WHO raises concern on accelerating mpox spread in Congo

• A deadly mpox outbreak in Congo has been rapidly spreading across the country, raising concerns of international transmission, the World Health Organisation (WHO) said.

• Over 13,000 cases have been reported through mid-November with over 600 deaths including in three provinces not previously affected. 

• The WHO reported that the strain of the virus responsible for the current outbreak in Congo, called clade I, is more virulent than the predominant strain in the 2022 global outbreak clade II. 

• The outbreak in Congo outpaces the global mpox case fatality ratio fourfold, and up to nine times in endemic areas. 

• Human-to-human transmission in areas in which mpox is endemic is accelerating and 70 per cent of cases there are in children under 15. 

What is mpox?

• Mpox (monkeypox) is an infectious disease caused by the monkeypox virus (MPXV). 

• Mpox virus belongs to the Orthopoxvirus genus in the family Poxviridae. The Orthopoxvirus genus also includes variola virus (which causes smallpox), vaccinia virus (used in the smallpox vaccine), and cowpox virus.

• Mpox has symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, mpox continues to occur in countries of central and west Africa.

• Mpox is zoonosis: a disease that is transmitted from animals to humans.

Mpox was formerly called monkeypox. Following a series of consultations with global experts, WHO began using “mpox” as a synonym for monkeypox. 

• Monkeypox was first discovered in 1958 when outbreaks of a pox-like disease occurred in monkeys kept for research, hence the name ‘monkeypox’.

• The first human case was recorded in 1970 in the Democratic Republic of the Congo (then known as Zaire), and since then the infection has been reported in a number of central and western African countries. Most cases are reported from Congo and Nigeria. 

• In 2003, monkeypox was recorded in the United States when an outbreak occurred following importation of rodents from Africa. Cases were reported in both humans and pet prairie dogs. All the human infections followed contact with an infected pet and all patients recovered. 

• Mpox is endemic in densely forested regions of West, Central and East Africa, particularly in the northern and central regions of Congo. Eleven of the 26 provinces of the country are identified as endemic for mpox, but in more recent years the total number of mpox cases and the number of provinces reporting mpox has been expanding, to 22 provinces as of November 2023. 

• There are two known clades of monkeypox virus (MPXV): clade I, previously known as the Congo Basin clade, and clade II, previously called the West African clade. Clade II further has two sub-clades — clade IIa and clade IIb. 

• Before 2018, very few cases were reported outside of the African continent. 

• Since 2022, an epidemic of clade IIb MPXV has been ongoing globally, affecting many countries outside the African continent that had never reported mpox previously. 

Transmission

• Mpox does not spread easily between people.

• Spread of mpox may occur when a person comes into close contact with an animal (rodents are believed to be the primary animal reservoir for transmission to humans), human, or materials contaminated with the virus. 

• The virus enters the body through broken skin (even if not visible), the respiratory tract, or the mucous membranes (eyes, nose, or mouth).

Person-to-person spread is very uncommon, but may occur through:

• Contact with clothing or linens (such as bedding or towels) used by an infected person.

• Direct contact with mpox skin lesions or scabs.

• Coughing or sneezing of an individual with a mpox rash.

Symptoms

Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off.

Treatment

• Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. 

• Mpox, in most cases, is a mild condition which will resolve on its own and have no long-term effects on a person’s health. Most people recover within a few weeks. However, severe illness can occur in some individuals.

• Treatment of mpox patients is supportive dependent on the symptoms. Various compounds that may be effective against mpox virus infection are being developed and tested.

• Prevention and control of human mpox rely on raising awareness in communities and educating health workers to prevent infection and stop transmission.

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