Countries in the Americas should strengthen Mpox surveillance in light of potential spread of new variant detected in African region, says PAHO
August 10, 2024
Washington DC, August 9, 2024 (PAHO/WHO) – In aepidemiological alert Published on August 8, the Pan American Health Organization (PAHO) called on countries in the Americas to strengthen surveillance, including laboratory detection and genomic sequencing of confirmed cases, following the identification of a new variant of the mpox virus, Clade I (Clade Ib), in the sub-Saharan African Region. Although the new variant has not been reported in the Americas, countries should remain vigilant for possible imported cases.
The new variant is associated with sustained transmission, as well as cases occurring in a wider range of age groups than in previous outbreaks, including children. It is estimated to have emerged in the Democratic Republic of the Congo in September 2023 and is associated with a significant increase in cases in the country.
MPOX is a viral disease caused by the monkeypox virus, a species of the genus Orthopoxvirus. There are two different clades: clade I and clade II. Symptoms include fever, severe headache, muscle aches, back pain, low energy, swollen lymph nodes, and a rash or mucous membrane lesions. The rash tends to be concentrated on the face, palms of the hands, and soles of the feet, but can also be found on the mouth, anogenital area, and eyes. Symptoms usually last 2 to 4 weeks and go away on their own without treatment.
Since the beginning of 2024 (as of July 26, 2024), the Ministry of Health of the Democratic Republic of the Congo has reported 14,479 cases of mpox and 455 deaths. According to the report, “the number of cases reported in the first six months of this year is consistent with the number reported in the entire last year.” Children under 15 years of age accounted for 66 % of the cases and 82 % of the deaths. Cases of the new variant have also been reported in Rwanda, Uganda, and Kenya. Testing is also underway in Burundi to determine whether the cases reported there are also due to the new variant.
Due to the rising number of cases, World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus announced on August 7 that he would convene a panel of experts to advise him on whether the growing outbreak constitutes a global health emergency.
Although no cases of the new variant have been reported in the Americas, PAHO recommends that countries in the Americas remain vigilant regarding the possibility of an introduction into the region.
In the Americas, 62,752 cases of MPOX have been reported from 31 countries and territories between 2022 and 1 July 2024, including 141 deaths. To date, only clade II has been detected in the region. Most cases were identified through HIV patient care services, sexual health services or primary health care settings and were primarily, but not exclusively, in men who have sex with men. The epidemiological alert urges health authorities in countries to “continue laboratory-based surveillance and rapid reporting of confirmed and probable cases”. Genomic surveillance is also essential to determine the clades in circulation and their evolution.
Suspected cases of MPOX should avoid contact with other people and seek testing to confirm the diagnosis, followed by clinical management of symptoms.
In the alert, PAHO reminds Member States that efforts should focus on “early detection and diagnosis, isolation and contact tracing.” While vaccination can help prevent infection of those at risk, “mass vaccination against MPOX is neither required nor recommended.”
PAHO also recommends the dissemination of public health messages to inform and educate target populations, including health personnel and populations with the highest prevalence of HIV and other sexually transmitted infections (STIs), primarily, but not exclusively, men who have sex with men, to improve early recognition of signs and symptoms.
On 23 July 2022, the WHO Director-General determined that the multi-country outbreak of mpox constituted a Public Health Emergency of International Concern (PHEIC). The number of cases reported globally peaked in August 2022 and began to decline steadily through April 2023. On 11 May 2023, following a significant reduction in global spread, the Director-General determined that the event no longer constituted a PHEIC.
Japanese smallpox remains a global public health problem, with cases and outbreaks still being reported worldwide. As of June 2024, 26 countries have reported over 930 cases and 4 deaths worldwide.
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