Mpox is a viral disease originating in central Africa that causes skin rashes and lesions along with flu-like symptoms. Most cases typically present with mild symptoms, and there is complete recovery within two to four weeks. However, in severe forms, the disease leads to brain inflammation and sepsis, and can be fatal. The disease was first identified in captive laboratory monkeys in Denmark in 1958 and was formerly known as monkeypox. In addition to monkeys, the virus has been detected in Gambian pouched rats, dormice and African squirrels, which are often used as food. The first cases in humans were identified in 1970, and sporadic cases were reported in central and east Africa in the decades since then. A major global outbreak occurred in 2022-2023, and there are now widespread fears of a far worse one. Last month, the World Health Organisation (WHO) declared Mpox an international public health emergency of major concern, in response to a deadly outbreak in the Democratic Republic of Congo (DRC).
How is Mpox transmitted?
It’s a so-called “zoonotic” disease, which is spread from animals to humans via bites or scratches, or activities such as hunting and skinning infected animals. The pathogen enters the body via broken skin, or “mucosal” surfaces such as the mouth and respiratory tract, and can then be passed on to others during prolonged periods of intimate face-to-face interaction, in particular, that involving close contact and touching. During the recent global outbreak – the first of its kind since the identification of the virus – human-to-human transmission was almost exclusively via sexual contact (and mostly affected men who have sex with men). The outbreak spread from Africa to 115 countries, on every continent, where Mpox had never been seen before, resulting in about 100,000 reported cases globally and roughly 200 known deaths, though this is widely thought to be an underestimate. Internationally, the first cluster of cases was found in the UK, linked to a patient who had visited Nigeria.
What’s happening this time?
Already, far more people have died of Mpox – with more than 1,300 known deaths in the DRC alone. Almost 30,000 cases have been identified in that country, and the virus has spread to neighbours including Burundi, Rwanda, Uganda and the Central African Republic. Two cases have been reported in Sweden and Thailand, both in people who had recently visited the region. There’s a crucial difference this time: a different strain of Mpox is involved, which is more dangerous and more deadly – the “clade 1” version and, in particular, a strain known as “clade 1b”, which has a fatality rate of between 1.4% and 10%. Sexual activity is still a primary means of transmission. Female sex workers, their male customers and gay men are all highly vulnerable groups and are hard for health workers to reach in countries where prostitution and homosexual acts are illegal. But this time, unlike in the previous outbreak, many of those with Mpox are children. According to the Africa Centres for Disease Control, almost 70% of Congolese cases are children aged under 15, and they account for 85% of the deaths. One medical charity running an isolation site near Goma (a city in the DRC on the Rwandan border) says 75% of cases there have been children under 10.
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Why are children so vulnerable?
Children are more likely to have weaker immune systems due to malnutrition, recent cholera and measles outbreaks, and untreated HIV infections. They may also be more vulnerable because Mpox has some similarities to smallpox; older generations who had the smallpox vaccine may have some protection. Another reason for the rapid spread, says Leana Wen in The Washington Post, is the ongoing civil unrest in the DRC. In the eastern provinces of North and South Kivu, nearly a million displaced people are living in desperately crowded refugee camps, including hundreds of thousands of children – an ideal breeding ground for the virus. Meanwhile, the M23 armed rebels in control of swathes of North Kivu falsely claim there are no cases there.
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Will Mpox become a pandemic?
According to Airfinity, a health-data firm, London and Dubai are the global cities at greatest risk of importing the new strain. However, “Mpox is not the new Covid”, says the WHO. There is every chance of the outbreak spreading globally and causing deaths. But Mpox is harder to pass on and there is no evidence the virus spreads easily, like Covid, via respiratory droplets and airborne particles. Moreover, children in rich countries are healthier and better nourished, and far less likely to become infected. On the other hand, there’s no room for complacency. The WHO’s confidence depends partly on the outbreak in Africa being contained – and at the moment it isn’t.
What about vaccines?
The global population’s collective immunity against pox viruses has deteriorated in recent decades after the eradication of smallpox in 1980 meant that vaccines were no longer necessary, says The Economist. Vaccines against related pox viruses provide some immunity from Mpox, but scientists are not yet certain how effective they are. Last month there was disappointment when an antiviral drug, tecovirimat, also known as TPOXX – which had shown promising results against clade 2 – did not reduce the severity of illness with clade 1. International help has been slow to arrive, in part due to hold-ups in approving new vaccines. But last week the first donation of Mpox-specific vaccines – 200,000 doses of Bavarian Nordic’s Imvanex vaccine – were sent to Kinshasa, as part of an EU donation programme. In all, about 380,000 doses of Mpox vaccines have been pledged by donors including the EU and US, according to Africa CDC. However, three million doses are needed. Distribution will be difficult. Of the two main vaccines, one needs refrigeration; the other uses a rare specialised needle. What Congo is crying out for is more help, says The Economist. “Because all countries stand to benefit, all should contribute what they can to organising a swifter, more rational response.”
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