The World Health Organization (WHO) has taken decisive action in response to the rapidly spreading mpox outbreak in Africa. WHO Director-General, Tedros Adhanom Ghebreyesus, PhD, announced at a media briefing that an emergency committee will be convened to assess the threat posed by the complex situation in Africa. The outbreak, which initially began in the Democratic Republic of Congo (DRC), has now expanded beyond the country's borders, with multiple countries reporting outbreaks involving different clades of the virus.

The decision to convene an emergency committee was based on the emergence of a novel mpox clade outside the DRC, raising concerns about its potential spread to other African nations and the rest of the world. The committee, comprised of outside experts, will meet as soon as possible to assess the situation and provide recommendations. These recommendations will be crucial in determining whether the outbreak should be classified as a Public Health Emergency of International Concern (PHEIC). This designation depends on factors such as the novelty of the threat, the crossing of international borders, and the need for global collaboration to control the spread.

The WHO has been working closely with affected countries, the Africa Centres for Disease Control and Prevention (Africa CDC), and non-governmental organizations to gain a better understanding of the factors driving the outbreaks. According to Tedros, halting the transmission of the virus will require a comprehensive response with communities at the center.

The mpox outbreak in the DRC has been ongoing since 2022, with over 14,000 cases reported this year, including 511 fatalities. Initially concentrated in South Kivu and later spreading to North Kivu provinces, the outbreak in the eastern DRC is caused by a novel clade 1b virus, which is believed to cause more severe disease compared to other clades.

Alarmingly, four neighboring countries that had not previously reported mpox cases have recently confirmed 50 cases, with additional suspected cases. The clade 1b virus has been identified in Kenya, Rwanda, and Uganda, while investigations are still underway in Burundi. Furthermore, the clade 1a virus, which is endemic in certain African countries, is fueling outbreaks in other parts of the DRC, as well as the Central African Republic and the Republic of Congo. Meanwhile, the global clade 2 strain, responsible for the 2022 global outbreak, has triggered new outbreaks in Cameroon, Ivory Coast, Liberia, Nigeria, and South Africa.

Tedros disclosed that the WHO has already developed a regional response plan, requiring $15 million in financing. The organization has allocated an initial $1 million from its emergency contingency fund. In addition, the WHO has initiated the process of emergency use listing for two mpox vaccines, already approved by some countries in the region and recommended by the WHO's vaccine advisory group. Tedros expressed his gratitude to Japan, the United States, the European Union, and manufacturers for their collaboration in donating vaccines.

The transmissibility and severity of the new clade are still being assessed by scientists. However, there are indications that it can efficiently spread through sexual contact, particularly within interlinked sexual networks, leading to rapid transmission. Cases of severe infections and deaths have also been linked to this novel clade. Other modes of transmission, such as household contact, fomites, and respiratory spread, may contribute to the virus's spread.

While most affected patients are adults, children appear to be more vulnerable to the disease. The severity of infections varies depending on the context of circulation. The overall case fatality rate in the DRC is 3.6%, with higher rates observed in endemic areas of the country's central, western, and northern provinces, and lower rates in the eastern part of the country. Children primarily contract the virus through household contact, resulting in higher death rates among this group. In contrast, adults who contract the virus through sexual transmission experience lower mortality rates. The virus has now spread beyond sex workers to include students, business people, and travelers.

Maria Van Kerkhove, acting director of WHO's Department of Epidemic and Pandemic Preparedness and Prevention, emphasized the urgent need to gather more information about the epidemiology of the multicountry outbreaks. Understanding the specifics of these outbreaks will enable tailored response strategies to be implemented. Kerkhove expressed gratitude for ongoing sequencing efforts and called for even greater collaboration in this regard.

The WHO's initiation of an emergency committee and the development of a regional response plan reflect the organization's commitment to addressing the growing mpox outbreak in Africa. It is crucial to control the spread of the virus, not only within the affected countries but also on a global scale, to safeguard public health worldwide.