The African Centre for Disease Control (CDC) and the World Health Organization (WHO) have recently raised alarms over a significant increase in mpox cases, primarily driven by a newly identified strain. Elri Voigt provides a detailed look into the current outbreak and its potential implications for South Africa.
Mpox, a viral disease first recognized in Africa in 1970, gained international attention in 2022 when it spread globally for the first time. Since then, the outbreak has continued to evolve, with various strains of the virus emerging in different regions. The latest surge in cases is largely attributed to a new strain known as clade Ib, which was first detected in the Democratic Republic of Congo (DRC).
The evolving nature of the situation has been a key focus of discussions, particularly during a special session at the World Health Organization (WHO) Regional Committee for Africa meeting in late August. This session was held in response to the WHO’s designation of the mpox outbreak as a Public Health Emergency of International Concern, highlighting the urgency and complexity of the situation.
Dr. Jean Kaseya, Director General of the African Centre for Disease Control (CDC), emphasized that the outbreak consists of multiple simultaneous outbreaks rather than a singular epidemic. This complexity arises from the presence of various clades of the mpox virus, each contributing to the ongoing crisis.
Professor Tulio de Oliveira, Director of the Centre for Epidemic Response and Innovation (CERI) at Stellenbosch University, explained that clades are classifications based on genetic differences among virus strains. Significant genetic changes lead to the emergence of new clades or variants. This classification helps in understanding the diversity and evolution of the virus, much like the categorization of SARS-CoV-2 variants.
Dr. Duduzile Ndwandwe, a molecular biologist with Cochrane South Africa, drew parallels between mpox clades and SARS-CoV-2 variants, noting that while different mpox clades exhibit distinct genetic variations, they all fall under the broader category of mpox.
Dr. Aida Sivro from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) provided insight into the clades identified in 2022. At that time, two main clades were recognized: Central African (clade I) and West African (clade II). Since then, clade I has evolved significantly, resulting in the emergence of clade Ib in the DRC. Additionally, clade Ia is also circulating, adding to the complexity of the outbreak.
The DRC currently accounts for approximately 90% of mpox cases in Africa. Dr. Fiona Braka from WHO’s AFRO region highlighted that the full scope of the outbreak remains unclear due to limitations in diagnostic capabilities. The DRC is experiencing two distinct outbreaks: clade Ia in areas where mpox is endemic, predominantly affecting children, and clade Ib, which is spreading among adults in the eastern provinces.
Clade Ib has also been detected in neighboring countries such as Burundi, Rwanda, Uganda, and Kenya, with isolated cases reported in Sweden and Thailand. As of September 1, 2024, WHO reported 3,751 confirmed cases and 32 deaths across 14 African countries, though many suspected cases have yet to be tested.
For South Africa, Professor de Oliveira advised maintaining vigilance without unnecessary alarm. Raising public awareness about mpox symptoms is crucial for early diagnosis and treatment. Dr. Ndwandwe emphasized the importance of vigilance due to the potential for clade Ib to spread to South Africa through cross-border travel.
South Africa has reported 24 mpox cases this year, with three deaths, 19 recoveries, and two active cases, the most recent of which was identified in early August.