African mpox epidemic

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African mpox epidemic
African mpox epidemic.svg
  Countries with 10,000+ cases
  Countries with 1,000–9,999 cases
  Countries with 100–999 cases
  Countries with 1–99 cases
  No confirmed cases
Disease Mpox (clade Ib)
LocationPrimarily Central Africa, limited local transmission in Europe and South Asia
DateSeptember 2023 – present
(PHEIC: 14 August 2024 – present)
Confirmed cases14,654
Deaths
517

An epidemic of a new variant of clade I [1] mpox began in Central Africa at least as early as September 2023. [2] [3] As of August 2024, more than 17,000 cases have been reported, with 517 fatalities, [4] the vast majority of which are in the Democratic Republic of the Congo. [5]

Contents

On 14 August 2024, the World Health Organization declared the epidemic a public health emergency of international concern (PHEIC). [1] [6]

Background

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 of the following year. [7]

Cases started surging again in the Democratic Republic of the Congo in September 2023 and continued into 2024, with the Africa Centres for Disease Control and Prevention (ACDC) reporting a 160% increase in cases from the previous year. [8]

Outbreak

Reported casualties

As of 11 August 2024
Casualties
LocationCases [9] [10] Deaths [9] [10]
Flag of the Democratic Republic of the Congo.svg Democratic Republic of the Congo 14,091 [lower-alpha 1] 511 [lower-alpha 2]
Flag of the Central African Republic.svg Central African Republic 213 [lower-alpha 3] 0
Flag of the Republic of the Congo.svg Republic of the Congo 146 [lower-alpha 4] 1
Flag of Burundi.svg Burundi 830
Flag of Cameroon.svg Cameroon 35 [lower-alpha 5] 2
Flag of Nigeria.svg Nigeria 240
Flag of South Africa.svg South Africa 24 [11] 3
Flag of Kenya.svg Kenya 12 [lower-alpha 6] 0
Flag of Cote d'Ivoire.svg Ivory Coast 70
Flag of Ghana.svg Ghana 40
Flag of Rwanda.svg Rwanda 40
Flag of Pakistan.svg Pakistan 3 [12] 0
Flag of Uganda.svg Uganda 20
Flag of Sweden.svg Sweden 1 [13] 0
Total14,654517
  1. ↑ 1,888 of which have been laboratory confirmed
  2. ↑ 8 of which have been laboratory confirmed
  3. ↑ 28 of which have been laboratory confirmed
  4. ↑ 19 of which have been laboratory confirmed
  5. ↑ 5 of which have been laboratory confirmed
  6. ↑ One of which has been laboratory confirmed

Timeline

Mpox cases from clade Ib infections were growing in the Democratic Republic of the Congo (DRC) by September 2023, [2] [3] with several of them being identified in Kamituga, a mining town in the province of South Kivu. [2] [14] A nationwide outbreak was reported in January 2024. [2] [15]

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. [5] [16] 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. [5] On 14 August, the World Health Organization declared the epidemic a public health emergency of international concern (PHEIC), or global health emergency. [1] [6]

As of 16 August 2024, fifteen countries were reported to have identified cases of mpox; [10] 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. [5] The ACDC reported that 70% of reported cases in the DRC were in children under 15, as that demographic represented 85% of reported deaths. [5] 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. [5]

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, [17] [18] although the agency reiterated that the risk of sustained transmission of the virus strain in Europe was still considered to be minimum. [17]

Countries with widespread transmission

Democratic Republic of the Congo

As of 16 August 2024, a cumulative total of 16,839 suspected cases of mpox (at least 1,888 of which were laboratory confirmed) and 501 deaths (at least 8 of which were laboratory confirmed) have been reported in the Democratic Republic of the Congo (DRC). [9] [10]

Countries with limited local transmission

As of August 2024, fifteen countries have reported cases of mpox; [10] the WHO reported that new cases of the mpox strain, all of which linked to the outbreak in the DRC, [5] had been identified for the first time in four East African nations: Burundi, Kenya, Rwanda and Uganda. [5] [10] Ivory Coast also reported new cases for the first time. [10]

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. [19] 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. [19]

