Key facts
Since 2023, mpox outbreaks, particularly in the Democratic Republic of Congo (DRC), have increased alarmingly, with 14,626 suspected cases and 654 deaths in 2023, and 18,078 suspected cases and 610 deaths in 2024. This situation is exacerbated by the emergence of a new variant of the virus, which has spread to other African countries such as Burundi, Kenya, and Uganda.
Follow the latest scientific news on the subject!
As part of the ANRS MIE Emergence program, the agency publishes a weekly scientific review on Mpox, providing updates on the most recent research findings.
It includes
- A detailed chronology of the epidemic,
- a brief overview of the epidemiology, virology, clinical features and risk assessment of the disease,
- recommendations for diagnosis, prevention and care,
- recent scientific articles published in peer-reviewed journals,
- an update on the current pipeline of drug development, clinical trials and technologies aimed at preventing and treating the disease,
- an overview of current clinical trials,
- official reports from health agencies and press releases from reliable sources.
Mpox epidemic: a Public Health Emergency of International Concern
Since the beginning of 2023, there has been a significant increase in outbreaks of clade I mpox in African regions, particularly in the Democratic Republic of Congo (DRC). In 2023, health authorities in the DRC reported 14,626 suspected cases and 654 deaths, marking the highest incidence ever recorded in the country. As of August 31, 2024, there have been 18,078 suspected cases and 610 deaths, representing a two-fold increase compared to the same period in 2023. Furthermore, cases have been reported in previously unaffected regions of Central Africa, including new provinces in the DRC and neighboring countries such as Burundi, Kenya, and Uganda, which had not previously documented mpox circulation. Surveillance data indicate that these expanding infections outside the DRC are due to a new variant of clade I MPXV (sub-lineage Ib).
In response, on August 14, 2024, the World Health Organization (WHO) declared the mpox epidemic a Public Health Emergency of International Concern (PHEIC) for the second time.
Activation of a level 1 emergence unit by ANRS MIE
On 11 December 2023, the ANRS MIE activated a level 1 emergence unit, in response to developments in the mpox situation in the DRC. In this context, the agency has undertaken several actions:
- Publishing a weekly scientific review ;
- Organizing the definition of research priorities in collaboration with various French and international experts and research partner associations ;
- Initiating coordination efforts at the European level.
Mpox epidemic: the 2022-2024 timeline
2022: Mpox global outbreak – 1st declaration of a Public Health Emergency of International Concern
In the summer of 2022, an unprecedented mpox outbreak affecting multiple regions outside Africa, with no previous history of community transmission, led the World Health Organisation (WHO) to declare a public health emergency of international concern (PHEIC) on 23 July 2022. This outbreak, caused by clade IIb MPXV strains from the B.1 lineage, led to nearly 97,000 cases and 186 deaths across more than 100 countries.nd 186 deaths in more than 100 countries.
The spread of this epidemic was mainly driven by local, in-country transmission via sexual contact among men who have sex with men (MSM), rather than at the animal-human interface as seen previously during zoonotic outbreaks observed in Africa.
Timely and concerted public health responses from governments, international health organizations and affected communities – primarily MSM – yielded a significant decline of the disease burden over the following months, leading the WHO to end the mpox emergency status on 10th May 2023. During the PHEIC period, the ANRS MIE activated a level 2 emergence unit to mobilize emergency funds through a Flash Call for Proposals launched on 16 June 2022, which resulted in the funding of 10 mpox research projects.
Alarming increase in cases of clade 1 mpox in the DRC
Since the beginning of 2023, the increasing frequency of outbreaks with clade I mpox in African regions, particularly in the DRC, has become a major concern. In 2023, health authorities in DRC have reported 14,626 suspected cases and 654 deaths, the highest incidence ever recorded in the country. This surge has been accompanied by the virus’s spread into new provinces, extending beyond rural geographical areas into urban and peri-urban regions that were not the usual breeding grounds for epidemic outbreaks or mpox clusters.
In September 2023, the DRC’s Ministry of Health and Population informed the World Health Organisation (WHO) of a cluster of mpox cases associated with transactional sex practices in the South Kivu region. The Institut National de Recherche Biomédicale (INRB) found that these infections were linked to a new variant of clade 1, marking the first documentation of sexual transmission of clade 1 MPXV. Although clade Ib MPXV currently accounts for a minority of reported mpox cases in the country, the rapid spread of the outbreak in South and North Kivu, particularly among sex workers, raises significant concerns about further expansion into countries that share borders or cultural ties with the DRC.
2024: 2nd declaration of a public health emergency of international and intercontinental concern
As of 31 August 2024, the health authorities in the DRC has reported 18,078 suspected cases of Mpox and 610 deaths, representing a marked increase compared to the same period in 2023. Additionally, human mpox infections caused by clade Ib were reported for the first time in Rwanda, Burundi, Kenya, and Uganda— four countries that had never previously recorded mpox cases.
In response to these developments, on 14 August 2024, the World Health Organisation declared a Public Health Emergency of International Concern (PHEIC) for the second time. This declaration came a day after the Africa CDC has designated the escalating outbreak in DRC and in a growing number of countries in Africa as a Public Health Emergency of Continental Security (PHECS).
The WHO is currently reviewing the risk assessment for mpox for the general population and is developing a new regional response plan to support surveillance, preparedness and response efforts. This plan will be implemented in collaboration with the governments of the affected countries, the Africa CDC, NGOs, and civil society. Additionnally, in collaboration with international organizations and manufacturers, the WHO has activated emergency measures to accelerate access to vaccines in the most affected regions, including facilitating vaccine donations from high-income countries to recipient countries.
In an opinion issued on July 30, the Africa CDC assessed the risk of mpox in African countries as high due to (i) the likelihood of the virus spreading to other Member States, (ii) the higher case fatality rate on the continent, despite the disease being moderately transmissible and usually self-limiting, and (iii) the lack of effective treatments, vaccines and other control measures. In the EU/EEA, the risk associated with clade 1, including the novel variant 1b, is considered very low.