UPDATE 26 June: The country has recorded another mpox death after a 40-year-old man from Ladysmith in KwaZulu-Natal died on Sunday. 

According to the National Department of Health the deceased presented with mpox-like symptoms including rash all over his body. 

National health spokesperson Foster Mohale says in a statement released on Tuesday afternoon, the man had not been admitted to hospital. He tested positive for mpox but later died at home. 

“The country has also recorded three more positive cases of mpox which brings cases of mpox to 16 since the outbreak of the disease in May. Two [more] cases were confirmed in Gauteng, a 43-year-old man was diagnosed on Saturday at a private health facility in Johannesburg. A 29-year-old man was  diagnosed in Mamelodi health facility on Friday last week,” he says. 

Eight cases are from KwaZulu-Natal, seven cases from Gauteng, and one from Western Cape. 

[UPDATE 13 June] A second person has died of mpox amid an outbreak of the disease in the country. Minister of Health Dr. Joe Phaahla announced today another laboratory confirmed case of mpox and second death linked to the disease just less than 24 hours after he provided an update on the government’s efforts to curb the spread of this infectious disease. 

The deceased is a 38-year-old male who was admitted at a local hospital in uMgungundlovu in KwaZulu-Natal and tested positive for mpox on Wednesday 12 June, after presenting with extensive lesions, headache, fatigue, oral ulcers, muscle pain and sore throat. 

The patient died on the same day his test results came back positive. This brings the total number of positive cases in the country to 6, within a period of 5 weeks. 

[12 June] On Wednesday, at a media conference, Health Minister Dr Joe Phaahla said the 37-year-old patient, who tested positive with mpox on Friday, died at Tembisa hospital in Gauteng on Monday. This is the fifth case of mpox that the department has announced since last month.Two of the cases are from Gauteng and three from KwaZulu-Natal. All the patients were men between 35 years and 37. They all had severe illness and needed hospitalisation. 

South Africa joins a growing list of countries currently facing an mpox outbreak. It’s a viral infection that spreads between people through direct contact with a person with the disease, or objects and surfaces that have been touched by a person with mpox. 

“One patient has been discharged and another discharged for home isolation. Two cases are still admitted in hospital,” the minister says. “The cases have co-morbidities and have been identified as key populations, men who have sex with men. One of the patients indicated that he had sexual contact with multiple partners including both males and females.” 

He says the department has reached out to organisations working on HIV programmes and key populations such as men sleeping with men to reach their members since they fall under the category of people at risk. Phaahla says 38 contacts were identified in KwaZulu-Natal by the outbreak response team. 

Dr Jacqueline Weyer, a principal medical scientist at the Centre for Emerging and Zoonotic Disease at  the National Institute of Communicable Diseases (NICD) adds that  contact tracing is dependent on the information shared by patients.

“Mpox is not a disease you expect to find in the South African population. We are not an endemic country.  At the moment we are dealing with the stigma issues. In some cases people don’t want to disclose their contacts,” she says.

Treatment 

Phaahla says the country does not have registered treatment for mpox.

“The World Health Organisation (WHO) recommends the use of Tecovirimat (TPOXX) for treatment of severe cases such as in individuals with a CD4 count less than 350,” he says.

He says three of the five cases had access to Tecovirimat as advocated for by the NICD.

Dr Fabian Ndanzeako, director for WHO South Africa who was part of the briefing, added that in terms of treatment they are working very closely with the health ministry.  

“We want to ensure we get the drugs available to the patients. As we speak Tecovirimit has been packed and waiting shiftment from Geneva to here. We are working with the team to make sure the paperwork is done and this treatment is available,” he says. 

Vaccines

The health department says the country does not have the mpox vaccine. Phaahla says the department is working with the WHO to get donations from member countries. 

“There is no procurement of mpox vaccine at the moment. South Africa is trying to source vaccines from WHO member countries who have stockpiles that exceed their needs as well as from GAVI,” he says. 

He says additional intervention is being considered. The National Advisory Group for Immunisation and a technical working group are considering the mpox vaccine for both pre and post exposure administration for high risk groups which include but not limited to sex workers, men who have sex with men, healthcare workers and laboratory workers. 

Epidemiologist Dr Joseph Wamala adds that there will be no mass vaccination but targeted vaccination for high risk groups. 

“Vaccines are one of the tools we are using to ensure that within the next two years we eliminate mpox. Mpox vaccines will not be used like the COVID-19 vaccines. The high risk groups have been identified in the context of South Africa. And we will continue to identify them as we get a better understanding of epidemiology in the country,” he says. 

He says at the moment there are bilateral discussions with Western European countries that have stockpile vaccines beyond their country’s need. And those vaccines might expire if not used. 

“There is an option of doing bulk procurement from manufactures but the availability of vaccines will depend on how fast funding is procured from the Treasury,” he says. 

“We have a potential big outbreak in our hands. All the cases reported in South Africa have no history of travel but are from a local transmission. It has not been easy to identify the contacts and that has been experienced by other countries. We should report promptly to the clinics,” he adds.

Phaahla says there will be limited doses of mpox vaccines. 

“We hope to acquire the first doses in a matter of days as discussions are ongoing. We will prioritise those at high risk, including healthcare workers exposed to mpox,” he says. – Health-e News