‘Expanding Outbreak’ of Mpox Cases in African Country

Health care workers put on personal protective equipment (PPE) at an intensive care unit (ICU) at Thomayer hospital, in Prague, Czech Republic, on Oct. 14, 2020. Michal Cizek/AFP/Getty Images

The East African nation of Burundi has seen a surge in monkeypox (mpox) infections, with children and adolescents accounting for a major share of those affected, according to UNICEF.

Children and vulnerable communities in Eastern and Southern Africa are facing the brunt of an “expanding outbreak” of mpox, with more than 200 cases reported across five African nations—Burundi, Rwanda, Uganda, Kenya, and South Africa, according to an Aug. 22 statement from UNICEF.

“The new variant of the mpox virus (clade 1b) has been identified in all affected countries except South Africa, which is causing concern due to its potential for wider transmission across age groups, particularly young children,” the agency stated.

“Burundi is reporting the highest number of infections across the region. As of 20 August 2024, 170 confirmed Mpox cases have been detected across 26 out of the 49 districts in the country, of whom 45.3 percent are female.”

Children and adolescents below the age of 20 make up almost 60 percent of the cases in Burundi, with those younger than the age of five making up 21 percent of infections.

UNICEF stated that the risks posed by clade 1b mpox are heightened for children in Burundi as there is a simultaneous outbreak of measles in the region.

The country is facing multiple challenges in combating the disease, including low community awareness, a shortage of diagnostic test kits and medications, and high operational costs.

Etleva Kadilli, the UNICEF regional director for Eastern and Southern Africa, called the new strain of mpox a “serious threat to vulnerable children and families.”

“In the fight against the Mpox outbreak, prioritizing the needs of children is not just necessary—it’s urgent,” he said. “Their heightened vulnerability requires that we dedicate our full attention and resources to ensure their protection and well-being in this critical response phase.”

Mpox has two genetic clades—1 and 2. According to experts, clade 1 variants cause more severe cases than clade 2 while also spreading with far more ease, thus posing major health risks.

The global mpox outbreak that began in 2022 was caused by the clade 2 variant. Until the beginning of August, no cases of clade 1 mpox had been detected outside of the African continent.

This changed on Aug. 15, when Swedish authorities reported a case of clade 1 infection in that country.

The individual got infected while staying in an African country “where there is a large ongoing outbreak of mpox clade I,” Olivia Wigzell, director-general of the Public Health Agency of Sweden, told reporters in a briefing.

On Aug. 24, the Lancet stated that the Swedish case and a separate case in Pakistan in mid-August were confirmed to be “the first mpox case with clade 1b outside Africa.”

On Aug. 22, Thailand confirmed its first case of clade 1 virus. A 66-year-old European man who came from an African country was found to have been infected with the clade 1b strain.

According to the WHO, clade 1 variants have now been detected in eight African nations—Democratic Republic of the Congo, Burundi, Central African Republic, Cameroon, Congo, Rwanda, Uganda, and Kenya.

Symptoms of mpox can include high temperature, joint pain, backache, shivering, swollen glands, headaches, and muscle aches.

After the first symptoms, a rash or pus-filled lesions typically appear. The rashes tend to start out from the face and then spread to other parts of the body such as the mouth and genitals.

Countries Taking Precautionary Measures

Several nations have instituted screening measures for mpox. Singapore’s health ministry announced on Aug. 22 that the country would “put in place temperature and visual screening” at two of its airports for people arriving from places exposed to the risk of mpox outbreaks.

The country has so far reported 13 mpox cases this year, all of which have been the less severe clade 2 strains.

Chinese customs on Aug. 15 implemented “tighter surveillance measures” at ports of entry to prevent importing mpox cases.

Individuals coming from nations with confirmed mpox cases and who have been exposed to the virus or have symptoms such as fever, headache, back pain, muscle pain, swollen lymph nodes, and rashes are required to declare their condition to customs authorities when entering China.

“Customs officers will implement medical measures and conduct sampling and testing in accordance with the prescribed procedures,” Chinese customs stated.

“Additionally, contaminated or potentially contaminated vehicles, containers, and goods from countries and regions where mpox cases have been reported will be sanitized according to prescribed procedures.”

WHO Director-General Tedros Adhanom Ghebreyesus declared the mpox outbreak a “public health emergency of international concern” on Aug. 14 in response to surging cases in Congo and the rest of Africa. He called for a “coordinated international response” to stop the outbreaks and save lives.

On Aug. 22, the Centers for Disease Control and Prevention (CDC) stated that the Biden administration has already instituted an “incident response structure” across agencies to boost the country’s preparedness for potential clade 1 mpox infections.

The CDC estimates that because the clade 1 variant is endemic to countries that do not have widespread supportive care, it would likely “cause lower morbidity and mortality in the United States.” The 2022 outbreak of clade 2 strain resulted in more than 32,000 infections and 58 deaths in the United States.