The World Health Organization headquarters in Geneva, Switzerland. File
| Photo Credit: AP

The United Nations health agency said on Friday (October 4, 2024) that it had approved the use of the first diagnostic test for mpox, a key tool in countries battling outbreaks.

More than 800 people have died across Africa from mpox, where the disease has been officially detected in 16 countries, according to the African Union’s disease control centre.

“The approval for emergency use” of the test “will be pivotal in expanding diagnostic capacity in countries facing mpox outbreaks, where the need for quick and accurate testing has risen sharply”, the World Health Organization said in a statement.

The test, called the Alinity m MPXV assay and manufactured by Abbott Molecular Inc., enables the detection of the mpox virus from swabs taken from human lesions.

“By detecting DNA from pustular or vesicular rash samples, laboratory and health workers can confirm suspected mpox cases efficiently and effectively”, the WHO said.

“Limited testing capacity and delays in confirming mpox cases persist in Africa, contributing to the continued spread of the virus”, it said.

The approval of the test “represents a significant milestone in expanding testing availability in affected countries,” the statement quoted Yukiko Nakatani, an assistant director-general of WHO, as saying.

“Increasing access to quality-assured medical products is central to our efforts in assisting countries to contain the spread of the virus and protect their people, especially in underserved regions”, Ms. Nakatani said.

Mpox, previously known as monkeypox, is caused by a virus transmitted to humans by infected animals but can also be passed from human to human through close physical contact.

It causes fever, muscular aches and large boil-like skin lesions, and can be deadly.

The World Health Organization headquarters in Geneva, Switzerland. File
| Photo Credit: AP

In an important move to improve global access to Mpox testing, the World Health Organization (WHO) has listed the first Mpox in vitro diagnostic under its Emergency Use Listing procedure.

“The approval for emergency use of the Alinity m MPXV assay, manufactured by Abbott Molecular Inc, will be pivotal in expanding diagnostic capacity in countries facing Mpox outbreaks, where the need for quick and accurate testing has risen sharply. Early diagnosis of Mpox enables timely treatment and care, and control of the virus,’’ WHO said in a statement on Thursday (October 3, 2024).

Currently, 35 laboratories across India are equipped to test suspected cases of Mpox. In mid-August 2024, the WHO declared the surge of Mpox cases in several parts of Africa as a public health emergency of international concern. In India, 30 Mpox cases have been reported since the WHO’s declaration.

Limited testing capacity

The latest WHO statement added that limited testing capacity and delays in confirming Mpox cases persist in Africa, contributing to the continued spread of the virus. In 2024, over 30,000 suspected cases were reported across the region.

The presence of the monkeypox virus is confirmed by nucleic acid amplification testing, such as a real-time or conventional polymerase chain reaction (PCR), according to the WHO’s interim guidance on diagnostic testing for the monkeypox virus (MPXV). The recommended specimen type for diagnostic confirmation of an MPXV infection in suspected cases is lesion material.

The Alinity m MPXV assay is a real-time PCR test that enables detection of monkeypox virus (clade I/II) DNA from human skin lesion swabs. It is specifically designed for use by trained clinical laboratory personnel who are proficient in PCR techniques and in vitro diagnostic procedures. By detecting DNA from pustular or vesicular rash samples, laboratory and health workers can confirm suspected Mpox cases efficiently and effectively.

Expanding availability

“This first Mpox diagnostic test listed under the Emergency Use Listing (EUL) procedure represents a significant milestone in expanding testing availability in affected countries,” said Yukiko Nakatani, WHO’s assistant director-general for access to medicines and health products. “Increasing access to quality-assured medical products is central to our efforts in assisting countries to contain the spread of the virus and protect their people, especially in underserved regions,” Dr. Nakatani added.

The EUL process accelerates the availability of life-saving medical products, such as vaccines, tests and treatments, in the context of a public health emergency of international concern.

Slumped on the ground over a mound of dirt, Divine Wisoba pulled weeds from her daughter’s grave. The 1-month-old died from mpox in eastern Congo in August, but Ms. Wisoba, 21, was too traumatized to attend the funeral.

In her first visit to the cemetery, she wept into her shirt for the child she lost and worried about the rest of her family. “When she was born, it was as if God had answered our prayers — we wanted a girl,” Wisoba said of little Maombi Katengey. “But our biggest joy was transformed into devastation.”

In Congo’s Kamituga children are the worst sufferers

Her daughter is one of more than 6,000 people officials suspect have contracted the disease in South Kivu province, the epicenter of the world’s latest mpox outbreak, in what the World Health Organization has labeled a global health emergency. A new strain of the virus is spreading, largely through skin-to-skin contact, including but not limited to sex. A lack of funds, vaccines and information is making it difficult to stem the spread, according to alarmed disease experts.

