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Things to know about the resurgence of mpox.
The World Health Organization recently declared a global public health emergency because of a new outbreak of mpox, raising concerns worldwide about the spread of this disease, particularly a more severe version known as Clade I. The declaration has prompted governments and public health agencies, including the United States, to respond to the potential threat. But what exactly is this new mpox outbreak, and should you be concerned?
Mpox, previously known as monkeypox, is a viral infection related to smallpox but generally less severe. Historically, it has been confined to parts of Central and West Africa, where it occasionally jumps from animals to humans. However, in 2022, the world witnessed a global outbreak of Clade II mpox, spreading to over 115 non-endemic countries and resulting in more than 99,500 cases, according to data from the Centers for Disease Control and Prevention.
The new concern stems from Clade I mpox, a more virulent strain currently spreading in the Democratic Republic of the Congo and several neighboring African countries. According to health officials, this strain has a higher case fatality rate and tends to cause more severe infections than Clade II. The WHO’s declaration highlights the potential for Clade I mpox to spread beyond Africa.
Clade I mpox is concerning because of its higher mortality rate and the severity of the disease it causes. According to the CDC, Clade I historically results in more severe outcomes, including a greater proportion of fatalities, especially in areas with limited access to healthcare. Dr. Jennifer McQuiston, deputy director of the Division of High Consequence Pathogens and Pathology at the CDC, explained in an interview with The Advocate that this strain has been responsible for a significant outbreak in the DRC, spreading to neighboring regions.
“The Clade I variant has caused severe disease in a higher number of patients than we have seen in the past with Clade II,” McQuiston said. While the strain is more dangerous, she added that it is not yet circulating in Europe, nor are the U.S. health agencies monitoring it. However, on Thursday afternoon, Reuters reported that a case had been discovered in Sweden.
Experiencing mpox can be both physically painful and emotionally distressing. In July 2022, The Advocate interviewed men who contracted mpox during the Clade II outbreak, offering insight into the challenging symptoms and the social stigma associated with the disease.
Wesley Wallace, a tech professional and adult content creator from Houston, described his experience, which began with irritation on his face after attending a social event. The irritation quickly developed into painful sores, severe body aches, and swollen lymph nodes. Wallace shared that these symptoms, along with the visible sores on his face, led to significant emotional distress, exacerbated by the stigma attached to his condition.
Similarly, Kyle Planck, a Ph.D. student in New York, recounted the excruciating pain from mpox lesions, particularly those in the genital area, which kept him up at night. Despite receiving the antiviral TPOXX, Planck emphasized the emotional toll of the disease, noting the frustration of navigating the complex process to access treatment. Since 2022, access to treatment and preventative vaccines has improved significantly.
The Jynneos vaccine, developed by drug maker Bavarian Nordic, has been deemed effective at preventing the spread of mpox or significantly reducing the severity of infection, especially among high-risk groups. In April, the vaccine became widely accessible in the U.S., marking a significant step forward in public health efforts, particularly as the country approached Pride Month.
The vaccine is administered in two subcutaneous doses, meaning it’s a small shot under the skin. North American medical director for Bavarian Nordic Peter Costa told The Advocate that the vaccine’s effectiveness ranges from 66 percent to 8 percent after two doses. The manufacturer says the vaccine has been studied for over 20 years, with a strong safety profile compared to older smallpox vaccines.
While the vaccine is a key component of mpox prevention, McQuiston explained that behavioral changes within the LGBTQ+ community also played a significant role in curbing the 2022 Clade II outbreak. She emphasized the importance of vaccination and informed decision-making to protect against the virus.
“We saw during the Clade II outbreak that behavioral change in the LGBTQ communities contributed more to the outbreak stopping than the vaccine did, at least initially,” McQuiston said.
She explained that while lesions might initially appear in the genital region, particularly if the infection is acquired through sexual contact, the rash can spread to any part of the body. “With both clades, the rash could appear on any part of the body or spread to multiple parts of the body,” she said. She also emphasized that skin-to-skin contact with someone with mpox risks spreading the virus, meaning wherever the skin touches, there’s a risk of the rash spreading there.
For the general public in the United States, the risk from Clade I mpox remains very low, according to the CDC. The U.S. Department of Health and Human Services has emphasized that there are currently no known cases of Clade I mpox in the country, and the U.S. is well-prepared to detect and manage any potential cases.
“The risk to the general public in the United States from Clade I mpox circulating in the DRC is very low,” HHS said in a statement. The department also highlighted the country’s robust surveillance system, including clinical testing and wastewater analysis, to identify and contain potential outbreaks quickly.
The CDC continues to recommend vaccination for those at higher risk, including gay, bisexual, and other men who have sex with men, as well as transgender or nonbinary people. These groups were disproportionately affected by the Clade II outbreak in 2022, and the CDC urges them to complete the two-dose Jynneos vaccine regimen.
For those who have traveled to or are planning to travel to the DRC or neighboring countries, the CDC has issued a Travel Health Notice recommending enhanced precautions. Travelers should be aware of the symptoms of mpox, which include fever, rash, and swollen lymph nodes, and seek medical attention if they develop any signs of the disease.
The U.S. government and international partners are taking proactive steps to prevent the spread of Clade I mpox. According to HHS, the U.S. has provided $17 million in additional funding to support preparedness and response efforts in Central and Eastern Africa, including enhancing surveillance and vaccine distribution. As part of this effort, the U.S. is donating 50,000 doses of the Jynneos vaccine to the DRC.
The Biden administration says that in the U.S., HHS and CDC are working to ensure that the U.S. remains ready to manage any possible cases. “The United States is well-prepared to rapidly detect, contain, and manage Clade I cases should they be identified domestically,” HHS wrote.
