Mpox Outbreaks in Kenya and Central African Republic: The Race to Contain the Spread in Africa
In recent months, Africa has seen a concerning rise in mpox cases, with the Africa Centers for Disease Control and Prevention (Africa CDC) reporting a 160% increase in cases compared to the previous year. The majority of these cases have been reported in the Democratic Republic of the Congo (DRC), which accounts for 96% of the total cases. However, other African nations, including Kenya, Cote d’Ivoire, and the Central African Republic (CAR), have also experienced new outbreaks. As of July 28, 2024, there have been a total of 14,250 cases and 456 deaths across ten African countries, including Burundi, Cameroon, CAR, Congo, DRC, Ghana, Liberia, Nigeria, Rwanda, and South Africa.
The DRC has been particularly hard-hit, with 13,791 cases and 450 deaths reported in 25 out of its 26 provinces. Males account for 73% of the cases, while children under 15 years make up 68% of the cases and 85% of the deaths. The outbreak in the DRC has been exacerbated by the emergence of a new mpox lineage, clade 1b, which was identified last year. This new lineage has a higher transmissibility and case fatality rate than the previous lineage, clade 2, and is believed to be spreading through household and sexual transmission. Both clades are currently co-circulating in the DRC, further complicating efforts to contain the outbreak.
Despite the availability of safe and effective vaccines and treatments for mpox in the US and Europe, these resources are not commonly used in Africa. This disparity in access to medical interventions has contributed to a higher case fatality rate on the continent compared to the rest of the world. The European Centre for Disease Prevention and Control (ECDC) has stated that the risk of clade 1b spreading to Europe is currently low, but they are working with partners in Africa to contain the outbreak and strengthen preparedness and response capabilities.
The Coalition for Epidemic Preparedness Innovations (CEPI) has announced a clinical trial of a mpox vaccine in the DRC to determine its efficacy in preventing infection. This trial represents a significant step forward in addressing the outbreak, but it will take time to yield results and implement widespread vaccination. In the meantime, the US CDC has reported a decline in wastewater detections of mpox in the West, which has been the region with the highest levels during the summer. However, the situation remains precarious, with studies showing a higher incidence of thrombocytopenia (low platelet count) after the first dose of the AstraZeneca vaccine.
Kenya and the Central African Republic have recently declared new outbreaks of mpox, adding to the growing list of affected countries. The outbreak in Nairobi was announced after a case was detected in a traveler from Uganda to Rwanda. Similarly, the CAR was the first to declare a new outbreak, which has since spread to its capital, Bangui. Health officials in both countries are working tirelessly to contain the spread of the disease, but the limited availability of vaccines and treatments presents a significant challenge.
Mpox is caused by a virus that originates in wild animals and can spread to humans through contact with infected animals, contaminated objects, or respiratory droplets. Symptoms include fever, muscle aches, and lesions on the body. If left untreated, mpox can be fatal, with the new strain having a 10% death rate. The World Health Organization confirmed the sexual transmission of mpox in Congo for the first time in November, raising concerns about the difficulty of containing the disease.
The public health minister of the Central African Republic has expressed concern about the spread of the disease in region 7 of the country. In response, health workers have been dispatched to towns and villages with confirmed cases to transport patients to hospitals for isolation and treatment. Traditional healers have been warned against treating suspected patients, and citizens are advised to wash their hands after contact with animals or sick people. Despite these efforts, the quick spread of the disease remains a significant concern for CAR officials.
Central African Republic officials are also coordinating with neighboring countries to stop the spread of mpox. Health Minister Pierre Somse has pleaded with community leaders to inform officials of symptoms and to avoid contact with wild animals. Communication Minister Maxime Balalou has emphasized that CAR cannot tackle this outbreak alone due to porous borders and the difficulty of controlling the movement of people and animals across the Congo basin. The collaboration with neighboring countries is crucial in the fight against mpox.
South Africa, which had its last case of mpox in 2022, has also reported an outbreak this year. The East African Community has issued an alert to member states about the disease in Congo, urging partner states to provide information and take preventive measures. Burundi has already confirmed three cases of mpox, further highlighting the widespread nature of the outbreak. The deputy secretary general of the East African Community has called for public support to help slow the spread of the disease.
In addition to the immediate health concerns, the mpox outbreak has broader implications for public health and safety in Africa. The lack of vaccines and treatments makes it difficult to contain the disease, and the stigma associated with mpox can lead to families hiding infected relatives, increasing the risk for others. The densely populated nature of cities like Bangui in CAR exacerbates the risk of transmission, making it essential for health officials to implement effective containment measures.
The international community has a role to play in supporting Africa’s efforts to combat the mpox outbreak. Organizations like the ECDC and CEPI are already working with African partners to contain the outbreak and strengthen response capabilities. However, more needs to be done to ensure that vaccines and treatments are accessible to those who need them most. The global response to the mpox outbreak must be coordinated and inclusive, recognizing the unique challenges faced by African nations.
As the mpox outbreak continues to unfold, it is crucial for African countries to remain vigilant and proactive in their response. Public awareness campaigns, community engagement, and cross-border collaboration are essential components of an effective response strategy. By working together and leveraging available resources, African nations can mitigate the impact of the mpox outbreak and protect the health and well-being of their populations.
In conclusion, the rise of mpox cases in Africa, particularly in the DRC, Kenya, and CAR, underscores the urgent need for a coordinated and comprehensive response. The limited availability of vaccines and treatments, coupled with the higher transmissibility and case fatality rate of the new mpox lineage, presents significant challenges. However, with the support of the international community and a commitment to public health and safety, Africa can overcome this outbreak and build resilience against future health threats.