Mpox cases in the African region have been declining over the past 6 weeks, due to the intensification of key public health steps, such as deploying more community health workers to do contact tracing and active surveillance, a top official from Africa Centre for Disease Control and Prevention (Africa CDC) said yesterday at the group’s regular weekly briefing.
However, Yap Boum, PhD, MPH, deputy incident manager for Africa CDC’s mpox response, said the region still remains on guard, with the virus popping up in new countries—most recently in Malawi—and with 17 of 24 countries still reporting active transmission.
Promising trends in hot spot countries
Part of the decline is due to a drop in cases in Burundi, one of the outbreak hot spots, Boum said, noting that the country had been averaging 200 new cases a week but is now reporting about 30 a week. Improvements in outbreak response, which has included decentralized testing, will make a lasting imprint on the county’s health system, he said. “Burundi will be a different country.”
Officials are also seeing promising trends in the Democratic Republic of the Congo (DRC), where conflict in some of the hardest hit regions in the East and foreign aid cuts have led to decreased testing rates and posed other major challenges to the outbreak response, Boum said.
Burundi will be a different country.
In the DRC, the goal is to keep increasing testing coverage, “so that we are confident in the total picture that we see on the ground,” he said. In the Kinshasa hot spot, community health workers are going household to household to identify cases earlier and contacts who are candidates for the country’s targeted mpox vaccine strategy.
The DRC has received 754,000 vaccine doses and is expecting 300,000 million more in the weeks ahead.
North Kivu and South Kivu provinces, where conflict is still flaring, still carries the country’s highest burden, and Boum said outbreaks of measles, with a rash that resembles mpox, is complicating efforts and speaks to the need for a multiplex test that can distinguish between the two diseases.
He said other countries are at different outbreak phases, with Uganda—like Burundi—reporting a promising decline in cases and deaths. However, he said cases are trending upward in Kenya, which is experiencing infections in truck drivers. The country recently launched its mpox vaccination campaign.
Evidence points to community circulation in Malawi
Malawi’s health ministry this week declared an mpox outbreak, with three cases initially reported.
Four cases have now been reported from two districts, three from Lilongwe and one from Mangochi, Boum said. One of the patients is a 2-year-old child, and all are male. So far, 34 contacts have been identified.
None of the patients have a history of travel to outbreak areas, suggesting that the virus is circulating within the country, he said. Sequencing on samples from patients has identified the clade 1b virus.
Rapid tests under evaluation
Boum said two rapid mpox tests are under evaluation at the DRC's National Institute for Biomedical Research (INRB), one from Conti Pharma and the other from Revital Healthcare. None of the tests in earlier evaluation had met minimal sensitivity requirements.
Rapid tests can be used in the lowest level health settings and can quickly identify cases, useful for preventing onward spread, he said. “This can be a changemaker in the response, he said.
