Mpox: Outbreaks and Challenges

Mpox is a global health threat that challenged us during the third year of the COVID-19 pandemic, stressing public health response and calling attention to the gaps in how we support affected communities. While mpox isn’t likely to cause a COVID-esque public health emergency, there is still much we need to do to address transmission and vaccine equity. This zoonotic pathogen has underscored the intersection of human, animal, and environmental health, but fundamentally the need to ensure global access to health resources and vaccines.

As mpox is spread mostly through close contact and less through environmental contamination, our interventions require a bit of a shift in this post-respiratory pathogen pandemic era. Maria Van Kerkhove, PhD, COVID-19 technical lead of the World Health Organization (WHO) noted that “Transmission is really happening from close physical contact, skin-to-skin contact. So it’s quite different from COVID in that sense,” Van Kerkhove said.

The WHO has released the latest situation report on mpox (formally known as monkeypox) as this year has seen an increase in cases. Since January 2022, there have been 88,288 laboratory-confirmed cases and 149 deaths across 112 countries. Since the last sit-rep in late June, there have been 316 new cases and two deaths. What is concerning though, is the increase in cases in early July, which was a rise of 9.2% compared to the week before. The WHO sit-rep noted that, “the Western Pacific Region has reported the largest proportion of cases (92 cases, 34%) in the past three weeks (19 June through 10 July 2023), followed by the Americas (88 cases, 32%) and the African and South-East Asia Regions (35 cases each, 13%). In total, 11 countries reported an increase in cases in the last three weeks (20 June through 10 July 2023) compared to the three weeks prior (30 May through 19 June 2023). As of 11 July 2023, 17 of the 112 affected countries have reported new cases within the last 21 days, the maximum disease incubation period.”

Currently, there are 11 countries reporting the higher number of cases. The United States accounts for the highest number of cases (30,324), followed by Brazil (10,961), Spain (7,559), France (4,147), Colombia (4,090), Mexico, Peru, the United Kingdom, Germany, and Canada—all of which represent 83.7% of global cases. When reviewing cases in July 2023, the largest increase has been in the South-East Asia Region, with 35 new cases which is 40% increase over a three-week span. The European Region and Region of the Americas both saw over a 10% increase in cases, whereas the Western Pacific Region had a 25% reduction in cases, which was 92 in the three-week timeframe.

“Among cases with information available, 84.1% (26 049 / 30 965) have self-identified as gay, bisexual and other men who have sex with men. This proportion, while slightly fluctuating over time, has consistently been above 75%, highlighting that most transmission continues to occur in this community.” Moreover, “Of all reported modes of transmission since the start of the outbreak, skin and mucosal contact during sex has been the most reported, in 16 518 of 20 126 (82.1%) reported transmission events, followed by person-to-person non-sexual contact; this pattern has also been observed over the last 12 weeks.

Detailed information on the route of transmission is not available for most cases from the WHO African Region, thus the available information on transmission might not fully describe the spread of the virus in the region. Ultimately, this latest situation report from WHO confirms several key pieces, most importantly, that mpox is still circulating globally and surveillance and intervention efforts must be maintained and resourced. While global fatigue surrounding infectious diseases and public health interventions may be very real in this post-COVID emergency world, we must continue to invest in global public health.