Regional Mpox Bulletin: 08 December 2024

Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 0/16 08 DECEMBER 2024 Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 1/16 Table 1. 2024 Mpox Cases, Testing Coverage among Suspected Cases and Test Positivity Rate last 12 weeks All Countries except DRC Weeks Suspected before tests Tests Positive Testing coverage TPR Tested negative Suspected after tests WK38 785 764 154 97.3% 20.2% 631 0 WK39 766 754 190 98.4% 25.2% 576 0 WK40 799 794 177 99.4% 22.3% 622 0 WK41 675 673 245 99.7% 36.4% 430 0 WK42 721 718 183 99.6% 25.5% 538 0 WK43 865 863 388 99.8% 45.0% 477 0 WK44 790 786 290 99.5% 36.9% 500 0 WK45 794 791 282 99.6% 35.7% 512 0 WK46 837 833 310 99.5% 37.2% 527 0 WK47 1020 1020 354 100.0% 34.7% 666 54 WK48 693 691 289 99.7% 41.8% 404 0 WK49 444 444 287 100.0% 64.6% 157 0 Cum 2024 15306 15186 4196 99.2% 27.6% 11110 54 DRC Only Table 1b Weeks Suspected before test Tests Positive Testing coverage TPR Tested negative Suspected after tests WK38 2460 1023 303 41.6% 29.6% 720 1437 WK39 2358 963 184 40.8% 19.1% 779 1395 WK40 2466 1074 168 43.6% 15.6% 906 1392 WK41 2179 1087 251 49.9% 23.1% 836 1092 WK42 2250 958 308 42.6% 32.2% 650 1292 WK43 2308 917 213 39.7% 23.2% 704 1391 WK44 2230 791 243 35.5% 30.7% 548 1439 WK45 2536 697 285 27.5% 40.9% 412 1839 WK46 2436 594 268 24.4% 45.1% 326 1842 WK47 2535 665 262 26.2% 39.4% 403 1870 WK48 2549 449 178 17.6% 39.6% 271 2100 WK49 604 203 8 33.6% 3.9% 195 401 Cum 2024 53860 24517 11984 45.5% 48.9% 12533 30266 Period AFRO countries affected AFRO countries with active transmission AFRO Suspected cases AFRO Suspected deaths AFRO confirmed cases AFRO confirmed deaths AFRO negative tests Since 01/01/2024 19 14 39 475 1 255 15 992 60 (CFR:0.4%) 23 603 Change since the last update on 1December 2024 Week 49 No change +1 (Guinea) +9 009 +77 +1 143 +1 +8 889 Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 2/16 Key strategic developments in epidemiology • Cases: In 2024 alone, 19 countries have reported 15 992 laboratory confirmed cases, including 60 deaths. • Most affected countries: The Democratic Republic of the Congo (DRC) accounts for most cases in 2024 with 11,984 cases, followed by Burundi with 2,523 cases, and Uganda with 925 cases. • Curve in DRC: Case numbers in the DRC, which accounts for 74.9% of the laboratory confirmed cases in the region, shows a wave like flow in the curve over the last 6 weeks. • Outbreaks under control: The Republic of Congo, Gabon, Mauritius, Zambia, Zimbabwe and South Africa have reported no new cases in the past 42 days. Epidemiological summary Since January 1, 2022, Mpox cases have been reported to WHO from 21 Member States within the WHO African Region. As of December 1, 2024, a total of 18, 349 laboratory-confirmed cases, including 82 deaths, have been reported. In 2024 alone, as of December 1, 19 countries have reported 15, 992 confirmed cases, including 60 deaths. The majority of cases in 2024 have been reported from three countries: the Democratic Republic of the Congo (11,984 cases), Burundi (2,523 cases), and Uganda (925 cases). In the last 6 week from 08 December 2024, 14 countries have collectively reported 3 400 laboratory confirmed cases with seven deaths (CFR=0.2) trends in the last 6 weeks compared to the 3 208 cases and 15 deaths (CFR=0.5) in the previous 6 weeks). The epidemiological comparison between the WHO AFRO Regional figures (Table 1) and the DRC figures (Table 1b) highlights significant disparities in surveillance and testing performance for Mpox cases across Weeks 38 to 49. WHO AFRO reported a total of 15,306 suspected cases, with 15,186 tests conducted, achieving near-total testing coverage of 99.2% and a test positivity rate (TPR) of 27.6%. This high testing coverage ensured timely identification of cases, leaving only 54 suspected cases unresolved after testing. In contrast, the DRC reported a far higher burden of 53,860 suspected cases but conducted only 24,517 tests, resulting in a much lower testing coverage of 45.5% and a significantly higher TPR of 48.9%. Over 30,000 suspected cases in the DRC remain untested, reflecting critical testing gaps and resource limitations. Weekly trends in WHO AFRO figures showed consistent testing coverage above 97%, with a gradual rise in positive cases and TPR peaking at 64.6% in Week 49, indicating either rising transmission or improved targeting of high-risk cases. Conversely, the DRC figures showed declining testing coverage over time, dropping from 41.6% in Week 38 to 17.6% in Week 48, despite sustained high numbers of suspected cases. The sharp decrease in testing and the corresponding drop in positive cases to 3.9% in Week 49 suggest under detection and significant surveillance challenges. Overall, the WHO AFRO Regional figures reflect a robust and consistent response, while the DRC figures reveal critical gaps in testing capacity and surveillance, which hinder effective control of the Mpox epidemic. Addressing these gaps through enhanced testing coverage, resource mobilization, and improved surveillance strategies is crucial to reducing the burden of Mpox in the DRC. Note: A significant number of suspected cases, that are clinically compatible with mpox are not tested due to limited diagnostic capacity and never get confirmed. For this reason, suspected cases (where no tests were done or with pending laboratory results) are also shown in this section. Care should be taken when interpreting these cases, as they are collected according to different case definitions. In some countries, suspected cases that are negative after laboratory tests are not removed from case counts. Not all countries have robust surveillance systems for mpox, so case counts are likely to be underestimated. Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 3/16 Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 4/16 Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 5/16 Note: cases in the most recent reporting weeks may not yet be reflected in the graph above. Any downward trend should be assessed with caution. Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 6/16 Epidemiological update The Democratic Republic of the Congo: In epidemiological week 49, as of the date of this report (08 December 2024, the date of the last received report), a cumulative total of 11,984 confirmed cases had been documented, resulting in 43 deaths (case fatality rate [CFR] = 0.4%) across the 24 reporting provinces. This figure is derived from a total of 30,266 suspected cases, which include 1,255 deaths (CFR = 4.1%) and 12,533 negative results. During epidemiological week 49, a total of 604 suspected cases were reported prior to testing, reflecting a testing rate of 33.6%. This represents an increase in testing coverage compared to the 2,549 suspected cases reported in epidemiological week 48, which exhibited a testing coverage of 17.6% among suspected cases. Despite the reporting remaining incomplete during the week, a total of 8 confirmed cases with zero deaths (CFR = 0%) were recorded, in contrast to the 11 confirmed cases with 2 deaths (CFR = 0.4%) reported in epidemiological week 48. The average turnaround time from sample collection to laboratory arrival is approximately 9 days, indicative of logistical delays. The country continues to face critical challenges in mpox surveillance and testing, as only ten national laboratories are equipped for mpox diagnostics, all of which operate under significant staffing constraints. This limited capacity, particularly at the provincial level, hinders case detection and delays response efforts, thereby weakening the country’s ability to contain the outbreak. The top seven provinces with the highest number of cases are South Kivu, Tshuapa, Sankuru, North Kivu; South Ubangi, Equateur and Bas Uele Mpox vaccination was launched on October 6, with a focus on frontline workers, sex workers, transgender individuals, men who have sex with men (MSMs), eco-guards/hunters, contacts, and other high-risk populations, as determined by a risk assessment. To date, over 51,600 individuals have been vaccinated across six provinces. Additionally, vaccination efforts have commenced in the Kokolo health zone in Kinshasa, the capital city. Monitoring of vaccination activities in the Limete health zone of the industrial area of Limete (in Pakadjuma) has recorded 145 individuals vaccinated as of week 47. Points of entry surveillance: This week, 2 new suspected cases detected and notified including: 1 case in the Equateur province at PoE LUKOLELA/ZS/LUKOLELA, coming from the Republic of Congo, it was taken and referred to HGR LUKOLELA while the second case in the South Kivu province at PoE Ruzizi II/ZS/Ibanda, a traveller departing for Burundi, it was sampled and referred to the CHU of Bukavu. Cumulatively, a total of 97 suspected cases have been detected at points of entry, of which 35 were confirmed, 10 turned negative, 47 are pending results, and 5 were not sampled. In epidemiological week 48, out of 162,042 passengers passing through points of entry, 161,583 were screened (99.7%), of which 158,647 had washed their hands (98.2%), and158,647 (98.2%) demonstrated awareness of the mpox outbreak. Burundi: On July 25, 2024, the Ministry of Health in Burundi declared an outbreak of mpox, attributed to clade 1b of the virus, following the confirmation of three cases by the National Reference Laboratory of the National Institute of Public Health. The situation escalated rapidly in the subsequent weeks, and the outbreak continues to evolve. As of epidemiological week 49 (ending December 8), 172 new positive cases were reported, resulting in a cumulative total of 2,523 confirmed cases, of which 52.3% are male and 47.7% female. The country reported its first death among the confirmed cases in week 46 (ending November 17, 2024). The age groups most significantly affected include individuals aged 20 to 30 years, who account for 29.1% of total cases, followed by those under 5 years old (22.5%) and those aged 5 to 9 years (13.0%). Children under 15 years of age represent 43.8% of all confirmed cases. Out of a total of 5,250 tests conducted, 2,523 yielded positive results for mpox, resulting in a positivity rate of 48.1%, which is indicative of active community transmission. Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 7/16 A total of 45 (91.8%) out of 49 health districts reported at least one confirmed case of mpox since the onset of the outbreak. Among these 45 health districts, 24 (49%) reported active cases over the past three weeks. Of the total 2,523 cases reported, three districts within Bujumbura City accounted for 1,417 cases (60.7%). The geographic distribution of mpox cases in Burundi revealed significant clustering, with eight health districts accounting for approximately 80% of all reported cases. Bujumbura North was the most affected district, with 913 cases (38.1%), followed by Bujumbura Centre (317, 13.1%), Gitega (277, 11.1%), Bujumbura South (212, 8.8%), Isare (162, 7.2%), and another Isare district (171, 7.1%). The investigation rate for mpox alerts in Burundi is 89.6%, while the validation rate of alerts as suspected cases is estimated at 91.8%. Efforts are underway with health districts to reduce the proportion of uninvestigated alerts, currently estimated at 12.1%. Out of a total of 139 alerts, 64 were investigated, including 51 that were validated and collected. All these alerts are distributed across 37 of the 49 health districts. Uganda: It has been 137 days since the start of the outbreak when the first two mpox cases were reported on 24 July 2024 in Kasese District. As of 8 December, the country has reported a cumulative total of 925 confirmed mpox cases with six deaths (a CFR of 0.7%), spread across 56 districts, primarily driven by clade Ib. During week 49, a total of 58 confirmed cases with two deaths were reported from 22 districts, namely Kampala (83), Wakiso (22), Mbarara (07), Luwero (07), Masaka (03), Mubende (02), Kanungu (02), Kabarole (01), Isingiro (01), Mbale (01), Kagadi (01), Oyam (01), Kakumiro (01), Butambala (01), Arua (01), Hoima (01), Buikwe (01), Namayingo (01), Busia (01), Kabale (01), Lwengo (01), and Maracha (01). More males (56%) are affected compared to females (44%), with the 19-39 age group being the most affected, accounting for 64% of the total cases. To date, 792 cases have been successfully treated and discharged, while 108 remain admitted across the treatment facilities in the country. Most of the cases (64%) are from the Greater Kampala Metropolitan Area. The top 10 districts with the highest number of cases include: Kampala (365), Wakiso (118), Nakasongola (68), Mukono (25), Mayuge (25), Luwero (23), Mbarara City (13), Namayingo (11), Jinja City (11), and Mityana (11). While over 63% of the cases are from the Greater Kampala Metropolitan Area, Nakasongola District has the highest attack rate of 31 per million population. Attack rates for selected (most affected) districts per million population are as follows: Nakasongola (31), Kampala (24), Luwero (6), Mbarara (5), Mayuge (4), Wakiso (4), and Mukono (3). In week 49, the districts of Kabarole, Busia, and Mbale reported mpox cases for the first time. The increasing geographical spread of the disease in the country underscores the need for a more decentralized response focusing on the key drivers in the hotspots, with the active involvement of leaders at all levels. Cumulatively, 56 districts have been affected while 49 remain active. While the initial cases were linked to sex worker networks, with anecdotal reports of sexual activities occurring on the premises, there has recently been a shift toward commercial motorcycle riders, market vendors, timber dealers, and household transmission, with an increasing number of children affected, which poses challenges for contact tracing and follow-up. However, this issue has not been observed in other districts. Additionally, stigma related to sexual transmission is prevalent. In Nakasongola and Mayuge districts, the burden falls on fishing communities and sex worker networks, both of which have historically been key populations in the context of HIV. Sporadic cases are emerging in congregate settings, with at least three primary-level and "day" schools reporting cases. Furthermore, two prisons have reported confirmed cases, both linked to one case transferred between the prison facilities. Death audits of all mpox fatalities are being conducted by the case management team. Nigeria: In 2024, a cumulative total of 152 confirmed cases have been reported from 30 states and the Federal Capital Territory (FCT) out of 1,754 suspected cases from 36 states and the FCT (as of week 48, ending 1 December 2024, the last report received by the WHO). Of the confirmed cases, 43 cases of mpox and VZV co- infection have been reported in 21 states and the FCT. No deaths have been reported. During the week, 7 new cases were reported out of 66 suspected cases (positivity rate = 11%) reported from 19 states and the FCT. The confirmed cases in week 48 were distributed as follows: Imo (@), Benue (1), Kwara (1), Lagos (1), Ondo (1), and Yobe (1), Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 8/16 with no cases of mpox and Varicella zoster virus (VZV) co-infection. Males account for 64% of the total confirmed cases, compared to 36% for females. An analysis of 70 confirmed cases indicated that the most affected occupations, in order, were infants/pupils, businessmen/women, and students. Cumulatively, 521 contacts have been line-listed. Mpox vaccine deployment assessments were conducted in Cross River, Akwa Ibom, Enugu, and Benue. Additionally, five laboratories in Rivers, Cross River, Enugu, Bauchi, and Kano were optimized to enhance testing capacity and reduce turnaround time—one of the major challenges faced by the states. Genomic sequencing for 60 samples from cases confirmed in epidemiological weeks 42 and 43 confirmed all to be clade IIb. Côte d’Ivoire: In epi week 49, four (4) newly confirmed cases were reported from Guiglo (3) and Toumodi (1). As of 1 December 2024, a total of 101 confirmed cases, including one death (CFR = 1%), along with 2 probable cases (epidemiologically linked), out of a cumulative total of 442 suspected cases, have been reported across 34 of the 113 