A child caught mpox gets treatment at a hospital in the Nyiragongo territory near Goma, North Kivu province, eastern Democratic Republic of the Congo (DRC), on Aug. 15, 2024. [Photo/Xinhua]

The World Health Organization (WHO) earlier this month declared monkeypox (mpox) a public health emergency of international concern (PHEIC), sounding the alarm over its potential for further international transmission.

Mpox is "not the new Covid" and the risk to the general population is low, the WHO's regional director for Europe Dr. Hans Kluge has said.

The WHO has recommended enhancing monitoring of mpox transmission and is committed to working with each of the affected countries to prevent transmission, treat those infected and save lives.

Risks of spread from Africa

In July 2022, the mpox outbreak was declared a PHEIC as it spread rapidly across a range of countries where the virus had not been seen before. That PHEIC was declared over in May 2023 after there had been a sustained decline in global cases.

It is the second time in two years that the WHO has declared mpox a PHEIC, following an outbreak of the viral infection in the Democratic Republic of the Congo that has spread to neighboring countries.

Mpox cases reported so far this year have exceeded last year's total, with more than 14,000 cases and 524 deaths, according to WHO data.

Data from the Africa Centers for Disease Control and Prevention (Africa CDC) show that from the beginning of 2024 to Aug. 23, a total of 21,466 potential cases of mpox and 591 deaths have been reported from 13 African Union members.

According to the WHO, the current outbreak has been exacerbated by the emergence of a deadlier new variant of the virus, Clade 1b, with a mortality rate estimated at 3.6 percent, much higher than previous strains.

"We are not dealing with one outbreak of one clade; we are dealing with several outbreaks of different clades in different countries with different modes of transmission and different levels of risk," said the WHO director-general.

The European Centre for Disease Prevention and Control (ECDC) has updated its risk assessment of the mpox outbreak, recommending heightened preparedness within the European Union (EU) and the European Economic Area (EEA).

Europe faces a high likelihood of more imported mpox cases from the clade I virus. Although the risk of sustained transmission within EU/EEA remains very low, it is important to prepare swift diagnosis and effective control measures, the Sweden-based ECDC said.

The ECDC advises EU/EEA member states to issue travel advisories for individuals traveling to or returning from regions affected by the outbreak.

Monkeypox, first detected in laboratory monkeys in 1958, is assumed to be transmitted from wild animals such as rodents to people, or from human to human.

The common symptoms of mpox are a rash, fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.

More infectious new variant

This year's rising mpox cases are driven by Clade 1b, a variant more deadly and infectious compared to the Clade II prevalent in 2022, media reported.

Outbreaks of mpox have historically resulted from a zoonotic spillover of Clade I in Central Africa and Clade II in West Africa. Since 2022, each has morphed into a subclade, its sexually transmitted "b" version.

Since its emergence in the Democratic Republic of the Congo last year, Clade 1b has spread to neighboring countries, including Burundi, Kenya, Rwanda, and Uganda, where mpox cases had not been previously reported.

The spread is one of the main reasons why the WHO declared mpox a public health emergency of international concern, activating its highest level of global alert for mpox for the second time in two years.

Data suggest that Clade 1b can spread effectively among people in a variety of ways, including sexual contact, the journal Nature said in a June article, adding that the virus has already spread to densely populated areas, potentially carried by the highly mobile part of the population like sex workers.

Kluge on Tuesday said that mpox is "not the new Covid," stressing that the risk from mpox to the general population is low.

"We know how to control mpox -- and in the European region -- the steps needed to eliminate its transmission altogether," he added.

Catherine Smallwood, senior emergency services officer at WHO Europe, said that the Clade I infection reported by Sweden is the only mpox case detected in Europe, and that the patient only showed mild clinical symptoms.

Enhancing prevention

The WHO needs to assess the groups at risk of contracting mpox and develop countermeasures, WHO spokesperson Tarik Jasarevic told a press briefing on Tuesday.

Jasarevic said that countries need to have surveillance systems in place to find out where the virus was and enhance clinical testing capacity.

It was equally important to target key groups.

The public health advice of the last two years in Europe is still in place, the WHO said, adding that mpox in Europe could be controlled thanks to direct engagement with the most affected communities, for example, men who have sex with men.

The WHO said it remains important to inform persons in high-risk communities and avoid stigma and discrimination because "when there is stigma or discrimination related to a medical condition, people may not seek care quickly, the quality of health care may suffer, and access to health services for the most vulnerable is reduced."

"Mpox spreads from person to person mainly through close contact with someone who has mpox. Close contact includes skin-to-skin and mouth-to-mouth, or mouth-to-skin contact, and can also include being face-to-face with someone who has mpox," the WHO said. "During the global outbreak that began in 2022, the virus mostly spread through sexual contact."

"Avoid close contact with anyone who has mpox, including sexual contact. Clean your hands frequently with soap and water or an alcohol-based hand rub," it added.

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