Mpox triggers second global alert in 2 years as new variant spreads rapidly

A new mpox variant, clade Ib, detected in Sweden and Pakistan, spreads mainly through household contact and has a higher fatality rate, prompting increased global alert

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World Health Organisation's (WHO) Director-General, Tedros Adhanom Ghebreyesus, announced on Wednesday that the spread of Monkeypox, also known as Mpox, in Africa has been classified as a global health emergency.

This declaration follows the Africa Centres for Disease Control and Prevention declaring the virus a public health emergency across the continent.

On Friday, Pakistan reported a positive case, making it the second country outside Africa to do so. The individual had recently returned from a Gulf nation. Pakistani health officials stated that tests are being conducted to identify the specific variant.

New variant: 'clade Ib'

The recent outbreak is linked to a new variant called "clade Ib", an offshoot of clade I, which is native to the African Congo. Swedish authorities have noted that clade Ib primarily spreads through household contacts and often affects children.

In contrast, Clade IIb, responsible for a previous global alert by the WHO in 2022, was mainly transmitted through sexual contact. The outbreak in July 2022 infected nearly 100,000 people, predominantly gay and bisexual men, across 116 countries and resulted in around 200 deaths. India reported 27 cases and one fatality during that time.

Although clade Ib causes a similar illness to clade IIb, it is believed to spread more rapidly and has a higher potential for causing fatalities. Clade II, originating from West Africa, has a mortality rate of up to 1 per cent (about one in 100 cases are fatal), but reports suggest that clade I could have a fatality rate as high as 10 per cent.

Cases largely among children

Since the current outbreak began in January 2023, the Democratic Republic of the Congo (DRC) has recorded 27,000 cases and more than 1,100 deaths, predominantly among children. Over 15,000 cases and 548 deaths have occurred just this year. The surge in cases and fatalities has also led to the disease spreading to Burundi, Kenya, Rwanda, and Uganda.

Symptoms of mpox

Mpox is a virus related to the smallpox family. It typically causes blisters or sores that can persist for 2 to 4 weeks. The illness may begin with symptoms such as fever, headache, muscle aches, back pain, fatigue, and swollen lymph nodes. Blisters may develop on the face, palms, soles, groin, genital, and anal areas, and can also appear in the mouth, throat, and eyes. While symptoms often resolve on their own within a few weeks, with medications available to manage pain or fever, mpox can sometimes lead to serious complications and even be fatal in some cases.

Vaccinations

In January 2022, the European Medicines Agency approved Tecovirimat, an antiviral initially created for smallpox, for use in treating mpox. According to the World Health Organisation (WHO), such medications are generally reserved for uncommon situations.

Additionally, there are three vaccines for mpox — MVA-BN, LC16, and OrthopoxVac — that were originally developed for smallpox. The WHO advises that vaccination should be targetted at individuals who are at risk, such as close contacts of those infected, rather than conducting widespread immunisation campaigns.