districts, primarily driven by clade IIa. To date, 95 cases have been successfully treated and recovered, while 5 cases are still undergoing treatment across 3 health districts. Currently, a total of 94 contacts are being monitored in 8 health districts out of a cumulative total of 1,205 listed contacts. Cumulatively, 442 suspected cases have been detected and investigated. A case of clade iib was detected in addition to subclade IIa, confirming the co-circulation of clades in the country. Active surveillance continues to ensure early detection and management of any new cases, with particular attention to the hotspot districts of Yamoussoukro, Yopougon, and Bouaké-Beoumi. However, weaknesses in case investigations and contact tracing have been observed, confirming that several contacts are never seen throughout their follow-up period. The Central African Republic: As of epidemiological week 48, a total of 19 suspected cases were tested, resulting in the confirmation of 6 cases, distributed as follows: Mbaïki sanitary district (3 confirmed cases). Currently, 13 cases are admitted to the Mbaïki treatment center. The Mbaïki district is identified as the current epicenter of the epidemic (weeks 43-48), with 21 out of 23 confirmed cases (91%) occurring within the Mbaïki health district. In epidemiological week 47, nine recovered cases were discharged from the Mbaïki treatment center, while 13 confirmed cases remain under treatment. As of December 1, two health districts remain active out of the 15 health districts that have reported at least one case in 2024. Cumulatively, there have been 85 confirmed cases and 3 deaths (case fatality rate = 3.5%), with 81% of cases occurring in individuals under 25 years of age, including 27% of cases in children under 5 years old. The circulating mpox strain in the Central African Republic has been identified as clade Ia. Kenya: As of epidemiological week 49 (with the latest report shared on December 8, 2024), a cumulative total of 28 confirmed cases and one death (case fatality rate = 3.6%) have been reported across 12 counties. Four new cases were documented in epidemiological week 48. In total, 310 samples have been tested, with 23 testing positive, 286 testing negative, and one sample awaiting testing. Among the confirmed cases, 13 individuals have fully recovered, 5 are still receiving treatment, and one has died. A total of 207 contacts have been listed; 147 have completed follow-up, while 7 developed symptoms and tested positive for Mpox. 50 are still under follow-up, and 3 were lost to follow-up. Cumulatively, 323 samples have been tested, of which 28 tested positive, 293 tested negative (marking a test positivity rate of 8.7%), and 2 are still pending testing. Thirty-six (76%) counties have reported suspected cases (thanks to heightened surveillance) although confirmed cases have been reported from 12 counties namely: Taitataveta (1), Busia (1), Nairobi (3), Nakuru (9), Mombasa (6), Makueni (1), Kajiado (2), Bungoma (2) with one death, Kericho (1), Kilifi (1), Uasin Gishu (1) and Kiambu (1). Genomic sequencing of 13 confirmed cases has identified the circulating strain as clade 1b of the mpox virus, with one sample still pending analysis. A cumulative total of 2,207,715 travelers have been screened at the 26 points of entry (PoEs). Genomic sequencing of 13 confirmed cases has identified the circulating strain as a Clade 1b virus. Nakuru (Mai Mahiu), Mombasa (Jomvu and Changamwe sub-counties) are the known hotspots identification and key drivers while the key affected populations include truck drivers and sex workers. Cases are mainly concentrated along Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 9/16 the main A104 (Kampala--Nakuru-Nairobi –Mombasa) corridor among heterosexual networks with a few cases from hhousehold transmission. Rwanda officially declared an mpox outbreak on July 27, 2024. In epi week 48 (ending December 1), 164 suspected cases of Mpox were reported by 70 health facilities. Rwanda has documented a cumulative total of 37 confirmed mpox cases, with no deaths reported. During week 45, a total of 11 confirmed cases were reported. These cases fall within 3 main clusters. The Kigali cluster is primarily linked to sexual transmission. A significant cluster in Kigali reveals interconnected cases, primarily linked to sexual transmission; cases were detected at the points of entry during daily screening for the early detection of Mpox cases. The Kirehe cluster case was identified through a random survey conducted among high-risk groups. Currently, 28 patients are in treatment, 9 have completed follow-up, and 425 contacts are under active monitoring. All patients are stable and responding well to oral medications, with no critical cases reported. Mpox clade Ib transmission in Rwanda has primarily involved a limited number of laboratory-confirmed cases, with active screening and testing prioritized among high-risk populations, including sex workers and truck drivers. Liberia: As of December 8, 2024, the country has reported a cumulative total of 63 laboratory-confirmed cases out of 380 suspected cases. In epidemiological week 49, eleven (11) new cases were confirmed. Cumulatively, 14 out of 15 (93%) counties in Liberia have reported at least one confirmed case, specifically: Nimba (21), Lofa (7), Rivercess (6), Sinoe (5), Bong (6), Montserrado (3), Grand Bassa (4), Grand Kru (1), River Gee (1), Maryland (1), Margibi (1), Bomi (1), and Grand Cape Mount (1). Currently, there are 34 active cases undergoing treatment in isolation facilities, while 213 contacts are under follow-up. A total of 43 cases (70.9%) have been recorded in the last six weeks (epidemiological weeks 44 to 49 of 2024), in contrast to 12 cases (19.4%) reported in the preceding six weeks (epidemiological weeks 38 to 43). Among the confirmed cases, 36 (58%) are male, while 26 (42%) are female. The most affected age group is children under 15 years, followed by individuals aged 30-40 years and 20- 30 years, who account for 39.2%, 29.4%, and 23.5%, respectively. Notably, no deaths have been reported among the confirmed cases, which is an encouraging sign for the country’s response efforts. Both clades IIa and IIb have been detected in Liberia. The mpox outbreak was initially sporadic, with cases primarily reported in the latter half of 2022, alongside minor increases in 2023 and the first half of 2024. Beginning in epidemiological week 41, the outbreak has rapidly evolved, with sustained community transmission reported. Despite the rapidly changing epidemiological landscape, the country currently faces challenges due to a lack of resources to support the response. The World Health Organization (WHO) is presently the sole partner assisting in the response, and the funds from the Contingency Fund for Emergencies (CFE) have been exhausted at the time of the observed increases in cases. Angola reported its first case of mpox on 15 November 2024. The case involves a 27-year-old Congolese national residing in Mabor Commune, 11 de Novembro Urban District, Cazenga Municipality, Luanda Province. On 3 November 2024, she exhibited symptoms, including fever, headache, general malaise, and the presence of multiple papules and vesicles on her face, body, hands, feet, and soles. The diagnosis of mpox was confirmed via PCR on 15 November 2024, and she is currently alive and receiving treatment. The source of her exposure remains unidentified, as she reports no travel history to an endemic region nor contact with a confirmed case in the preceding three weeks. However, her husband, a truck driver who is currently asymptomatic, is reported to have traveled to the Democratic Republic of the Congo (DRC) and had contact with a confirmed case five days prior to the onset of his wife's symptoms. Cumulatively, Angola has reported a total of two confirmed cases, with no fatalities recorded (CFR = 0%). Cameroon – A new confirmed case was reported from Mefou Park, Mfou Health District in the central region in week 48 (27 November). Cumulatively in 2024, the country has reported a total of 10 confirmed cases, including 2 Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 10/16 deaths (CFR=22.2%), spread across 6 regions. The majority of the cases are males, accounting for 88%, with the 20-24 year age group being the most affected. Cumulatively, a total of 120 suspected cases have been reported, of which 107 samples were collected (88.3%), with 10 confirmed out of 22 suspected cases that were reported and tested (100% testing). In addition, 9 cases of VZV have been detected, and there are no coinfections with mpox. Clades Ia and II have been identified as the circulating strains in the country. Laboratory capacity for mpox testing remains limited, and there are challenges in community engagement and risk communication. Ghana - In week 46 (ending 17 November 2024), Ghana reported one new confirmed case of mpox after 10 weeks without new cases, following the last confirmed case on 4 October 2024 (epidemiological week 40, ending 6 October 2024). This new case indicates a potential risk of re-emergence in areas previously under control. In week 49, two (2) additional new cases were reported from Bibiani–Anhwiaso-Bekwai and Ga West (Amasaman) districts. The first case of mpox in 2024 was detected on 1 October 2024, when the National Public Health and Reference Laboratory confirmed the diagnosis in a 15-year-old male from the Western North Region. On 4 October 2024, the mother of the first case also tested positive, suggesting household transmission. Both individuals were successfully treated at a government hospital in the Bia West District and recovered. No deaths have been reported. Cumulatively in 2024, five (5) confirmed cases have been reported out of 428 suspected cases with no deaths. The newly confirmed cases are receiving treatment while the 32 listed contacts are being followed up. Cumulatively, 71 contacts have completed their follow-up period. Confirmed cases have been reported in 4 districts across 2 regions of Western North and Greater Accra. Surveillance efforts have been intensified across the country. The outbreak is currently limited to the Western North Region (specifically Bia West) and Greater Accra, but suspected cases have been reported in 18 districts across 11 regions. Transmission is linked to close contact, and genomic sequencing has confirmed that the circulating strain in Ghana is Clade IIb of the Mpox virus. Ghana previously reported mpox cases in 2022 (120 cases) and 2023 (8 cases). Investigations into the newly confirmed case are ongoing, revealing the geographic spread of the disease to a new district called Krowor. Guinea reported one new confirmed case from Macenta in Nzerekore after 14 weeks in the control phase, which began on 1 September 2024. This is the first confirmed case of mpox from Macenta, identified