2023–2024 mpox epidemic explained

2023–2024 mpox epidemic
Disease:Mpox (clade 1b)
Location:Primarily Central Africa, limited local transmission elsewhere
Date:September 2023 – present
(PHEIC: 14 August 2024 – present)
Confirmed Cases:18,991
Deaths:591

An epidemic of a new variant of clade I mpox (formerly known as monkeypox), known as clade 1b,[1] began in Central Africa at least as early as September 2023. As of August 2024, more than 17,000 cases have been reported, with 591 fatalities (~3.5% fatality rate),[2] nearly all in the Democratic Republic of the Congo.

On 14 August 2024, the World Health Organization declared the epidemic a public health emergency of international concern (PHEIC).[3]

Background

See main article: 2022–2023 mpox outbreak. In May 2022, the World Health Organization (WHO) declared a prior mpox outbreak, involving a different clade of the virus, as a global health emergency. The disease had infected 87,000 individuals and caused 140 deaths when the WHO ended its global emergency in May 2023.[4]

In September 2023, cases started increasing in the Democratic Republic of the Congo and continued into 2024, with the Africa Centres for Disease Control and Prevention (ACDC) reporting a 160% increase in cases from the previous year.[5]

Outbreak

Reported cases and casualties

LocationCasesDeathsFirst confirmed clade Ib case
Democratic Republic of the Congo17,794[6] 584January 2023[7]
Burundi572[8] 0July 2024
Central African Republic2630
Republic of the Congo1691
Nigeria400No confirmed clade Ib cases[9]
Cameroon352No confirmed clade Ib cases
Kenya310July 2024
Ivory Coast281No confirmed clade Ib cases
South Africa24[10] 3No confirmed clade Ib cases
Indonesia140No confirmed clade Ib cases
Liberia5[11] 0No confirmed clade Ib cases<---Ghana40
Rwanda40July 2024
Pakistan40No confirmed clade Ib cases
Taiwan4[12] 0Clade unspecified
Portugal30No confirmed clade Ib cases
Uganda20July 2024-Maldives20
Sweden1[13] 015 August 2024
Thailand1[14] 022 August 2024-Malawi10
Philippines10No confirmed clade Ib cases
Total18,977591

Timeline

See main article: article and Timeline of the 2023–2024 mpox epidemic.

Mpox cases from clade Ib infections were growing in the Democratic Republic of the Congo (DRC) by September 2023,[15] with several of them being identified in Kamituga, a mining town in the province of South Kivu.[16] [17] A nationwide outbreak was reported in January 2024.[18]

On 12 August 2024, the Africa Centres for Disease Control and Prevention declared that the growing mpox outbreaks in Africa had become a public health emergency, with over 517 deaths being reported. As a result, the organization requested the help and intervention of the international community to control the spread of the virus and treat infected patients.[19] [20] The ACDC stated that the fatality rate of the strain of virus causing the outbreak was 3–4%, significantly higher than the less than 1% fatality rate recorded during the 2022–2023 mpox outbreak. On 14 August, the World Health Organization declared the epidemic a public health emergency of international concern (PHEIC), or global health emergency.

As of 16 August 2024, fifteen countries were reported to have identified cases of mpox; and over 96% of all reported cases and fatalities from the disease were confirmed in the DRC, with 16,839 reported cases and 501 reported deaths. The ACDC reported that 70% of reported cases in the DRC were in children under 15, as that demographic represented 85% of reported deaths. Epidemiologist Jacques Alonda expressed concern over the disease's spread in refugee camps in the DRC and its neighbor countries, especially due to the amount of pressure already applied on the national healthcare system by concurrent outbreaks of cholera and measles, as well as widespread malnutrition.

Also on 16 August, the European Centre for Disease Prevention and Control (ECDC) officially raised the risk level of clade I to the general European population from "very low" to "low", due to the likelihood of more imported cases being identified across the continent, although the agency reiterated that the risk of sustained transmission of the virus strain in Europe was still considered to be minimum.[21] [22] The ECDC also advised travellers to consider getting vaccinated against mpox should they visit African countries affected by the outbreak.[23]

Countries with widespread transmission

Democratic Republic of the Congo

As of August 2024, a cumulative total of 16,839 suspected cases of mpox (at least 1,888 of which were laboratory confirmed) and 570 deaths[24] (at least 8 of which were laboratory confirmed) have been reported in the Democratic Republic of the Congo (DRC).

