Disease Outbreak News Mpox – African Region

Described below are the latest countries in the African region newly affected by mpox, either clade I or clade II, since the start of the multi-country outbreak in 2022. Additional countries in the region are continuing to report cases, please refer to the latest situation report published for an update on these countries including the latest epidemiological trends.

Central and East Africa 

Burundi  

On 25 July 2024, the Ministry of Health of Burundi declared an outbreak of mpox following the confirmation of three cases by the National Reference Laboratory of the National Institute of Public Health. These cases were identified on 22 July; one case from Kamenge University Hospital, a second case from Kamenge Military Hospital, and the third case from Isare Health District. They reported symptom onset on 24 July including fever, joint pain, and a widespread rash. Samples collected during a multidisciplinary investigation tested positive for mpox on 25 July with PCR. These are the first confirmed mpox cases ever identified in Burundi.

As of 17 August 2024, there had been 545 alerts of mpox cases since the outbreak declaration, of which 474 suspected cases (86.9%) had been investigated and validated. Of 358 suspected cases tested, 142 (39.7%) tested positive for MPXV. Genomic sequencing analysis has confirmed clade Ib MPXV. No deaths were reported as of 17 August.

Confirmed cases have been reported from 26 of the 49 districts (53.1%). The most affected district is Bujumbura Nord, an urban area, with 54 of the 142 confirmed cases (38%). No deaths had been documented at the time of reporting.

Males account for 55.6% of the cases and females for 44.4%. Children under the age of five years make up 60.3% of the cases, followed by those aged from 11 to 20 years (42.6%), and those aged from 21 to 30 years (38.2%).

Kenya  

On 29 July 2024, the Ministry of Health confirmed a case of mpox in Taita Taveta County bordering Tanzania. The patient is a 42-year-old Kenyan male residing in Kiambu County (neighbouring Nairobi). The case has a history of travel from Kampala, Uganda, to Mombasa, Kenya, and at the time of identification, the patient was travelling to Rwanda through Tanzania.

As of 13 August, a total of 14 suspected cases had been identified, one case had tested positive for MPXV Clade Ib,12 suspected cases had tested negative, and the test result for one case was pending. This is the first mpox case ever identified in Kenya. No deaths had been reported as of 13 August.

Rwanda  

On 24 July 2024, IHR National Focal Point (NFP) for Rwanda notified WHO of two laboratory-confirmed mpox cases in Rwanda, and on 27 July, the Ministry of Health declared an outbreak of mpox in the country. The cases included a 33-year-old female (case 1) who frequently travels to the Democratic Republic of the Congo, and a 34-year-old male (case 2) with a recent travel history to the Democratic Republic of the Congo. Case 1 was identified at a point of entry (PoE) and isolated in Rusizi district, and case 2 was identified at Kibagabaga hospital of Gasabo district. Both cases were reported to be in stable condition and under continuous medical follow-up. These are the first confirmed mpox cases ever identified in Rwanda.

As of 7 August 2024, four confirmed mpox cases and zero deaths had cumulatively been reported by the country. Among the two new cases, one is a 34-year-old male, residing in Gasabo District in Kigali. His symptoms started on 15 July 2024 with fever, swollen lymph nodes, sore throat, and rashes on the arms, face and genitals. He had travelled back from Burundi on 12 July 2024 and is currently in isolation. Five close contacts are under follow up. The other case is a 39-year-old Rwandan male, resident of Kicukiro District with travel history to the Democratic Republic of the Congo. He had similar symptoms, along with headache, which started on 12 July 2024. Four of his close contacts have been identified and they are under follow up. Sequencing analysis has confirmed MPXV Clade Ib.

