The African Centres for Disease Control and Prevention declared mpox a public health emergency of continental security on the 13th of August, with the World Health Organization following suit the following day, declaring it a global public health emergency, once again putting the disease back on the world stage.

Although the risk is generally associated with travel to affected regions, it's critical that travellers remain vigilant about potential contacts and mass gatherings and consider vaccination. Unfortunately, a repeat of the mistakes seen during the COVID-19 pandemic is evident, as countries begin stockpiling vaccines while the most needed communities in Africa are left wanting. There is an urgent need to join forces with the Africa CDC and local authorities to address this disparity and halt the spread.

The risk remains low for Australia as an island nation; however, maintaining vigilant surveillance is crucial to preventing any potential outbreak.

See some of my monkeypox publications below:

• Epidemiological Profile of Monkeypox-Varicella Zoster coinfection
• Travel-related outbreaks
• Genomic Analysis and Virology Insights

Mpox belongs to the Poxviridae family and can survive for a long time in dried scabs and on surfaces. It is very resistant in the environment. Once it infects cells it can then spill out into the blood stream causing viremia. Infected people will have fever, aches and pains and sometimes vomiting. Then a rash develops with oozing pox sores, lesions appear and then became scabs. Finally, the scabs fall off but leave scars behind, as the virus destroys all the layers of skin. The ancestor virus, Smallpox was known as the “speckled monster” because of the disfigurement left by scars from hundreds of virus lesions all over the body. 

Today we have won the battle against Smallpox. However, another Poxvirus called Monkeypox (Mpox) is still around and is a zoonotic emerging disease. Although Mpox is much less dangerous than smallpox, some strains can be fatal. The virus can be caught from infected rodents, squirrels, monkeys and infected humans. In the past, the smallpox vaccine also provided cross-reactive immunity to protect against Mpox. However, we are now seeing an increase in the number of cases of Mpox in people as smallpox vaccination has ceased. So, it is important to monitor this African virus outbreak and other countries via biosecurity surveillance.

Monkeypox, now referred to as mpox, is caused by the monkeypox virus (MPXV), a member of the orthopoxvirus genus, which also includes the variola virus responsible for smallpox. The first human case was documented in 1970 in the Democratic Republic of the Congo (DRC). Mpox has two primary clades: the more virulent Central African strain and the less severe West African strain. While historically rare outside Africa, cases surged globally starting in May 2022, prompting the World Health Organization (WHO) to declare the outbreak a Public Health Emergency of International Concern (PHEIC) due to its rapid spread and potential for severe health impacts.

Transmission

Monkeypox virus (MPXV) transmission occurs through several primary routes, with human-to-human transmission being the most significant. This typically involves direct contact with the lesions or bodily fluids of an infected person, particularly during intimate interactions, as well as respiratory droplets during prolonged face-to-face contact. Fomites, or contaminated surfaces, can also facilitate transmission. Animal-to-human transmission is another critical route, often occurring through direct contact with infected animals, such as rodents or non-human primates, particularly in regions where bushmeat is consumed. Vertical transmission from mother to fetus during pregnancy has also been reported. The epidemiology of mpox has shifted, especially since the outbreak in May 2022, with a notable increase in cases among men who have sex with men, indicating a change in transmission dynamics. The disease presents with symptoms such as fever, lymphadenopathy, and skin lesions, and while it is less lethal than smallpox, it poses significant health risks.

Enhanced surveillance, public health education, and vaccination are crucial in controlling the spread of mpox, particularly in non-endemic regions like Australia, where monitoring for potential cases is essential to prevent outbreaks. The WHO's designation of mpox as a PHEIC underscores concerns about the disease's potential to spread rapidly, especially in populations with low immunity due to the cessation of smallpox vaccination programs. This raises questions about the vulnerability of populations, such as in Australia, where there is currently no widespread immunity against orthopoxviruses. Australians should remain vigilant, as the potential for mpox to enter the country exists, particularly through international travel. Monitoring can be enhanced through robust surveillance systems, public health campaigns to educate about transmission risks, and vaccination strategies for at-risk populations.