On 19 August, the DRC's Ministry of Public Health,, said in a press conference that all of the country's provinces, including the capital city of Kinshasa, had been affected by the outbreak, while announcing that the national government would launch a €45 million response plan including awareness campaigns, medical team deployment and patient care, but not vaccines.[25]

Countries with limited local transmission

As of August 2024, fifteen countries have reported cases of mpox; the WHO reported that new cases of the mpox strain, all of which linked to the outbreak in the DRC, had been identified for the first time in four East African nations: Burundi, Kenya, Rwanda and Uganda. Ivory Coast also reported new cases for the first time.

Central African Republic

On 30 July 2024, the Minister of Health of the Central African Republic, Pierre Somsé, declared an outbreak of mpox in Bangui, following a period of time when the disease was mostly restricted to rural areas.[26] Somsé reported that some families in the country were hiding infected relatives in fear of being stigmatized, thus increasing the risk of transmission of the disease.

Sweden

On 15 August 2024, Sweden's Public Health Agency reported the first case outside Africa, which involved a person who had contracted clade I mpox during a stay in an area of Africa affected by the outbreak.[27] [28] In a public statement, the agency said that, while the case in itself did not represent a higher risk to the general population, occasional imported cases "may continue to occur".[29]

Taiwan

On 18 August 2024, the Public Health Bureau of the city council of Tainan, Taiwan announced that, as of 16 August, three cases of mpox—all of which involving men who had had close contact with unspecified people—had been confirmed in the city since the start of the year; further details about the patients' traveling history and the variant were not disclosed.[30] [31]

Thailand

On 21 August 2024, Thailand's Department of Disease Control confirmed a mpox case, involving a 66-year old European man who was a resident of Thailand, and had returned from an African country affected by the outbreak, with his flight transiting through an undisclosed Middle Eastern country.[32] [33] The strain was later confirmed to be clade 1b.[34]

Clade II cases

Some countries have reported contemporary mpox cases that then turned out to be infections with clade II variants, presumably unrelated to the clade Ib outbreak. There is an ongoing global outbreak of clade II infections that began in 2022.

Pakistan

On 15 August 2024, Pakistan's National Command and Operation Center (NCOC) reported a suspected case of mpox in the province of Khyber Pakhtunkhwa, involving a resident of Mardan who had recently returned from an Arab Gulf state;[35] the person was later confirmed to have been diagnosed with mpox by the Pakistani Ministry of Health, although sequencing of viral samples was still ongoing in order to determine the nature of the variant.[36] [37]

On 17 August, the health department of Khyber Pakhtunkhwa confirmed that two patients had tested positive for mpox, while another one was waiting for confirmation; all of the patients had recently returned to Pakistan from the United Arab Emirates.[38]

On 19 August, another suspected mpox case was reported, involving a resident of Azad Kashmir who had just returned from a Middle Eastern country; however, the Ministry of Health stated that none of the reported cases in the country had been caused by clade 1b of the virus.[39]

Portugal

On 16 August, Portugal's Directorate-General of Health (DGS) confirmed that three new cases of mpox had been confirmed in the country between May and July 2024;[40] [41] the agency reported that all of the cases had been detected in the North Region, with two of them having travelled abroad during the incubation period of the disease.[42] However, the DGS said that all of the three patients had contracted clade IIb mpox, whereas no clade I cases had been reported.

