By Sharon Atieno

Monkeypox cases continue to rise across the African continent as three countries (Ghana, Morocco and South Africa) report cases despite not having a previous history of human transmission.

As of 28 June, the continent has reported 1821 cases in 13 countries of which 109 are laboratory confirmed in nine countries. The number of confirmed cases accounts for 2% of the more than 4500 confirmed cases globally. However, there are a large number of suspected cases in the region, 81% of which are in the Democratic Republic of the Congo, underlining the need for increased diagnostic capacity.

It is in this regard, that the World Health Organization (WHO) is working with national health authorities in the continent to strengthen surveillance and laboratory diagnosis to detect cases and deter a silent spread of the virus.

“The geographic spread of monkeypox to parts of Africa where cases have never been detected before is a worrying sign,” said Dr Matshidiso Moeti, WHO Regional Director for Africa during a press briefing.

“It is critical that we support national efforts to boost surveillance and laboratory diagnosis, which are the cornerstones of disease control.”

While all African countries have the polymerase chain reaction machines needed to test for monkeypox thanks to reinforced laboratory capacity in the wake of COVID-19, many lack reagents and in some cases training in specimen collection, handling and testing.

The WHO is working to secure 60 000 tests for Africa, with around 2000 tests and reagents to be shipped to high-risk countries and 1000 to those facing lower risk.

Over the past month five more African countries have received donations of reagents from partners, bringing to 12 the number of countries in the region with enhanced monkeypox diagnostic capacity. Another group of countries in West Africa will receive reagents after participating in a training.

Outside the six countries in Africa with a history of human transmission, monkeypox has also been reported in three countries which have not previously had any human cases. They have confirmed the disease in two patients with no travel history, suggesting there is a high possibility of local transmission.

Currently seven countries can sequence the monkeypox virus. WHO has reports from South Africa and Nigeria which show that the two countries have sequenced 300 samples since January 2022 – these include samples from other countries. This is more than double all the samples sequenced in previous years. Most samples sequenced were from the West African region. The sequencing done so far shows that there is no recent linkage between what is circulating in Europe and Africa.

Years of research have led to the development of new and safer (second- and third-generation) vaccines for smallpox, some of which may be useful for monkeypox and one of which (MVA-BN) has been approved for prevention of monkeypox. However, supplies are limited.

“What happened in the early days of the COVID-19 vaccine rollout when Africa watched on the side-lines as other countries snapped up limited supplies must not be allowed to recur. There are some signs that this is already happening,” said Dr Moeti. “The current global spotlight on monkeypox should be a catalyst to beat this disease once and for all in Africa. For this, we know vaccines are a critical tool.”

With limited vaccines and antivirals, WHO does not recommend mass vaccination for monkeypox but rather targeted vaccination for people who have been exposed or at high risk including health workers, laboratory personnel and outbreak team responders.

In a recent Emergency Committee meeting convened by WHO Chief, Dr Tedros Adhanom Ghebreysus on the disease, under the International Health Regulations (IHR), to address the rising caseload, the international health body noted that Monkeypox is not a global health concern at the moment.

Monkeypox, a rare viral disease, occurs primarily in tropical rainforest areas of Central and West Africa, though it is occasionally exported to other regions.

Since May, more than 4,000 cases have emerged in 47 countries, many of which have never previously reported the disease. The highest numbers are currently in Europe, and most cases are among men who have sex with men.