The IHR Emergency Committee's initial report on the outbreak of pox in 2024 has been sent to the Director-General.
The temporary recommendations that the Director-General issued about the PHEIC associated with the ongoing upsurge of mpox are presented in the final section of this statement and reflect the advice that the Committee provided, noting that the Director-General will communicate to States Parties a 12-month extension of the current standing recommendations for mpox.
The Director-General wants to thank the Chair, Vice-Chair, Members, and Advisors of the IHR Emergency Committee as well as the Chair and Vice-Chair.
Proceedings of the meeting
On Wednesday, August 14, 2024, from 12:00 to 17:00 CEST, sixteen (16) members of the Emergency Committee and two advisors were brought together via Zoom teleconference. The meeting was attended by fifteen (15) of the 16 Committee Members in addition to the two Advisors to the Committee.
In-person, the World Health Organization's (WHO) Director-General welcomed the attendees. The Director-General's opening remarks can be found here.
The Emergency Committee's mandate was outlined by the relevant IHR articles, and the Representative of the Office of Legal Counsel briefed the Members and Advisors on their roles and responsibilities. The Members and Advisors were provided with an overview of the WHO Declaration of Interests procedure by the Ethics Officer from the Department of Compliance, Risk Management, and Ethics. Members and Advisors were made aware of their obligation to promptly report any personal, professional, financial, intellectual, or commercial interests that could result in a perceived or actual conflict of interest to WHO. Additionally, they were reminded of their obligation to protect the confidentiality of the Committee's work and meetings. A survey was conducted on each Member and Advisor, and no conflicts of interest were discovered.
By the Emergency Committee's procedures and working practices, the Representative of the Office of Legal Counsel then assisted in the election of Committee officers. By acclamation, Professor Dimie Ogoina was elected Committee Chair, Professor Inger Damon was elected Vice-Chair, and Professor Lucille Helen Blumberg was elected Rapporteur.
The meeting was handed over to the Chair, who then talked about the meeting's goals, which were to tell the Director-General if the incident is a public health emergency of international concern (PHEIC) and, if so, what the possible temporary recommendations might be.
Session open to representatives of States Parties invited to present their views.
The WHO Secretariat provided an overview of the global epidemiological situation of mumps, highlighting that the 1854 confirmed cases of mumps reported by States Parties in the WHO African Region account for 36% (1854/5199) of the cases observed worldwide during the first six months of 2024. Session open to representatives of States Parties invited to present their views. The Democratic Republic of the Congo (DRC) is experiencing an upsurge in cases of pox, with over 15,000 clinically compatible cases and over 500 deaths reported, exceeding the number of cases observed in the DRC in 2023. Of these confirmed cases in the WHO African region in 2024, 95% (1754/1854) were reported in the DRC.
Outbreaks involving two sub-clades of the clade I monkeypox virus (MPXV), clade Ia and clade Ib, are the primary cause of the rise in pox cases in the Democratic Republic of the Congo (DRC). According to studies carried out by WHO in the 1980s, Clade I mumps typically had a mortality rate of approximately 10%, with the majority of deaths occurring in children.
The disease is endemic in the Democratic Republic of the Congo (DRC), primarily affecting children. Data for 2024 indicate an aggregated case fatality rate of 3.6 percent, and the spread is likely sustained by multiple modes of transmission, including person-to-person transmission following zoonotic introduction in a community.
MPXV clade Ib, a brand-new strain of MPXV that originated in the Democratic Republic of the Congo (DRC), has been spreading throughout the country's eastern regions through what appears to be sexual contact between individuals. Even though it was first described in 2024, estimates indicate that it emerged in September 2023. The clade Ib outbreak in the Democratic Republic of the Congo mostly affects adults and is spreading quickly. It is mostly spread through sexual contact and is exacerbated in networks associated with commercial sex and sex workers.
Cases of pox caused by MPXV clade Ib, which have been epidemiologically and phylogenetically linked to the outbreak in the eastern provinces of the Democratic Republic of the Congo (DRC) since July 2024, have been discovered in four neighboring nations that had not previously reported cases of pox: Uganda, Burundi, Kenya, and Rwanda.
In addition, cases of pox that are associated with MPXV clade Ia were reported in the Central African Republic and the Republic of Congo in 2024, while cases that are associated with MPXV clade II were reported in Cameroon, Côte d'Ivoire, Liberia, Nigeria, and South Africa.
Historically, the clinical presentation of mpox associated with MPXV clade Ia has been characterized by a disease that is more severe than that of MPXV clade II. From July 2022 to May 2023, a multi-nation outbreak that was a PHEIC spread Clade IIb viruses. There is currently insufficient data to fully characterize the severity of pox due to clade Ib, and few deaths have been recorded, preventing age-stratified analyses.
The secretariat warned against overinterpreting the available data to calculate crude CFRs by various clades or outbreaks because of the difficulties in comprehending the true extent of infection, epidemiologic trends, and morbidity and mortality.
The WHO Secretariat classified the assessed risk into geographic regions based on the assessment of affected population groups, predominant transmission modes, and MPXV clades involved: high" for the eastern DRC and its neighbors; high" for DRC regions where pox is known to be widespread; moderate" for Nigeria and the endemic countries of West, Central, and East Africa; and "moderate" for other African and international nations.
In addition, the WHO Secretariat gave an overview of the actions that have already been taken to support readiness and response interventions in States Parties that have seen an increase in cases of mumps and are at such risk. These include, among others: the release of 1.45 million dollars from the WHO Emergency Contingency Fund; kicking off the process of adding two mumps vaccines to the Emergency Use List; cooperating with partners and stakeholders, including making vaccines, treatments, and diagnostics more accessible to all; the creation of a regional response strategy with an initial price tag of $15 million and higher.
The Committee was briefed on the epidemiological situation in Burundi, the Democratic Republic of the Congo, Kenya, Rwanda, South Africa, and Uganda, as well as on the current response efforts, requirements, and difficulties. Although most countries only reported a few cases of pox caused by MPXV clade Ib, Burundi has reported 100 confirmed cases of pox caused by clade Ib since July 2024. These cases were found in multiple districts, and 28% of them involved children under the age of five.
