Mpox Outbreak: WHO Declares Public Health Emergency as Clade I Cases Rise

On August 14, 2024, the World Health Organization (WHO) declared a Public Health Emergency of International Concern regarding the increasing number of mpox cases, particularly those involving clade I, in the Democratic Republic of the Congo (DRC) and several other African countries. This declaration followed a similar announcement by the Africa Centres for Disease Control and Prevention (Africa CDC) on August 13, highlighting the growing threat to regional and global health security.

Clade I Mpox: A Growing Concern

The surge in cases involves clade I mpox, which differs from the clade IIb variant that caused a global outbreak in 2022, affecting over 115 non-endemic countries. While the 2022 outbreak was largely driven by sexual contact among men who have sex with men, the current outbreak of clade I in the DRC is spreading through sexual contact and within communities. A new variant of clade I MPXV has been identified in South Kivu province, DRC, exhibiting mutations suggesting adaptation to human-to-human transmission. This marks the first documented instance of sustained community transmission of the virus in the country.

As of May 26, 2024, the DRC reported 7,851 mpox cases, including 384 deaths, resulting in a case fatality rate of 4.9%. These cases are distributed across 177 of the country’s 519 health zones, spanning 22 of its 26 provinces.

U.S. Preparedness and Response

The Biden-Harris Administration has been proactively preparing for potential clade I mpox cases in the United States since December 2023. A coordinated response structure has been established across federal departments and agencies. Currently, the risk to most Americans is considered very low, and no cases of clade I mpox have been reported domestically.

Key preparedness measures include:

• Enhanced Surveillance: Increasing capacity to detect both clade I and clade IIb mpox through existing surveillance systems, including wastewater testing, and expanding diagnostic testing capabilities.
• Vaccination: Reaffirming the importance of mpox vaccination for eligible individuals. Over one million vials of the JYNNEOS vaccine have been distributed across the U.S. Since August 2022.
• Treatment Options: Working to understand the effectiveness of existing treatments for mpox and ensuring availability of treatment options.
• Public Information: Providing and disseminating recommendations for clinicians, health departments, diagnostic laboratories, and the public.

The CDC has issued an updated Health Alert Network advisory for clinicians and public health departments, as well as an updated Travel Health Notice recommending enhanced precautions for travelers to the DRC and neighboring countries.

U.S. Global Support

The U.S. Government has been closely monitoring the situation in the DRC since 2023 and collaborating with affected countries and global health partners. In fiscal year 2023, the United States allocated over $2.65 billion in bilateral health funding to countries in Central and Eastern Africa.

Since March 2024, USAID and CDC have jointly provided an additional $20 million to support the clade I mpox response in Central and Eastern Africa. On August 20, USAID announced up to an additional $35 million in emergency health assistance, bringing the total proposed U.S. Government financial support to over $55 million.

The U.S. Is also donating 50,000 doses of the JYNNEOS vaccine to the DRC and providing financial support for vaccine rollout. Efforts are underway to encourage additional vaccine donations from other countries.

Looking Ahead

The Biden-Harris Administration remains committed to a whole-of-government response, building on lessons learned from the 2022 mpox outbreak. Continued vigilance, international collaboration, and proactive preparedness measures are crucial to mitigating the impact of this evolving outbreak. For more information, please visit the CDC website.