The first doses of an Mpox vaccine called Jynneos arrived this week in the Democratic Republic of Congo. Authorities expect more than 250,000 doses to be delivered to the DRC in the coming days. Given the current steep rise in cases, it’s critical that sufficient supplies of vaccine are shipped to the DRC and other African countries and administered to the population at risk as soon as possible.
In the past week alone there have been 5,466 suspected new cases of Mpox (formerly known as monkeypox) in Africa, predominantly in the DRC, according to the Dutch news site NOS. Figures from CDC Africa show that 26 more people died from MPox last week.
It’s estimated that since the beginning of this year at least 25,000 people have been infected with Mpox, though in light of very limited access to diagnostic testing across Africa only a relatively small fraction has been confirmed. Since January, 643 people have died from the virus.
The World Health Organization declared last month that the rapid spread of Mpox in African countries constitutes a global public health emergency. This is the second time in three years that the WHO has designated an Mpox epidemic as a worldwide emergency. It previously did so in the summer of 2022, when an outbreak infected nearly 100,000 people in 116 countries and killed roughly 200.
The WHO’s designation of a “public health emergency of international concern” is intended to prompt member countries to begin preparing for the virus’ appearance and to share vaccines, treatments and other key resources, particularly with poorer nations.
The vaccine currently being shipped to the DRC, Jynneos, was licensed by the Food and Drug Administration in 2019 for adults ages 18 and older who are at high risk of exposure to Mpox. In an interview with STAT News, the maker of the product, Bavarian Nordic, said it can ramp up production by another eight million doses in 2025.
Notably, the vaccine can prevent Mpox and reduce the severity of the infection if it does occur. The United States Centers for Disease Control and Prevention recommend that people who’ve been exposed to Mpox or are at risk of exposure to the virus get vaccinated.
The FDA gave the green light two week ago for another Mpox vaccine, ACAM2000. It is a direct descendant of the world’s first vaccine invented by Edward Jenner more than two centuries ago.* First formally approved in 2007 by the FDA for the prevention of smallpox, the U.S. has a strategic stockpile of over 100 million doses of ACAM2000. The vaccine has more side effects and contraindications than Jynneos. Specifically, it is not recommended for those with compromised immune systems, such as HIV patients, pregnant women and people with autoimmune disorders.
It’s unclear whether the federal government will deliver any doses of its large inventory of ACAM2000 to African countries in need. On the other hand, the manufacturer of the product, Emergent BioSolutions, says it’s donating 50,000 doses to the Africa.
It appears that the current strain of Mpox, clade Ib, is more virulent than the one circulating in 2022, clade II, with possibly a higher case fatality rate.
While the 2022 outbreak occurred mostly among gay and bisexual men, Mpox in Africa is now being spread not only through sex, but also by close person-to-person contact in certain parts of the DRC, most notably to children.
What is known regarding transmission is that Mpox mainly spreads through direct contact with body fluids or sores of a person or animal who has the disease. It is also thought that Mpox can spread through direct contact with material, such as clothing and linens, that have touched body fluids or sores. In addition, Mpox may be contracted through consumption of bushmeat (meat from hunted wildlife in Africa).
The infection can produce fever, respiratory symptoms, muscle aches and swollen lymph nodes, as well as a rash on the hands, feet, chest, mouth or genitals. Reasons for hospitalization include the need for management of severe pain, but also pharyngitis limiting oral intake, encephalitis (brain inflammation), eye lesions, acute kidney injury and myocarditis (heart inflammation).
Thus far, the overall case fatality rate of the current clade Ib outbreak appears to be around 5%, but some regions have reported rates in excess of 10%. By comparison, the case fatality rate during the Mpox outbreak of 2022, driven predominantly by clade II, was just 0.18%.
Sweden confirmed its first case of a more virulent variant of Mpox in August. This was the first time this particular strain of the virus was detected outside Africa. At approximately the same time, Thailand confirmed a case of the clade Ib variant. Both persons with confirmed cases had traveled to a part of Africa where there is a large epidemic of the disease.
In response to the potential threat of global spread of the virus, the U.S. CDC have urged healthcare providers and the public to be vigilant.
For now the epidemic of the clade Ib variant of Mpox is mostly confined to the African continent. Nonetheless, amid a steadily expanding outbreak it’s urgent that the vaccination drive in Africa succeeds to contain the public health emergency there but also reduce the risk of it spreading worldwide.