Approved Vaccines for Monkeypox

Two vaccines have been approved for the prevention of monkeypox:

JYNNEOS (also known as Imvamune or Imvanex):

• A live, non-replicating smallpox and mpox vaccine developed by Bavarian Nordic.
• Approved by the U.S. Food and Drug Administration (FDA) for the prevention of mpox in individuals 18 years of age and older determined to be at high risk for mpox infection.
• Demonstrated 100% efficacy in clinical trials against mpox in non-human primates and has been shown to be well-tolerated in humans.

ACAM2000:

• A live vaccinia virus vaccine developed by Sanofi Pasteur.
• Approved by the FDA for the prevention of smallpox and mpox in individuals determined to be at high risk for infection.
• Demonstrated 85% efficacy in clinical trials against mpox in non-human primates.
• However, ACAM2000 is not recommended for immunocompromised individuals due to the risk of serious adverse events.

Both vaccines have been shown to be effective against the current circulating strains of mpox, particularly the West African clade. However, it is important to note that the vaccines may have reduced efficacy against the more virulent Central African clade.

There has been a global outbreak of mpox since 2022 due to a subtype called "clade II". However, the WHO announcement is in relation to another type of mpox called clade I, specifically Ib. Although both cause mpox illness (a flu-like illness with a rash), there had traditionally been some differences with clade I being associated with more severe disease and higher death rates.

This is one concern with the new outbreak. The large number of cases has been another concern with the Africa Centres for Disease Control finding a 160% rise in reported cases compared to 2023-24. Also, another worrying feature with this new outbreak is that most cases and most deaths have occurred in children <15, compared to the 2022 outbreak, which is mainly affecting adult males.

Although the epicentre for this new outbreak is the Democratic Republic of Congo, it has spread to a number of East African nations, highlighting its pandemic potential with so many large airports in the region. Two doses of a vaccine are very effective in preventing the infection, although this usually applies to adults rather than children, in which most of the cases have been; therefore, hopefully, the announcement by the WHO of this being a public health emergency of international concern will galvanise global resources to contain the outbreak within Africa, and ultimately terminate it. 

This current Mpox outbreak resembles the previous emergence of Mpox in 2022 where it was neglected and later caused a global outbreak. The declaration of a public health emergency of international concern is timely to allow health authorities of respective nations to reinforce measures in order to curb the spread. It is now time for us to act quickly to prevent history from being repeated.

Monkeypox [Mpox] is not a new disease: it was found in the 1950s in lab primates in Denmark and was first diagnosed in an infant in the 1970s in the Democratic Republic of Congo where the current outbreak is.

Monkeypox is a zoonotic disease and has mainly been transmitted from infected animals to humans, and has been endemic to West and Central Africa. Transmission can occur through contact with infected rodents, mice, rats, squirrels, monkeys and other primates. 

The new strain of the mpox virus is sexually transmitted, spreading through East, West and Central Africa. It’s important we provide as much information about the virus as possible in a non-stigmatising manner.

Specific actions include prioritising two vaccines available currently as a matter of urgency for those most at risk and targeting public health messaging. Actions individuals can take include maintaining contact details of sexual partners, avoiding sex if you have a rash until you get tested, considering avoiding skin to skin contact in large gatherings, if diagnosed with monkeypox, avoiding close physical contact, including sexual contact, with other people for the duration of the illness.

The WHO’s declaration of mpox as a public health emergency of international concern (PHEIC) is the best opportunity we have to prevent the global establishment of mpox. The spread of new, possibly more lethal variants in more African countries is worrying, and has the potential to lead to global spread. All infectious disease pandemics are different, but they are also the same. The key similarity is that early highly targeted action using effective tools can prevent global spread and the global establishment of endemicity.

Fortunately, we have the tools we need to prevent this happening. Currently available smallpox vaccines are highly (but not completely) effective in preventing mpox. We saw in 2022 that rapid roll-out of these vaccines was associated with rapid declines in transmission. In Australia, vaccine roll-out in gay and bisexual men averted a serious epidemic associated with the global gathering of LGBTQI+ people at the Sydney World Pride festival in early 2023. In 2024 numbers have rebounded, indicating that current vaccination levels are too low. Importantly, the strain that has led to a public health emergency in Africa has not been detected in Australia yet.