Sweden

On 15 August 2024, Sweden's Public Health Agency reported the first case outside of Africa, which involved a person who had contracted Clade I mpox during a stay in an area of Africa affected by an outbreak of the disease. [13] [20] [21] In a public statement, the agency said that, while the case in itself didn't represent a higher risk to the general population, [13] [21] occasional imported cases "may continue to occur". [13] [22]

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, [3] involving a resident of Mardan who had recently returned from an Arab Gulf state; [23] 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. [23] [24] [25]

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. [12]

Virology

Mpox is caused by the monkeypox virus . The virus is transmitted through close contact with infected animals or people, [26] including in-person communication and other kinds of physical contact, [27] [28] contaminated bedsheets, [27] clothing or needles, [28] sexual contact [26] [27] and consumption of contaminated meat. [27] [28]

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. [2] [29] Epidemiologists reported that the new variant—later named "clade Ib" [27] [28] or "clade 1b" [28] —had the potential to spread with greater ease compared to other mpox strains. [2] 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. [2]

Dr. Placide Mbala-Kingebeni, of Congo'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. [2] The research team determined the detected form to be a Clade I type strain, [2] which historically caused more severe symptoms in comparison to the Clade II type that was predominant during the 2022–2023 mpox outbreak. [2] [28]

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. [30]

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. [31] Jynneos was later approved in Nigeria, also for emergency use. [32] [33]

In August of the same year, 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. [3] 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. [3] 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. [32]

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. [32] [34] 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". [34]

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; [33] [35] the company cited as evidence the early results of a trial—sponsored by the NIH's National Institutes of Allergy and Infectious Diseases (NIAID) [35] [36] —in 315 adolescents included in the aforementioned age range and 211 adults aged 18 to 50 years, [37] which showed that both the immune responses and the safety profile were similar between the two age groups after vaccination with two standard doses. [35] [36] [37] 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. [35]

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. [36] [38]

On 17 August, Pakistan's Coordinator to the Prime Minister on National Health Services, Mukhtar Ahmad Bharath, said that national authorities had started screening travelers at all airports and at border crossings with surrounding countries—including Afghanistan, India, Iran and China—as part of preventive safety measures regarding the outbreak. [39]

Related Research Articles

<span class="mw-page-title-main">Mpox</span> Viral disease of humans and animals

Mpox is an infectious viral disease that can occur in humans and other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most of infected individuals recover within a few weeks without treatment. The time from exposure to the onset of symptoms ranges from five to twenty-one days, and symptoms typically last from two to four weeks. However, cases may be severe, especially in children, pregnant women, or people with suppressed immune systems.

<i>Monkeypox virus</i> Species of double-stranded DNA virus

The monkeypox virus is a species of double-stranded DNA virus that causes mpox disease in humans and other mammals. It is a zoonotic virus belonging to the Orthopoxvirus genus, making it closely related to the variola, cowpox, and vaccinia viruses. MPV is oval, with a lipoprotein outer membrane. The genome is approximately 190 kb. Smallpox and monkeypox viruses are both orthopoxviruses, and the smallpox vaccine is effective against mpox if given within 3–5 years before the disease is contracted. Symptoms of mpox in humans include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The virus is transmissible between animals and humans by direct contact to the lesions or bodily fluids. The virus was given the name monkeypox virus after being isolated from monkeys, but most of the carriers of this virus are smaller mammals.

<span class="mw-page-title-main">Public health emergency of international concern</span> Formal declaration by the World Health Organization

A public health emergency of international concern is a formal declaration by the World Health Organization (WHO) of "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response", formulated when a situation arises that is "serious, sudden, unusual, or unexpected", which "carries implications for public health beyond the affected state's national border" and "may require immediate international action". Under the 2005 International Health Regulations (IHR), states have a legal duty to respond promptly to a PHEIC. The declaration is publicized by an IHR Emergency Committee (EC) of international experts, which was developed following the 2002–2004 SARS outbreak.

<span class="mw-page-title-main">2017 Democratic Republic of the Congo Ebola outbreak</span> Disease outbreak in the Democratic Republic of the Congo

On 11 May 2017, the Democratic Republic of the Congo (DRC) was identified by the World Health Organization (WHO) as having one Ebola-related death.

