The WHO Director-General Tedros Adhanom's decision came on the advice of the International Health Regulations (IHR) Emergency Committee, which informed him that it considers the upsurge of Mpox a PHEIC, with the potential to spread further across countries in Africa and outside.

"The emergence of a new clade of Mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighbouring countries are very worrying. On top of outbreaks of other Mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives,” Adhanom said while declaring the PHEIC on 14 August.

Meanwhile, the WHO collaborates with countries and vaccine manufacturers to facilitate equitable access to vaccines, therapeutics, diagnostics, and other tools.

It anticipates needing an initial $15 million for surveillance, preparedness, and response activities. It has already released $1.45 million from its Contingency Fund for Emergencies, with potential for more funding in the coming days. The WHO has also urged donors to support the Mpox response.

What is Mpox?
 

According to WHO, Mpox is a viral disease caused by the monkeypox virus, which belongs to the Orthopoxvirus genus, and was first discovered in humans in 1970.

The disease has two distinct genetic clades, Clade I and Clade II, which differ in their geographic distribution, severity, and transmission characteristics, disclosed the health agency.

Clade I is more virulent, deadlier, and endemic in the Congo Basin in Central Africa, while Clade II is less severe and endemic to West Africa.

Mpox has been reported for over a decade in the DRC, with the cases' number increasing annually.

As of 2024, there are 3,101 confirmed and 15,636 suspected cases across Africa leading to 541 deaths, corresponding to a fatality rate of 2.89 percent, the Africa Centres for Disease Control and Prevention (CDC) said in a statement on Saturday.

The DRC, where the new Clade 1b strain was first detected in September 2023, remains the hardest-hit country with 1,005 cases (222 confirmed, 783 suspected) and 24 deaths reported in just one week, according to the CDC.

The WHO responded by closely monitoring the situation and eventually declaring an international emergency in August.

Outbreak history
 

After 1970, Mpox occurred sporadically in Central and East Africa (Clade I) and West Africa (Clade II).

In 2003, an outbreak in the United States was linked to imported wild animals (Clade II).

Since 2005, thousands of suspected cases have been reported annually in the DRC.

Then, Mpox re-emerged in Nigeria in 2017 and continues to spread across the country and through travellers to other destinations.

In May 2022, a Mpox outbreak rapidly spread across Europe, the Americas, and all six WHO regions, with 110 countries reporting about 87,000 cases and 112 deaths. This global outbreak primarily affected gays, bisexuals, and other men who have sex with men, spreading through sexual networks.

Moreover, Clade I MPXV outbreaks occurred in refugee camps in Sudan in 2022. A zoonotic origin has not been identified. 

The global outbreak of Mpox was previously declared a PHEIC on 23 July 2022.

Symptoms
 

According to WHO, Mpox can present with a range of symptoms varying in severity.

Commonly, it begins with a rash, fever, headache, muscle aches, back pain, low energy, and swollen lymph nodes.

Typically for Mpox, fever, muscle aches, and sore throat appear first.

After the initial symptoms, a rash appears, lasting two to four weeks, characterized by liquid-filled blisters, which may be itchy or painful; however, as they heal, the lesions dry up, crust over, and fall off.

The severity of the rash varies, with some individuals developing only a few lesions while others may have hundreds or more.

They can appear on various body parts, including the face, hands, feet, and genital regions, as well as internal areas such as the mouth, throat, or other locations.

Most people recover with supportive care, such as pain and fever management. 

However, severe cases can lead to complications such as widespread lesions, especially in the mouth, eyes, and genitals; secondary bacterial infections of the brain (encephalitis), heart (myocarditis), lungs (pneumonia), or eye problems; and even death. Hospitalization and antiviral treatment may be necessary during such instances.

Transmission characteristics
 

Mpox primarily spreads through close contact with an infected person, including skin-to-skin, mouth-to-mouth, and sexual contact. It can also be transmitted via respiratory particles when close to someone infected, WHO said.

The virus can enter the body through broken skin, mucosal surfaces, or the respiratory tract, putting household members and sexual partners, particularly those with multiple partners, at higher risk. 

It can also be passed from a pregnant person to their fetus, during birth, or through close contact after birth. That is in addition to contaminated objects like clothing, linens, or sharps injuries in healthcare units and tattoo parlours.

The transmission of Mpox by individuals who do not show symptoms (asymptomatic), before symptoms appear (pre-symptomatic), or after the healing process (post-symptomatic) is not well understood and remains unclear due to insufficient data, the health agency explained.

In addition, animal-to-human transmission occurs through bites, scratches, or handling infected animals, with the extent of viral circulation in animals still under study. Consuming undercooked contaminated meat can also spread the virus.

Meanwhile, the spread of the virus from humans to animals has been not very frequent. A few reports of Mpox were detected in pet dogs. However, given that many animals are susceptible to the virus, there is a risk of the virus spreading from humans to animals.

Precautionary measures
 

The WHO said most people with Mpox will recover within two to four weeks.

To help alleviate symptoms and prevent infecting others, stay home and, if possible, in your room. Wash your hands often with soap and water or hand sanitiser, especially before and after touching sores.

Wear a mask and cover lesions when around others until your rash heals. Keep your skin dry and uncovered unless you are in a room with someone else.

Avoid touching items in shared spaces, and disinfect those spaces frequently. Use saltwater rinses for sores in the mouth and take sitz or warm baths with baking soda or Epsom salts for body sores. Over-the-counter pain medications like paracetamol (acetaminophen) or ibuprofen can help manage pain.

Avoid popping blisters or scratching sores, as this can slow healing, spread the rash to other parts of the body, and cause infections. Do not shave areas with sores until scabs have healed and new skin has formed underneath, as this can also spread the rash.

To prevent the spread of Mpox, individuals with the virus should isolate at home, or in a hospital if necessary, for the duration of the infectious period (from the onset of symptoms until lesions have healed and scabs have fallen off).

Covering lesions and wearing a medical mask when in the presence of others may help prevent transmission. While using condoms during sex can reduce the risk of contracting Mpox, it will not prevent the spread from skin-to-skin or mouth-to-skin contact.

Treatment
 

The goal of treating Mpox is to manage the rash, alleviate pain, and prevent complications, with early and supportive care being crucial, according to WHO.

Vaccination is recommended, particularly for those at high risk such as health workers, men who have sex with men, individuals with multiple sexual partners, and sex workers.

The vaccine is most effective when administered within four days of exposure.

Mpox patients should be isolated from others, and antivirals like tecovirimat, initially developed for smallpox, are being used in ongoing studies.

The WHO recommends newer vaccines (MVA-BN or LC16) for protection, which have received approval in various countries.

In August, the WHO director-general initiated an Emergency Use Listing (EUL) to accelerate vaccine availability in lower-income countries. However, mass vaccination is not currently advised, with WHO emphasizing that vaccines should be part of a broader strategy including other public health measures.

Severity
 

The mortality rate for Mpox varies from 0.1 to 10 percent, influenced by factors like healthcare access and underlying health conditions of affected individuals.

“New-born babies, children, people who are pregnant and people with underlying immune deficiencies such as from advanced HIV disease may be at higher risk of more serious Mpox disease and death,” WHO disclosed.

On 14 August, the WHO revealed that Mpox was recently identified for the first time in four East African countries: Burundi, Kenya, Rwanda, and Uganda.

Meanwhile, the first cases of Mpox outside of Africa were recorded this week in Sweden and Pakistan,  AFP reported.