interim guidance, 25 November 2024
This is the 42nd situation report for the multi-country outbreak of mpox, which provides an update on the epidemiological situation of mpox in Africa (including countries in the WHO African Region and some countries in the WHO Eastern Mediterranean Region), with data as of 3 November 2024.
On 27 September 2024, the Rwanda Ministry of Health announced the confirmation of Marburg virus disease (MVD). Blood samples taken from people showing symptoms were tested by real-time reverse transcription polymerase chain reaction (RT-PCR) at the National Reference Laboratory of the Rwanda Biomedi...cal Center and were positive for Marburg virus. As of 29 September 2024, a total of 26 confirmed cases, including eight deaths have been reported. The cases are reported from seven of the 30 districts in the country. Among the confirmed cases, over 70% are healthcare workers from two health facilities in Kigali.
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On 27 September 2024, the Ministry of Health of Rwanda confirmed the country’s first outbreak of Marburg virus disease (MVD), with health-care workers in Kigali particularly affected. While sporadic outbreaks have occurred in various parts of Africa since the first recognized cases in 1967, this o...utbreak is the third largest outbreak of MVD ever recorded to date. Marburg virus disease is a severe disease clinically similar to Ebola disease. With no approved treatments or vaccines for MVD, early intervention for those showing symptoms is crucial for improving survival rates.
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This threat assessment addresses the implications of the ongoing Marburg virus disease (MVD) outbreak in
Rwanda for the European Union/European Economic Area (EU/EEA). MVD is a severe disease in humans and,
although uncommon, it has the potential to cause epidemics with significant case fatality. ...All recorded MVD
outbreaks to date have originated in Africa. MVD is not an airborne disease and is considered not to be
contagious before symptoms appear. Direct contact with the blood and other body fluids of infected people
and animals or indirect contact with contaminated surfaces and materials like clothing, bedding and medical
equipment is required for transmission. The risk of infection is minimised when proper infection prevention and
control precautions are strictly followed. There is no approved treatment or vaccine for MVD; however, several
pharmaceuticals and candidate MVD vaccines are under investigation.
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Du 09 janvier au 08 avril 2024, le Congo a confirmé 19 cas de Mpox dans 04 départements, à savoir : 14 cas dans la Cuvette, 02 cas dans la Likouala, 02 cas dans les Plateaux et 01 cas à Pointe-Noire. Au regard de cette situation, le Gouvernement de la République, via le Ministère de la Santé ...et de la Population, a déclaré, en date du 23 avril 2024, l’épidémie de Mpox conduisant à l’activation du COUSP1 en date du 03 mai 2024 avec la mise en place du Système de Gestion d’Incident (SGI) assorti de toutes ses fonctions essentielles et élargies sous l’approche « Une Seule Santé ». A la 39ème semaine épidémiologique, 1 nouveau cas a été confirmé par le LNSP2 dans le département de Brazzaville, DS de Madibou, dans l’aire de santé de Mansimou, donnant un total de 22 cas confirmés.
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Uganda confirmed the first cases of mpox on 24 July 2024 following the confirmation of two case-patients from Kasese District, Bwera Hospital by the Uganda Virus Research Institute (UVRI) through a routine sentinel surveillance system. Cumulatively, 80 confirmed cases of mpox have been registered.
On August 13, 2024, the Africa CDC declared the mpox outbreak a Public Health Emergency of Continental Security (PHECS). The following day, the WHO declared it a Public Health Emergency of International Concern (PHEIC). A coordinated, continent-wide response is essential, co-led by the African Union... (AU) through the Africa CDC and the World Health Organization (WHO), in close collaboration with global partners working under a unified plan, budget, and monitoring framework.
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i. A person who is a contact of a probable or confirmed mpox case in the 21 days before the onset of signs or symptoms, and who presents with any of the following: acute onset of fever (>38.5°C), headache, myalgia (muscle pain/body aches), back pain, profound weakness or fatigue.