<span class="mw-page-title-main">2018 Équateur province Ebola outbreak</span> Disease outbreak in the Democratic Republic of the Congo

The 2018 Équateur province Ebola outbreak occurred in the north-west of the Democratic Republic of the Congo (DRC) from May to July 2018. It was contained entirely within Équateur province, and was the first time that vaccination with the rVSV-ZEBOV Ebola vaccine had been attempted in the early stages of an Ebola outbreak, with a total of 3,481 people vaccinated. It was the ninth recorded Ebola outbreak in the DRC.

<span class="mw-page-title-main">Kivu Ebola epidemic</span> Ebola virus outbreak in the eastern DRC from 2018 to 2020

The Kivu Ebola epidemic was an outbreak of Ebola virus disease (EVD) mainly in eastern Democratic Republic of the Congo (DRC), and in other parts of Central Africa, from 2018 to 2020. Between 1 August 2018 and 25 June 2020 it resulted in 3,470 reported cases. The Kivu outbreak also affected Ituri Province, whose first case was confirmed on 13 August 2018. In November 2018, the outbreak became the biggest Ebola outbreak in the DRC's history, and had become the second-largest Ebola outbreak in recorded history worldwide, behind only the 2013–2016 Western Africa epidemic. In June 2019, the virus reached Uganda, having infected a 5-year-old Congolese boy who entered Uganda with his family, but was contained.

<span class="mw-page-title-main">2022–2023 mpox outbreak</span> World public health emergency (May 2022–May 2023)

In May 2022, the World Health Organization (WHO) made an emergency announcement of the existence of a multi-country outbreak of mpox, a viral disease then commonly known as "monkeypox". The initial cluster of cases was found in the United Kingdom, where the first case was detected in London on 6 May 2022 in a patient with a recent travel history from Nigeria where the disease has been endemic. On 16 May, the UK Health Security Agency (UKHSA) confirmed four new cases with no link to travel to a country where mpox is endemic. Subsequently, cases have been reported from many countries and regions. The outbreak marked the first time mpox had spread widely outside Central and West Africa. The disease had been circulating and evolving in human hosts over several years before the outbreak and was caused by the clade IIb variant of the virus.

<span class="mw-page-title-main">2022–2023 mpox outbreak in the United Kingdom</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in the United Kingdom is part of the larger outbreak of human mpox caused by the West African clade (type) of the monkeypox virus. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. As of 22 July 2022, there were 2,208 confirmed cases in the United Kingdom, with 2,115 in England, 54 in Scotland, 24 in Wales, and 15 in Northern Ireland.

<span class="mw-page-title-main">2022–2023 mpox outbreak in the United States</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in the United States is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. The United States was the fourth country outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Boston, Massachusetts, on May 17, 2022. As of August 22, mpox has spread to all 50 states in the United States, as well as Washington, D.C., and Puerto Rico. The United States has the highest number of mpox cases in the world. California has the highest number of mpox cases in the United States.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Canada</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in Canada is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak started in Canada on May 19, 2022, with the country since then becoming one of the most affected in the Americas.

The 2022 – 2023 mpox outbreak in France is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. France had its first case on 20 May 2022.

The 2022–2023 mpox outbreak in Belgium is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Belgium was the fifth country, outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Antwerp, Belgium, on 19 May 2022. As of 10 August, Belgium has 546 cases and 1 suspected case.

The 2022–2023 mpox outbreak in Israel is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Israel on 20 May 2022 when the Health Ministry announced a suspected case which was confirmed on 21 May 2022. One month later, on 21 June, the first locally transmitted case was reported.

The 2022–2023 mpox outbreak in Switzerland is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak started in Switzerland on 19 May 2022, with the country since then becoming one of the most affected in Europe.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Brazil</span> Ongoing outbreak of mpox in Brazil

The 2022–2023 mpox outbreak in Brazil is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Brazil on 9 June 2022 when a man in São Paulo was registered as the country's index case.

