African heads of state from countries affected by mpox will meet virtually on Sunday to address the “worrying” increase of the virus – with 2,912 new cases and 14 deaths recorded in the past week, the Africa Centres for Disease Control and Prevention reported at a media briefing on Thursday.

“Mpox is not under control in Africa. We still have this increase of cases that is becoming worrying for all of us. In many countries, we have different clades [so] the mpox outbreak is a combination of many outbreaks in one,” Africa CDC Director-General Dr Jean Kaseya told the media briefing.

Clade 1A and Clade 1B are both circulating in Kinshasa, the capital of the Democratic Republic of Congo (DRC) which is worst affected by mpox. 

However, because the continent’s surveillance, testing and laboratory systems are not strong enough, “we cannot confirm that we don’t have this kind of joint circulation of clades” across the continent, Kaseya admitted.

Of the 29,152 suspected mpox cases identified since the beginning of the year, only 6,105 have been confirmed by laboratory testing.

In the past week, Morocco in North Africa reported its first mpox cases, which means that mpox now affects all regions of the continent, said Kaseya.

Japan donates three million vaccines

On Wednesday, the government of Japan signed an agreement with the DRC to donate three million KM Biologics’ LC16 vaccines which, unlike Bavarian Nordic’s MVA-BN vaccine, are authorised for children. Around 40% of the continent’s suspected mpox cases are in children.

However, health workers will need special training to vaccinate people with LC16, which requires a similar process to that of smallpox, said Dr Mike Ryan, the World Health Organization’s (WHO) global head of health emergencies.

“The LC 16 vaccine is not delivered by the same method as the MVA vaccine, and that does introduce complexity to the training and logistics,” Ryan confirmed at a WHO global press conference on Thursday.

“The LC16 is given the same way the previous smallpox vaccination was done, which is scraping intradermally on the skin. That’s quite a skilled technique, and that will take time, and that hasn’t been used in vaccination programs for decades now.” 

Rwanda meanwhile started its vaccination campaign earlier in the week, but it has only received 1,000 donated so far vaccines.

The DRC will start its vaccination campaign in the first week of October, while the Africa CDC expects to soon dispatch vaccines to South Africa, Uganda, Burundi “and any other country that will be in need”. 

It is also establishing an expert technical review committee to assist countries to develop “strong vaccination campaign plans”, said Kaseya.

Isolating at home or hospital?

Burundi, despite having 1,600 case, has recorded zero deaths. However, Dr Ngashi Ngongo, Africa CDC Chief of Staff, told the media briefing that all Burundi’s cases were hospitalised and in isolation.

Dr Maria Van Kerkhove, WHO’s interim director for epidemic and pandemic preparedness and prevention, stressed that it is “really important that cases do isolate, but there are options for where they can isolate”.

“If there’s an indication of clinical severity, if they have a risk of developing severe disease, it’s important that they get appropriate clinical care, so isolation in a hospital is helpful,” said Van Kerkhove.

“But we do have guidance for isolation at home. For people who are presenting mildly, and people who aren’t at risk of developing severe disease, home care is completely appropriate,” she added.

“It is really important that the scabs are covered, that we use good hand hygiene, that the close physical contact between caregivers is done appropriately so that we can prevent onward spread,” said Van Kerkhove.

“Also, it is really critical to clean bed linen and clean clothes, etcetera and that’s very difficult in many different contexts.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus told the briefing that the mpox virus “is being spread primarily through close personal contact, including sex and within families, through caring for young children, breastfeeding and sharing clothing or bedding”. 

“The response to the outbreak is made more difficult by the context with insecurity in the affected areas and concurrent outbreaks of other diseases, including measles and chicken pox,” added Tedros.

In comparison to a year ago, there has been a 177% increase in cases and a 38.5% increase in deaths in Africa, and the Africa CDC has committed to developing an open-access dashboard that is regularly updated with information about the spread of the virus.