Health officials in Africa continue to report progress in the region’s battle against mpox, but some challenges remain, including cutting the number of deaths and helping emerging hot spot countries such as Kenya contain rising cases, leaders from the Africa Centres for Disease Control and Prevention (Africa CDC) said today at a weekly briefing.
A year has passed since the World Health Organization (WHO) declared a public health emergency of international concern (PHEIC) for Africa’s mpox outbreaks. Scientists, country health officials, and other stakeholders are meeting this week to take stock of mpox research and discuss new ways to operate and fund research projects to support the outbreak response.
Yap Boum, PhD, MPH, deputy incident manager for Africa CDC’s mpox response, said overall the number of confirmed cases has declined 70% since the year’s peak, and testing coverage continues to rise steadily. Boum said the increase in testing is a sign of progress with disease surveillance, though healthcare system weaknesses and other challenges add to a varied epidemiologic picture in different countries.
“An increase in the number of deaths is the major concern,” he said, noting that many of the fatal cases are in people with underlying health conditions, especially HIV. Boum said efforts to support patients with chronic conditions, such as food security, would help save lives.
Worrisome developments in Kenya
Kenya currently has one of the most worrisome mpox situations, and the virus has spread from coastal regions to Nairobi, raising the risk of exponential spread given the urban population density in the country’s capital, he said. Nairobi is also Kenya’s largest city, with a population topping 5 million people.
Clade 1b is circulating in the country, and the case-fatality rate is 2%, which is on the higher end of affected countries, Boum said, noting that Africa CDC will fast-track support to the country.
The country hopes to launch a vaccination campaign on September 1, which Boum said would ideally be conducted hand-in-hand with surveillance activities.
Hot spot countries at different outbreak stages
In the Democratic Republic of the Congo (DRC), which had been one of the region’s main hot spots with clades 1a, 1b, and 2b circulating, health officials are seeing a continuing decline in cases, but a shift of toward other provinces, including Sankuru, Bas Uele, Tanganyika, and South Kivu.
Boum said mpox has been detected in a range of animals, including dogs, rats, bats, and squirrels in Equateur and Tshopo provinces. And though human-to-human spread is still the key driver, he said the importance of the One Health approach still remains.
Liberia has shown a sharp drop in cases, though test positivity is still high. Infections in Burundi rose slightly, mainly due to enhanced surveillance. Boum said the country’s health officials are adjusting their messaging about mpox to emphasize that the disease is still present and that people need to keep up their precautions.
In Guinea, which experienced exponential spread in July, Boum said test positivity is still high, at 80%, which he said suggests there is still a lot of missed cases in the community. Africa CDC support teams are planning a visit to the country to help find ways to increase capacity for surveillance and patient isolation.
US to transfer mpox doses as DRC launches vaccine effort
Earlier in the outbreak, the US government had pledged about 1 million doses of mpox vaccine for the continent’s mpox response, much of it in limbo given the January change in presidential administrations. African health officials have said the region urgently needs 3.4 million doses to meet its demand.
In a promising development, Boum said the US government has authorized the shipment of 219,000 doses, though it’s not clear when they will be shipped. He added that the partnership with the United States is moving in a good direction.
In another vaccine development, the LC16 vaccine was deployed in the DRC on August 12, targeting six health zones across Kinshasa. So far, more than 28,000 people have been vaccinated. The LC16 vaccine was donated by Japan and can be used in children as young as 2 years old. Children were among the most affected groups by clade 1 in the DRC.
The single-dose live-replicating attenuated vaccine is delivered by dermal scarification.