Liberia Sees Rise Amid Declines
UK Detects Novel Mpox Variant
Geneva: Health officials are closely monitoring an emerging mpox outbreak in Mali, where 10 confirmed cases have surfaced since November, at least five of which trace back to introductions from neighbouring Guinea, raising alarms about the potential for cross-border spread and the establishment of sustained transmission in a country previously unaffected by this strain. Epidemiological probes indicate these infections represent separate importations linked to travel or exposure, with cases continuing to appear over the past four weeks, underscoring the urgency for enhanced vigilance, rapid detection, and regional collaboration to contain the virus before it takes hold more firmly.
Compounding concerns in West Africa, Liberia has seen a recent uptick in mpox reports, bucking the broader regional trend, with 176 confirmed cases and two deaths in the six weeks through mid-December, even as neighbouring nations report declines. This rise in Liberia, amid a continental case fatality rate of 0.5 per cent, highlights persistent challenges in interrupting human-to-human transmission, particularly in areas with active circulation of the monkeypox virus.
In a separate development that has drawn international attention, the United Kingdom reported a travel-linked mpox infection involving a novel recombinant strain blending genetic elements from clades Ib and IIb, detected in an individual who likely acquired it during a recent trip to Asia. The patient experienced mild symptoms typical of the disease, but experts note that recombination can occur in co-infections with related viruses, especially within interconnected networks where multiple strains circulate. While the extent of this recombinant’s spread remains unknown, along with its implications for transmissibility or treatment efficacy, the case serves as a reminder of the virus’s evolving nature.
Adding to the global picture, Romania has retrospectively confirmed its first case of clade Ib mpox, stemming from an adult male traveller diagnosed in August after probable high-risk exposure in China and subsequent hospitalisation upon arrival home. No secondary infections were identified, thanks to prompt isolation, but the notification marks Romania as the latest addition to the list of countries detecting this variant outside Africa.
These pockets of concern emerge against a backdrop of encouraging overall progress in curbing the multi-country mpox outbreak, as detailed in the World Health Organization (WHO)’s latest situation report. Globally, from January through November, 50,751 confirmed cases across 96 countries have resulted in 206 deaths, but November saw just 2,150 new infections and five fatalities, reflecting a case fatality ratio of 0.2 per cent. The African Region, which accounted for 68 per cent of November’s cases, continues its downward trajectory following a peak in May, with weekly confirmed reports dipping below 500 for the past seven weeks. Across the continent, 28 countries have logged 43,522 cases and 197 deaths since January, but active transmission in 19 nations over the recent six-week period yielded 1,435 cases and seven deaths, with declines evident in hotspots like the Democratic Republic of the Congo, Guinea, Kenya, and Ghana.
In the Democratic Republic of the Congo, the epicentre of the outbreak, transmission persists across provinces with co-circulating clades Ia and Ib, though suspected cases have eased from peaks of 3,000 weekly in mid-2024 to over 1,000 recently, amid heterogeneous subnational trends. Confirmatory testing has dropped below 20 per cent since October, complicating assessments, but test positivity has fallen to around 25 per cent, suggesting reduced circulation despite limited visibility in some areas. Provinces such as Sankuru, South Kivu, and Tshuapa report the highest burdens, with Sankuru benefiting from intensified surveillance, while insecurity hampers efforts in South Kivu. Geographically, cases span multiple health zones, with hotspots in central and eastern regions, though the number of affected zones has decreased.
Outside Africa, community transmission of clade Ib continues in Spain and the Netherlands, with Spain tallying 14 non-travel-related cases and the Netherlands 10, but no new countries have reported such local spread. Four WHO regions noted case declines in November compared to October, though Europe saw a 120 per cent increase to 380 cases, and the Western Pacific a modest rise to 112.
Sierra Leone, meanwhile, has declared its outbreak over after six weeks without new confirmations, offering a positive note amid the declines in Burundi and Uganda. The WHO assesses the public health risk as moderate for high-risk groups like men who have sex with men with multiple partners, sex workers, and others similarly exposed, but low for the general population, urging sustained surveillance, genomic sequencing in areas with multiple strains, and adherence to recommendations extended through August 2026.
Response efforts, aligned with the organisation’s strategic framework, include coordination with the Africa CDC, expert deployments via the Global Outbreak Alert and Response Network to bolster epidemiology and community engagement in affected areas, and a recent symposium in Kinshasa gathering researchers on mpox advancements. Vaccine deliveries under the Access and Allocation Mechanism have reached 16 countries, including recent shipments of 20,000 MVA-BN doses each to Kenya and Liberia, with guidance promoting dose-sparing to maximise limited supplies. Diagnostic tools continue to expand, with a new nucleic acid test receiving emergency use listing earlier this month.
Community assessments in the Democratic Republic of the Congo and Liberia are informing tailored interventions, while clinical data platforms aid in characterising the disease. Officials caution that data variations due to detection and reporting differences may lead to adjustments, emphasising the need for ongoing caution to prevent resurgence.
– global bihari bureau
