HEALTH: Why has the WHO declared mpox a global health emergency?

WHO director general Dr Tedros Adhanom Ghebreyesus says the latest outbreak is ‘very worrying’. ABC

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The rapid surge of mpox in multiple African countries has prompted the World Health Organization (WHO) to sound its highest level of alert.

On Wednesday, the UN agency declared a global health emergency in response to a severe outbreak of the viral disease in the Democratic Republic of Congo (DRC), which has spread to at least four neighbouring countries where it has not been reported before.

The WHO announcement follows a decision earlier this week by the African Centres for Disease Control and Prevention (CDC) to also declare mpox a public health emergency.

More than 15,600 mpox cases and 537 deaths have been detected in the DRC this year, a situation the WHO Director General Tedros Adhanom Gebrselassie described as “very worrying”.

Children have been most affected by the latest outbreak.

So what does the WHO’s global health emergency designation mean? And what are the implications?

Mpox, formerly known as monkeypox, is an infectious disease caused by the monkeypox virus which was first discovered in 1958. It is endemic in parts of central and west Africa.

Mpox causes a distinctive skin rash or lesions, accompanied by flu-like symptoms, such as fever, sore throat and headache.

The arms and torso of an mpox patient with skin lesions.

It is transmitted through close physical contact with an infected person or animal, and through contaminated materials (such as clothing and linen).

Most people with mpox recover within two to four weeks, but it can cause severe illness, particularly in children, pregnant women, and people who are immunocompromised.

Treatment involves managing the symptoms, and can include pain medicines and antibiotics. There are also antiviral medications undergoing clinical trials that may be administered if more serious complications arise.

While outbreaks of mpox are not uncommon in the DRC, there has been rapid rise in cases — in the past six months there have been the same number of cases as reported to the WHO for all of last year.

WHO director general Dr Tedros Adhanom Ghebreyesus says the latest outbreak is “very worrying.” (Getty Images: Xinhua News Agency)

There are two main strains or “clades” of the virus — clade I (once known as the Congo Basin clade), which historically has a higher death rate, and clade II (formerly the West African clade), explains epidemiologist Raina MacIntyre.

The current outbreak is being driven by a new offshoot of clade 1, known as clade 1b, which appears to spread more easily through close contact. For the first time, clade 1 mpox is also spreading via sexual contact.

“The way (mpox) has spread historically has been in families – one person gets it, other people in the family get sick,” says Professor Macintyre, a professor of biosecurity at the Kirby Institute.

“The degree of spread (in this outbreak) is far more than small intra-familial clusters. There’s much more widespread transmission.”

Outside the DRC, clade 1b has been detected in Burundi, Kenya, Rwanda and Uganda, while other forms of the mpox virus continue to circulate in central and eastern Africa, and other parts of the continent.

According to the WHO, several outbreaks of different clades “with different modes of transmission and different levels of risk” are occurring, with cases now confirmed in 13 countries.

Data from the African CDC shows children have been most affected: almost 70% of cases and 85% of deaths this year have occurred in those under 15.

The WHO declared a public health emergency of international concern (PHEIC) in July 2022 in response to a significant and unusual outbreak of mpox in non-endemic regions, including Europe, North America, and Australia.

A PHEIC is declared when a disease outbreak is considered serious and unusual, has the potential to spread across borders, and is likely to require international action to contain it.

The 2022 outbreak predominantly affected gay, bisexual and other men who have sex with men, but it was fuelled by a different, less deadly version of the mpox virus known as clade 2b.

“We saw very different epidemiology in 2022, which was mainly sexual transmission, a very low death rate, and in countries that have access to vaccines,” Professor MacIntyre says.

After 10 months, the PHEIC was declared over, but the spread of clade 2b has continued, including in Australia, where there’s been a resurgence of cases in recent months.

Rhonda Stuart, director of public health and infection prevention at Monash Health, says unlike in 2022, most new cases in Australia are being driven by local transmission, rather than coming from overseas.

“Every case is followed up and we look for upstream and downstream contacts,” she says.

“But there are some cases we don’t know about, so that’s how this can be a grumbling issue.”

So far, no cases linked to the latest outbreak have been detected outside central and eastern Africa.

Professor Stuart says while Australian health authorities worry about “any outbreak occurring anywhere in the world”, mpox poses a more significant risk in resource-limited settings, where the ability to prevent and control the virus is more challenging.

“Without good health systems or the ability to give vaccinations, it does mean morbidity and mortality can be higher.”

But Professor MacIntyre says signs the mpox virus is evolving to transmit more efficiently are concerning.

“The more transmissible it becomes between humans, the more pandemic potential it acquires. That to me is a real worry.”

Mpox transmission primarily occurs through direct contact with infectious skin lesions or bodily fluids, but she says more research is needed to understand the extent to which respiratory transmission is playing a role.

A spokesperson for the Australian Department of Health says the department is aware of the ongoing rise of mpox cases, and that it continues to monitor local and international trends.

“The Department will consider any recommendations made by the World Health Organization in relation to this outbreak and their application to the Australian context.”

Vaccines are key to preventing mpox, and can be given even after exposure has occurred, but access to mpox vaccines in Africa is a significant challenge.

According to the African CDC, just 200,000 mpox vaccine doses are currently available, when 10 million are needed to control the outbreak.

“We do have effective vaccines for mpox, but accessibility is a huge issue,” Professor MacIntyre says.

“Even in 2022, countries were queuing up and there were long waits to get it.”

In response, the WHO has triggered an emergency use listing for two brands of the mpox vaccine, a process that helps to accelerate vaccine access in lower-income countries.