Indonesia

On 17 August 2024, Indonesia's Independence day, the Indonesian Ministry of Health (Kemenkes) reported a total of 14 confirmed mpox cases from January to April 2024.[43] This brought the cumulative total to 88 cases in Indonesia when combined with the previous outbreak's 73 cases reported in 2023 and one case from 2022.[44] The outbreak, which initially began in Jakarta, has since spread to the Riau Islands. Among the total cases, 87 patients have been declared cured, with 54 of those cases involving the Clade IIB variant. The distribution of cases by region includes 59 in Jakarta, 13 in West Java, nine in Banten, three in East Java, three in the Special Region of Yogyakarta (DIY), and one in the Riau Islands.[45]

Philippines

On 19 August 2024, the Philippines' Department of Health (DOH) announced that a 33-year old male from Metro Manila, with no prior history of traveling overseas, had tested positive for mpox the day prior.[46] The patient was later determined to have contracted clade II mpox.[47]

Virology

Mpox is caused by the monkeypox virus. The virus is transmitted through close contact with infected animals or people,[48] including in-person communication and other kinds of physical contact,[49] [50] contaminated bedsheets, clothing or needles, sexual contact and consumption of contaminated meat.

In April 2024, researchers identified a novel subgroup of clade I of mpox in Kamituga, a mining town in South Kivu, Democratic Republic of the Congo. Epidemiologists reported that the new variant—later named "clade Ib" or "clade 1b"—had the potential to spread with greater ease compared to other mpox strains. The researchers theorized that the strain had undergone genetic mutations allowing it to spread more easily through human transmission, due to the mining town's remote location greatly limiting contact with animals that naturally carry and spread the disease.[51]

Dr. Placide Mbala-Kingebeni, of DRC's National Institute of Biomedical Research, reported that the results of the analysis marked "a new phase of mpox" from the prior outbreak in 2022 and 2023, since the new variant reportedly produced lesions predominantly on the genitals, making the disease more difficult to diagnose compared to strains that caused chest, feet, and hand lesions. Mbala-Kingebeni also noted that the new variant could result in a higher likelihood of silent transmission, due to its different manifestations. The research team determined the detected form to be a Clade I type strain, which historically has caused more severe symptoms in comparison to the Clade II type that was predominant during the 2022–2023 mpox outbreak.

Prevention and mitigation

Until June 2024, mpox vaccines were not approved by any African government and the efficacy of vaccines had not been attested by the Strategic Advisory Group of Experts. The director of the WHO's Health Emergencies Programme, Michael J. Ryan, noted in an interview with NPR that the Democratic Republic of the Congo was simultaneously facing several other endemic diseases, including measles and cholera. Up to that point, only two labs in the DRC were able to perform polymerase chain reaction testing for mpox.[52]

Also in June 2024, Reuters reported that authorities in the DRC had approved the vaccines Jynneos, manufactured by Bavarian Nordic, and LC16, manufactured by KM Biologics, for emergency use.[53] Jynneos was later approved in Nigeria, also for emergency use.[54] [55] Both the countries officially started vaccination campaigns for mpox by the end of August of the same year.[56]

Also in August 2024, the chief executive officer of GAVI, Sania Nishtar, said the organization had already allocated up to $500 million as part of their "First Response" fund—which had originally been set up during the COVID-19 pandemic, mostly through donations by governments and global health funders, but was later kept in place in order to respond to new health emergencies. However, Nishtar said that GAVI and UNICEF still had to wait for official requests from the countries affected by the outbreak, as well as definitive approval of mpox vaccines from the World Health Organization, in order to start ordering the doses and distributing them to affected nations. In response, the WHO announced the launch of a process that would enable access to vaccines for emergency use in countries whose national approval was still pending.

On 14 August, the U.S. Department of Health and Human Services (HHS) announced that the national government would donate 50,000 doses of the Jynneos vaccine to the DRC.[57] The HHS also said that the U.S. had previously provided $17 million USD to "support clade I mpox preparedness and response efforts in Central and Eastern Africa".

On 16 August, Bavarian Nordic announced in a press statement that it had submitted clinical data to the European Medicines Agency to support the extension of the approval of Jynneos/Imvanex to include adolescents aged 12 to 17 years;[58] the company cited as evidence the early results of a trial—sponsored by the NIH's National Institutes of Allergy and Infectious Diseases (NIAID)[59] —in 315 adolescents included in the aforementioned age range and 211 adults aged 18 to 50 years,[60] which showed that both the immune responses and the safety profile were similar between the two age groups after vaccination with two standard doses. In the same statement, Bavarian Nordic also stated that a study of the vaccine in children aged 2 to 12 years would take place in the DRC and Uganda later in 2024.

