In light of the continued spread of Mpox across the continent, the Africa Centre for Disease Control (Africa CDC) has written to all African health ministers calling for coordinated efforts to tackle the infection and improve testing methods.
In a letter dated August 23 and signed by Africa CDC Director General Jean Kaseya, the public health agency said the disease was spreading rapidly and cases had nearly tripled in a short period.
This is different from what was possible in 2022, when Mpox was first declared a Public Health Emergency of International Concern (PHEIC).
Mr Kaseya said the disease's fatality rate is high, around 3 per cent, and has been linked to HIV, making it more worrying.
“Several countries with no previous cases have recently reported imported cases of their first Mpox cases for 2024. Given this trend, there is a high risk of spread beyond Africa as well,” the letter reads.
Mr Kaseya said the agency declared Mpox a public health emergency on August 13 after assessing the danger the attack posed to the mainland.
He said the statement was made after “the Africa CDC convened a meeting of a high-level independent technical body called the Emergency Advisory Group (ECG).”
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The ECG, comprised of a group of 20 high-level experts in science and health, reviewed the epidemiological situation on the continent and made recommendations.
The epidemiological situation
Between 1 January and 23 August, 21,466 cases of Mpox were reported in 13 African Union member states.
Of these, 3,350 were confirmed cases and 18,116 were suspected cases. The outbreak also resulted in 591 deaths, resulting in a fatality rate of 2.9%.
Mr Kaseya said the affected countries include Burundi, Cameroon, Central African Republic, Congo, Côte d'Ivoire, Democratic Republic of Congo, Gabon, Liberia, Kenya, Nigeria, Rwanda, South Africa and Uganda.
He also noted that Gabon has confirmed its first case of the disease, while Sierra Leone and Malawi have begun testing suspected cases.
“As I write this letter, Gabon has confirmed its first case, while Sierra Leone and Malawi are testing their suspected cases,” the letter added.
Nigeria has currently recorded 40 confirmed cases and 830 suspected cases of the zoonotic disease, but has yet to report any deaths.
Laboratory tests are not reliable
However, the Director-General told African health ministers that laboratory testing alone cannot sufficiently detect Mpox cases and should not be relied upon as the sole method to identify confirmed cases.
“I would like to draw the attention of Your Excellencies to the fact that a negative result in a laboratory test does not mean that there is no Mpox epidemic,” he said.
“Some of you are contacting us, especially in the context where the lab is negative for Mpox.
“To better advise them, the Africa CDC has also consulted with our top African epidemiologists and laboratory experts, but also with international experts and relevant agencies such as the US CDC, the China CDC, the European CDC and the WHO.”
He said the recommendation provided was that countries should refrain from relying solely on laboratory test results to diagnose Mpox.
Instead, he said, a holistic approach is needed that integrates laboratory testing with clinical assessment and epidemiological data.
According to him, this is essential to accurately diagnose and treat Mpox.
Mr Kaseya told ministers that diagnosis and treatment of Mpox must involve a comprehensive approach that considers multiple factors.
He said one of these factors is the clinical presentation, which involves monitoring for signs and symptoms of Mpox, such as fever, rash, swollen lymph nodes and lesions.
He also recommended a complete clinical examination, especially when laboratory results are inconclusive or negative.
“Epidemiological context: It is essential to understand the patient’s exposure history, such as contact with known cases or travel to areas with current Mpox outbreaks.
“This context can provide strong evidence of a probable case, even in the absence of positive laboratory results,” he warned.
Testing for confirmed cases
Mr. Kaseya suggested that health ministers review the patient's medical history, including any recent exposure to animals or contaminated materials that may offer additional clues to the diagnosis.
“While important, laboratory tests must be interpreted in conjunction with clinical and epidemiological data. False negatives are possible, and a negative test is not an effective method for detecting breast cancer.”
“Mpox cannot be completely ruled out, especially if there is strong clinical suspicion,” he said.
The CDC Director General for Africa added that for all cases of Mpox, countries should conduct HIV and STI testing.
He urged continued monitoring of the patient's symptoms and possibly repeat testing may help make a definitive diagnosis.
He said health care providers also need to be aware of the timing, quality and type of samples collected.
According to him, the accuracy of the Mpox test depends significantly on when the sample is collected.
He said if the sample is taken too early or too late in the course of infection, the viral load could be too low to be detected.
“The type of sample collected (for example, from an injury, blood, or other body fluids) can affect test results. Injury swabs are usually the most reliable,
But if a different type of sample is used, it may not contain enough viral material for detection,” he said.
In addition, he revealed that different strains or mutations of the Mpox virus might not be detected as easily by certain tests.
“Some tests were designed for a specific strain,” he said.
He also noted that in some cases, an individual's immune system could eliminate the virus or suppress its replication to such an extent that it becomes undetectable by laboratory tests.