Uganda   

In June and early July 2024, Kasese District enhanced surveillance for mpox disease along the border with the Democratic Republic of the Congo in light of reported increasing cases in the neighbouring country. Following the orientation of screeners at the Bwera point of entry and Bwera Hospital, six suspected cases were identified on 11 July. Samples were collected for laboratory testing from the suspected cases, two of which tested positive for MPXV Clade Ib on 15 July. The first of the confirmed cases is a 37-year-old female and the second case is a 22-year-old female national of the Democratic Republic of the Congo. These are the first mpox cases identified in the country. Both cases had onset of symptoms on 11 July and were confirmed by a PCR test at the Uganda Virus Research Institute on 15 July 2024.

Investigations revealed that transmission occurred outside Uganda and no secondary transmission has been linked to the two cases as of 12 August 2024. By the same date, 39 suspected cases had been reported. Furthermore, 37 contacts of the confirmed cases were under follow-up. No deaths have been reported as of 20 August.

West Africa  

Côte d’Ivoire 

In July 2024, Côte d’Ivoire confirmed two non-fatal cases of mpox. The first case is a 46-year-old patient who consulted a doctor on 1 July with a fever, headache and skin rash, in Tabou district, San Pedro region, on the border with Liberia. Mpox was confirmed by the Institut Pasteur de Côte d’Ivoire laboratory on 3 July and again on 14 July by the Institute Pasteur in Dakar. The second case is a 20-year-old patient, in the Koumassi health district in Abidjan, who presented with skin rash and oral mucosal lesions on 14 July. No epidemiological link between these first two cases has been identified.

As of 7 August 2024, seven mpox cases had been confirmed in three health districts: Koumassi (one case), Tabou (one case), and Yopougon-Ouest-Songon (five cases). Four of the confirmed cases (57%) are male, and all seven cases are above 15 years of age.  Forty contacts have been identified and are being followed up. The country has previously reported mpox, but no cases had been notified since the start of the multi-country outbreak in 2022. The newly detected cases in 2024 belong to clade II MPXV.

Mpox is an infectious disease caused by the monkeypox virus (MPXV). There are two known clades of MPXV: clade I, previously called the Congo Basin clade, which includes subclades Ia and the recently identified Ib; and clade II, previously called the West African clade, which includes subclades IIa and IIb. Subclades Ia and Ib have been defined based on the emergence of subclade Ib in the South Kivu province of the Democratic Republic of the Congo, where it has predominantly spread through sexual contact. Subclade Ia is currently considered to encompass all other strains of Clade I that are not Ib.

MPXV transmits between humans through close contact with lesions, body fluids, infectious respiratory particles or contaminated materials, or from animals to humans through contact with live animals or consumption of contaminated bushmeat. Mpox causes signs and symptoms which usually begin within a week of exposure but can start one to 21 days later. Symptoms typically last for two to four weeks but may last longer in someone with a weakened immune system. Normally, fever, muscle aches and sore throat appear first, followed by skin and mucosal rash. Lymphadenopathy (swollen lymph nodes) is also a typical feature of mpox, present in most cases. Transmission through sexual contact has been observed to lead to the appearance sometimes of only genital lesions. Children, pregnant women and people with weak immune systems are at risk of developing complications and dying of mpox.

It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also concurrently have another sexually transmissible infection such as herpes. Alternatively, a child or adult with suspected mpox may have chickenpox. For these reasons, laboratory testing is important for confirmation of mpox, particularly for the first cases in an outbreak or new geographic area.

The primary diagnostic test for MPXV infection is polymerase chain reaction (PCR). The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. However, while a positive result of oropharyngeal, anal or rectal sample confirms mpox, a negative result is not enough to rule out MPXV infection. Testing of blood is not recommended. Serology does not distinguish between different orthopoxviruses and is therefore restricted to reference laboratories where antibody detection methods may be applied for retrospective case classification or in special studies.

Treatment is based primarily on managing clinical symptoms, ensuring skin care, reducing pain, and preventing and managing complications. Where available through emergency or compassionate use programmes, specific antiviral medications such as tecovirimat can also be used in the treatment of mpox, particularly for severe cases or individuals at higher risk of complications.

