The monkeypox virus (MPXV), responsible for the disease now known as mpox, is an orthopoxvirus primarily transmitted through close human contact, although zoonotic transmission from animal reservoirs in East, Central, and West Africa also occurs. In May 2022, mpox cases emerged in non-endemic regions, spreading across 117 countries and affecting all WHO regions. This outbreak involved sustained human-to-human transmission through direct skin contact, notably impacting people with HIV. While similar transmission patterns were documented in Africa, the global response to diagnostics, vaccines, and treatment for mpox was previously limited.

MPXV includes two main clades with differing characteristics: Clade I, prevalent in East and Central Africa, has a higher case fatality rate and is common in the Democratic Republic of the Congo. Clade II, generally found in West Africa, led to a significant outbreak in Nigeria in 2017, with its subclade IIb spreading internationally by 2022. Recognizing the surge in mpox cases and changing transmission dynamics, the WHO declared a Public Health Emergency of International Concern in July 2022, advocating for immediate measures to curb mpox spread, including halting human-to-human transmission and reducing zoonotic risks. Community actions—such as stigma reduction, public health integration, and community-led prevention—were key in slowing the outbreak, leading the WHO to lift the emergency status in August 2023, while issuing Standing Recommendations to support transmission elimination.

To build on these gains, WHO introduced the Strategic Framework for Mpox Prevention and Control, aimed at global and local mpox containment. The framework’s primary goal is the elimination of human-to-human mpox transmission, driven by three objectives:

  1. Control of Mpox Outbreaks: This includes strengthening outbreak surveillance, case detection, and containment through targeted contact tracing and public health response measures in endemic and newly affected regions.

  2. Advancing Mpox Research and Access to Countermeasures: Increased research and equitable access to diagnostics, vaccines, and therapeutics are essential for effective mpox response, minimizing health impact.

  3. Reducing Zoonotic Transmission: This objective includes educating communities at risk and actively monitoring animal reservoirs to prevent mpox re-emergence.

The framework emphasizes integrating mpox interventions into existing health programs, such as sexual health services, HIV/STI testing, and broader primary healthcare services, rather than creating standalone programs. Such integration is expected to strengthen health system resilience and improve efficiency.

Four guiding principles shape the framework: support for community leadership, a commitment to equity and human rights, context-specific strategies, and continuous learning from evolving outbreaks. Engaging affected communities is central to achieving the framework’s objectives, especially for early detection and response.

The 2022 outbreak, the first global orthopoxvirus spread since smallpox, underscores mpox’s potential risk worldwide. The WHO’s Framework provides a structured approach for countries to define, achieve, and monitor mpox control and elimination, aiming to prevent mpox from becoming endemic globally and to bolster global health security.

 

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