Jean Kakuru Biyambo, 48, a father of six from the Muja internally displaced persons camp, gestures outside his room at the Goma general hospital where he has been receiving treatment against Mpox - an infectious disease caused by the monkeypox virus that spark-off a painful rash, enlarged lymph nodes and fever; following Mpox cases in Nyiragongo territory, in Goma, North Kivu province, Democratic Republic of the Congo July 16, 2024. PHOTO/REUTERS
Barely a month after mpox was confirmed in Uganda, the World Health Organisation (WHO) declared that the cross-border infections and upsurge in cases of the viral disease constitute a public health emergency of international concern.
Dr Jane Ruth Aceng, the Health minister, said the detection of the two cases in Uganda was indicative of rising cross-border transmission of mpox. She also indicated that the two cases were a spillover of the high disease burden in the neighbouring Democratic Republic of the Congo (DRC).
“The two individuals were admitted and treated in Bwera Hospital and have since recovered and been discharged with no complications. This is the first time mpox has been confirmed in Uganda,” Minister Aceng said.
The minister, like the Africa Centres for Disease Control and Prevention (Africa CDC) scientists, said mpox transmission in the eastern DRC is expanding rapidly “with a new epicentre in North Kivu that is adjacent to Uganda.”
“This happens amidst our regular cross-border human interactions between our two countries for trade, culture and social reasons. This means the risk of importation into Uganda remains high given the long incubation period of seven to 14 days,” Minister Aceng added.
Information from Africa CDC, an autonomous body of the African Union, indicates that the surge in mpox cases across Africa in 2024 has matched 2023’s total in just six months. Details from the Africa health body show that, from January to July, about 15,074 mpox cases (2,853 confirmed; 12,221 suspected) and 461 deaths (a case fatality rate of 3.06 percent) have been reported across 12 AU member states.
“This represents a 160 percent increase in cases and a 19 percent increase in deaths in 2024 compared to the same period in 2023,” Africa CDC notes in an August 2 statement.
What is mpox?
It’s a self-limiting viral disease that presents with small boils on the skin. It is also associated with high-grade fever, swelling of lymph nodes, headache and general body weakness.
According to scientists, mpox is in the same family of viruses such as smallpox that was eradicated over 40 years ago. Details from the WHO indicate that the mpox virus was discovered in Denmark in 1958 in monkeys kept for research and the first reported human case of mpox was a nine-month-old boy in the DRC in 1970.
However, the emergence of the new mpox variant, dubbed MPX Clade 1b, which is said to be driving transmission in the DRC and other countries, including Sweden, is still a concern to scientists. The variant was first reported in the DRC late last year.
Details from WHO also indicate that of the 99,000 mpox cases reported between January 1, 2022, through June 30, the “region of the Americas” reported the highest mpox cases, standing at 62,900 cases, followed by European region 27,000 cases and then Africa at 4,200 cases. But there have been concerns by the Africa CDC that testing rates in Africa are lower than that of Europe and America, meaning there could be some unreported cases in communities.
Of the 99,000 cases, the majority of the patients who died were from the Americas at 141, followed by Africa (35) and Europe (10) over the same period.
How is mpox transmitted?
The viral disease transmission to humans is by contact with the infected animals. Among humans, it spreads by direct contact with an infected person and sexual intercourse. Treatment is symptomatic depending on the complaint as there is no specific treatment for the virus.
To prevent the infections, Uganda’s Health ministry is promoting measures which include avoiding physical contact with someone who has signs and symptoms of mpox; avoiding sharing clothes, beddings, and other personal items with infected persons; washing hands with soap and water or use an alcohol-based sanitiser after contact with a suspected mpox case.
The other measures include encouraging contacts and frontline workers to take vaccination when it’s available and suspected cases be reported to the nearest health facility for assistance.
Why the new WHO declaration?
The public health emergency declaration by the WHO came a day after the Africa CDC, in a historic step, declared that the increased mpox cases is a public health emergency of continental security. The declarations by the two bodies, Global Vaccine Alliance (Gavi), notes in a Thursday statement, “will help create an enabling environment in support of a comprehensive region-led response.”
Minister Aceng, on her side, noted: “The two declarations call for concerted global and continental investment to reduce mortality and to maintain stable global trade and economy and to avoid stretching health systems as seen in DRC and Burundi.”
