08-18-2024, 01:21 AM
With the WHO declaring a global emergency in response to mpox cases in Africa, experts weigh the risk in the United States.
By Steven Ross Johnson | Aug. 15, 2024, at 5:20 p.m.
The move this week by the World Health Organization to declare a global emergency in response to mpox cases in African countries and the announcement of a case of a more severe type in Sweden raises concerns that the disease could continue to spread.
Since the beginning of 2024, there had been more than 500 deaths and more than 17,000 suspected cases of mpox across at least 12 African countries as of Aug. 13, according to figures from the Africa Centers for Disease Control and Prevention. Yet health officials fear the situation could get much worse due to inadequacies in disease surveillance, laboratory testing and contact tracing in that region.
“This is not just an African issue. Mpox is a global threat, a menace that knows no boundaries, no race, no creed,” said Africa CDC Director General Dr. Jean Kaseya in an Aug. 13 statement. “It is a virus that exploits our vulnerabilities, preying on our weakest points. And it is in these moments of vulnerability that we must find our greatest strength and demonstrate that we all learned from COVID by applying solidarity.”
From Jan. 1, 2022, to June 30, 2024, more than 99,000 cases of mpox have been reported across 116 countries, according to the WHO.
Among the concerns around this latest outbreak has been the emergence of a new strain of the clade 1 type of mpox, which is a more severe form than the clade 2 type that was dominant during a 2022 global outbreak. Outbreaks involving clade 1 mpox are associated with a death rate of up to 10% of those infected, compared with clade 2 outbreaks, where 99.9% of those infected survive, according to the CDC.
On Thursday, Sweden reported the first case of the more dangerous mpox strain outside of the African continent.
For more perspective on the potential health threat the current mpox outbreak poses, infectious disease experts Dr. Priya Sampathkumar, a professor of medicine with the Mayo Clinic, and Kari Debbink, an associate teaching professor in the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, spoke with U.S. News about the possibility of another mpox outbreak in the U.S., how to reduce the threat and lessons from 2022’s outbreak.
The interview below has been edited for length and clarity.
What is mpox?
SAMPATHKUMAR: Mpox is an orthopox viral infection that spreads from person to person and causes a rash illness. It’s a distant cousin of smallpox. The mpox lesions look a little bit similar to that of smallpox, they are painful and they can be associated with generally feeling unwell, such as having a fever. Because the rash tends to be in very sensitive areas (of the body) like the genitalia, it is very, very painful.
How concerned are you about the possibility of the current mpox outbreak in Africa spreading to the U.S.?
DEBBINK: At this point, we don’t have any clade 1 cases here, but I think that the declaration gives us pause that it’s a possibility that we might see cases of it.
SAMPATHKUMAR: We do know that mpox spreads quite easily from person to person, so if a case is imported into the U.S. it could spread. Previously, the cases were pretty much limited to (Congo), which doesn’t have as much travel in and out. Now that cases have spread to neighboring countries, including Rwanda and Uganda, there’s concern that because there is more travel in and out of these countries, this could spread around the world.
Are you concerned about the emergence of a new mutated strain of the clade 1 type of mpox? Have there been any indications thus far that this new strain may be more transmissible or more resistant to current treatments?
SAMPATHKUMAR: The main concern about this is the fact that it is more severe, so there is a higher risk of people dying from the infection. I don’t think there’s any indication yet that this is more resistant to current treatments, or that it is more transmissible.
One of the big lessons from prior outbreaks is that there’s a big disparity between where the cases are and where the resources are. In the United States, we have ready access to vaccines and antiviral treatment, so our outbreak (in 2022) was controlled. We also have the resources for surveillance, case-finding and limiting transmission.
Unfortunately, these resources are not as readily available in the places where the outbreaks are happening.
What are the major lessons from the 2022 mpox outbreak?
DEBBINK: Now that the World Health Organization has issued this warning, I think it’s really important the United States and other countries outside of central and east Africa do what they can to help the countries where there are cases to contain them. So, providing financial aid, vaccines, medical supplies and anything they need to contain this is really important.
Domestically, since 2022 we have developed a really good testing structure at this point. It’s set up more to identify clade 2 viruses, but the testing is such that you can identify whether it’s a clade 2, and if it’s not you can do additional testing to determine whether it’s a clade 1. There’s wastewater testing for mpox here, so there’s an indication that we would hopefully be able to detect it through wastewater surveillance.
Has there been an effort to think more globally in addressing disease threats?
DEBBINK: I think there are a lot of things people are doing in those affected countries that are not necessarily seen by the public. But at the same time, there are things that are more visible that we could be doing better as far as making sure that when there is a vaccine available, and there is a cost in terms of some countries being able to afford it, we should make sure that we’re not hoarding it for ourselves and sharing it with the people that need it the most. A lot of times that is a better approach than waiting for cases to show up here.
SAMPATHKUMAR: We have become better at messaging the public about the concerns and ways to prevent the illness. There’s a very effective vaccine available and there’s plenty of supply in the U.S. We’re not as good about sharing our resources with others. Controlling the outbreak at its epicenter would be much more effective than letting mpox into the U.S. and then working to control it here.