Three vaccines are currently available for use to prevent mpox in different countries (MVA-BN, LC16-KMB, and OrthopoxVac – the latter not yet commercialized). WHO recommends use of MVA-BN or LC16 vaccines when the others are not available.

Vaccination is recommended by WHO for individuals at high risk of exposure.

Coordination 

The WHO African Regional Office (AFRO) reviewed and expanded the regional incident management support team to ensure that Member States receive the necessary support for managing the mpox outbreak. A critical meeting held in South Africa discussed urgent measures to address the rising number of mpox cases. It also proposed a review of the regional risk assessment given the acute situation. WHO has engaged in technical coordination meetings with the Africa Centres for Disease Control and Prevention (Africa CDC) to develop a joint mpox taskforce. Additionally, both organizations agreed on actions to accelerate the operational response, particularly in strengthening the technical working group on vaccines and enhancing cross-border readiness and surveillance.

Risk Communication and Community Engagement (RCCE)  

There is ongoing development of an RCCE operational plan in Sud-Kivu, with regular partner meetings to coordinate efforts. Online social listening software called DIGIMIND has been employed to capture discussions and rumours about mpox. This data is analysed to produce reports that inform risk communication strategies. A series of briefings were conducted for 141 stakeholders, including journalists, social mobilizers, and community leaders in South-Kivu and Sankuru Provinces.

WHO has produced and broadcast interactive programs in multiple regions and languages, conducted public sensitization, and engaged in home visits and advocacy with political authorities to raise awareness and manage the outbreak.

Infection Prevention and Control (IPC)

An IPC Rapid Assessment Tool (RAT) for health facilities has been developed and disseminated to countries that are experiencing an active outbreak of mpox, in order to rapidly assess IPC and WASH capacities to care for mpox patients safely in health facilities. Countries are encouraged to work with partners to support improvements as identified through this rapid assessment.  WHO has also published posters for health and care workers on how to put on and remove personal protective equipment. WHO is also coordinating actions with IPC focal points in countries currently experiencing an active outbreak of mpox. WHO is supporting South Africa through a review of protocols, national IPC guidelines for mpox and strengthening the capacity of health and care workers through training.

Preparedness and Readiness

WHO is supporting Member States to increase their preparedness and readiness capacities. Additionally, South Africa has undergone subnational readiness assessments, focusing on non-affected provinces. The organization is supporting the development of contingency plans in priority and bordering countries and will continue to provide technical support to address gaps in readiness.

Surveillance

WHO continuously collects and analyses data from affected countries to monitor the spread and impact of the mpox outbreak, utilizing epidemiological tools to identify trends and transmission patterns. WHO also provides real-time situation reports and implements dashboards to help stakeholders interpret complex data. Training sessions and workshops are conducted for national surveillance teams, along with the development and distribution of guidelines and Standard Operating Procedures (SOPs) to ensure consistent surveillance activities.

WHO supports the upgrading of surveillance infrastructure and the implementation of community-based surveillance programs, particularly in high-risk areas such as Internally Displaced People’s (IDP) camps. In the short term, WHO’s focus is on implementing standardized protocols, deploying real-time reporting systems, enhancing data integration and sharing, building local capacity, and strengthening early warning systems.

Laboratory

WHO has supported the procurement of laboratory reagents for South Africa and Liberia, and aims to improve logistics for specimen collection and transportation, ensuring timely delivery and adequate supplies across all health facilities. Countries are encouraged to sequence a subset of samples to monitor evolutionary trends and transmission partners.

Vaccination

WHO supports countries in obtaining regulatory approval for vaccine products, identifying target populations, and developing vaccination strategies. WHO provided technical support for a vaccination strategy workshop took place in Kinshasa in the Democratic Republic of the Congo, ahead of anticipated deployment of mpox vaccines in the country. WHO is assisting countries in developing research protocols to address existing data gaps.