<span class="mw-page-title-main">Mpox in the Democratic Republic of the Congo</span>

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.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Asia</span> Ongoing outbreak of mpox in Asia

The 2022 mpox outbreak in Asia is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was reported in Asia on 20 May 2022 when Israel reported a suspected case of mpox, which was confirmed on 21 May. As of 10 August 2022, seven West Asian, three Southeast Asian, three East Asian and one South Asian country, along with Russia, have reported confirmed cases.

The 2022–2023 mpox outbreak in Taiwan is a part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. According to the Centers for Disease Control, Taiwan's first mpox case was reported on 24 June 2022.

The 2022–2023 mpox outbreak in South America is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak reached South America on 27 May 2022 when Argentina reported their first case of mpox. As of 14 August 2022, 8 South American countries and territories have confirmed cases.

This article documents the chronology and epidemiology of the ongoing 2023 mpox epidemic, an outbreak of clade Ib of mpox.

References

  1. 1 2 3 "WHO Director-General declares mpox outbreak a public health emergency of international concern" (Press release). World Health Organization. 14 August 2024. Archived from the original on 14 August 2024. Retrieved 16 August 2024.
  2. 1 2 3 4 5 6 7 8 9 10 Cheng, Maria; Christina, Malkia (2 May 2024). "A new form of mpox that may spread more easily found in Congo's biggest outbreak". Associated Press. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  3. 1 2 3 4 5 Junaidi, Ikram (15 August 2024). "NCOC issues advisory as first suspected mpox case quarantined". Dawn . Reuters. Agence France-Presse. Archived from the original on 16 August 2024. Retrieved 15 August 2024.
  4. ↑ Bariyo, Nicholas (14 August 2024). "Rapid Spread of Mpox in Africa Is Global Health Emergency, WHO Says" . The Wall Street Journal . Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  5. 1 2 3 4 5 6 7 8 Cheng, Maria (14 August 2024). "WHO declares mpox outbreaks in Africa a global health emergency as a new form of the virus spreads". Associated Press. Archived from the original on 16 August 2024. Retrieved 14 August 2024.
  6. 1 2 Mandavilli, Apoorva (14 August 2024). "W.H.O. Declares Global Emergency Over New Mpox Outbreak" . The New York Times . Archived from the original on 15 August 2024. Retrieved 14 August 2024.
  7. ↑ Mandavilli, Apoorva (11 May 2023). "W.H.O. Ends Mpox Global Emergency" . The New York Times . Archived from the original on 15 August 2024. Retrieved 14 August 2024.
  8. ↑ "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" (Press release). Africa Centres for Disease Control and Prevention. 17 August 2024. Retrieved 18 August 2024.
  9. 1 2 3 Africa Centres for Disease Control and Prevention 2024, p. 1.
  10. 1 2 3 4 5 6 7 World Health Organization 2024, p. 2–3.
  11. ↑ "Mpox Updates". National Institute for Communicable Diseases. Archived from the original on 17 August 2024. Retrieved 17 August 2024.
  12. 1 2 Mehra, Pallavi (17 August 2024). "Pakistan Reports Three Mpox Cases". Times Now. Archived from the original on 18 August 2024. Retrieved 17 August 2024.
  13. 1 2 3 4 "One case of mpox clade I reported in Sweden". Public Health Agency of Sweden. 15 August 2024. Archived from the original on 16 August 2024. Retrieved 15 August 2024.
  14. ↑ Newey, Sarah (16 April 2024). "Mutated strain of mpox with 'pandemic potential' found in DRC mining town". The Daily Telegraph . Archived from the original on 15 August 2024. Retrieved 14 August 2024.
  15. ↑ Scott, Dylan (24 January 2024). "A deadly new outbreak is testing Africa's ambitious public health efforts". Vox . Archived from the original on 8 August 2024. Retrieved 14 August 2024.
  16. ↑ "Africa CDC Declares Mpox A Public Health Emergency of Continental Security, Mobilizing Resources Across the Continent" (Press release). Africa Centres for Disease Control and Prevention. 13 August 2024. Archived from the original on 17 August 2024. Retrieved 18 August 2024.
