Mpox is spreading across several African countries. The World Health Organization declared mpox a “public health emergency of international concern.” The Democratic Republic of Congo has been hardest hit, though Burundi has also seen a recent surge of cases. To date this year, 36,000 suspected cases have been reported, with more than one-half among children younger than 15 years old. In Burundi alone, two-thirds of the recent cases have been in those younger than 19.
There are two types of mpox. The one currently circulating in Africa (clade I) has historically been the deadliest, with a fatality rate as high as 10%. However, a much lower death rate, between 1% and 3.3%, has been observed in the current outbreak.
Before jumping into panic about mpox finding its way to the U.S., it is best to look at what mpox is, and perhaps more important, what it is not, to gain a better understanding of the risks it poses here and outside Africa in general.
Mpox is a viral disease. It spreads between people when they are in close physical contact. People are also most prone to spread the disease when they are symptomatic, which often includes a rash, fever, chills and swollen lymph nodes. For example, an infected person can infect another person if the infected person’s mpox rash touches the skin of another person. Therefore, any close physical contact with an infected person poses a risk for transmission; hence, it should be avoided. This explains why during the 2022 mpox outbreak, men who have sex with men were observed to be most at risk.
There is some good news about transmission. Mpox is not believed to be airborne over short time periods, so the transmission we saw with COVID-19 is not possible. Simply breathing the air in a room with an infected person does not appear to pose a risk.
At present, there are no approved treatments for mpox. Medication for pain control can provide comfort but not a cure.
There are, however, vaccines that can prevent people from becoming infected. These vaccines are actually for smallpox but are being used for mpox because the viruses for the two diseases are in the same family. The United Kingdom’s government recently ordered 150,000 doses of the Bavarian Nordic vaccine to protect those who remain uninfected in Africa. This is in addition to the 50,000 already donated by the U.S. and the 200,000 received from the European Union.
The best way to suppress the spread of mpox in Africa and around the world is via vaccination. Fortunately, vaccines exist. The challenge is getting them into areas of Africa that need it and into the arms of people most vulnerable.
The U.S. is not sitting still with mpox. The National Institutes of Health released a research summary for combating mpox, focusing on detection, treatment and vaccines. Such efforts are prudent, since an infectious disease somewhere in the world has the potential to become an infectious disease anywhere in the world.
Fortunately, lessons learned from COVID-19, and more importantly, mpox in 2022 and Ebola in 2014, are being heeded. There are no calls to close the borders of the African countries affected, which would be unnecessary and ineffective. The key risk-reduction strategy is to get to the source of the virus and target resources there to suppress its spread.
Much like a fire that has the potential to spread out of control, the best strategy to tame the fire and limit damage is to cut off its fuel supply at the source. That is what countries around the world are focusing on as funds are being raised for shipping vaccines to Africa.
At this time, there is no imminent danger outside the affected area in Africa, and it is unnecessary to close borders and perform airport screenings. In particular, there have been no reported clade I mpox cases in the U.S.
The mpox outbreak in Africa should be treated as a dress rehearsal for a deadlier and more communicable virus sprouting up somewhere in the world. Managing infectious disease risk is not new. However, every infectious disease outbreak has its own unique characteristics, demanding flexibility and real-time decision-making under uncertainty. The current mpox outbreak in Africa is no exception.
Sheldon H. Jacobson, Ph.D., is a professor in computer science who teaches in the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. Dr. Janet A. Jokela, MPH, is an infectious disease and public health physician and a dean in the Carle Illinois College of Medicine.
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