As we approach the 1-year mark since an atypical outbreak of mpox (monkeypox) was declared in the WHO European Region (May 2022), there is much cause for optimism: after a rapid rise and peak of case numbers in mid-July 2022, there has been a sustained reduction in cases ever since.
While the exact reasons behind this encouraging decline have yet to be disentangled, it is likely that a combination of factors have helped us better control disease transmission, including:
- improved case detection with associated clinical and public health management;
- acquisition of natural and vaccine-derived immunity; and
- wider behaviour change among affected communities following public awareness campaigns.
There is much to celebrate in the reduced spread of mpox. However, as Member States transition out of the emergency phase of the outbreak, what will happen next is uncertain.
Where we are now with mpox
At this point, many Member States of the Region are no longer seeing sustained local person-to-person transmission of mpox. However, a handful of countries are still reporting continued low-level mpox transmission, predominantly among the group most affected throughout this outbreak: gay, bisexual and other men who have sex with men (GBMSM).
With significant transmission still occurring in endemic and newly affected countries in other regions, it is also likely that continued re-introductions into the European Region will occur, with potential to develop into new localized or dispersed outbreaks.
The risk of a resurgence in previously affected groups could also be compounded by the large international festivals set to take place this spring and summer, where sexual activity is likely. The need for continued vigilance is therefore imperative.
Being vigilant to an mpox surge and aiming to interrupt person-to-person spread
With this in mind, WHO/Europe has developed a new policy brief, “Considerations for the control and elimination of mpox in the WHO European Region update 25 April 2023: the need for integrated national operational plans”. It outlines the actions Member States in the Region need to take to prepare for the upcoming season of mass gatherings, and to prevent sustained person-to-person transmission of mpox in the medium to long term.
This provides an update and extension to WHO/Europe’s previous policy brief, “Considerations for the control and elimination of monkeypox in the WHO European Region: policy brief No.1, 26 August 2022”, and is intended to provide a framework for countries to develop 5-year national action plans.
Talking about what mpox control and elimination should mean for the Region, Dr Richard Pebody, who leads WHO/Europe’s High-threat Pathogen team, commented: “The ultimate goal is for all Member States in our Region to achieve and sustain elimination of mpox infection. This will be evidenced by the absence of sustained local person-to-person transmission in the presence of high-quality national surveillance systems with integrated laboratory diagnostics.”
Dr Pebody added, “Our comprehensive new policy brief is designed to help Member States formulate effective, integrated operational plans to do this.”