Mpox — which causes mostly mild symptoms like fever and body aches, but can trigger serious cases with prominent blisters on the face, hands, chest and genitals — had been spreading mostly undetected for years in Africa, until a 2022 outbreak reached more than 70 countries. Globally, gay and bisexual men made up the vast majority of cases in that outbreak. But officials note mpox has long disproportionately affected children in Africa, and they say cases are now rising sharply among kids, pregnant women and other vulnerable groups, with many types of close contact responsible for the spread.

Health officials have zeroed in on Kamituga, a remote yet bustling gold mining town of some 300,000 people that attracts miners, sex workers and traders who are constantly on the move. Cases from other parts of eastern Congo can be traced back here, officials say, with the first originating in the nightclub scene.

Since this outbreak began, one year ago, nearly 1,000 people in Kamituga have been infected. Eight have died, half of them children.

Not enough awareness about symptoms

Last month, the World Health Organization said mpox outbreaks might be stopped in the next six months, with governments’ leadership and cooperation.

But in Kamituga, people say they face a starkly different reality.

There’s a daily average of five new cases at the general hospital, which is regularly near capacity. Overall in South Kivu, weekly new suspected cases have skyrocketed from about 12 in January to 600 in August, according to province health officials.

Even that’s likely an underestimate, they say, because of a lack of access to rural areas, the inability of many residents to seek care, and Kamituga’s transient nature.

Locals say they simply don’t have enough information about mpox.

Before her daughter got sick, Ms. Wisoba said, she was infected herself but didn’t know it.

Painful lesions emerged around her genitals, making walking difficult. She thought she had a common sexually transmitted infection and sought medicine at a pharmacy. Days later, she went to the hospital with her newborn and was diagnosed with mpox. She recovered, but her daughter developed lesions on her foot.

Nearly a week later, Maombi died at the same hospital that treated her mother.

Ms. Wisoba said she didn’t know about mpox until she got it. She wants the government to invest more in teaching people protective measures.

Local officials can’t reach areas more than a few miles outside Kamituga to track suspected cases or inform residents. They broadcast radio messages but say that doesn’t reach far enough.

Kasindi Mwenyelwata goes door to door describing how to detect mpox — looking for fevers, aches or lesions. But the 42-year-old community leader said a lack of money means he doesn’t have the right materials, such as posters showing images of patients, which he finds more powerful than words.

ALIMA, one of the few aid groups working on mpox in Kamituga, lacks funds to set up programs or clinics that would reach some 150,000 people, with its budget set to run out at year’s end, according to program coordinator Dr. Dally Muamba.

If support keeps waning and mpox spreads, he said, “there will be an impact on the economy, people will stop coming to the area as the epidemic takes its toll. … And as the disease grows, will resources follow?”

Health experts said that, what’s needed most are vaccines — even if they go only to adults, under emergency approval in Congo.

None has arrived in Kamituga, though it’s a priority city in South Kivu, officials said. It’s unclear when or how they will. The main road into town is unpaved — barely passable by car during the ongoing rainy season.

Once they make it here, it’s unclear whether supply will meet demand for those who are at greatest risk and first in line: health staff, sex workers, miners and motorcycle taxi drivers.

Congo’s government has budgeted more than $190 million for its initial mpox response, which includes the purchase of 3 million vaccine doses, according to a draft national mpox plan, widely circulating among health experts and aid groups this month and seen by The Associated Press. But so far, just 250,000 doses have arrived in Congo and the government’s given only $10 million, according to the finance ministry.

Most people with mild cases recover in less than two weeks. But lesions can get infected, and children or immunocompromised people are more prone to severe cases.

Doctors can ensure lesions are clean and give pain medication or antibiotics for secondary infections such as sepsis.

But those who recover can get the virus again.

Lack of resources and knowledge

Experts say a lack of resources and knowledge about the new strain makes it difficult to advise people on protecting themselves. An internal report circulated among aid groups and agencies and seen by AP, said confidence in the available information about mpox in eastern Congo and neighbouring countries low.

While the variant is known to be more easily transmissible through sex, it’s unclear how long the virus remains in the system. Doctors tell recovered patients to abstain from sex for three months, but acknowledge the number’s largely arbitrary.

“Studies haven’t clarified if you’re still contagious or not … if you can or can’t have sex with your wife,” said Dr. Steven Bilembo, of Kamituga’s general hospital.

Doctors say they’re seeing cases they simply don’t understand, such as pregnant women losing babies. Of 32 pregnant women infected since January, nearly half lost the baby through miscarriage or stillbirth, hospital statistics show.

