South Africa might face an mpox (formerly monkeypox) outbreak as people may not come forward if they are infected for fear of stigmatisation. This is a warning by bioinformatician at the South African National Bioinformatics Institute, Peter van Heusden. 

Heusden was reacting to the news this week that two more cases of mpox were reported in KwaZulu-Natal (KZN). This brings the total number of mpox cases in the country to four. Three of the cases are in KZN and one is in Gauteng. 

According to health department spokesperson Foster Mohale, none of the patients diagnosed with mpox had any travel history to countries currently facing an outbreak of the disease.  

Mohale says a preliminary case finding report shows two new cases in KZN had been in contact with the patient that was diagnosed a week prior. 

“This suggests that there is local transmission of the disease which could lead to a larger outbreak in the province,” Mohale says. 

Beyond that, Van Heusden, whose research focus is on the genomics of pathogens that cause infectious diseases, warns that the lack of a travel history outside the country among the cases reported suggests that there is some kind of local transmission happening but undetected. 

“Mpox is a disease that is not as contagious as COVID-19 and will likely remain a very rare disease. The worst case scenario for mpox is that due to stigma and fear, people do not seek treatment and they also do not isolate themselves during the infectious period,” he explains. 

“We know from other countries that mpox can sometimes present with milder symptoms,” he adds.  

Mpox outbreaks

Mpox is an infectious disease caused by the monkeypox virus (MPXV). The virus is transmitted from one person to another by close contact with lesions, sexual contact, body fluids, respiratory droplets and contaminated materials such as bedding. Most people who get mpox fully recover while some get very sick.

Since January 2022 there’s been an ongoing multi-country outbreak of mpox with cases reported in all of the World Health Organisation’s (WHO) regions. 

The Democratic Republic of Congo (DRC) reports the highest number of cases in the WHO’s Africa region. The country has been battling an mpox outbreak since 2023, that’s been driven by the monkeypox virus (MPXV) clade I.  

The virus is classified into two clades. Clade I, identified as the Congo Basin clade, and clade II, formerly referred to as the West African clade.

Van Heusden says the 2022 global mpox outbreak was centred around men who have sex with men and featured what is known as clade IIb viruses. The mpox cases reported in South Africa feature this clade of the virus. 

While there is a vaccine for mpox, it is not widely available due to the pricing policies of the company making it. 

“It is also not likely to be needed urgently given how rare this disease is. The high pricing of this vaccine is still shameful though,” Van Heusden says.

Call to come forward 

The department appeals to members of the public who have been in close contact with known or suspected patients of mpox to cooperate with health officials and present at the nearest health facility or healthcare provider.

“The health officials rely on transparency and cooperation from cases/patients for contact tracing and case finding in order to determine the rate of transmission of this infectious virus at community level,” says Mohale. 

He says the department in collaboration with various stakeholders in the health sector is intensifying epidemiology and surveillance and also risk communication and community engagement activities. 

“This will help to address social stigma which contributes to people’s decision not to openly speak out because they fear that they will not be accepted by their community. In most cases stigma contributes to the spread of the virus making the outbreak and transmission worse.” Health-e News