Action in the most-affected countries in Africa is critical to avoiding the global establishment of mpox. We need greatly increased access to the vaccine, targeted towards those people in African countries at highest risk of mpox. Current vaccine inequity must be addressed as part of the response to the PHEIC.

The World Health Organization (WHO) has just declared mpox a public health emergency of international concern following a significant surge in cases in the Democratic Republic of Congo (DRC) and neighbouring countries. Mpox, caused by the monkeypox virus, was first identified in laboratory monkeys in 1958, although its natural hosts are primarily rodents. The virus is closely related to other poxviruses such as smallpox and cowpox.

Mpox typically presents with a rash that progresses through several stages, accompanied by symptoms like fever and swollen lymph nodes. While the disease is generally self-limiting, it can be severe, especially in young children, pregnant individuals, and those with weakened immune systems.

The disease gained global attention in 2022 when it began spreading rapidly across continents, including Australia. In Australia, mpox primarily spread through close physical contact, with most cases occurring among men who have sex with men, as well as transgender and bisexual individuals. In 2022, Australia reported over 100 cases, but the numbers dropped significantly in 2023. However, this year has already seen 40 cases, surpassing the total for 2023. Our public health authorities have managed to control mpox through vaccination efforts, particularly targeting close contacts of infected individuals.

A new strain of mpox emerged in the DRC late last year, raising concerns due to its higher transmissibility and potential to cause more severe disease than the strain circulating in 2022. This development has prompted the WHO to take decisive action, highlighting the need for increased vigilance and international cooperation to prevent further spread.

Mpox is a slow-burning fire that has been allowed to smoulder in central Africa and is flaring up again. This time the WHO is ringing the alarm.

Mpox outbreaks have been occurring in central Africa for decades constituting an ongoing risk that has largely been ignored outside the countries involved. The current outbreak is larger and involves more person-to-person spread, such that many more people have been infected, and spread is affecting several countries. Current concern has also been heightened by the potential of Mpox to spread rapidly via the close contact that occurs during sexual encounters, which caused the 2022 global outbreak.

There is evidence to suggest that the current outbreak, which is caused by a different variant of the virus is also spreading by this route. This is a disease that can be stopped by an existing vaccine, but vaccine supplies are not getting to the places they are needed. It is hoped that the WHO call to action by issuing their notice of concern will turn this around so that the spread of this disease can be stopped.

Mpox is a relative of the now eradicated human pathogen variola virus – the causative agent of smallpox. Mpox is not as transmissible as variola virus. Mpox relies on close human to human contact.

Whilst the spread of mPox is indeed troubling -the good news is, we know that vaccines against viruses in the Orthomyxovirus genus (like variola and mpox) are highly effective. Indeed, smallpox is the only viral disease to be completely eradicated by vaccination.

So with a coordinated international response (surveillance, education, vaccination) control of this outbreak and future outbreaks is achievable.

The World Health Organization's (WHO) declaration of mpox as a public health emergency of international concern again emphasises the need for coordinated international efforts to control the outbreak. This includes enhancing access to vaccines, diagnostics, and treatments, especially in lower-income countries. 

For Australians, this declaration highlights the importance of global health vigilance, as diseases can easily cross borders and impact regions far from their origin. The situation underscores the need for proactive measures to prevent the spread of mpox and similar diseases worldwide. This is happening because high-income countries have not supported efforts to limit this, and other, diseases in Africa.

Mpox is a viral disease caused by an orthopoxvirus. It was first identified in humans in 1970 in the Democratic Republic of the Congo (DRC) and is endemic to central and west Africa. Mpox can be transmitted from animals to humans and between humans through direct contact with skin lesions, body fluids, or respiratory droplets of an infected person, prolonged face-to-face contact with an infected person, and rarely, touching contaminated objects.

Historically, mpox was neglected in Africa, but gained global attention during a 2022 outbreak that spread to regions like Europe, Australia, and the United States leading the WHO to declare a PHEIC that lasted 10 months. The current outbreak is concerning due to a new strain, clade 1b, which is spreading rapidly in the DRC and at least 12 neighbouring countries. This strain is potentially more deadly and appears to infect children at a higher rate than other strains.