Ten thousand doses of mpox vaccines arrived in Nigeria on Aug. 27, courtesy of the U.S. government, in response to the World Health Organization's Aug. 14 declaration of a public health emergency of international concern regarding an outbreak of a new strain of mpox in the Democratic Republic of the Congo.
Previously, the WHO declared a PHEIC in response to a global outbreak of the disease in 2022 that lasted 10 months. This new PHEIC was explained by WHO Director-General Dr. Tedros Adhanom Ghebreyesus in an Aug. 14 WHO press release: “The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying.”
Mpox is the name of the disease caused by the monkeypox virus first discovered in Denmark in 1958 via research monkeys. This makes mpox a zoonotic disease, meaning that the monkeypox virus is able to be transmitted from non-humans to humans. The WHO notes that “cases [are] often found close to tropical rainforests where there are animals that carry the virus.”
However, outbreaks of the disease are largely the result of the spread from humans to humans.
According to the WHO, this method of transmission is sustained “through contact with bodily fluids, lesions on the skin or on internal mucosal surfaces, such as in the mouth or throat, respiratory droplets and contaminated objects.” The resulting infection can cause fever, sore throat and swollen lymph nodes. The rash that accompanies mpox consists of painful blisters that can develop all over the body including on the groin, genital areas and the anus. The name “monkeypox” simply reflects the animal origin of the virus and its status as a member of the Orthopoxvirus genus, which also includes the variola virus responsible for the disease smallpox. The eradication of smallpox in 1980 was one of the greatest achievements in public health history, and the success of the effort is due in part to the fact that the disease existed on every continent for centuries and posed a clear danger, with a 30% fatality rate, to all demographics.
In contrast, mpox had its first human case in the Democratic Republic of the Congo in 1970, and it has remained endemic to Central and Western Africa since. Additionally, mpox does not carry as severe of a prognosis as smallpox did. Both of these facts contributed to a lack of global attention to mpox compared to smallpox.
Mpox eventually gained worldwide recognition in 2022 with the global outbreak of clade (or strain) IIb mpox, which was previously known as the West African clade of monkeypox. Aside from the pictures of those infected, many people’s first impressions of the disease came from both its name and reports that the disease spread quickly through sexual contact. Moreover, it was clear that the disease disproportionately affected LGBTQ+ individuals, particularly men who have sex with men. Existing discrimination against these groups served to both limit factual information about the disease within communities and discourage men who have sex with men from seeking medical care.
Discussions of the global outbreak were prone to errors and prejudice that further stigmatized LGBTQ+ individuals and African nations. For its part, the WHO worked to reduce stigma by formally adopting different nomenclature. This included referring to the disease as mpox instead of monkeypox and replacing the use of African regions in naming clades, with the disease's two major strains being instead referred to as clade I and clade II mpox.
Additionally, the WHO and numerous qualified medical professionals, including those in the Tufts community, have made it clear that mpox can affect anyone regardless of sexuality or gender. Having multiple sexual partners does increase the likelihood of infection, but pre-exposure vaccination exists for those at potential risk living or working in Massachusetts, with some eligibility requirements listed on the Mass.gov mpox vaccination webpage.
According to the Centers for Disease Control and Prevention, the global outbreak of 2022 was the result of a subclade of clade II mpox, which is endemic to West Africa and has a 99.9% survival rate.
The ongoing outbreak is largely the result of a new subclade of clade I mpox, clade Ib. Clade I mpox is far deadlier than clade II, with a 10% fatality rate in some outbreaks, and is endemic to Central Africa. Early signs suggest clade Ib is even more easily transmissible, but more accurate testing in the affected regions and a lot of extensive research is needed to understand the true nature of mpox in general.
Some of this important work is currently ongoing at Tufts. The Martinot Lab at Cummings School of Veterinary Medicine, headed by Associate Professor in the Department of Infectious Disease and Global Health Amanda Martinot, has the aim of “researching the mpox virus in endometrial tissues to raise awareness of the potential increased risk of mpox virus for women.”
In a Mar. 28 news release from the Cummings School, Dr. Claire Lyons, an anatomic pathologist working in the lab, explained how the students and faculty at the lab work to address critical research gaps into the disease’s effects on women. “No research has been published for human women showing monkeypox in the reproductive tract anywhere other than the outside surface of the cervix,” said Lyons. “This research brings attention to the potential for the virus to travel outside the uterus.”
On the whole, one part of experts’ concerns regarding the ongoing outbreak is the lack of complete information. Information is indispensable in medicine for determining which diseases gain global attention, how research is conducted, where resources are delivered, and who receives treatments. Effectively addressing the current outbreak of mpox necessitates a well-informed global community capable of exercising compassion and international cooperation. Whether or not one gets directly involved in disease research or in humanitarian activities, everyone can play a role in sharing facts over fear.
