Editorial: Reasons for Increasing Global Concerns for the Spread of Mpox

On August 14, 2024, the Director General of the World Health Organization (WHO) declared that the increasing outbreaks of mpox (formerly monkeypox) should be regarded as an international public health emergency due to the growing number of cases in endemic and non-endemic geographical areas, and increasing disease severity [1–3]. Two years previously, outbreaks of mpox became so high that on July 23, 2022, the WHO declared mpox as a Public Health Emergency of International Concern (PHEIC) [4,5]. However, almost a year later, on May 11, 2003, the WHO declared the end of the global public health emergency for mpox [6,7].

The mpox virus (MPXV), or Orthopoxvirus monkeypox, is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family, which also includes several animal poxviruses, cowpox virus, vaccinia virus, and variola virus [8,9]. Infection with MPXV causes a disease similar to smallpox [5,6]. MPXV consists of two genetically distinct clades, clade I (formerly the Congo Basin/Central African clade), and clade II (formerly the West African clade [4,9]. The genetic differences between the genomes of the two MPXV clades and the ongoing development of new variants could explain the recent increase in spread, epidemiology, and pathogenesis, as Clade I is associated with more severe disease, with increased mortality rates [9–11].

An important feature in the pathogenesis of viruses of the genus Orthopoxvirus is their known long-lasting stability in the environment [12]. Viable MPXV can be detected on surfaces for at least 15 days after contamination and are less sensitive to organic disinfectants when compared to other enveloped viruses [12].

The latest update from the WHO and the alerts given regarding the PHEIC status of mpox follows an upsurge of mpox in the Democratic Republic of the Congo (DRC) and an increasing number of African countries, with spread to other continents and countries [1]. The spread of a new sexually transmissible strain of the MPXV and new clades and virus variants may be explained by inadequate infection surveillance during 2022 and 2023 [2]. Now, mpox infection should be regarded as an emergency for Africa and the rest of the world [1,2].

Although mpox has been endemic in West and Central Africa it came to the attention of the World Health Organization in 2022 when laboratory-confirmed cases were reported in 50 non-endemic countries, mainly in adults, and mainly in Europe [4,5]. In the US, the Centers for Disease Control and Prevention (CDC) identified an outbreak of mpox in May 2022, with 99% of cases in adult men, 94% reported cases being due to male-to-male sexual contact or intimate contact three weeks before symptoms of infection [13]. Also, in 2022, 46% of infected patients reported one or more genital lesions, and in the US, 41% of adult patients also had HIV infection [13]. Therefore, initial public health measures in the US aimed to prioritize specific adult male demographic groups for infection prevention and testing [13]. By August 4, 2022, the Department of Health and Human Services (HHS) declared the mpox outbreak a public health emergency in the US [13]. On August 22, 2022, the European Centre for Disease Prevention and Control (ECDC) rapidly published a factsheet for health professionals on the prevention and management of mpox [14].

Because MPXV is crossing geographical boundaries and has varied and unpredictable transmission patterns, it is urgently needed to contain this infection before it reaches pandemic status (1,3). Public health measures require infection surveillance, rapid diagnosis, contact tracing, patient isolation and management, and vaccination [15]. The three main approved MPXV vaccines are ACAM2000, MVA-BN, and LC16, all recommended by the WHO [1,15]. The WHO has now provided vaccination guidance for those in contact with infected people or those in current non-endemic areas who may be at risk for contracting pox when traveling [1,15]. However, mass vaccination is still not currently recommended, and in many countries, vaccine availability is limited [1,2].

Conclusions

The current status of the global spread of MPXV and the increasing number and severity of cases of mpox in African countries has occurred due to a lack of infection surveillance and control and a lack of availability of approved vaccines. Urgent public health measures are required to prevent the spread of pox and prevent it from reaching pandemic status.