Also on 16 August, China's General Administration of Customs declared that national authorities would deploy screening measures for people and goods entering the country from areas affected by the outbreak for the following six months.[61] By 17 August, Pakistan had started screening travellers at all airports and at border crossings with surrounding countries.[62]

On 17 August, the ACDC announced that they had pledged to distribute 10 million doses of the mpox vaccine by 2025, and that Bavarian Nordic had agreed to enhance vaccine manufacturing capabilities across Africa,[63] in order to increase local supplies and reduce production costs. The association's Director General, Dr Jean Kaseya, later pleaded with foreign countries not to implement travel bans against African nations, as it had previously happened during the COVID-19 pandemic.

On 19 August, the DRC's Ministry of Public Health,, said in a press conference that the DRC needed about 3.5 million doses of mpox vaccines, with roughly 215.000 doses set to be donated by Belgium and up to three million doses being donated by Japan, and further donations being expected by the United States.

References

Cited works

Notes and References

  1. 14 August 2024 . WHO Director-General declares mpox outbreak a public health emergency of international concern . live . https://web.archive.org/web/20240814192152/https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern . 14 August 2024 . 16 August 2024 . World Health Organization.
  2. News: Bariyo . Nicholas . 14 August 2024 . Rapid Spread of Mpox in Africa Is Global Health Emergency, WHO Says . live . https://archive.is/EltQ6 . 14 August 2024 . 14 August 2024 . . subscription.
  3. News: W.H.O. Declares Global Emergency Over New Mpox Outbreak . 14 August 2024 . Mandavilli . Apoorva . . 14 August 2024 . 15 August 2024 . https://web.archive.org/web/20240815030819/https://www.nytimes.com/2024/08/14/health/mpox-who-emergency-africa.html . live . limited.
  4. News: W.H.O. Ends Mpox Global Emergency . 11 May 2023 . Mandavilli . Apoorva . . 14 August 2024 . 15 August 2024 . https://web.archive.org/web/20240815000645/https://www.nytimes.com/2023/05/11/health/mpox-who-emergency.html . live . limited.
  5. 17 August 2024 . Statement by His Excellency President Cyril Ramaphosa, the African Union Champion on Pandemic Prevention, Preparedness, and Response (PPPR) on the situation of Mpox outbreak in Africa . 18 August 2024 . Africa Centres for Disease Control and Prevention.
  6. Web site: 21 August 2024 . Congo reports more than 1000 cases in a week. African authorities ask for vaccines. 21 August 2024 . ctvnews.ca.
  7. News: The mpox strain spreading now is different from the one in 2022: Here's what to know. Bendix. Aria. NBC News. 16 August 2024. 22 August 2024.
  8. News: Congo reports more than 1,000 new mpox cases in a week. African authorities ask for vaccines. Imray. Gerald. 21 August 2024. Associated Press. 22 August 2024. [Africa CDC director-general Dr. Jean Kaseya] said it was noticeable that cases in nearby Burundi had more than doubled to 572 in a week..
  9. First meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024. 19 August 2024. World Health Organization. 22 August 2024. Additionally, in 2024, cases of mpox linked to MPXV clade Ia have been reported in the Central African Republic and the Republic of Congo, and cases linked to MPXV clade II have been reported in Cameroon, Côte d’Ivoire, Liberia, Nigeria and South Africa..
  10. Web site: Mpox Updates . 17 August 2024 . . en-ZA . 17 August 2024 . https://web.archive.org/web/20240817120155/https://www.nicd.ac.za/mpox-updates/ . live .
