Surge of Mpox Cases Sparks Alarm in Africa Amid New Variant Outbreak
A concerning new variant of mpox, formerly known as monkeypox, has emerged and begun spreading across several countries in Africa, primarily following its transmission from the Democratic Republic of Congo (DRC). The Africa Centers for Disease Control and Prevention (CDC) reported that as of 2024, there have been over 18,000 suspected or confirmed cases of mpox on the continent—outpacing all recorded cases from 2023 and 2022. This surge comes on the heels of a public health emergency declared by the World Health Organization (WHO) in July 2022.
The sharp rise in cases appears to be linked to a new variant that is more easily transmissible and has spread to many countries. Two distinct genetic clades of the mpox virus have been identified in Africa: variant I and variant II. The global outbreak that initiated in 2022 was attributed to variant II, which is endemic in certain West African nations. Most infections at that time were reported externally, particularly in the United States, which was the hardest-hit country.
Currently, variant I has shown a heightened capacity for transmission and is prevalent in Central Africa, especially in the DRC, where an ongoing outbreak of this variant has been reported since November 2023. This past June, a new subvariant of clade I, referred to as variant Ib, was uncovered in the DRC, leading to a second outbreak alongside a primarily Ia outbreak. Alarmingly, DRC, where 80% of the population lives below the poverty line, is experiencing two simultaneous outbreaks of mpox.
The new variant has raised particular concern as preliminary data suggest it can be transmitted sexually, as well as through close physical contact, such as mouth-to-mouth or mouth-to-skin interactions. Unlike its predecessor, which mainly affected children, the new strain increasingly impacts the adult population. Goma, a city bordering Rwanda with a population of two million, has reported cases of this variant.
As of late July, the DRC accounted for nearly all mpox cases across the continent. In August, this trend continued, with the DRC documenting 85% of the cases. Additionally, newly confirmed cases began appearing in previously untouched countries, including Burundi, Rwanda, Kenya, Ivory Coast, and Uganda—all tracing back to patients who had traveled to the DRC.
Burundi has experienced a dramatic surge, with cases spiking from three to 400 within a month. The World Health Organization (WHO) declared a state of emergency, noting that no new cases of the variant had been found in other African nations during the past week.
Tragically, the outbreaks have resulted in at least 541 deaths across Africa, with 535 fatalities occurring in the DRC. An alarming trend was noted, as the number of weekly deaths climbed from fewer than 20 until late July, exceeding 50 in line with the increased case numbers.
While Africa's data indicates a mortality rate of about 3% as of mid-August, this number fluctuates significantly by country, reaching over 11% in South Africa—partly attributable to the prevalence of serious pre-existing conditions like HIV among patients. The new virus subvariant appears to exhibit more severe symptoms and a higher fatality rate, particularly among children.
In the previous years of 2022 and 2023, when the new variant was not identified, mpox's lethality was below 1%, with only 208 deaths resulting from infections. The situation remains tenuous as Africa's weaker surveillance systems make it difficult to ascertain whether the increased lethality of the newer subvariants is a real trend.
Despite the rising cases in Africa, health authorities in Europe and the United States maintain that the potential for sustained transmission in their regions remains low, thanks to efficient diagnostic measures and vaccination initiatives. Nonetheless, experts are wary that this new variant might become predominant in other African nations, where existing conditions such as malnutrition and chronic diseases could exacerbate its impact.
The global health community watches closely as mpox continues to pose significant challenges, particularly in vulnerable regions. Efforts to bolster prevention and control measures are more critical than ever in addressing the rapidly evolving threat posed by this virus.
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