Alice Neema was among them. From the hospital’s isolation ward, she told AP she’d noticed lesions around her genitals and a fever — but didn’t have enough money to travel the 30 miles (50 kilometers) on motorbike for help in time. She miscarried after her diagnosis.

As information trickles in, locals say fear spreads alongside the new strain.

Diego Nyago said he’d brought his 2-year-old son, Emile, to the hospital for circumcision when he developed a fever and lepasions.

“I didn’t believe that children could catch this disease,” he said as doctors gently poured water over the boy to bring his temperature down. “Some children die quickly, because their families aren’t informed.

“Those who die are the ones who stay at home.”

New Delhi:

The government has issued a directive over the Mpox outbreak and suggested screening, testing, and contact tracing of all suspected patients. States have also been asked to identify hospitals to prep isolation facilities for treating suspected as well as confirmed cases.

The centre has also directed a review of public health preparedness by senior officials.

Symptoms

The most common symptom is rash (including symmetrical or genital rash), followed by fever, the government directive said citing the World Health Organization (WHO).

The WHO has declared the Mpox outbreak as a Public Health Emergency of International Concern (PHEIC), but assessed the risk of the spread of the disease to be moderate beyond Africa.

Most Mpox cases are found among young men in the 18-44 years age group, the directive said. Sexual contact is the most commonly reported modes of Mpox transmission globally, followed by person-to-person non-sexual contact.

Read | “Prevent Undue Panic”: Centre’s Advisory To States On Mpox

The mpox virus was discovered in Denmark (1958) in monkeys kept for research and the first reported human case was a nine-month-old boy in the Democratic Republic of the Congo (DRC, 1970).

No confirmed case has been reported from India so far, but a man who recently returned from a country where confirmed cases have been reported was isolated on Sunday and his samples are being tested. His conditions is reported as stable.

Over 120 countries have reported Mpox cases between January 2022 and August 2024, according to the WHO. There have been over 100,000 lab-confirmed cases and around 220 deaths. This includes five Mpox cases in Pakistan, reports Geo News.

According to the WHO, a vaccine can help prevent the infection. It can also be administered after a person has been in contact with someone found infected with Mpox.

The hands of a patient with skin rashes caused by the mpox virus are pictured at the treatment center of Vijana Hospital in Kinshasa, Democratic Republic of Congo on August 30, 2024
| Photo Credit: Reuters

Dozens of feverish patients lay on thin mattresses on the floor of a makeshift mpox isolation ward in east Democratic Republic of Congo, as overstretched hospital workers grappled with drug shortages and lack of space to accommodate the influx.

Congo is the epicentre of an mpox outbreak that the World Health Organization declared to be a global public health emergency last month.

Vaccines are set to arrive within days to fight the new strain of the virus, while Congo’s President Felix Tshisekedi has allowed a first USD 10 million disbursement to fight the outbreak.

But at the hospital complex in the town of Kavumu, where 900 symptomatic patients have been taken in over the past three months, health workers are desperate for support.

“We run out of medicine every day,” said head doctor Musole Mulamba Muva. “There are many challenges we struggle to overcome with our local means,” he said, noting that donations from international organisations rapidly dwindled.

Last week there were 135 patients in the mpox ward, children and adults combined, crammed between three large plastic tents pitched into damp earth without a floor cover.

Relatives that usually provide the bulk of meals in underfunded public facilities such as the Kavumu hospital were banned from visiting the mpox ward to avoid contamination. “We do not have anything to eat,” said Nzigire Lukangira, the 32-year-old mother of a hospitalised toddler.

“When we ask for something to lower our children’s temperature, they do not give us anything,” she said, coaxing honey into her daughter’s mouth.

The head of Congo’s mpox response team, Cris Kacita, acknowledged that parts of the vast central African country lacked medicine and that dispatching donations, including 115 tonnes of medicine from the World Bank, was a priority.

Traditional remedies

Mpox causes flu-like symptoms and pus-filled lesions and, while usually mild, it can kill. Children, pregnant women and people with weakened immune systems are all at higher risk of complications.

Like other mothers in the Kavumu mpox ward, Lukangira had started improvising with traditional remedies to ease her baby’s pain. They dipped their fingers in potassium bicarbonate or salty lemon juice and popped their children’s blisters. Adult patients did the same to themselves.

Most cases came from the town itself and surrounding villages. Two other makeshift mpox wards have been set up in the area.

Local health ministry representative, doctor Serge Munyau Cikuru, called on the government to continue pushing for vaccines.

Kacita said high-risk contacts and nine priority areas had already been identified for the first vaccination stage.

There were 19,710 suspected cases of mpox reported since the start of the year in Congo by August 31, according to the health ministry. Of those, 5,041 were confirmed and 655 were fatal.

