Overview
What is mpox?
Mpox (previously named monkeypox) is caused by infection with mpox virus, a member of the genus Orthopoxvirus in the family Poxviridae. There are currently more than 80 poxviruses known to science and these poxviruses have been isolated from different species of birds, insects, reptiles, marsupials and mammals. Poxviruses that may cause human disease include the smallpox (or variola) virus and molluscum contagiosum virus.
Mpox has been historically reported in several countries in West and Central Africa (WCA). This distribution of mpox virus is attributed to the fact that it is naturally harboured by animals found in this part of Africa. It is believed that rodents, most likely certain species of squirrels found in the deep forested areas of this region in Africa, may be the natural host of the virus.
Mpox infections in humans have historically been noted in these countries, albeit at a relatively low level. However, since the 1990s, there have been more cases, and factors that have contributed to this include the discontinuation of smallpox vaccinations, increased contact with wildlife due to population migration and deforestation, the consumption of bushmeat, and increased population densities.
The Democratic Republic of Congo (DRC) has seen an increase in mpox cases between 2008 and 2018, and in 2017, the disease returned to Nigeria. According to the World Health Organization (WHO), the number of cases in areas of Central and East Africa this year [2024] is unprecedented (See mpox outbreak update Aug 2024). In mid-August, WHO and Africa CDC declared the outbreak a public health emergency of international concern (PHEIC) and public health emergency of continental security (PHECs), respectively.
Clade I, previously known as the Congo Basin clade, has two sub-clades, Ia and Ib. Clade Ib denotes the new strain of the disease discovered in September 2023 that has taken hold in the DRC and neighbouring countries. This outbreak is happening concurrently with the multi-national outbreak that started in 2022. Clade II, previously known as the West African clade, has two sub-clades, IIa and IIb. Clade IIb is the strain that caused the 2022 global outbreak and is primarily transmitted through sex. In this outbreak, the most at-risk group was identified as men who have sex with men. Vaccinations and behavioural adjustments curbed the spread of the outbreak; however, new infections are still occurring. With regards to the multi-country outbreak, South Africa reported 5 cases in 2022 and 24 cases in 2024, as of August 2024. No cases of Clade I have been detected in South Africa to date (August 2024).
The mode of transmission and the high-risk population groups distinguish the deadlier Clade I strain from Clade II. In addition to sexual contact, Clade Ia is transmitted through household contact and contact with contaminated animals. The new variant, Clade Ib, seems to spread more easily through routine close contact, as evidenced by the number of children affected by the outbreak.
Travel Advisory:
When visiting the DRC or its neighboring countries (Burundi, Central African Republic, Republic of Congo, Rwanda, Uganda: 1) Avoid close contact with individuals who exhibit symptoms of mpox, such as skin lesions or genital lesions. 2) Refrain from coming into contact with wild animals, either dead or alive, such as small mammals like apes and monkeys and rodents like rats and squirrels. 3) Avoid contaminated items that were either handled by sick people (such as bedding, clothes, or items used in medical facilities) or that had come into contact with wildlife. 4) Refrain from consuming or processing wild animal meat (bushmeat) or using items made from them (creams, lotions, powders).
If you experience a new, unexplained skin rash (lesions on any part of the body), whether or not you have a fever and chills, get medical attention right away and stay away from other people. Inform the medical professional treating you where you have been for the past 21 days prior to the onset of symptoms.
Vaccines:
There is currently no mpox vaccine available in South Africa. After decades of widespread concern due to a dangerous new strain of the virus (Clade I), the first 10,000 mpox vaccines are finally scheduled to arrive in Africa at the beginning of September 2024. The COVID-19 pandemic’s lessons about global healthcare disparities have not changed quickly, as evidenced by the delayed arrival of vaccines, despite being made available in more than 70 countries outside of Africa.
The National Department of Health has endorsed the mpox vaccine recommendations by the National Advisory Group on Immunization (NAGI) Technical Working Group for South Africa. Men who have sex with men, healthcare professionals, and laboratory workers are risk groups for pre-exposure vaccination; sexual, household, and healthcare facility contacts will receive post-exposure vaccination. There are currently ongoing discussions about available vaccine procurement options. The WHO and its partners are assisting in creating vaccination plans for emergency situations and are in talks about clinical trials for medications and vaccines.
Stay informed with the latest mpox statistics—visit our up-to-date dashboard here.