on 2 September 2024, from a sample collected on 30 August 2024. The case involved a 7-year-old child, with the source of infection still unknown. MPXV clade IIa was identified. Out of 91 identified contacts, 73 were fully followed up, while 18 were not traced. Public health interventions, including active case searches, continue, along with efforts to socially reintegrate the patient into the community without stigma. Investigations into the source of exposure and clade determination for the new case are ongoing. The Republic of Congo reported one new confirmed case in epi week 48 after 12 weeks in the control phase (since 3 November 2024). Since the outbreak was declared on 9 January 2024, the country has recorded a total of 23 confirmed cases with no deaths. Of these, 22 cases have been treated and discharged, while one case is still undergoing treatment. In week 48 (ending 1 December 2024), three suspected cases were reported, one of which tested positive for mpox. A cumulative total of 256 suspected cases have been reported, with 250 (97.7%) samples collected and tested. Additionally, 166 contacts have been successfully monitored. Clade Ia of the mpox virus has been identified as circulating in the Republic of Congo. Confirmed cases have been reported across four departments: Likouala (4), Cuvette (14), Plateaux (2), Brazzaville (1), and Pointe-Noire (1). The district of Mossaka-Loukoléla in Cuvette has been the epicenter, showing a high attack rate of 12.2 per 100,000 inhabitants. Since the beginning of the year, 20 (38.5%) of the 52 health districts have reported no cases. Gabon, currently in the control phase, reported its first confirmed mpox case on 22 August in Libreville. The case involved a 30-year-old male who had recently traveled to Uganda, where he likely contracted the virus. After Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 11/16 returning to Gabon, he developed symptoms, including fever, fatigue, and a generalized skin rash, and sought medical attention on 21 August. As of the last situation report on 6 October 2024, out of 15 suspected cases tested, two were confirmed positive for mpox (the initial case and a known contact). No genomic sequencing for clade determination was performed. Gabon entered the control phase on 1 September 2024 after reporting no new cases in 42 days. The country is advised to enhance and maintain active case surveillance and community-based interventions to prevent missed community transmission South Africa, also in the control phase, has reported a total of 25 mpox cases, including 3 deaths (CFR = 12%). Cases have been identified across three provinces: KwaZulu-Natal (11 cases, 2 deaths), Gauteng (12 cases, 1 death), and Western Cape (2 cases, no deaths). The affected population includes individuals aged 17 to 43, with 48% of cases among men who have sex with men (MSM) and 68% in individuals living with HIV. Genomic sequencing was conducted on 22 of the 25 cases, identifying mpox clade IIb, sub-lineage B.1.20, including one imported case from Peru. The last confirmed case from South Africa was reported on 6 September 2024. As of 18 October, the country has entered the control phase after 42 days without reporting a confirmed case. Zambia, in the control phase, reported its first case of mpox on 10 October 2024. The case involved a 32-year-old male Tanzanian truck driver who presented at Mukando Health Post in Chitambo District on 4 October 2024, with complaints of a body rash starting on the face and spreading, joint pain, sore throat, and general malaise that began on 1 October 2024. A sample collected from the patient confirmed mpox by PCR testing conducted by the Zambia National Public Health Reference Laboratory (ZNPHRL), with sequencing identifying it as clade 1b. A total of 22 contacts were listed for this case, and none developed the disease. Zambia, being a transit route for many countries, must maintain active surveillance at points of entry and resting centers along the transit routes to ensure no potential cases are missed. The last confirmed case in the country was reported on 10 October 2024, epi week 41 (week ending 13 October 2024). As of 21 November, the country entered the control phase, meaning that it had spent 42 days without reporting a confirmed case. Zimbabwe, in the control phase, reported its first 2 mpox cases, one in Harare and another in Mberengwa, on 12 October 2024. The first case involved an 11-year-old male with a history of travel to South Africa in August 2024, returning on 10 September 2024. He developed symptoms on 23 September 2024 and was confirmed on 12 October 2024; however, his sample was insufficient for sequencing. The individual was isolated at home and is no longer infectious, with seven contacts identified and monitored. The second case was a 24-year-old male with a history of travel to Tanzania on 14 September, returning on 21 September 2024. Genomic sequencing conducted by the National Microbiology Reference Laboratory (NMRL) in South Africa confirmed that his sample was a clade 1b mpox strain. He is also isolated at home and is no longer infectious, with contact tracing and monitoring ongoing. However, it is important to note that Tanzania has not reported any cases of mpox. Similarly, South Africa has not reported any active transmission in the last six weeks. The last confirmed case in the country was reported on 12 October 2024, epi week 41 (week ending 13 