New Delhi:
The World Health Organization has declared that an outbreak of mpox, a viral infection that spreads through close contact, represents a global health emergency for the second time in two years. Mpox causes flu-like symptoms and pus-filled lesions.

Here’s your 10-point cheat sheet to this big story

DR Congo:

An mpox outbreak in the Democratic Republic of Congo has killed 548 people since the start of the year, with all provinces affected by the virus, the health minister said on Thursday in a statement.

The World Health Organization (WHO) on Wednesday declared the mpox surge in Africa a global public health emergency, worried by the rise in cases in DRC and the spread to nearby countries.

“According to the latest epidemiological report, our country has recorded 15,664 potential cases and 548 deaths since the beginning of the year,” Health Minister Samuel-Roger Kamba said in a separate video message seen by AFP on Thursday.

The DRC is made up of 26 provinces and has a population of around 100 million.

The most affected provinces are South Kivu, North Kivu, Tshopo, Equateur, North Ubangi, Tshuapa, Mongala and Sankuru, Kamba said.

The UN health agency’s decision came the day after the African Union’s health watchdog declared its own public health emergency over the growing outbreak.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

Two years after a global outbreak, fears are rife that a new strain of mpox — previously known as monkeypox — identified in DR Congo and now also in several neighbouring countries could further spread.

Deadlier and more transmissible than previous forms, the mpox strain surging in the Democratic Republic of Congo (DRC) since September, known as the Clade Ib subclade, is spread person-to-person.

The World Health Organization (WHO) said on Sunday it was considering convening an expert committee to advise on whether to declare an international emergency, as it did during the global mpox outbreak in 2022.

The Clade Ib strain causes skin rashes across the whole body, unlike other strains where lesions and rashes are usually limited to the mouth, face and genitals.

The African Union health agency, Africa CDC, registered 14,479 confirmed and suspected cases of the strain and 455 deaths in DRC as of August 3, representing a mortality rate of around three percent.

But researchers in the vast Central African nation say the mortality rate from the strain can be as much as 10 percent among children.

The Congolese government acknowledged last month an “exponential increase” in cases.

“The disease has been seen in the displacement camps around Goma in North Kivu where the extreme population density makes the situation very critical,” Louis Albert Massing, medical coordinator for Doctors Without Borders in DRC said.

“The risks of explosion are real given the enormous population movements” in the conflict-ridden region, which borders several countries, he added.

Already, the Clade Ib strain has jumped national borders — in the last two weeks, cases have been reported in Uganda, Burundi, Rwanda and Kenya, Rosamund Lewis, the WHO’s technical lead for mpox, told AFP.

‘Raging’

Authorities in the four countries have confirmed mpox cases — Burundi in particular has reported 127 cases — without specifying the strain.

The eight-member East African Community (EAC) has urged governments to educate their citizens on how to protect themselves and prevent the spread of the disease.

Lewis, from the WHO, said it was the first time that the four countries lying to the east of DRC had reported mpox cases.

“Rwanda, Burundi, Uganda are countries that don’t have this disease in an endemic way… that means it’s an extension of the outbreak which is raging in the DRC and in Central Africa generally,” she said.

Africa CDC has also reported 35 suspected and confirmed cases, including two deaths, in Cameroon, 146 cases, including one death, in Congo Brazzaville, 227 cases in the Central African Republic, 24 in Nigeria, five in Liberia and four cases in Ghana.

In West Africa, Ivory Coast recently reported six confirmed non-fatal cases, five of which were in the economic capital Abidjan, without specifying the strain.

Detection capacity

Mpox was first discovered in humans in 1970 in the DRC, then called Zaire. It has since been mainly limited to certain West and Central African nations. Humans mainly catch it from infected animals, such as when eating bushmeat.

In May 2022, mpox infections surged worldwide, mostly affecting gay and bisexual men. That spike was driven by a new subtype, dubbed Clade II, which took over from Clade I. Around 140 people died out of about 90,000 cases across 111 countries.

The outbreak is “still raging”, Lewis said, including in South Africa, which has seen 24 cases, three of which were fatal, but she added it was “controlled” and spreading less.

Mpox remains a global health threat, WHO chief Tedros Adhanom Ghebreyesus warned in early July.

Countries are now able to detect cases, Lewis said, pointing to a system of surveillance, laboratories and communication with affected areas. It is hard to know if there has been “a substantial rise” in cases, or whether “it’s just a matter of increased awareness”, said Maria Van Kerkhove, the WHO’s epidemic and pandemic preparedness and prevention director, who confirmed concern over the Clade Ib strain.

“There are some vaccines that are licensed that can be used for mpox,” she said.

Negotiations between the WHO and affected countries are under way to authorise the use of one, Lewis said.