Top line
Officials in Pakistan said on Friday they had confirmed a case of Mpox and were investigating whether the variant is the same one linked to a growing outbreak in central Africa, a day after Sweden reported the first case outside Africa, while the World Health Organization sounded the alarm about the growing outbreaks.
The WHO has declared an MPOX outbreak in Africa a global health emergency.
Key data
Pakistan confirmed at least one case of MPOX on Friday in a patient who returned from an unnamed Gulf state – reports have named both Saudi Arabia and the United Arab Emirates (UAE) – and tests are underway to determine whether the virus is the same form as the Clade I variant responsible for a growing outbreak in Africa.
Pakistani health officials, who said they had not been able to locate the man since he returned home, also retracted a statement made earlier in the day that said three patients suffering from MPOX had been discovered in the country this week after arriving from the United Arab Emirates.
Sweden on Thursday became the first country outside Africa to report an Mpox infection caused by the clade I variant, but officials said the person became infected during a stay in the region and stressed that the risk from the virus to the general population was “very low.”
At least 12 African countries have reported MPOX outbreaks so far, the Africa Centers for Disease Control and Prevention (Africa CDC) said when declaring the emergency on Tuesday. These include four countries – Burundi, Kenya, Rwanda and Uganda – that had not previously reported MPOX outbreaks.
The vast majority of cases have been reported in the Democratic Republic of Congo (DRC), where the variant has been resident for more than a decade. At least twelve neighboring countries, including those listed above, have confirmed cases or are considered high-risk due to their shared border with DRC: Republic of Congo, Central African Republic, Rwanda, Cameroon, Gabon, Angola, South Sudan, Tanzania and Zambia.
Key quote
“We encourage all countries to strengthen surveillance, share data and work to better understand transmission; share tools such as vaccines; and apply lessons from previous international health emergencies in tackling the current outbreak,” WHO chief Tedros Adhanom Ghebreyesus said on Friday.
How many cases have been reported?
According to the Africa CDC, African authorities have so far confirmed 2,863 cases of MPOX and 517 deaths in 2024, most of them in the Democratic Republic of Congo. Only a fraction of suspected infections undergo genetic testing to confirm MPOX and determine the variant responsible. Authorities say the number of suspected cases is already over 17,000, well above last year’s total of around 15,600 cases and 537 deaths. These numbers are “just the tip of the iceberg,” experts said, as it is difficult to track and test cases.
What is Mpox?
Mpox, formerly known as monkeypox, is a viral disease caused by infection with the monkeypox virus. The virus belongs to a large family of viruses known to cause disease in humans and other animals, including smallpox or variola, cowpox, Alaskan pox, and vaccinia, a weakened form of which is used in Mpox and smallpox vaccines. Mpox infections are usually mild but can and do be fatal. Data suggest that the clade I variant has a fatality rate of up to 10%. Young children, pregnant women, and those with weakened immune systems are most at risk for a poor outcome. Symptoms of infection include fever, swollen lymph nodes, and a characteristic, purulent rash. The virus spreads primarily through close contact with infected people, animals, or contaminated materials such as towels.
Are there Mpox vaccines?
Yes. The preferred choice of health authorities is Bavarian Nordic’s two-dose vaccine. The vaccine, sold under the names Jynneos, Imvamune and Imvanex, has a more favorable risk profile compared to available alternatives and has been approved for use against Mpox by major health authorities around the world, including the Food and Drug Administration. The company says it can deliver 10 million vaccines to fight the outbreak by the end of 2025, including 2 million by the end of the year. There are ample supplies of Emergent BioSolutions’ ACAM2000 smallpox vaccine in national stockpiles around the world. The vaccine, which is being held for national security reasons in case the now-eradicated smallpox somehow resurfaces or is weaponized, is generally not preferred for widespread use due to its higher risk of potentially serious side effects, but could be used to protect against Mpox if needed. KM Biologics received approval for its smallpox and Mpox vaccine LC16 in its home country of Japan during the 2022 outbreak. However, the company has not sought global approval of the vaccine, and it is not commercially available. Significant supplies are reportedly in Japan’s national stockpile should Tokyo release them. Another smallpox vaccine that could be used against smallpox has already been approved in Russia. However, the vaccine, which the WHO says is the “first fourth-generation smallpox/orthopoxvirus vaccine,” is not widely available, and given the agency that developed it, it is unknown whether Moscow would release supplies internationally. The vaccine was developed and registered by Russia’s Vector Institute, the historic seat of the Soviet Union’s bioweapons program and one of two authorized smallpox repositories worldwide (the other is the CDC).
Who should be vaccinated against Mpox?
Most countries consider the risk of an Mpox outbreak to be very low and do not advocate widespread vaccination. The Centers for Disease Control and Prevention in the U.S. recommends Mpox vaccination for the high-risk groups identified during the last global outbreak in 2022, and although case numbers have declined, the virus variant is still circulating. These include gay, bisexual or other men who have sex with men or transgender, nonbinary or gender diverse people, especially those who have multiple sexual partners, have sex in commercial sex venues such as clubs or saunas, and have received a new diagnosis of a sexually transmitted infection such as chlamydia, gonorrhea or syphilis in the past six months. People with an occupational risk of exposure such as laboratory or health care workers are also recommended to get the vaccine, as are people who have had sex with or come into contact with someone diagnosed with Mpox. The agency recommends two doses of Jynneos, four weeks apart.
What happened to the other Mpox variant?
The Clade II variant that caused the 2022 Mpox outbreak is still circulating. Cases in Western countries have declined following extensive vaccination efforts, but cases are still emerging and authorities are closely monitoring the spread of the virus. The variant is also still responsible for outbreaks in Africa, primarily in West Africa, where it has historically circulated. In reporting on the Clade I outbreak, the WHO mentioned a “separate” Mpox outbreak in Ivory Coast that is linked to Clade II.
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