October 2024). As of 23 November, the country entered the control phase, meaning that it had spent 42 days without reporting a confirmed case. Mauritius - in the control phase as of epi week 49 (ending 8 Dec 2024 - reported its first case on 26 October 2024. The case is a 49-year-old Nigerian. He’s being monitored from the Dr. A.G. Jeetoo Hospital in Port-Louis by a multidisciplinary team of doctors. Skin samples taken from the skin lesions were analysed at the Central Health Laboratory where the PCR test was positive for Mpox. Public health response actions so far include reactivation of mpox operational protocol and contact tracing as well as vaccination of contacts. Investigations are ongoing for clade determination. Interpretation Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 12/16 The Mpox outbreaks in countries across Afro Region, ranging, have shown varied trends in transmission, case numbers, and control efforts throughout 2024. While some countries have made significant progress in managing the outbreaks, others continue to experience challenges in detecting new cases, especially with the movement of populations across borders and the complexities of surveillance in vulnerable communities. Across the region, countries have managed varying levels of Mpox outbreaks in 2024, with significant efforts focused on case identification, contact tracing, and genomic sequencing to determine the strain of the virus. While some countries such as Gabon, Mauritius, Morocco, South Africa*, Zambia, and Zimbabwe have entered or are in the control phase, others like DRC, Burundi, Uganda, Nigeria, Cote d’Ivoire, CAR, Liberia, Rwanda, Kenya, Cameroon, Angola, Ghana, Guinea and Republic of Congo continue to face active cases. The Democratic Republic of the Congo and Gabon have been battling recurrent outbreaks, with genomic sequencing helping to track the specific Clade strains in circulation. Meanwhile, countries like South Africa, Zambia, and Zimbabwe have seen periods of control but remain vigilant due to the risk of re-emergence from imported cases. The first case in Mauritius and the resurgence in Ghana underscore the continued risks of cross- border transmission and the potential for Mpox to spread within regions that are already under pressure from other health concerns. Despite progress in controlling the disease in some countries, it remains crucial to monitor Mpox closely, especially in countries transitioning to or remaining in the control phase. The evidence of new cases, despite the completion of 42 days without new infections, highlights the importance of maintaining strong surveillance and response measures. In countries like Uganda and Burundi, the expanding geographic spread and rise in cases signify high levels of community transmission with considerable risk of further escalation. In contrast, nations such as Côte d'Ivoire and the Central African Republic are experiencing smaller, more contained outbreaks. Although there appears to have been a plateau in reported cases over the past three weeks, it is premature to draw epidemiologically sound conclusions due to potential delays in data reporting. Nevertheless, regionally, cases of mpox are not seen to be increasing at this moment in time. Recent deaths linked to mpox-HIV co-infections in Uganda, Central African Republic, and Kenya emphasize the heightened risks for immunocompromised individuals. Challenges such as limited testing capacity and slow turnaround times persist, with a significant proportion of suspected cases in countries like DRC unconfirmed due to diagnostic limitations. Public health actions Current Situation Overview While the regional Mpox situation has shown a decline in the number of countries reporting active cases, ongoing transmission in key hotspot areas continues to require vigilance. The Democratic Republic of the Congo (DRC) remains the most heavily impacted country, with sustained community transmission. Additionally, expanding outbreaks in Burundi and Uganda, as well as the importation of a case into a new district in Ghana after over 10 weeks without cases, underscore the persistent risk of cross-border spread. These developments, coupled with concurrent outbreaks in several countries, highlight the complex challenges faced by affected regions. In response, the WHO African Region Incident Management Support Team (AFRO-IMST) continues to coordinate logistical, technical, and operational support for affected countries. To enhance response efforts, WHO and partners have launched Intra-Action Reviews (IARs) in eight hotspot countries and the continental IMST. Reviews have commenced in the DRC and Liberia, with additional reviews scheduled for Uganda and Kenya (December 9–11, 2024). Outcomes from country-specific IARs will feed into the physical continental IAR, scheduled to take place from December 16–19, 2024, in Addis Ababa, with participation from AFRO and HQ. Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 13/16 Epidemiology and Health Information Collaborative efforts to enhance Mpox surveillance and response have advanced across the region. Key updates include: • Preparatory meetings held to review the terms of reference for a unified Mpox database involving WHO, Africa CDC, and UNICEF. • Targeted surveillance engagements in Liberia and Kenya to understand transmission dynamics and guide hotspot strategies. • Consultations with Uganda's Mpox response team to address issues related to false-negative results in cases with typical Mpox symptoms. A follow-up meeting with Nigeria is planned to share cross-country experiences in managing similar challenges. Clinical care The Clinical Care pillar has continued to strengthen healthcare capacity through targeted initiatives: • Conducted five clinical webinars over nine weeks on Mpox case management, with over 1,400 participants, including clinicians from 12 of 19 priority countries. • Successfully organized an in-person Trainer of Trainers (ToT) session in Kinshasa, training 50 clinicians from 12 Member States. • Developed three clinical tools to support Mpox case identification, differential diagnosis, and patient triage. These tools, translated into French, are now accessible on the WHO website. Vaccination Efforts to expand vaccine access and coverage among vulnerable populations have made notable progress: • Eight countries (DRC, Nigeria, Uganda, CAR, Rwanda, South Africa, Cameroon, and Mozambique) have secured Emergency Use Authorization (EUA) for Mpox vaccines. Uganda is the first to authorize the vaccine for adolescents aged 12–17. • Facilitated prequalification of the MVA-BN vaccine and initiated emergency use listings for the LC-16 and ACAM2000 vaccines. • Conducted an online workshop for National Immunization Technical Advisory Groups (NITAGs) to develop Mpox vaccine recommendation notes, with participation from Rwanda, Sierra Leone, Zambia, Mauritius, Uganda, and Congo. • Developed a library guide for NITAGs' evidence-to-recommendation processes in collaboration with the NITAG Support Hub/University of Cape Town. Laboratory and Diagnostics Efforts to strengthen laboratory capacity have focused on enhancing diagnostic quality and genomic surveillance: • Conducted Mpox external quality assurance (EQA) across all testing laboratories, with the original deadline for submissions extended to December 13, 2024. • The first EQA includes testing genomic sequencing and bioinformatics capacity. • Deployed the Laboratory Diagnostics and Genomic Surveillance Team Lead to Uganda to address false- negative samples among symptomatic patients and provide other laboratory support. Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 14/16 Risk Communication and Community Engagement (RCCE) The RCCE team has empowered communities through strategic communication, community engagement, and infodemic management: • In the DRC, conducted online and offline social listening to address community concerns, including vaccine origins, animal reservoirs, and self-medication practices. • Shared an infodemic trends report with over 2,000 readers via the INSP website, email, and WhatsApp. • Conducted 18 radio broadcasts in Sankuru and trained 610 individuals on Mpox. • Organized two community engagement dialogues in Goma to improve case tracking and awareness. • Reached over 35,669 individuals through awareness campaigns targeting students, teachers, households, bikers, indigenous and displaced communities, marketgoers, and patients at treatment centers. Conclusion The mpox situation within the WHO African region constitutes a dynamic and significant public health challenge. While advancements have been observed in certain areas, the ongoing community transmission in countries such as the Democratic Republic of Congo, Burundi, and Uganda emphasizes the persistent risk of a broader outbreak. The WHO underscores the necessity of enhancing surveillance efforts in countries experiencing community transmission by improving contact tracing, active case finding, and timely investigations, which are crucial for augmenting case detection and response. Additionally, the expansion of laboratory capacity and the assurance of access to diagnostic tools are essential for the accurate and prompt confirmation of cases. Community-based surveillance, in conjunction with effective cross-border monitoring, will be critical for controlling transmission, particularly in high-risk regions. Strict adherence to isolation protocols and comprehensive management of confirmed cases are imperative to mitigate further spread. Strategic vaccination campaigns must be intensified and precisely targeted, especially in areas with elevated transmission rates and among key populations. Furthermore, community-based vaccination initiatives should be contemplated in regions with significant community transmission of mpox. Ongoing initiatives in the Democratic Republic of Congo underscore the necessity for coordinated vaccination efforts that are closely integrated with current surveillance activities. Community engagement, facilitated through targeted risk communication and media outreach, remains a vital component in promoting vaccine uptake and enhancing public awareness, ultimately contributing to the reduction of transmission within vulnerable communities. Mpox in the WHO African region Weekly Regional Situation Report #16 | 8 December 2024 15/16 Figure 1: Figure 1: Health worker flashes her vaccination card after receiving mpox vaccine Figure 2: Delivery of IPC kits and medicines for mpox response in CAR For more information, please contact Dr Fiona Braka EMR Programme Area Manager; Email: brakaf@who.int Dr Etien Koua HIR Programme Area Manager; Email: kouae@who.int Dr Jerry-Jonas MBASHA Incident Manager, Regional mpox IMST, Email: mbashaj@who.int For media inquiries, please contact Meenakshi Dalal Media Relations Officer, Email: dalalm@who.int