A severe mpox outbreak in the Democratic Republic of the Congo (DRC) continues at a brisk pace, with cases in the first quarter of 2024 triple that of the same period last year, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said yesterday at a media briefing that covered a host of global health issues.

The DRC's outbreak involves a different clade than the one circulating globally. The clade 1 virus in the DRC has proven to be more virulent and the pattern of spread is notable, given that children are among the hardest-hit groups and because until now, the clade 1 virus hadn't been known to spread sexually. The virus that is spreading globally belongs to clade 2. 

Tedros said more than 4,500 cases have been reported so far this year, up from nearly 4,000 reported in the middle of March. Nearly 300 deaths have been reported in 2024.

"While mpox is spread among children by close contact, there is also a concerning outbreak among adults due to sexual transmission in previously unaffected areas," he said.

A call for financial support, vaccine access

The WHO and its partners are supporting the DRC's health ministry with the mpox outbreak response and to assess mpox vaccines. 

Tedros said more funding is needed to support the response and to ensure that the outbreak doesn't spread to neighboring countries. He added that the WHO's vaccine advisory group last month called for steps to help the DRC gain easier access to mpox vaccines.

A new study released ahead of the upcoming European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Barcelona, Spain, shows that transmission of pneumococcus was highest among older adults who had frequent contact with preschoolers and young school-aged children.

The authors of the small, community-based study say the findings suggest that pneumococcal vaccination in adults could be beneficial even in populations where children are vaccinated at high rates.

Substantially higher pneumococcal carriage 

To assess the risks for acquisition of Streptococcus pneumoniae among community-dwelling older adults, researchers from Yale School of Public Health designed a longitudinal study that included 183 adults age 60 and over (mean age 70.9 years) from 93 households with and without young children. Every 2 weeks over a 10-week period across two seasons (November 2020 to August 2021 and November 2021 to September 2022), they obtained saliva samples and questionnaires regarding social behaviors and health status, then used polymerase chain reaction tests to detect pneumococcal DNA.

Overall, 52 (4.8%) of 1,088 samples tested positive for pneumococcus, with 27 (22.3%) of 121 individuals colonized on at least one time point. Several study participants were colonized at multiple time points, including two who were colonized throughout the 10-week sampling period. 

The point prevalence of pneumococcal carriage was substantially higher among those who reported contact with children compared with those who reported no contact with children (10.0% vs 1.6%). In addition, 14.8% and 14.1% of participants who reported contact with children aged 5 years and under and those aged 5 to 9 years had pneumococcal carriage, compared with 8.3% of those who reported contact with children over age 10.

Although the numbers were small, participants who had contact with children daily or every few days had the highest prevalence of pneumococcal carriage (15.7% and 14.0%, respectively). There was no clear evidence of adult-to-adult transmission.

"This suggests that the main benefit of adult pneumococcal vaccination is to directly protect older adults who are exposed to children who may still carry and transmit some vaccine-type pneumococcal strains despite successful national childhood vaccination programs," lead study author Anne Wyllie, PhD, said in an ECCMID press release.

Global life expectancy increased by 6.2 years since 1990 in large part because of a reduction in infectious diseases, according to a study yesterday in The Lancet. The progress came from reducing deaths from diarrhea, lower respiratory infections, stroke, and heart disease, but has been slowed by the COVID-19 pandemic.  

The study compared 288 causes of death from 1990 to 2021 in 204 countries and territories.

A super-region comprising Southeast Asia, East Asia, and Oceania had a net life expectancy gain of 8.3 years from 1990 to 2021. The region also had some of the tightest COVID-19 restrictions, which helped limit deaths from the novel coronavirus. Eastern sub-Saharan Africa experienced the largest increase in life expectancy, 10.7 years.

Most of these gains were owing to control of diarrheal and enteric diseases. Improvements in managing diarrheal diseases increased life expectancy worldwide by 1.1 years from 1990 to 2021, the authors said. 

COVID-19 replaces stroke as second-leading cause of death

In those three decades, the leading causes of age-standardized deaths globally remained the same: ischemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. 

COVID-19 replaced stroke as the second-leading age-standardized cause of death in 2021, however, with 94.0 deaths (95% uncertainty interval, 89.2 to 100.0) per 100,000 population. The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3.6 years). 

"As a leading cause of death, COVID-19 reduced life expectancy in 2 years nearly as much as reductions in communicable and [noncommunicable diseases] have improved it over decades," the authors concluded. 

As a leading cause of death, COVID-19 reduced life expectancy in 2 years .

"On one hand, we see countries’ monumental achievements in preventing deaths from diarrhea and stroke," said Liane Ong, PhD, a co-first author of the study and lead research scientist at the Institute for Health Metrics and Evaluation (IHME), in a press release from IHME. "At the same time, we see how much the COVID-19 pandemic has set us back."