Togo's health ministry declared an mpox outbreak late last week, with three confirmed cases reported so far, raising concerns about further disease spread in West Africa where illness activity is surging in Sierra Leone, the region's latest hot spot, health officials from the Africa Centres for Disease Control and Prevention (Africa CDC) said yesterday at a weekly briefing.
Yap Boum, PhD, MPH, deputy incident manager for Africa CDC mpox response, said Africa's mpox activity reflects a mixed picture, with promising signs in some of the earlier affected countries and with different regions of the continent experiencing different clades and transmission patterns.
Source of virus unclear in Togo
Confirmation of cases in Togo pushes the number affected African countries to 25, with active transmission under way in 16.
Boum said none of Togo's patients had a travel history to other outbreak countries, but one had recently been in Benin, which hasn't reported any confirmed cases.
Sequencing has revealed the clade 2 virus, which is fueling Sierra Leone's surge. So far 55 contacts have been identified in the Togolese patients. Africa CDC officials are working with their counterparts in Togo, and a mission is being planned to support the country.
Boum also said neighboring Ghana, where the virus was under control after 8 weeks with no cases, has reported four new cases. Clade 2 has also been detected in Ghana.
Rapid growth continues in Sierra Leone
Health officials are deeply concerns about the continued mpox surge in Sierra Leone, where cases have been detected in all 16 districts. Cases are concentrated in urban areas, including Freetown, the country's capital.
Last week, 658 cases were confirmed, up from 526 the previous week. Cases in Sierra Leone accounted for 61% of all infections in Africa last week.
The pace of infections has overwhelmed the country's capacity to treat and isolate mpox patients, and Boum said that, in some instances, healthcare providers have had to place two mpox patients in the same bed. Earlier sequencing showed that the global clade 2b virus is fueling the country's surge. In-country sequencing has identified 22 clade 2b A.2.2 sublineage viruses.
Kyeng Mercy, PhD, epidemic intelligence unit lead at Africa CDC, said that, unlike the earlier hot spots in Africa, where officials saw virus spread in both adults and children, transmission in Sierra Leone seems to be focused among young adults.
She added that health officials are still sorting out transmission patterns with help from genetic sequencing. Sex workers don't seem to play a prominent role in mpox spread in Sierra Leone, and several of the cases have involved students and drivers.
Other Africa hot spots
Boum said health officials are closely tracking gradual case rises in Kenya, Zambia, and Nigeria.
Meanwhile, in the earlier hot spots, cases continue to decline in the Democratic Republic of the Congo, where the conflict situation has stabilized in North Kivu and South Kivu provinces, allowing mpox vaccination to resume and epidemiologists to be redeployed.
Elsewhere, cases in Burundi showed a downward trend, but mpox illnesses in Uganda tracked upward for the second week in a row. Officials, though, are seeing some positive effects from targeted vaccination in high-risk groups.