OR
ii. A per...son presenting since 01 January 2022 with an unexplained acute skin rash, mucosal lesions or lymphadenopathy (swollen lymph nodes). The skin rash may include single or multiple lesions in the ano-genital region or elsewhere on the body. Mucosal lesions may include single or multiple oral, conjunctival, urethral, penile, vaginal, or ano-rectal lesions. Ano-rectal lesions can also manifest as ano-rectal inflammation (proctitis), pain and/or bleeding.
AND
for which the following common causes of acute rash or skin lesions do not fully explain the clinical picture: varicella zoster, herpes zoster, measles, herpes simplex, bacterial skin infections, disseminated gonococcus infection, primary or secondary syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, allergic reaction (e.g., to plants); and any other locally relevant common causes of papular or vesicular rash.
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On 13 August 2024, Africa Centres for Disease Control and Prevention (Africa CDC) declared the ongoing Mpox outbreak a Public Health Emergency of Continental Security (PHECS). This was followed the next day by the World Health Organization (WHO), which extended the alert internationally as a public ...health emergency of international concern (PHEIC). After these declarations, many countries have made efforts to mobilize resources to introduce or expand laboratory testing, surveillance, and response activities. In particular, as the number of suspected cases surges in the Democratic Republic of Congo (DRC), Burundi, and the Central African Republic, and an increasing number of new countries report cases, there is an urgent need to implement testing to strengthen the Mpox response. However, access to appropriate quality assured diagnostics is a challenge. There is limited information on important characteristics, such as available test kits’ performance and ability to detect relevant clades.
To address the challenge of mpox access in the continent, the Africa CDC Diagnostic Advisory Committee (DAC) met in Kigali from 19-23 August 2024 to review the available evidence on molecular tests for Mpox and to shortlist tests that may be useful for Mpox testing in countries. The shortlist aims to provide guidance to Africa CDC, countries and partners on appropriate high-quality molecular tests to procure and use for the mpox response.
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Mpox is a zoonotic disease caused by a double-stranded DNA virus that belongs to the Orthopoxvirus genus of the Poxviridae family. The disease presents with symptoms similar to smallpox but with a lesser severity. It was first discovered in 1958 when two outbreaks of a poxlike disease occurred in co...lonies of monkeys kept for research, hence the name ‘mpox. The first human case of mpox was recorded in 1970 in the Democratic Republic of the Congo (DRC), which has subsequently spread to other central and western African countries. There are two known clades of the virus: clade I and clade II. Clade I, which is most frequently reported from countries in Central Africa, tends to be more severe than clade II. Cameroon is the only country known to harbour both clades.
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There has been a global outbreak of mpox since 2022; this outbreak has been caused by the strain of mpox virus called Clade 2 and has affected around 116 countries worldwide. The current surge in cases is being driven by the rapid spread of a different strain – Clade 1b – which is predominantly ...affecting countries across the African region, particularly DRC, Burundi, Kenya, Uganda and Rwanda [1]. The guidance in this document applies to both Clades of mpox. WHO publishes a dashboard of updated cases globally here. Different Clades and Sub-Clades of mpox behave slightly differently to each other; WHO is monitoring for any significant differences between the Clades, including transmission routes. This guidance will be updated as more information becomes available on this issue.
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Ebola virus (EBOV) and Marburg virus (MARV) are associated with severe, potentially fatal, systemic diseases. During the development of the Infection Prevention and Control Guideline for Ebola Disease and Marburg Disease, the Guideline Development Group (GDG) identified multiple research gaps in key... areas and practices that lacked strong evidence to help in the formulation of recommendations. Because of the lack of strong evidence, there exists an array of research questions related to infection prevention and control (IPC) in the context of Ebola Disease (EBOD) and Marburg Disease (MARD). Identifying those that are priorities would help policy-makers target efforts and funding to support the most relevant studies. The objective of this research prioritization exercise was to identify the short- to medium-term (over the next two years) priority research questions for IPC in health care settings based on the gaps identified during the EBOD/MARD IPC guideline development process.
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WHO needs US$ 87.4 million over 6 months, from September 2024 to February 2025, to work with countries, partners and other stakeholders to stop and contain the current outbreak of mpox.