More awareness ‘key’ to containing Mpox: experts amid rising cases

Health minister has confirmed two deaths from the disease. Experts have stressed the importance of increased awareness about Mpox as they warned South Africa is likely to see more cases in what appears to be the worst outbreak of the disease to date.

By Khanyisile Ngcobo, Reporter

Mpox, which mostly occurs in West and Central Africa, is a rare viral infection similar to human smallpox, though milder. Experts have called for increased awareness about the disease amid rising cases and two fatalities.

Image: Cynthia S. Goldsmith, Russell Regnery/ CDC/ REUTERS

The health department on Thursday confirmed a second death from the disease, barely 24 hours after the first was announced, and four other cases were confirmed by health minister Joe Phaahla.

The first death was reported at Tembisa Hospital in Gauteng, while the second was a hospital in uMgungundlovu, KwaZulu-Natal. The department said the second patient was HIV positive and had listed Brakpan, Ekurhuleni, as his residential address.

All patients are men aged between 30 and 39 without a travel history to countries experiencing an outbreak, which suggests there is local transmission of Mpox in South Africa.

Phaahla said the department is considering Mpox vaccines for pre- and post-exposure administration for high-risk groups and looking into which population groups should be targeted.

Reacting to the news was renowned bioinformatician Prof Tulio de Oliveira, who said on X it was 'sad that a preventable and treatable disease is spreading and killing people here' and that 'as normal, vaccines have been hoarded by rich countries'.

'This third generation of the vaccine ... is the current and new generation of vaccine that has been licensed by many countries and produced on a larger scale since 2022 during the Mpox outbreak in the northern hemisphere and seems to be efficient, but [the stock] has been concentrated in rich countries that keep the vaccine for themselves,' he told TimesLIVE Premium.

Despite this criticism, De Oliveira praised the department for its fast response to the outbreak.

'That is positive and I found it good that the minister decided to do a briefing highlighting what we knew about Mpox in South Africa and information about the first death. That was appropriate, the early communication and coming from a high-level [person] like the minister.

'That's what we need, for public health officials to act quickly and transparently ... so it's positive to see that happening.'

De Oliveira also spoke about the challenges around early detection of the disease, saying because it was still a 'very rare disease in South Africa' it wouldn't be common to carry out testing for patients seeking medical assistance.

This is likely to change in the coming days and weeks, he said, as 'we become more aware of more cases and deaths'.

'For example, even the second death, which is sad, they only tested for Mpox the day before [death] so there was not awareness because we consider it to be a rare disease in South Africa.

'That's why it is important that as [the department] detected the first case, it became public [because] with awareness it will influence nurses and clinicians to request a test for Mpox when they see someone [with skin lesions]. The important thing is to not only make people aware of the disease but to encourage them to get tested and also have facilities getting access to the [necessary] therapy.'

That's what we need, for public health officials to act quickly and transparently ... so it's positive to see that happening.

Prof Tulio de Oliveira

De Oliveira added that because the variant discovered in South Africa was the same one behind most infections globally and was 'concentrated, at least around the world, on sexual networks of men who have sex with men [MSM]', it made it easier to control its spread.

'For example, in the world we had the big peak of infections in 2022 ... in Europe and the US and within a few months that had been controlled and [this was done] in two main ways. One was behaviour change ... and also what we call ring vaccinations.

'To control Mpox when it is restricted to one risk group is much easier than when it spreads,' he said.

Adding to this was infectious diseases specialist at the University of KwaZulu-Natal Dr Richard Lessells, who also stressed the importance of increased awareness amid rising cases.

'I'm almost certain there are more cases [and] infections happening that we're not detecting. So it's either people are having a mild illness and not presenting to a healthcare facility or maybe they are ... and it's not getting recognised and detected as Mpox.

'So we should expect to see more cases as awareness is raised among medical professionals and the public, particularly the risk groups. One of the key things is raising awareness and educating healthcare professionals to recognise Mpox, given that we haven't seen many cases before now in South Africa and given that people can present to different healthcare specialists.'

Lessells assured citizens about the risk of the disease spreading to the public, saying it was 'very low' given that it was concentrated among 'certain groups in the population', such as MSM.

This, he said, did not negate the importance of improving awareness as it would help prevent stigmatising these groups.

Both experts spoke about access to vaccines, and while De Oliveira criticised rich countries for hoarding stock, Lessells said sourcing the vaccine was 'one strand of the public health approach to an outbreak like this'.

'It's an important part of it, but it's not the only part. It's likely this is not a vaccination strategy where the public would be asked to get vaccinated, but it is likely that it would be highly targeted at those at highest risk of infection and those at high risk of getting severe disease,' he said.

News date: 2024-06-13