  17. 1 2 "ECDC recommends enhancing preparedness as more imported cases of clade I mpox highly likely" (Press release). European Centre for Disease Prevention and Control. 16 August 2024. Retrieved 18 August 2024.
  18. ↑ Ryan, Benjamin (18 August 2024). "Could the new mpox threat cause significant harm in the U.S.?". NBC News . Retrieved 18 August 2024.
  19. 1 2 Chibelushi, Wedaeli (30 July 2024). "Central African Republic latest to declare mpox outbreak". BBC News. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  20. ↑ Kirby, Paul (15 August 2024). "First case of more contagious mpox found outside Africa". BBC News. Archived from the original on 15 August 2024. Retrieved 15 August 2024.
  21. 1 2 "Första bekräftade fallet av nya mpox-varianten i Sverige" [First confirmed case of the new mpox variant in Sweden] (in Swedish). SVT Nyheter. 15 August 2024. Archived from the original on 15 August 2024. Retrieved 15 August 2024.
  22. ↑ Mandavilli, Apoorva (15 August 2024). "How Did Mpox Become a Global Emergency? What's Next?" . The New York Times . Archived from the original on 15 August 2024. Retrieved 15 August 2024.
  23. 1 2 Ali, Mushtaq; Greenfield, Charlotte (16 August 2024). "Mpox virus detected in Pakistan, health authorities say". Reuters . Retrieved 16 August 2024.
  24. ↑ "Pakistan says at least one case of mpox virus detected". Al Jazeera. 16 August 2024. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  25. ↑ Khan, Riaz (16 August 2024). "Pakistan's health ministry confirms a case of mpox but more tests are being done for its variant". Associated Press. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  26. 1 2 Sampson, Eve (14 August 2024). "What to Know About Mpox" . The New York Times . Archived from the original on 16 August 2024. Retrieved 14 August 2024.
  27. 1 2 3 4 5 Lay, Kat (15 August 2024). "What is mpox and why has it been declared a global health emergency?". The Guardian . Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  28. 1 2 3 4 5 6 "Cosa sappiamo della nuova variante di mpox". Il Post (in Italian). 16 August 2024. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  29. ↑ Murhula Masirika et al. 2024, p. 1.
  30. ↑ Emmanuel, Gabrielle (2 April 2024). "Major mpox outbreak in the Democratic Republic of Congo is a worry to disease docs". NPR. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  31. ↑ Rigby, Jennifer (27 June 2024). "Congo authorities approve mpox vaccines to try to contain outbreak". Reuters . Retrieved 14 August 2024.
  32. 1 2 3 Johnston, Ian; Peel, Michael (15 August 2024). "Vaccine bottlenecks pose risk to mpox response as Sweden reports variant case" . Financial Times . Archived from the original on 15 August 2024. Retrieved 16 August 2024.
  33. 1 2 Gilchrist, Karen (16 August 2024). "Mpox vaccine maker Bavarian Nordic seeks 'critical' EU approval for teens after WHO declares health emergency". CNBC . Retrieved 16 August 2024.
  34. 1 2 "United States Government's Response to the Clade I Mpox Outbreak in the Democratic Republic of the Congo and Other Countries in the Region" (Press release). United States Department of Health and Human Services. 14 August 2024. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  35. 1 2 3 4 Collins, Helen (16 August 2024). "Bavarian Nordic asks EU to extend mpox shot license to adolescents". Politico . Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  36. 1 2 3 Sambado, Cristina (16 August 2024). "Mpox. Fabricante dinamarquês da vacina quer aprovação para adolescentes" (in European Portuguese). RTP. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  37. 1 2 "A Phase 2 Randomized Multisite Trial to Inform Public Health Strategies Involving the Use of MVA-BN Vaccine for Mpox". ClinicalTrials.gov . National Library of Medicine. 9 August 2024. Archived from the original on 18 August 2024. Retrieved 16 August 2024.
  38. ↑ Mai, Jun; Ziwen, Zhao (16 August 2024). "China to screen arrivals showing mpox symptoms as cases spread outside Africa". South China Morning Post . Retrieved 16 August 2024.
  39. ↑ Haider, Kamran (17 August 2024). "Pakistan Begins Screening All Travelers for Mpox Virus" . Bloomberg News . Retrieved 18 August 2024.

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