outbreak different from previous ones and why did it trigger a Public Health Emergency?
The current outbreak of mpox (formerly known as monkeypox) is different from previous outbreaks in several keyways, which contributed to it being declared a **Public Health Emergency of International Concern (PHEIC)** by the World Health Organization (WHO) in 2022.
1. **Wider Geographic Spread**
- Historically, mpox outbreaks were primarily confined to regions of Central and West Africa, where the virus is endemic. However, in the 2022 outbreak, the virus spread to multiple non-endemic countries across Europe, North America, and other regions, affecting a much wider geographic area. This unusual spread led to global concern.
2. **Different Modes of Transmission**
- Mpox has typically been transmitted through direct contact with infected animals or close contact with infected individuals. However, in the current outbreak, there was a notable increase in **human-to-human transmission**, particularly through close physical contact, such as skin-to-skin contact, including in sexual networks. Many cases were also linked to large gatherings or events, which facilitated the rapid spread of the virus.
3. **Affected Populations**
- Unlike previous outbreaks that primarily affected rural populations in Africa, the 2022 outbreak disproportionately affected men who have sex with men (MSM), including people attending certain mass gatherings. This shift in affected populations and the potential for stigma raised the need for targeted public health responses.
4. **Speed of Spread**
- The 2022 mpox outbreak saw a more rapid spread of cases across different countries compared to previous localized outbreaks. This rapid international transmission occurred within weeks or months, which was unusual and concerning.
5. **Larger Number of Cases**
- The total number of cases in the 2022 outbreak surpassed all previous outbreaks combined. Over 80,000 confirmed cases were reported globally, which is far greater than previous outbreaks where the number of cases remained relatively small and contained.
6. **Potential for Misinformation**
- Given the novelty of this outbreak in non-endemic countries, there was a significant amount of public misunderstanding and misinformation surrounding the virus, its transmission, and its risks, contributing to the urgency for a coordinated public health response.
Why Was It Declared a Public Health Emergency?
The WHO declared mpox a **Public Health Emergency of International Concern (PHEIC)** for several reasons:
- **Risk of further international spread**: The unusual spread of the virus across many countries presented the risk of continued global transmission.
- **Need for coordinated international response**: A PHEIC declaration allows for increased funding, research, and international collaboration to control the outbreak.
- **Prevent severe public health consequences**: While the mortality rate of mpox is relatively low compared to other diseases, the outbreak posed risks of serious illness, especially in vulnerable populations such as immunocompromised individuals.
- **Prevention of stigma**: The need to prevent stigma and discrimination was emphasized, particularly because of the demographics affected in the early stages of the outbreak.
These factors combined to trigger the emergency response and mobilize global resources to prevent further spread and manage the outbreak effectively.
➡️ What does that mean for countries and for you?
The declaration of a Public Health Emergency of International Concern (PHEIC) for mpox has important implications for both **countries** and **individuals**, including healthcare workers like yourself.
**For Countries**
1. **Enhanced Surveillance and Reporting**
- Countries are required to improve their **surveillance systems** for detecting and reporting mpox cases. This includes tracking the spread of the virus, reporting cases to international health authorities (e.g., the WHO), and monitoring any unusual patterns of transmission.
2. **Strengthened Public Health Measures**
- Governments must take proactive measures, such as issuing **public health alerts**, raising awareness, and informing the public about prevention, symptoms, and treatment. They may also issue **travel advisories** or screening measures to prevent further international spread.
3. **Vaccine and Treatment Rollout**
- Countries need to assess their **vaccine supplies** and prepare to distribute vaccines to at-risk populations, especially in areas with rising cases. They also must ensure the availability of **antiviral treatments** and other medical supplies.
4. **Collaboration with International Agencies**
- Governments are expected to collaborate with global health organizations like the WHO and other nations. This involves sharing data, research, and resources to combat the spread of mpox more effectively.
5. **Public Health Communication**
- Countries are tasked with preventing **stigma** and promoting factual information. Because mpox affects certain demographics disproportionately, it is crucial to address the disease without discrimination and ensure vulnerable groups receive proper support and care.
6. **Resource Allocation**
- Governments may divert resources (healthcare workers, funds, vaccines) to affected regions or populations. In some cases, **public health emergencies** can lead to lockdowns, restrictions, or the reallocation of resources from other areas of public health.
