Introduction
mpox a global health emergency. In recent years, the world has witnessed the rapid spread of various infectious diseases, some of which have escalated into global pandemics. The most notable of these in recent history is COVID-19, a virus that brought unprecedented challenges to public health systems and economies worldwide. As the world continues to recover from the impacts of COVID-19, another virus, known as mpox (formerly referred to as monkeypox), has come into the spotlight. On August 14, 2024, the World Health Organization (WHO) declared mpox a global health emergency, raising concerns about the potential for another widespread outbreak.
Mpox is not a new virus; it has been known to scientists for decades. However, recent developments, including the emergence of a new, more virulent subtype of the virus, have prompted international health authorities to issue warnings and take action. Despite the alarming headlines, experts are quick to point out that mpox is unlikely to lead to a lockdown situation similar to what the world experienced with COVID-19. This article aims to provide a comprehensive overview of mpox, the current outbreak, the implications of the WHO’s declaration, and what measures can be taken to prevent its spread.
About Mpox
Mpox is a highly contagious viral disease caused by the mpox virus, a member of the orthopoxvirus family, which also includes the smallpox virus. While mpox is less severe than smallpox, it can still cause significant illness in humans. The virus was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, which is how the disease initially got its name.
The virus primarily spreads through close contact with an infected person or animal, or with contaminated materials. Human-to-human transmission occurs through respiratory droplets, direct contact with body fluids, or lesions on the skin. Mpox is characterized by flu-like symptoms such as fever, headache, muscle aches, and fatigue, followed by a distinctive rash that can spread across the body. In severe cases, the disease can lead to complications such as pneumonia, encephalitis, and secondary bacterial infections.
The mpox virus is divided into two main clades: Clade I and Clade II. Clade I, which is primarily found in Central Africa, is known to cause more severe disease and has a higher mortality rate, with past outbreaks resulting in death rates as high as 10%. Clade II, found in West Africa, is generally less severe and more transmissible, but it rarely leads to death. Over 99% of people infected with Clade II mpox survive, making it less of a global threat compared to Clade I.
In 2023, a new subtype of Clade I, referred to as Clade Ib, emerged in the Democratic Republic of Congo (DRC). This new subtype has caused concern among health authorities due to its rapid spread within the DRC and to neighboring countries. The emergence of Clade Ib has brought mpox back into global focus, prompting the WHO to take action.
Current Outbreak
The recent declaration of mpox as a global health emergency is largely driven by the outbreak in Central Africa, particularly in the DRC. The DRC has been a hotspot for mpox for many years, with Clade I mpox being endemic in the region. However, the current outbreak is more widespread and severe than previous ones. The number of reported cases in the DRC has already surpassed last year’s total, indicating a significant increase in transmission.
The outbreak has not been confined to the DRC alone. In the past few months, mpox cases have been reported in at least 12 other countries in the African region, including Burundi, Kenya, Rwanda, and Uganda. These countries had not previously reported mpox cases, highlighting the rapid spread of the virus. The new Clade Ib subtype is believed to be more transmissible and may have different characteristics compared to the original Clade I and Clade II viruses.
The spread of Clade Ib mpox beyond the African continent has also been documented. In August 2024, Swedish health officials confirmed the first case of Clade I mpox outside of Africa. The patient had recently traveled to Africa, where the outbreak is occurring. Additionally, a new case of mpox was reported in the Philippines, though it is unclear whether this case is linked to Clade I or Clade II. Pakistan has also reported a case of Clade II mpox.
The WHO’s declaration of mpox as a global health emergency is based on the potential for further spread of the virus to other regions of the world. While the risk of mpox becoming a pandemic on the scale of COVID-19 is low, the situation in Central Africa is concerning enough to warrant international attention and coordinated efforts to contain the outbreak.
WHO Declaration
The World Health Organization’s decision to declare mpox a global health emergency is significant for several reasons. A Public Health Emergency of International Concern (PHEIC) is the highest level of alarm that the WHO can issue. It is a call to action for countries to implement measures to prevent the further spread of a disease and to allocate resources to support affected regions.
The WHO’s declaration was prompted by the rapid spread of Clade Ib mpox in Central Africa and the emergence of cases in countries that had not previously reported the disease. The situation in the DRC is particularly alarming, as the current outbreak is more severe and widespread than any previous mpox outbreak in the region. The African Centers for Disease Control and Prevention (Africa CDC) also declared mpox a public health emergency for the continent shortly before the WHO’s declaration.
In the declaration, WHO Chief Dr. Tedros Adhanom Ghebreyesus emphasized the need for a coordinated international response to stop the outbreaks and save lives. The declaration is a call for increased surveillance, testing, and vaccination efforts in affected regions, as well as for global collaboration to prevent the spread of the virus to other parts of the world.
While the WHO’s declaration is a serious call to action, it is important to note that it does not mean that the situation is out of control. The declaration is a proactive measure to prevent the situation from worsening and to ensure that countries are prepared to respond if the virus spreads further.
Risk to the U.S.
The risk of mpox spreading to the United States remains low, according to experts. Clade II mpox, which caused a large outbreak in 2022, is still present in the U.S., but at very low levels. The U.S. Centers for Disease Control and Prevention (CDC) reports that only a few cases of Clade II mpox are detected each month, and the virus is not spreading widely in the community.
There are currently no known cases of Clade I or Clade Ib mpox in the U.S. The U.S. Department of Health and Human Services (HHS) has stated that the risk of Clade I mpox importation into the U.S. is very low due to the limited number of travelers and the lack of direct commercial flights from the DRC and its neighboring countries to the U.S.
Even if Clade I mpox were to be imported into the U.S., experts believe that the risk of a major outbreak is low. Mpox is not airborne and does not spread as easily as respiratory viruses like COVID-19. The virus primarily spreads through close contact, which limits its ability to cause widespread outbreaks in settings where close contact is less common.
Likelihood of Lockdown
Given the current situation, the likelihood of a lockdown in response to mpox is extremely low. Experts agree that there is no need for such drastic measures, as mpox is a known virus with existing tools available to control its spread. Unlike COVID-19, which was a novel virus with no available vaccines or treatments when it first emerged, mpox is well understood by the medical community, and vaccines are available to protect against it.
Dr. Daniel Kuritzkes, chief of the division of infectious diseases at Brigham and Women’s Hospital, states that there would be absolutely no reason to implement lockdowns in response to mpox. The virus does not spread as easily as COVID-19, and the risk to the general public remains low.
Dr. Anne Rimoin, a professor of epidemiology at the University of California, Los Angeles, echoes this sentiment, emphasizing that mpox is not new, and there are already tools available to control it. She points out that the global mpox outbreak in 2022 was brought under control without the need for lockdowns, and the same approach can be taken with the current outbreak.
Mpox Transmission and Symptoms
Mpox primarily spreads through close contact with an infected person or their lesions, scabs, bodily fluids, and respiratory secretions. Transmission can occur during sexual activity, as well as through kissing, hugging, touching, and non-intimate face-to-face contact. The virus can also spread through close contact with an infected animal, such as rodents or primates, or through direct contact with contaminated materials like clothing or sheets.
The symptoms of mpox typically appear between several days and several weeks after exposure to the virus. The most common symptoms include:
- Rash
- Fever
- Chills
- Fatigue
- Malaise
- Headache
- Muscle aches
- Swollen lymph nodes
The rash is often the most obvious symptom of mpox. It usually begins as flat, reddish sores that may be painful or itchy. Over time, these sores turn into firm, raised bumps, which eventually become fluid-filled blisters and then pustules. These lesions eventually burst and scab over, and the rash can take several weeks to heal.
