Mpox - A Pandemic Rears Its Head Once Again

On August 14, 2024, WHO called the latest mpox outbreak an ‘emergency of international concern’. A UNICEF press release states that children are among those at great risk of contracting Mpox in Congo, one of the most affected countries.

Mpox, previously known as monkeypox, is a self-limiting viral infection caused by mpox virus (MPXV). At least 99,176 cases and 208 deaths due to mpox have been reported from 116 countries since 2022, according to data from the WHO. This is the second time the infection has received the designation in as many years — the outbreak between July 2022 and May 2023 was also declared as a Public Health Emergency of International Concern (PHEIC).

Mpox was discovered in 1958 (in captive monkeys, hence the original misnomer “monkeypox”) and the first human case was identified in 1970. Then for decades it was largely neglected by the scientific and public health communities, regarded as an uncommon infection in remote rural areas in tropical Africa without relevance for the rest of the world. The mpox outbreak in Africa is yet another example of how infectious diseases perceived to be “someone else's problem”, and affecting mainly poor, developing countries, may suddenly pose unexpected global threats. Other examples of neglected diseases include the West Nile, Zika and Chikungunya viruses.

The disease has been renamed “mpox” but the name of the virus, for now, remains “monkeypox” (MPXV). It is closely related to the smallpox virus. MPXV was considered a zoonotic disease endemic in parts of central and west Africa. It was acquired mainly through close contact with wild mammals, especially handling bush meat, but there was no sustained human-to-human transmission. Only very occasionally were cases seen outside the endemic areas, due to infected travellers or import of infected small mammals. This changed abruptly in 2022: a massive, rapidly evolving global outbreak caused over 99,000 laboratory-confirmed cases in 116 countries. At its peak in August 2022, over 6,000 cases were reported each week.

The global outbreak in 2022 was caused by clade II of MPXV, which is endemic in west Africa and not as virulent as clade I MPXV, which so far has only been seen in the Congo Basin. The African region is experiencing an upsurge in mpox cases which started in 2023. The current clade I MPXV (formerly called Congo Basin strain) is more virulent than the clade II (west African) strain, resulting in a higher case fatality rate. The ongoing outbreak has its epicentre in South Kivu province, eastern DRC, and has the potential to fuel a large pandemic

In India, officials at some airports and ports have been called on to maintain a vigil in case any passengers show symptoms of MpoX

The World Health Organization has urged manufacturers to ramp up production of mpox vaccines.