WHO publishes new mpox prevention and management framework

The new framework sets out to achieve and sustain the elimination of human-to-human transmission of the disease.

Mpox, caused by the monkeypox virus (MPVX), continues to affect people around the world. The disease causes a painful rash, fever and enlarged lymph nodes, and while most people recover fully, some become very seriously ill. Mpox is spread from person to person through close contact, including sexual contact, and has animal reservoirs in Central, East and West Africa. Spillover from these reservoirs occurs occasionally, causing further outbreaks. Due to the nature of this disease and current outbreaks, the World Health Organization (WHO) has published a new framework for enhancing the prevention and control of mpox from 2024 until 27.

The MPVX virus has two clades [groups of organisms with a common evolutionary ancestor]. Clade I outbreaks result in higher mortality than those of clade II. From July 2022 to May 2023, a clade II outbreak was declared a Public Health Emergency of International Concern after it spread to 117 countries across all six WHO regions. This outbreak has mostly concluded, but low levels of worldwide transmission continue. However, a major outbreak of MPVX clade II is ongoing in the Democratic Republic of Congo. Since January 2024, 6,500 cases and 345 deaths have been reported, almost half among children under 15 years of age.

There were more than 66,000 cases in 2022 in the 10MM

The overall goal of the new framework is to achieve and sustain the elimination of human-to-human transmission of mpox. This will be achieved through three core objectives: (1) Achieving control of mpox outbreaks in every context, (2) Advancing mpox research and access to countermeasures, and (3) Minimising zoonotic transmission. To accomplish this, coordinated planning for sustainable long-term action has been outlined as the WHO’s top priority.

WHO went on to define an mpox outbreak and the timeline to reaching control and elimination after an established outbreak. The levels of current transmission in a given community were outlined by specific epidemiological criteria defining each level, and appropriate mitigation considerations for each level were listed. Two stages were defined for mpox control and elimination, the first of which is to develop mpox control and elimination plans through community engagement, elimination of stigma to encourage equitable access to health services, and improved access to high-quality tests. The second is to continue implementation via integration with routine services to ensure mpox is transitioned from emergency response to more sustainable monitoring. Overall, the framework highlights the need for integration of mpox control strategies with routine health systems.

According to GlobalData, there were more than 66,000 cases of mpox in 2022 across 10 major markets (10MM: Australia, Brazil, Canada, France, Germany, Italy, Mexico, Spain, the UK and the US). In the US in 2022, there were more than 30,000 cases, most of which were men of Hispanic or Black ethnicity aged between 25 and 39. These markets do not include the ongoing high-mortality outbreak occurring in the Democratic Republic of Congo, which largely impacts children instead of adults, and suggests that the true scale of this issue is likely much larger and more complex across different contexts. This illustrates the need for new thinking around mpox control and prevention, as led by the WHO. The integration of ongoing surveillance with existing health programmes and the improved organisation of health system response before outbreaks occur will be the levers by which the new WHO mpox prevention and control framework contributes to a world with improved health outcomes for all.