By Steven Ross Johnson | Aug. 15, 2024, at 5:20 p.m.
The move this week by the World Health Organization to declare a global emergency in response to mpox cases in African countries and the announcement of a case of a more severe type in Sweden raises concerns that the disease could continue to spread.
Since the beginning of 2024, there had been more than 500 deaths and more than 17,000 suspected cases of mpox across at least 12 African countries as of Aug. 13, according to figures from the Africa Centers for Disease Control and Prevention. Yet health officials fear the situation could get much worse due to inadequacies in disease surveillance, laboratory testing and contact tracing in that region.
“This is not just an African issue. Mpox is a global threat, a menace that knows no boundaries, no race, no creed,” said Africa CDC Director General Dr. Jean Kaseya in an Aug. 13 statement. “It is a virus that exploits our vulnerabilities, preying on our weakest points. And it is in these moments of vulnerability that we must find our greatest strength and demonstrate that we all learned from COVID by applying solidarity.”
From Jan. 1, 2022, to June 30, 2024, more than 99,000 cases of mpox have been reported across 116 countries, according to the WHO.
Among the concerns around this latest outbreak has been the emergence of a new strain of the clade 1 type of mpox, which is a more severe form than the clade 2 type that was dominant during a 2022 global outbreak. Outbreaks involving clade 1 mpox are associated with a death rate of up to 10% of those infected, compared with clade 2 outbreaks, where 99.9% of those infected survive, according to the CDC.
On Thursday, Sweden reported the first case of the more dangerous mpox strain outside of the African continent.
For more perspective on the potential health threat the current mpox outbreak poses, infectious disease experts Dr. Priya Sampathkumar, a professor of medicine with the Mayo Clinic, and Kari Debbink, an associate teaching professor in the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, spoke with U.S. News about the possibility of another mpox outbreak in the U.S., how to reduce the threat and lessons from 2022’s outbreak.
The interview below has been edited for length and clarity.
What is mpox?
SAMPATHKUMAR: Mpox is an orthopox viral infection that spreads from person to person and causes a rash illness. It’s a distant cousin of smallpox. The mpox lesions look a little bit similar to that of smallpox, they are painful and they can be associated with generally feeling unwell, such as having a fever. Because the rash tends to be in very sensitive areas (of the body) like the genitalia, it is very, very painful.
How concerned are you about the possibility of the current mpox outbreak in Africa spreading to the U.S.?
DEBBINK: At this point, we don’t have any clade 1 cases here, but I think that the declaration gives us pause that it’s a possibility that we might see cases of it.
SAMPATHKUMAR: We do know that mpox spreads quite easily from person to person, so if a case is imported into the U.S. it could spread. Previously, the cases were pretty much limited to (Congo), which doesn’t have as much travel in and out. Now that cases have spread to neighboring countries, including Rwanda and Uganda, there’s concern that because there is more travel in and out of these countries, this could spread around the world.
Are you concerned about the emergence of a new mutated strain of the clade 1 type of mpox? Have there been any indications thus far that this new strain may be more transmissible or more resistant to current treatments?
SAMPATHKUMAR: The main concern about this is the fact that it is more severe, so there is a higher risk of people dying from the infection. I don’t think there’s any indication yet that this is more resistant to current treatments, or that it is more transmissible.
One of the big lessons from prior outbreaks is that there’s a big disparity between where the cases are and where the resources are. In the United States, we have ready access to vaccines and antiviral treatment, so our outbreak (in 2022) was controlled. We also have the resources for surveillance, case-finding and limiting transmission.
Unfortunately, these resources are not as readily available in the places where the outbreaks are happening.
What are the major lessons from the 2022 mpox outbreak?
DEBBINK: Now that the World Health Organization has issued this warning, I think it’s really important the United States and other countries outside of central and east Africa do what they can to help the countries where there are cases to contain them. So, providing financial aid, vaccines, medical supplies and anything they need to contain this is really important.
Domestically, since 2022 we have developed a really good testing structure at this point. It’s set up more to identify clade 2 viruses, but the testing is such that you can identify whether it’s a clade 2, and if it’s not you can do additional testing to determine whether it’s a clade 1. There’s wastewater testing for mpox here, so there’s an indication that we would hopefully be able to detect it through wastewater surveillance.
Has there been an effort to think more globally in addressing disease threats?
DEBBINK: I think there are a lot of things people are doing in those affected countries that are not necessarily seen by the public. But at the same time, there are things that are more visible that we could be doing better as far as making sure that when there is a vaccine available, and there is a cost in terms of some countries being able to afford it, we should make sure that we’re not hoarding it for ourselves and sharing it with the people that need it the most. A lot of times that is a better approach than waiting for cases to show up here.
SAMPATHKUMAR: We have become better at messaging the public about the concerns and ways to prevent the illness. There’s a very effective vaccine available and there’s plenty of supply in the U.S. We’re not as good about sharing our resources with others. Controlling the outbreak at its epicenter would be much more effective than letting mpox into the U.S. and then working to control it here.