  11. Mpox Outbreak. 14 August 2024. National Public Health Institute of Liberia. 22 August 2024. https://web.archive.org/web/20240822150004/https://www.nphil.gov.lr/wp-content/uploads/2024/08/outbreak-of-the-Monkeypox.pdf. 22 August 2024. live.
  12. News: Taiwan's CDC reports 4 new mpox cases. Scanlan. Sean. 21 August 2024. Taiwan News. 22 August 2024.
  13. Web site: 15 August 2024 . One case of mpox clade I reported in Sweden . live . https://web.archive.org/web/20240816002546/https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/disease-information-about-mpox/one-case-of-mpox-clade-i-reported-in-sweden/ . 16 August 2024 . 15 August 2024 . Public Health Agency of Sweden.
  14. News: Drury . Flora . 22 August 2024 . Thailand confirms first Asian case of new Mpox strain . live . https://web.archive.org/web/20240822132952/https://www.bbc.com/news/articles/czrgpg127zgo . 22 August 2024 . 22 August 2024 . BBC News.
  15. News: Junaidi . Ikram . 15 August 2024 . NCOC issues advisory as first suspected mpox case quarantined . live . https://web.archive.org/web/20240816002538/https://www.dawn.com/news/1852458/ncoc-issues-advisory-as-first-suspected-mpox-case-quarantined . 16 August 2024 . 15 August 2024 . . en-PK . Reuters. Agence France-Presse.
  16. 10.1038/s41591-024-03130-3 . Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo . 2024 . Vakaniaki . Emmanuel Hasivirwe . Kacita . Cris . Kinganda-Lusamaki . Eddy . o'Toole . Áine . Wawina-Bokalanga . Tony . Mukadi-Bamuleka . Daniel . Amuri-Aziza . Adrienne . Malyamungu-Bubala . Nadine . Mweshi-Kumbana . Franklin . Mutimbwa-Mambo . Léandre . Belesi-Siangoli . Freddy . Mujula . Yves . Parker . Edyth . Muswamba-Kayembe . Pauline-Chloé . Nundu . Sabin S. . Lushima . Robert S. . Makangara-Cigolo . Jean-Claude . Mulopo-Mukanya . Noella . Pukuta-Simbu . Elisabeth . Akil-Bandali . Prince . Kavunga . Hugo . Abdramane . Ombotimbe . Brosius . Isabel . Bangwen . Eugene . Vercauteren . Koen . Sam-Agudu . Nadia A. . Mills . Edward J. . Tshiani-Mbaya . Olivier . Hoff . Nicole A. . Rimoin . Anne W. . Nature Medicine . 1–5 . 38871006 . 1 .
  17. News: Newey . Sarah . 16 April 2024 . Mutated strain of mpox with 'pandemic potential' found in DRC mining town . 14 August 2024 . . 15 August 2024 . https://web.archive.org/web/20240815000017/https://www.telegraph.co.uk/global-health/science-and-disease/mpox-outbreak-kamituga-democratic-republic-of-congo-africa/ . live .
  18. News: A deadly new outbreak is testing Africa's ambitious public health efforts . 24 January 2024 . Scott . Dylan . . 14 August 2024 . 8 August 2024 . https://web.archive.org/web/20240808162443/https://www.vox.com/future-perfect/2024/1/24/24048361/mpox-covid-outbreak-africa-cdc-public-health . live .
  19. News: Cheng . Maria . 14 August 2024 . WHO declares mpox outbreaks in Africa a global health emergency as a new form of the virus spreads . 14 August 2024 . . en . 16 August 2024 . https://web.archive.org/web/20240816004320/https://apnews.com/article/who-mpox-africa-health-emergency-cc9bdf31b49d06bec5efd44fb55d5e42 . live .
  20. 13 August 2024 . Africa CDC Declares Mpox A Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent . 18 August 2024 . . 17 August 2024 . https://web.archive.org/web/20240817202424/https://africacdc.org/news-item/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent/ . live .
  21. ECDC recommends enhancing preparedness as more imported cases of clade I mpox highly likely . 16 August 2024 . . 18 August 2024 . live . https://web.archive.org/web/20240819061047/https://www.ecdc.europa.eu/en/news-events/ecdc-recommends-enhancing-preparedness-more-imported-cases-clade-i-mpox-highly-likely . 19 August 2024.