Dr Jean Kaseya, the Africa CDC director general, said the decision was made after consulting and meeting at least 600 African leaders and top health experts across the continent, including Prof Nelson Sewankambo of Uganda’s Makerere University.
“Mpox has now crossed borders, affecting thousands across our continent. Families have been torn apart and suffering has touched every corner of our continent. Based on the consensus or even unanimity reached from various bodies and consultations,” Dr Kaseya said this week.
“With a heavy heart but with an unyielding commitment to our people, to our African citizens, we declare mpox as a public health emergency of continental security,” he added.
Dr Kaseya explained this week that the declaration will allow for the “proactive approach” that will boost cross-border operations to prevent the spread of the virus. He, however, emphasised that they do not recommend travel restrictions over mpox, a disease which Prof Salim Abdool Karim, who heads the Emergency Consultative Group for Africa CDC, described as “mild” but increasing at a concerning rate.
Prof Karim disclosed there are “far more cases now” in Africa than even when the WHO declared an international public health emergency (PHEIC) previously.
“We looked at the evidence and we reflected on that evidence in relation to a set of criteria that had been developed by the Africa CDC. The criteria were very helpful and very comprehensive. So, when we looked at it in relation to those criteria, we were able to pinpoint the areas that we need most to understand and to reflect on,” he noted.
Prof Karim also added that there was concern because there were new cases being reported in countries that previously did not have cases.
“The evidence we have does not seem to be that it’s zoonotic transmission, in other words, from an animal reservoir. It seems to be mostly from human-to-human transmission,” he revealed.
So what next now?
Dr Daniel Kyabayinze, the director of public health at Uganda’s Health ministry, said they have increased surveillance and community engagement to prevent the importation and spread of the disease.
“We have a lot of alerts coming from everywhere and once we investigate these people and find that they are not mpox we give them appropriate treatment,” he disclosed, adding, “But the two confirmed cases which were here, one was treated successfully and was discharged and the other one must have gone back to his country because he had relatives across the border. We don’t have him in any of our hospitals.”
Dr Kyabayinze told Saturday Monitor that the ministry’s “community mobilisation and engagement teams are on ground and the district task forces have been activated to ensure they are planning and looking out for any cases.”
Minister Aceng said the East African Centres for Disease and Prevention, which comprises countries in the region, will be meeting to determine the areas of collaboration in cross-border response. She added that Uganda’s health system has developed adequate capacity to handle epidemics.
All the 42 samples tested at the Uganda Virus Research Institute, per the minister, came back negative for mpox, indicating that no secondary transmission has been found from the prevention of two cases in Kasese.
“We didn’t declare an outbreak when we got the two cases because we did not want to scare people. We are just out of Ebola and Covid. The country must move on and trade must continue. Whenever there is an outbreak we don’t restrict movement. But we have the capacity, that is why we could detect the two cases in real-time,” the minister said. “We have port health where we do routine surveillance. The Ministry of Health is in control.”
Minister Aceng also disclosed that they are engaging the WHO and US embassy in Kampala to acquire vaccines for mpox. “Following the declaration by the WHO the production of vaccine will also go up but may not be adequate to cover everybody and so it may start with the most at risk persons.”
Mr Felix Okot Ogong, the Dokolo South County legislator, expressed concern about the availability of funds required by the ministry to respond to the mpox threat. Minister Aceng said they are so far engaging development partners to mobilise resources. Response to epidemics and essential health system operations in the country have greatly been supported by partners such as WHO and the American government. Dr Aceng said the government should have a special fund for emergencies to ease response in the events like mpox outbreak.
What other leaders say...
Dr Charles Ayume, the outgoing chairperson of the House Health Committee.
“Several times when vaccines come, some of us, the leaders, decampaign the vaccination yet vaccine has been the biggest enabler of public health and it helped us eradicate diseases like smallpox.”
Dr Abed Bwanika, a veterinary doctor and lawmaker
“In some of our communities people interact with the wild animals freely. We need to sensitise our people on minimising the contacts. The population of monkeys is also increasing in Kampala City. Anyone who has wildlife as a pet needs to be given a licence.”
Betty Nambooze, Mukono Municipality MP
“We need to build a culture that discourages shaking hands and hugging. During Covid we installed handwashing facilities in markets and other public facilities, but most of them are broken down. Can we make this a policy that these places should have handwashing facilities?”