Case Management

WHO is supporting the distribution of mpox therapeutics (tecovirimat) to South Africa. Participation in clinical webinars and review of guidelines for mpox dead body management are ongoing. Future efforts include engaging with WHO Country Offices in the Democratic Republic of the Congo and South Africa to develop clinical case identification job aids, creating home-based care guidelines for mild mpox cases, and collaborating with neighbouring countries to enhance regional preparedness.

Response measures by country

Burundi 

Following the confirmation of the mpox case in Kenya, the Ministry of Health has undertaken various response measures, including:

After the confirmation of two mpox cases, the Ministry of Health and relevant stakeholders went to Rusizi and Rubavu Districts, which are bordering the Democratic Republic of the Congo where mpox cases are increasing, to conduct a situation analysis which led to the investigations of the confirmed cases. Efforts to contain cases are actively underway, with thorough contact tracing and active case search in high-risk groups in Rubavu, Rusizi, Kicukiro and Gasabo districts. The Ministry of Health, in collaboration with its partners, is continuing to implement the following response interventions:

Coordination leadership:

Surveillance:

RCCE:

Case Management and IPC:

Diagnostic and laboratory capacity:

The current expansion of mpox in the African continent is unprecedented. At least four countries have identified cases for the first time and others, such as Côte d’Ivoire, are reporting re-emerging outbreaks. The modes of transmission in these countries are not fully described yet and are likely to include exclusive human-to-human transmission.

General 

Health authorities and clinicians/health and care workers of all countries should be aware that the global mpox outbreak linked to clade IIb MPXV is ongoing in all WHO regions, and Clade I monkeypox virus (MPXV) outbreaks are increasing in Central and East Africa, therefore, the risk of cross-border and international spread persists.

WHO strongly advises that countries continue to follow the Standing Recommendations of the Director-General of the WHO issued in August 2023 and extended for another year, as well as the Temporary Recommendations issued by the Director General after the declaration of the PHEIC.

Countries need to have in place mpox epidemiological surveillance and strengthen laboratory diagnostic capacities in line with updated WHO interim guidance, including genomic sequencing of viruses. Additionally, countries need to have diagnostic capacities capable of detecting both MPXV clades.

There must be sustained implementation of risk communication and community engagement appropriate to each context, maintenance or initiation of vaccination (where available) for persons at risk, optimal case management, adherence to infection control measures, strengthening research to better appreciate modes of transmission in different contexts, and sustained support for the development of rapid diagnostic methods and treatments adapted to the needs of patients.

Where circulation remains low, health authorities should strive to achieve the elimination of human-to-human transmission of mpox and ensure the maintenance of capacity for outbreak response.

Anyone with a clinical or laboratory-confirmed diagnosis of mpox should follow the instructions of health authorities according to the local context, possibly including isolation during the infectious period. Mpox cases should avoid travel, including international travel, unless the reason for travel is seeking mpox medical care, until they do not present any mpox symptoms and the scabs of their lesions have fallen off. Contacts of a confirmed case are asked to limit their movements (and, if necessary, to abstain from sexual relations) for 21 days, the monitoring period for the appearance of possible symptoms.

Smallpox vaccines composed of vaccinia virus also protect against mpox, cross-protecting due to the antigenic similarity of the viruses. Vaccination against mpox is recommended for people possibly at risk of contracting the disease. Mass vaccination is not required nor recommended for mpox at this time.

For specific antiviral treatments currently being assessed for effectiveness against mpox, such as tecovirimat, access is possible through a request from WHO for compassionate use, application for use under the WHO MEURI protocol or direct purchase from the manufacturer.

It is essential to deepen knowledge in different contexts on the epidemiological links between mpox and HIV infection, their respective and common risk factors for infection and progression to severe disease, optimal case management in the event of co-infection and the effectiveness of vaccines and therapeutic approaches.