  22. News: Satija . Bhanvi . Rigby . Jennifer . 16 August 2024 . EU public health body raises mpox risk alert level . 20 August 2024 . Reuters.
  23. Web site: Roberts . Michelle . 16 August 2024 . Mpox: Travellers advised to consider vaccine . 21 August 2024 . . en-GB . 21 August 2024 . https://web.archive.org/web/20240821160858/https://www.bbc.com/news/articles/c4gd2p04405o . live .
  24. Web site: 19 August 2024 . Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues . 21 August 2024 . . fr .
  25. Web site: 20 August 2024 . DR Congo on standby for first vaccines to fight mpox outbreak . 21 August 2024 . RFI.
  26. News: Central African Republic latest to declare mpox outbreak . 30 July 2024 . Chibelushi . Wedaeli . . 14 August 2024 . 14 August 2024 . https://web.archive.org/web/20240814102131/https://www.bbc.com/news/articles/cm52rk2el81o . live .
  27. News: Kirby . Paul . 15 August 2024 . First case of more contagious mpox found outside Africa . live . https://web.archive.org/web/20240815162156/https://www.bbc.co.uk/news/articles/c4gqr5lrpwxo . 15 August 2024 . 15 August 2024 . . en-GB.
  28. News: 15 August 2024 . Första bekräftade fallet av nya mpox-varianten i Sverige . First confirmed case of the new mpox variant in Sweden . live . https://web.archive.org/web/20240815152749/https://www.svt.se/nyheter/utrikes/fhm-mpox-lar-ta-sig-till-sverige-handlar-om-enstaka-fall . 15 August 2024 . 15 August 2024 . . sv.
  29. News: Mandavilli . Apoorva . 15 August 2024 . How Did Mpox Become a Global Emergency? What's Next? . live . https://web.archive.org/web/20240815165551/https://www.nytimes.com/2024/08/15/health/mpox-emergency-vaccines-treatments.html . 15 August 2024 . 15 August 2024 . . en-US . limited.
  30. Web site: 19 August 2024 . Taiwan confirms three mpox cases amid global outbreak . 19 August 2024 . . 19 August 2024 . https://web.archive.org/web/20240819035706/https://news.tvbs.com.tw/english/2589492?from=english_content_pack . live .
  31. Web site: 19 August 2024 . 世界衛生組織宣布M 痘為公衛緊急事件, 非洲相關國家提升旅遊為「警示」, 瑞典、巴基斯坦接連傳出病例, 衛生局呼籲民眾注意旅遊安全, 並依風險評估施打M痘疫苗 . 19 August 2024 . 臺南市政府衛生局 . zh-TW . 20 August 2024 . https://web.archive.org/web/20240820033708/https://health.tainan.gov.tw/page.asp?mainid=9571294A-4FFA-42EA-8798-C058C643CEEF . live .
  32. News: 21 August 2024 . New mpox case could be more transmissible strain . live . https://web.archive.org/web/20240821161520/https://www.bangkokpost.com/thailand/general/2851127/new-mpox-case-could-be-more-transmissible-strain . 21 August 2024 . 21 August 2024 . . Bangkok Post Public Co. Ltd. . en.
  33. News: 21 August 2024 . Thailand says mpox case recorded in traveller from Africa . limited . 21 August 2024 . Reuters.
  34. News: Thepgumpanat . Panarat . 22 August 2024 . Thailand confirms mpox case is clade 1b, second outside of Africa . Reuters.
  35. News: Ali . Mushtaq . Greenfield . Charlotte . 16 August 2024 . Mpox virus detected in Pakistan, health authorities say . 16 August 2024 . Reuters.
  36. News: 16 August 2024 . Pakistan says at least one case of mpox virus detected . live . https://web.archive.org/web/20240818041957/https://www.aljazeera.com/news/2024/8/16/pakistan-says-at-least-one-case-of-mpox-virus-detected . 18 August 2024 . 16 August 2024 . Al Jazeera.
  37. News: Khan . Riaz . 16 August 2024 . Pakistan's health ministry confirms a case of mpox but more tests are being done for its variant . 16 August 2024 . . 18 August 2024 . https://web.archive.org/web/20240818042007/https://apnews.com/article/pakistan-confirms-first-case-of-mpox-59f52c1b01d1632b3de5557d7bf0a93c . live .
