Q&A: Recent international mpox outbreaks highlight health care stigma, inequities
Key takeaways:
- Since 2022, two PHEIC have been declared following international spread of mpox.
- Johns Hopkins hosted a symposium to discuss the lessons that have been learned and how to better prepare for future outbreaks.
In July of 2022, mpox was declared a Public Health Emergency of International Concern, or PHEIC, by WHO during a surge in infections that led to more than 100,000 cases in 122 countries.
Although the PHEIC was declared over in May 2023, reports of sporadic cases and transmission have continued, including an outbreak of newly identified clade Ib mpox in the Democratic Republic of the Congo with sustained human-to-human transmission and spread into nearby countries. This led to a second PHEIC being declared in August 2024, during which approximately 12,000 cases have been reported in several countries including the United States.
Seth Judson, MD, MHS, an infectious disease at Johns Hopkins University’s School of Medicine, and colleagues wrote in a paper published in the Journal of Infectious Diseases that the outbreak response has highlighted stigma and inequities among patients, while also showcasing the strengths of sexual health clinics in caring for these patients and preventing transmission.
Following the multinational spread of clade Ib mpox, researchers believed it was important to revisit lessons learned from previous mpox outbreaks. Johns Hopkins University hosted an international mpox symposium to discuss these lessons and how the world can better prepare for future outbreaks.
We spoke with Judson about what was discussed at the symposium and where mpox stands both in the U.S. and globally.
Healio: Where does mpox stand both in the U.S. and globally?
Judson: Mpox continues to remain a local and global threat. In 2022, the first PHEIC was declared for clade IIb mpox, which caused outbreaks in many countries including the U.S. and continues to cause cases. Concurrently, there has been a rapidly growing outbreak for clade Ib mpox for which a second PHEIC was declared in 2024. The clade Ib outbreak has spread from the Democratic Republic of the Congo to neighboring countries, and there have been travel-associated cases in other countries, including in the United States.
Healio: What have we learned?
Judson: From the first mpox PHEIC we learned that vaccination and behavioral change were effective measures for preventing transmission, and sexual health clinics played a key role in sharing this information with patients. Studies also showed that two doses of the vaccine increased efficacy. Researchers also found inequities in vaccine access among certain local and global populations, which needs to be addressed during future vaccination campaigns.
The main treatment used for mpox, an antiviral called tecovirimat, was found not to be effective for symptom resolution in clade II or I mpox during two clinical trials. However, it appears that hospitalization and supportive care can improve outcomes.
Healio: How can we prepare better for future mpox outbreaks?
Judson: Equitable access to vaccines, diagnostics, and countermeasures will be important for preparing for future mpox outbreaks. Timely detection of cases, vaccination, and patient isolation and education will be essential to preventing transmission. Likewise, identifying effective treatments and improving access to supportive care will be critical to improving outcomes.
Healio: What tools do we have to try to either prevent or stop outbreaks once they have started?
Judson: During the clade IIb mpox outbreak, studies found that vaccination and behavioral change were the most effective measures in preventing transmission. These measures are also important for clade Ib mpox, and the efficacy of vaccination in clade Ib mpox is currently being studied.
Healio: What is the clinical take-home message of the paper?
Judson: Our main clinical take-home message is that there are still many unanswered questions about caring for patients with mpox. Because both the PALM007 and STOMP trials found that tecovirimat did not improve clade I or II mpox symptoms, there are currently no proven therapeutics for either mpox clade other than supportive care. Therefore, further research is necessary to identify effective treatments for mpox.
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