In the community 

RCCE activities are vital in motivating affected communities to become aware of the risks and protective behaviours, as well as to understand, prevent and combat stigma and discrimination. Key audiences should be identified, which depending on the context may include health professionals, commercial sex workers, men who have sex with men, trans- and gender-diverse individuals, people working at or attending venues and events where sexual activity takes place, and people at risk of more serious illness (including persons living with untreated or poorly controlled HIV infection).

Please refer to the WHO RCCE toolkit for mpox for further guidance on risk communication and community engagement.

It is also crucial that IPC and WASH measures be followed within the community to prevent and control transmission of mpox. Patients diagnosed with non-severe mpox can be isolated at home for the duration of the infectious period, provided a home assessment confirms that IPC and WASH conditions are met in the home setting. Patients being cared for at home should remain in a dedicated, well-ventilated room (e.g., with frequently opened windows) separate from other household members. Items such as eating utensils, linens, towels, electronic devices, and beds should be used exclusively by the person with mpox. Personal items should not be shared. If a health or care worker provides care at home, they should wear appropriate personal protective equipment (PPE) (gloves, gown, eye protection, and respirator), perform hand hygiene using soap and water or alcohol-based hand rub (ABHR) according to WHO’s 5 moments, and clean and disinfect any patient care equipment used and frequently touched surfaces or items. Contaminated laundry from an infected person should not be mixed with other laundry and should be managed in a way that does not produce splashes and particles in the air. Contaminated laundry can be washed in a washing machine using detergent.^[1] Waste generated in the infected person’s area should be placed in a strong bag, securely tied before disposal into the general waste stream (not recycling). Hand hygiene should be performed immediately after disposing of waste.

Please refer to “Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance” for further guidance on IPC measures in community settings.

In healthcare settings 

Implementing IPC and WASH measures in healthcare settings is necessary to prevent and control the transmission of mpox. It is important to train health and care workers on the modes of transmission for mpox and the control measures, including following standard and transmission-based precautions to prevent and control transmission of mpox. Screening of patients for mpox followed by appropriate patient placement and isolation should be in place. Health-care facilities should ensure health and care workers have access to and appropriately wear PPE (gloves, gown, eye protection, and respirator), adhere to WHO’s Five Moments for hand hygiene using soap and water or alcohol-based hand rub and ensure frequent cleaning and disinfection of the patient environment. Health and care workers should be reminded to handle and dispose of sharps safely and where possible and avoid the use of sharps on lesions (e.g. avoid deroofing) when collecting specimens. All bodily fluids and solid waste from patients with mpox should be treated as infectious waste. For further guidance on IPC measures that are required when caring for patients with mpox, please refer to the Clinical Management and infection prevention and control for mpox: Interim rapid response guidance.

Fully functioning water, sanitation, hygiene (WASH) and health care waste management services are a critical aspect of IPC practices and ensuring patient safety and quality of care. To ensure that the health care facility is compliant with imperative WASH standards, please refer to WASH FIT: A practical guide for improving quality of care through water, sanitation and hygiene in health care facilities.^[2]

While protecting themselves with recommended measures, health and care workers should also ensure that the stigmatization of patients with mpox presenting for care is avoided, and that psychological support is provided when needed.

At points of entry 

States Parties are recommended to encourage authorities, health and care workers and community groups to provide travellers with relevant information to protect themselves and others before, during and after travel to events or gatherings where mpox may present a risk.

WHO does not recommend any restrictions for travel to and trade with these countries, or any other mpox-affected country.

Situation Reports 

Mpox situation reports can be found in the following link: WHO – Emergency situation reports

The latest situation report published provides details on the latest epidemiological trends, including an update on the geographic expansion of mpox in the WHO African Region from July – August 2024.

Disease Outbreak News 

Recently published Disease Outbreak News:

Citable reference: World Health Organization (22 August 2024). Disease Outbreak News; Mpox in African Region. Available at:    https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON528