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Mpox is endemic in western and central Africa, with the overwhelming majority of cases occurring in the Democratic Republic of the Congo (DRC),  where the more virulent clade Ib has seen a rapid rise in infections since September 2023.Many cases occur sporadically.

The world’s first case of human mpox was detected in a nine-month old child in 1970 in the Democratic Republic of the Congo (then Zaire), two years after it reported its last case of smallpox. The onset of their rash was on 24 August. That year, the disease was identified in another four children, including three in Liberia who were playmates. At the time, evidence of the virus was found in non-human primates in Liberia and Sierre Leone.

Active surveillance by the World Health Organization (WHO) between 1981 and 1986, identified 338 cases with a human-to-human transmission rate of 28%. Until 1986, 95% of cases worldwide were identified in the DRC. During 2023, a clade I outbreak of mpox disease in the Democratic Republic of the Congo resulted in 14,626 suspected cases being reported, with 654 associated deaths, making for a case-fatality rate of 4.5%. The outbreak continued into 2024, with 3,576 suspected mpox cases and 265 deaths reported in the Democratic Republic of the Congo through the first nine weeks of the year, making for an estimated CFR of 7.4%.

Transmission of the virus in the outbreak appears to be primarily through sexual and close familial contact, with cases occurring in areas without a history of mpox, such as South Kivu and Kinshasa. An estimated 64% of the cases and 85% of fatalities have occurred in children. The outbreak consists of two separate sub-variants of clade I, with one of the sub-variants having a novel mutation, making detection with standard assays unreliable. 

The outbreak spread to the neighbouring country of the Republic of the Congo, with 43 cases reported in March 2024. By early August the outbreak spread further into central and southern Africa with cases of clade I and clade II strains reported in Burundi, Rwanda, Uganda, Kenya, Cote d’Ivoire and South Africa.The WHO declared this a Global Health Emergency on 14 August 2024. The following day, Sweden became the first non-African country to report a case of clade I mpox. 

On 19 August 2024, the DRC’s Ministry of Public Health, Samuel-Roger Kamba Mulamba [fr], 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.

Kamba also said 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.