**For You as a Healthcare Worker**
1. **Increased Awareness and Education**
- Healthcare workers like yourself are on the front lines and need to stay updated on **mpox symptoms**, **transmission routes**, and the latest **guidelines**. Training in recognizing mpox cases early and understanding the procedures for treatment and isolation is essential.
2. **Patient Communication and Safety**
- You may need to communicate **safety information** to patients, emphasizing how to prevent the virus's spread, recognize early symptoms, and seek timely care. Clear, compassionate communication helps to alleviate patient concerns and avoid misinformation.
3. **Infection Control**
- You will likely see enhanced **infection control protocols** in your healthcare setting, including using **personal protective equipment (PPE)**, isolating suspected or confirmed cases, and implementing strict hygiene measures to prevent the virus's spread within healthcare facilities.
4. **Managing Vaccinations**
- You may be involved in the **administration of vaccines** to at-risk populations, such as healthcare workers or communities with rising cases. It's important to stay updated on who is eligible for vaccination and how the vaccination process will be rolled out in your area.
5. **Handling Rising Cases**
- With increased cases, you might see a higher patient load or be involved in diagnosing and treating mpox cases. Knowing the appropriate **antiviral treatments** and care protocols will help you manage patients effectively.
6. **Public Outreach and Education**
- You may need to assist in **public education campaigns** to spread awareness of mpox and ensure accurate information reaches people, especially in high-risk communities. You might be asked to conduct workshops or distribute educational materials.
**For the General Public**
- **Increased Awareness**: Individuals should stay informed about mpox, how it spreads, and ways to protect themselves, particularly those in high-risk groups.
- **Vaccine Availability**: Some populations may become eligible for vaccination, and the public should follow health authority recommendations about who should get vaccinated.
- **Preventive Measures**: People should be vigilant about preventing transmission through safe practices like avoiding close contact with infected individuals, maintaining hygiene, and seeking medical advice if they show symptoms.
The global response aims to contain the outbreak, prevent further spread, and minimize its impact. By understanding the situation and following public health guidance, countries and individuals can both play key roles in managing and mitigating the risks of mpox.
➡️ Who is at risk?
For mpox (formerly known as monkeypox), certain groups of people are at a higher risk of contracting the virus based on various factors such as behavior, occupation, and underlying health conditions.
1. **People in Close Contact with Infected Individuals**
- **Household members, sexual partners, and caregivers** who come into close, prolonged contact with someone infected with mpox are at higher risk, especially if they handle bedding, clothing, or bodily fluids of an infected person. Transmission can occur through **direct contact with lesions**, respiratory droplets, or shared items.
2. **Sexual Networks (Especially MSM Communities)**
- During the 2022 outbreak, there was a disproportionately high number of cases among **men who have sex with men (MSM)**, particularly those with multiple sexual partners or those engaging in sexual activity in crowded settings (e.g., at large gatherings or parties). While mpox is not classified as a sexually transmitted infection (STI), close, skin-to-skin contact during sexual activity has been a key mode of transmission in these networks.
3. **Healthcare Workers**
- **Healthcare professionals** who treat patients with mpox are at risk of exposure, especially if proper infection control practices are not followed. This includes using appropriate personal protective equipment (PPE) and handling contaminated materials safely.
4. **Immunocompromised Individuals**
- People with weakened immune systems, such as those living with HIV, cancer patients undergoing treatment, or individuals on immunosuppressive medications, are at greater risk of contracting mpox and may experience more severe symptoms if infected. These individuals may also be at higher risk for complications from the virus.
5. **Individuals in Close-Knit or Communal Living Environments**
- People who live or work in **crowded settings** where close physical contact is common, such as in **dormitories, shelters, military barracks, prisons**, or other communal settings, are at higher risk of exposure due to the close proximity and shared facilities.
6. **People Traveling to Endemic Areas**
- Individuals who travel to or live in **Central and West African countries**, where the virus is endemic, are at higher risk. Exposure can occur through contact with infected animals, such as rodents and primates, or through handling wild game or consuming bushmeat.
7. **Children and Pregnant Women**
- While the majority of mpox cases have been in adults, **children** are also at risk, especially in households where someone is infected. **Pregnant women** are another at-risk group, as the virus may potentially cause complications, including transmission to the fetus.
8. **People Handling Animals (Zoonotic Risk)**
- Since mpox is a zoonotic virus, people who work with animals, such as **farmers, veterinarians, or animal researchers**, are at higher risk of contracting the virus, especially if they come into contact with infected wildlife or animals like rodents, primates, or other mammals that can carry the virus.
# Key Risk Factors Include:
- **Direct contact** with mpox lesions, bodily fluids, or contaminated objects (e.g., bedding, clothing).
- **Close physical contact**, including sexual contact, with an infected individual.
- **Weak immune systems** due to illness or medications.
- **Exposure to infected animals** in areas where mpox is endemic.
# Lower Risk for General Public
For most of the general population, the risk of contracting mpox is relatively low unless they fall into one of the high-risk categories. However, vigilance and public health guidance should be followed to minimize exposure, especially in regions experiencing active outbreaks.
WHO urges rapid access to mpox diagnostic tests, invites manufacturers to emergency review
WHO has asked manufacturers of mpox in vitro diagnostics (IVDs) to submit an expression of interest for Emergency Use Listing (EUL). WHO has been in ongoing discussions with manufacturers about the need for effective diagnostics, particularly in low-income settings. The request for EUL expressions of interest by manufacturers is the latest development in these discussions.
Testing is key for people to get treatment and care as early as possible and prevent further spread. Since 2022, WHO has delivered around 150 000 diagnostic tests for mpox globally, of which over a quarter have gone to countries in the African Region. In the coming weeks, WHO will deliver another 30 000 tests to African countries.
With as many as 1000 suspected cases reported in the Democratic Republic of the Congo alone this week, the demand for diagnostic tests is on the rise. In this heavily affected country, WHO has worked with partners to scale up diagnostic capacity to respond to the upsurge of cases. Since May 2024, six additional labs have been equipped to diagnose mpox, enabling a decentralization of testing capacity from major cities to affected provinces. Two of these labs are in South Kivu, selected to respond to the outbreak of the new viral strain, called Ib. Thanks to these efforts, testing rates have dramatically improved in the country, with four times as many samples tested in 2024 so far as compared to 2023.
WHO has also updated its diagnostic testing guidance to detect the new virus strain and is working with countries to roll it out. Earlier, WHO issued target product profiles to guide manufacturers in the development of new diagnostic tests.
WHO Director-General Dr Tedros Adhanom Ghebreyesus declared on 14 August 2024 that the upsurge of mpox in the Democratic Republic of the Congo (DRC) and in a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC) under the International Health Regulations (2005).
Manufacturers of IVDs are now asked to submit available quality, safety and performance data to WHO as soon as they can. IVDs are tests done in laboratories to detect a pathogen. Detection of viral DNA by PCR (Polymerase Chain Reaction) testing is the gold standard for mpox diagnosis. It detects the virus's DNA in samples taken from skin lesions, such as fluid or crusts from vesicles or pustules. Testing of blood is not recommended for routine diagnosis and antibody detection methods may be used for retrospective case classification but not for diagnosis.
Through the EUL procedure, WHO can approve medical products such as vaccines, tests and treatments for use, evaluating the acceptability of using specific products for time-limited procurement in emergency situations. The process aims to assist countries, which have not approved the medical products through national approval processes, to procure the critically needed products such as tests through UN agencies and other partners.
Mpox is an illness caused by the monkeypox virus, a species of the genus Orthopoxvirus, that can be transmitted to humans through contacts with someone who is infectious, with contaminated materials, or with infected animals.
Expanding access to diagnostic services is urgently needed as tests are essential to critical measures such as strengthened laboratory capacity, improved case investigation, contact tracing, surveillance data collection, and timely reporting. As a package, these help countries identify chains of transmission, detect cases early, prevent further spread, and monitor the virus in real-time. The establishment of Emergency Use Listing procedures for mpox diagnostic tests will help advance towards this goal.
Mpox is a viral illness that can affect anyone, regardless of their age, gender, sexual orientation, or lifestyle. If you have had close contact with someone with mpox, you may be at risk.
Symptoms to look out for include:
⚠️ Rash that develops into lesions
😮💨 Sore throat
🤒 Fever
🥱 Low energy
🤕 Headache
😩 Muscle aches
If you experience these symptoms, isolate at home, contact your local healthcare provider and get tested.