The Public Health Agency of Sweden reported the individual sought care at Region Stockholm and has been diagnosed with mpox caused by clade I.
Image credit: The Public Health Agency of Sweden
The Public Health Agency of Sweden announced that an individual in Sweden has been diagnosed with the first case of mpox clade I outside of Africa.1 The individual sought care at Region Stockholm, and was reported to have been infected during time spent in an African region where mpox clade I has broken out. Just this week, mpox was declared a Public Health Emergency of Continental Security (PHECS) by Africa CDC and a global emergency by the World Health Organization (WHO).2,3
The person in Sweden has received care and rules of conduct, according to Magnus Gisslén, MD, PhD, the state epidemiologist at the Public Health Agency of Sweden and the chief physician in the Department of Infectious Diseases at University of Gothenburg.1
The agency noted that a new assessment of the risk to the general population is expected soon, but the country is prepared to diagnose, isolate, and treat people with mpox safely, and is not currently concerned about an increased risk to the general population. The European Centre for Disease Prevention and Control (ECDC) currently considers the risk very low, and this case does not require any additional infection control measures. To date, an estimated 300 cases of mpox have been identified in Sweden, all linked to the global outbreak of the clade IIb virus variant.
"We are closely monitoring the outbreak and we are continuously assessing whether new measures are needed," Gisslén said in a statement.1
Update August 16: Pakistan's Ministry of Health is reporting today that they have detected at least 1 case of mpox. Determination of which clade will be made after testing can confirm if the patient has clade I or clade II.
Mpox has 2 distinct genetic clades (or subtypes of MPXV), I and II, which are endemic to central and west Africa, respectively. Clade I mpox has previously been observed to be more transmissible and to cause a higher proportion of severe infections than clade II MPXV.
A major emergence of mpox linked to clade II began in 2017, and since 2022, has spread to all regions of the world. Between July 2022 and May 2023, the outbreak was declared a Public Health Emergency of International Concern. That outbreak has waned, though cases and deaths continue to be reported, suggesting low-level transmission has continued.
Patients who present with mpox can exhibit several symptoms, including: rash that may be located on the hands, feet, chest, face, mouth, or near the genitals; fever; chills; swollen lymph nodes; fatigue; myalgia; headache; and respiratory symptoms like sore throat, nasal congestion, and cough.4
In terms of treatment, there are no FDA-approved therapies, but there is 1 vaccine approved in Europe and the US for mpox, and Africa CDC has signed a partnership agreement with the European Commission’s Health Emergency Preparedness and Response Authority (HERA) and Bavarian Nordic to provide more than 215,000 doses of the live, nonreplicating Modified Vaccinia Ankara–Bavarian Nordic vaccine (MVA-BN; marketed as Jynneos) for distribution on the continent.2
For clinical care, clinicians may be able to prescribe antivirals such as cidofovir or tecovirimat, which are approved to treat other viral infections, like smallpox. More often than not, mpox is a self-resolving disease for patients and typically lasts 2 to 4 weeks.5
Carlos del Rio, MD, FIDSA, executive associate dean at Emory School of Medicine & Grady Health System and distinguished professor in the Division of Infectious Diseases at Emory University School of Medicine, said in an interview with Contagion that the ongoing clade I outbreak in the Democratic Republic of Congo has already afflicted more than 14,000 individuals—mostly women and children under 15 years of age—and has resulted in upward of 500 deaths.
"The outbreak has now spread to other countries in Africa and there is the possibility of spread beyond the continent. Clade I is more virulent and has a higher mortality than clade II (which caused the 2022 outbreak mostly among MSM [men who have sex with men]). The available JYNNEOS vaccine is effective in the prevention of mpox clade I but the challenge is not having enough vaccine available in countries that need it most," del Rio explained.