  38. News: Mehra . Pallavi . 17 August 2024 . Pakistan Reports Three Mpox Cases . live . https://web.archive.org/web/20240818080259/https://www.timesnownews.com/health/pakistan-reports-three-mpox-cases-check-symptoms-and-preventive-measures-of-the-viral-infection-article-112590212 . 18 August 2024 . 17 August 2024 . Times Now.
  39. Web site: Junaidi . Ikram . 19 August 2024 . Another suspected mpox case sent to Pims; new strain not detected . 20 August 2024 . . . 21 August 2024 . https://web.archive.org/web/20240821161411/https://www.dawn.com/news/1853300 . live .
  40. Web site: 16 August 2024 . Mpox: Nenhum dos casos reportados em Portugal é da variante mais perigosa, mas a DGS pede vigilância e vacinação . 21 August 2024 . . pt . . 21 August 2024 . https://web.archive.org/web/20240821161416/https://expresso.pt/sociedade/saude/2024-08-16-mpox-nenhum-dos-casos-reportados-em-portugal-e-da-variante-mais-perigosa-mas-a-dgs-pede-vigilancia-e-vacinacao-3c8f2382 . live .
  41. Web site: 16 August 2024 . Mpox. Detetados três novos casos da variante antiga em Portugal entre maio de julho . 21 August 2024 . . pt . 16 August 2024 . https://web.archive.org/web/20240816172819/https://www.rtp.pt/noticias/pais/mpox-detetados-tres-novos-casos-da-variante-antiga-em-portugal-entre-maio-de-julho_n1593280 . live .
  42. Web site: 31 July 2024 . Mpox em Portugal e no Mundo - Informação a 31 de julho de 2024 . 21 August 2024 . . 1 . pt . 22 August 2024 . https://web.archive.org/web/20240822083344/https://www.dgs.pt/ficheiros-de-upload-2013/mpox-em-portugal-e-no-mundo-informacao-mensal-julho-2024-pdf.aspx . live .
  43. Web site: 2024-08-15 . Mpox: Kasus mpox di Indonesia mencapai 14 kasus sepanjang 2024 - Apa gejala dan bagaimana penyebarannya? . 2024-08-22 . BBC News Indonesia . id . 17 August 2024 . https://web.archive.org/web/20240817163526/https://www.bbc.com/indonesia/articles/c4gvemegvr5o . live .
  44. Web site: 2024-08-18 . 88 Kasus Konfirmasi Mpox di Indonesia, Seksual Sesama Jenis Jadi Salah Satu Penyebab . 2024-08-22 . Sehat Negeriku . Kementrian Kesehatan . id-ID . 22 August 2024 . https://web.archive.org/web/20240822025615/https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20240818/1546252/88-kasus-konfirmasi-mpox-di-indonesia-seksual-sesama-jenis-jadi-salah-satu-penyebab/ . live .
  45. Kemenkes Catat 88 Kasus Mpox di Indonesia, Ini Sebarannya . 21 August 2024 . Ramadhan . Muhammad Syahrul . id . 2024-08-22 . www.metrotvnews.com . 22 August 2024 . https://web.archive.org/web/20240822083350/https://www.metrotvnews.com/read/kBVCaPZp-kemenkes-catat-88-kasus-mpox-di-indonesia-ini-sebarannya . live .
  46. News: Valmonte . Kaycee . 19 August 2024 . Philippines detects new mpox case after WHO public health emergency declaration . 19 August 2024 . . 22 August 2024 . https://web.archive.org/web/20240822083415/https://www.rappler.com/philippines/mpox-case-doh-report-august-19-2024/ . live .
  47. News: Philippines says recent mpox case is mild Clade 2 variant . 21 August 2024 . Reuters . 21 August 2024.
  48. News: Sampson . Eve . 14 August 2024 . What to Know About Mpox . live . https://web.archive.org/web/20240816004330/https://www.nytimes.com/2024/08/14/world/africa/mpox-outbreak-symptoms-risks.html?searchResultPosition=1 . 16 August 2024 . 14 August 2024 . . limited.
  49. News: Lay . Kat . 15 August 2024 . What is mpox and why has it been declared a global health emergency? . 16 August 2024 . . en-GB . 18 August 2024 . https://web.archive.org/web/20240818042009/https://www.theguardian.com/world/article/2024/aug/16/what-do-we-know-mpox-outbreak-africa . live .
  50. News: 16 August 2024 . Cosa sappiamo della nuova variante di mpox . 16 August 2024 . . it . 18 August 2024 . https://web.archive.org/web/20240818042004/https://www.ilpost.it/2024/08/16/mpox-variante-1b/ . live .
