Mpox: is there still a global outbreak?

Last year the World Health Organization (WHO) declared mpox a global public health emergency. So what is happening now?

What is this story about?

An update on the global mpox outbreak, which began in May 2022. Mpox (formerly known as monkeypox) causes sores, rashes, fever, headaches, tiredness and muscle ache. It is not classified as a sexually transmitted infection as it is not yet known if mpox can spread through semen or vaginal fluids. But it is passed on through close personal contact, which is a big part of sex.

Last year, 110 countries reported mpox cases, mainly among gay men and other men who have sex with men. The outbreak was centred in Europe, the UK, North America and Latin America.

Why is this important?

In high-income countries, mpox is now under control, and it is likely that WHO will soon declare an end to the global public-health emergency. But it is a different story in some low- and middle-income countries, particularly in west and central Africa where mpox has been an issue for years.

What is happening?

Last year, high-income countries funded rapid public health measures to control mpox, targeted at men who have sex with men. Treatment (the antiviral tecovirimat) and vaccines were distributed. Massive, community-led awareness and behaviour change campaigns were also carried out.

As a result, in the USA mpox infections fell from 400 a day in August 2022 to fewer than 10 a day in December 2022. In Europe, mpox infections have fallen by over 95% since July 2022. As of 2 January 2023, 79 countries affected by the mpox outbreak had not reported any new infections.

But mpox remains a major public health issue in some countries, particularly in Africa and Latin America.

A lack of vaccines is a key reason why. Africa did not get any mpox vaccines until November 2022 when South Korea made a 50,000-dose donation. However, many more vaccines are needed. The situation is similar in Latin America. For example, Brazil has no access to vaccines or treatments, despite having nearly 10% of global mpox cases.

African countries are also struggling to access mpox treatment. Across Africa, tecovirimat is only available to people taking part in clinical trials.

Mpox data from African countries is also limited. According to the Africa Centres for Disease Control and Prevention, in 2022 more than 7,200 people were suspected to have mpox, 70% in the Democratic Republic of Congo, and 226 people died. But a lack of testing means only around 1,200 of all suspected cases were confirmed.

It is likely that the number of mpox infections and deaths in Africa are far higher than what has been reported. But the lack of testing and virus surveillance means the extent of the epidemic is not fully known.

What does this mean for HIV and sexual health services where I am?

HIV and sexual health services in Africa need to be aware of the symptoms of mpox and how to prevent it from spreading. The US Centres for Disease Control and Prevention has produced a useful five-step mpox prevention guide. WHO has also produced a one-hour online training session for health professionals in Africa on how to spot, diagnose, treat and prevent mpox.

The way mpox is transmitted in endemic countries (where mpox has been an issue for years) is more complex than in countries that were only affected by the global outbreak. In endemic countries, mpox is passed from animals (mostly rats and monkeys) to humans. It also affects the general population, not just men who have sex with men. (For example, in Nigeria about 40% of mpox case were among women in 2022. In the USA, only 5% of cases were.) This means more groups of people are at risk of mpox and need prevention information, treatment and vaccines.