2024-08-11-世界卫生组织-Multi-country_outbreak_of_mpox,_External_situation_report_35-_12_August_2024_18页_503kb

Summary of the Multi-country Outbreak of Mpox (August 2024)

Core Content

The document presents an updated report on the global multi-country outbreak of mpox (monkeypox) as of 30 June 2024, highlighting the geographic expansion and epidemiological trends. It outlines the current status, key findings, and WHO's response strategies.

Key Statistics

• Total laboratory-confirmed cases (1 Jan 2022 – 30 Jun 2024): 99,176
• Total deaths: 208
• Countries reporting cases: 116
• New cases in June 2024: 934
• Countries with the highest case counts:
  • United States of America (33,191)
  • Brazil (11,212)
  • Spain (8,084)
  • France (4,272)
  • Colombia (4,249)
  • Mexico (4,124)
  • United Kingdom (3,952)
  • Peru (3,875)
  • Germany (3,857)
  • Democratic Republic of the Congo (2,999)

Regional Trends

• African Region:

  • 61% of new cases in June 2024
  • Most affected with 567 cases
  • Cases linked to clade Ib and Ia
  • Mainly affects adults through sexual contact in Eastern DRC and neighboring countries
  • Children are more affected in endemic areas (clade Ia)
  • Limited testing in rural areas leads to underreporting

• Region of the Americas:

  • 19% of new cases in June 2024
  • 175 cases
  • 43% of cases in the Region of the Americas are linked to clade IIb
  • Cases predominantly among men who have sex with men

• European Region:

  • 11% of new cases in June 2024
  • 100 cases
  • 43.6% of cases in the last six months are linked to clade IIb
  • Cases mainly among men who have sex with men

• Western Pacific Region:

  • 81 cases in June 2024
  • 32% decline in cases compared to May 2024

• South-East Asia Region:

  • 11 cases in June 2024
  • 50% decline in cases compared to May 2024

• Eastern Mediterranean Region:

  • No cases reported in June 2024

Geographic Expansion in the African Region

• New countries reporting mpox cases (as of August 2024): Burundi, Kenya, Rwanda, and Uganda
• Clade identified in new cases: Clade Ib
• Côte d'Ivoire: Re-emerged with clade II cases
• South Africa: Reported two new confirmed cases, one linked to international travel

Epidemiological Findings

• Gender and age distribution:

  • 96.4% of confirmed cases are male
  • Median age is 34 years (IQR: 29–41)
  • 79.4% of reported cases in non-African regions are among males aged 18–44
  • 1.3% of cases are aged 0–17 years, with 0.4% aged 0–4 years
  • Children under 15 are most affected in DRC and other endemic areas

• Transmission modes:

  • Sexual contact is the most common mode (83.8%)
  • Non-sexual person-to-person contact is also significant
  • In some areas, zoonotic transmission is possible
  • In DRC, some cases present only with genital lesions, which is less typical for clade I

• Symptoms:

  • Rash is the most common symptom (88.5%)
  • Fever (57.9%), systemic rash (54.8%), and genital rash (49.5%) are also frequent
  • Mucosal (including genital) lesions are a consistent feature

• HIV status:

  • 51.9% of cases with HIV status data are in persons living with HIV
  • Sexual exposure is a shared risk factor between mpox and HIV

Underreporting and Reporting Trends

• Declining reporting to WHO may lead to underestimation of actual case numbers
• In June 2024, 24% of clinically compatible cases in DRC were tested, with 65% positivity
• 62% of reporting countries showed an increase in cases compared to May 2024
• DRC had the highest relative increase in cases (n = 543 vs 459)

WHO Response and Actions

• Global Risk Assessment:

  • DRC and neighboring countries: HIGH risk
  • Endemic areas in DRC: HIGH risk
  • Nigeria and West, Central, and East Africa: MODERATE risk
  • Countries with clade IIb outbreaks: MODERATE risk

• WHO Actions:

  • Upgraded the global mpox event to an acute grade 3 emergency
  • Extended standing recommendations for mpox for another year
  • Triggered the process for Emergency Use Listing of mpox vaccines
  • Released funds from the CFE to support the African Region
  • Convened an Emergency Committee under IHR to assess if the situation constitutes a Public Health Emergency of International Concern (PHEIC)

• Call to Action:

  • Strengthen surveillance and response
  • Ensure early outbreak detection and control
  • Improve access to diagnostics, clinical care, and vaccines
  • Promote stigma-free risk communication and community engagement
  • Integrate mpox response with ongoing HIV/AIDS and immunization programs

Key Resources and Guidelines

• Strategic Framework (2024–2027): Available at WHO
• Standing Recommendations (2023): Available at WHO
• Interim Technical Guidance:
  • Immunization: WHO
  • Clinical Management: WHO
  • Surveillance: WHO
  • Data Management: WHO Go.Data
  • Risk Communication and Community Engagement (RCCE): WHO
• Other Resources:
  • Clinical Data Platform: WHO
  • Technical Guidelines for Africa: WHO
  • Ethical Considerations: WHO
  • Strategic Preparedness and Response Plan (SPRP): WHO
  • Emergency Appeal: WHO

Conclusion

The mpox outbreak continues to spread globally, with the African Region being the most affected. While case numbers are stable or declining in some regions, the DRC and neighboring countries face high risk due to sexual transmission and limited testing. Underreporting remains a challenge, and WHO is actively working to enhance global response, including vaccine access, diagnostics, and community engagement. The organization is also evaluating the situation for potential designation as a Public Health Emergency of International Concern (PHEIC).