  51. News: Cheng . Maria . Christina . Malkia . 2 May 2024 . A new form of mpox that may spread more easily found in Congo's biggest outbreak . 14 August 2024 . . en . 14 August 2024 . https://web.archive.org/web/20240814015432/https://apnews.com/article/mpox-congo-outbreak-who-fda17cea128f46e48110ad7adcd9e5de . live .
  52. News: Emmanuel . Gabrielle . 2 April 2024 . Major mpox outbreak in the Democratic Republic of Congo is a worry to disease docs . live . https://web.archive.org/web/20240814003621/https://www.npr.org/sections/goatsandsoda/2024/03/27/1239276957/mpox-outbreak-democratic-republic-of-congo-deadlier-strain . 14 August 2024 . 14 August 2024 . NPR.
  53. News: Congo authorities approve mpox vaccines to try to contain outbreak . 27 June 2024 . Rigby . Jennifer . . 14 August 2024.
  54. News: Johnston . Ian . Peel . Michael . 15 August 2024 . Vaccine bottlenecks pose risk to mpox response as Sweden reports variant case . 16 August 2024 . . https://archive.today/20180224162530/https://ksiegarnia.pwn.pl/Obronca-skarbow,702610324,p.html . 24 February 2018 . live . subscription .
  55. News: Gilchrist . Karen . 16 August 2024 . Mpox vaccine maker Bavarian Nordic seeks 'critical' EU approval for teens after WHO declares health emergency . 16 August 2024 . CNBC.
  56. Web site: Roberts . Michelle . 20 August 2024 . Mpox not new Covid and can be stopped, expert says . 21 August 2024 . . en-GB . 20 August 2024 . https://web.archive.org/web/20240820151127/https://www.bbc.com/news/articles/cvg34y37jqgo . live .
  57. 14 August 2024 . United States Government's Response to the Clade I Mpox Outbreak in the Democratic Republic of the Congo and Other Countries in the Region . 16 August 2024 . . 18 August 2024 . https://web.archive.org/web/20240818042526/https://www.hhs.gov/about/news/2024/08/14/united-states-governments-response-clade-i-mpox-outbreak-democratic-republic-congo-other-countries-region.html . live .
  58. News: Collins . Helen . 16 August 2024 . Bavarian Nordic asks EU to extend mpox shot license to adolescents . 16 August 2024 . . 18 August 2024 . https://web.archive.org/web/20240818042527/https://www.politico.eu/article/bavarian-nordic-eu-extend-mpox-shot-imvanex-license-adolescents/ . live .
  59. News: Sambado . Cristina . 16 August 2024 . Mpox. Fabricante dinamarquês da vacina quer aprovação para adolescentes . 16 August 2024 . . pt-PT . 18 August 2024 . https://web.archive.org/web/20240818042529/https://www.rtp.pt/noticias/mundo/mpox-fabricante-dinamarques-da-vacina-quer-aprovacao-para-adolescentes_n1593286 . live .
  60. Web site: 9 August 2024 . A Phase 2 Randomized Multisite Trial to Inform Public Health Strategies Involving the Use of MVA-BN Vaccine for Mpox . 16 August 2024 . . . 18 August 2024 . https://web.archive.org/web/20240818042607/https://www.clinicaltrials.gov/study/NCT05740982 . live .
  61. News: Mai . Jun . Ziwen . Zhao . 16 August 2024 . China to screen arrivals showing mpox symptoms as cases spread outside Africa . 16 August 2024 . South China Morning Post.
  62. News: Haider . Kamran . 17 August 2024 . Pakistan Begins Screening All Travelers for Mpox Virus . registration . 18 August 2024 . .
  63. Web site: 17 August 2024 . Africa CDC and Bavarian Nordic Partner to Boost Mpox Vaccine Production in Africa . 21 August 2024 . . 21 August 2024 . https://web.archive.org/web/20240821160221/https://africacdc.org/news-item/africa-cdc-and-bavarian-nordic-partner-to-boost-mpox-vaccine-production-in-africa/ . live .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "2023–2024 mpox epidemic".

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