Mpox is a global health emergency. These 7 articles are helping me understand what that means as a health reporter.

The World Health Organization has declared mpox an international health emergency. You might remember mpox from 2022, when it was previously declared a public health emergency of international concern, or PHEIC, by the WHO. Back then, it was still known as monkeypox, a term the scientific community has since dropped. That summer, the virus was spreading in the U.S. and abroad primarily among men who have sex with men.

If you’re wondering what’s changed and what the WHO’s second declaration means, you’re not alone. The WHO’s warning about mpox is an important call to action for the international public health community, but it has also triggered confusion and misinformation among members of the public, which shows in the search trends: Google queries about whether mpox is the next COVID and whether lockdowns are coming have surged in the U.S. As a health reporter, it’s my job to tease out fact from fiction and unfounded panic from genuine canary-in-a-coal-mine moments. Here’s what I’m reading to stay up-to-date.

1. This outbreak is up to 10 times deadlier than the last one — but it hasn’t hit the U.S. Beginning in 2022, a branch of the mpox family tree known as clade II spread to 122 countries, including 115 that had not historically seen the virus before. More than 32,000 people in the U.S. have had the virus since then and 58 have died, according to the Centers for Disease Control and Prevention. The vast majority of the international cases in 2022 (and through last year) spread amid close, sexual contact between men who have sex with men. In 2022, clade II mpox’s mortality rate globally was less than 1%. However, clade I’s mortality rate has risen as high as 10% in the Democratic Republic of the Congo (DRC), and already this year the number of deaths from mpox clade II on the African continent has risen by 19% compared to 2023, according to a new study. Cases have also spread to women and children, with kids under 15 facing the highest risk of dying from the disease. [Wired]

2. Cases in Central Africa are the primary concern. The DRC is the epicenter of the current outbreak. The mpox virus is endemic (meaning ever-present) there, but infections have surged this year, driven by a deadlier variant of the virus than the one that began spreading in the U.S. in 2022. More than 22,000 suspected mpox cases have been reported in the DRC since January, and more than 1,200 people have died. Cases of the more dangerous clade I variant are on the rise in neighboring countries too, including Burundi, Central African Republic, Rwanda, Republic of Congo and Uganda. This version of the virus isn’t actively spreading anywhere else — yet. But the bigger concern is that there are no doses of vaccine against mpox where it’s needed most, and diagnostics and treatments are in short supply. [Your Local Epidemiologist]

3. A few cases of the more dangerous mpox strain have cropped up outside of Africa. When the WHO declared mpox an international emergency on Aug. 14, no cases of clade I had been reported outside the African continent. Within days, that changed. On Aug. 16, Swedish health officials reported that one person who had recently visited a part of Africa where clade I mpox is spreading had tested positive for the virus and received treatment in Stockholm. Health officials there said it’s not surprising that a case has been found outside the African continent, but that doesn’t mean there’s reason to believe the virus is widespread in Sweden or other European countries. Thailand confirmed its first case of mpox in a traveler who arrived from the African continent on Aug. 21. The patient is undergoing testing to determine whether they have the clade I version of the virus, but Thai officials are assuming they do. Remember when COVID cases were separated into “travel-associated” and not? This is like that. One person traveling to a country with a disease outbreak and bringing it home is different from finding cases of what scientists call locally transmitted virus, which would indicate that the virus is spreading within a country. That’s not happening outside of Africa yet. [Washington Post]

4. Mpox is not the "new COVID" and lockdowns aren’t coming. That’s what Dr. Hans Kluge, the WHO’s regional director for Europe, wants the international community to know. Mpox doesn’t spread as easily as COVID. Mpox is mainly transmitted through close, prolonged contact, including but not limited to sex, whereas COVID is spread through airborne particles and droplets from coughs and sneezes. While clade I is spreading in Africa within households — without sexual contact — it still requires closer contact than COVID. Globally, we also already have vaccines to provide some protection against the disease. When COVID emerged, it was entirely novel; we had no vaccines or treatments. The key now, experts say, will be getting mpox vaccines to African nations with surging outbreaks. [Today]

5. Bad news about treatments. A smallpox drug called tecovirimat was used widely to treat the mpox outbreak when it began in 2022. It was thought to have some effect on the virus because smallpox and mpox are cousins in the same viral family. However, the results of a National Institutes of Health study published last week suggest the drug is no better than a placebo at treating mpox. That’s particularly bad news because the more deadly strain continues to be a life-threatening illness for more people — including children — in Africa. [Stat News]

6. There’s no change in risk in the U.S. so far. The virus has been detected in wastewater in just three states between July 17 and August 13, according to Newsweek. But the levels were very low. This likely reflects the fact that clade II is still around. And it bears saying again: No cases of clade I mpox have been reported in the U.S., according to the CDC. Clade II is still affecting Americans, but it is far less active than it was in 2022. Daily infections with the less deadly clade II mpox strain peaked at over 400 cases in August of that year, but they have hovered around 10 or fewer per day since January 2023. The risk of contracting the more severe clade I mpox is still classified as “very low” in the U.S. Experts note that travel will almost certainly lead to the importation of some clade 1 cases in the United States and other countries outside of Africa. But they don’t anticipate widespread outbreaks like the ones in Africa. That's because, if it isn't already endemic, mpox doesn't spread as easily as other viruses (like COVID), and the U.S. has the resources, including vaccines, to prevent and contain infections. [NBC News]

7. Vaccines are available to the most at-risk Americans and are on their way to African countries. Vaccines against mpox are based on the smallpox virus, but they’ve shown better efficacy than the antiviral treatments. The vaccines are untested against clade I, but experts expect they’ll work equally well as they do against clade II. The DRC and other countries have effectively had no vaccines, but the first doses are due to arrive there from the U.S. and Japan by the last week of August, according to Reuters. Meanwhile, Americans who are at risk can get vaccinated (though the CDC doesn’t currently recommend booster shots for those who have already had a dose). Per the CDC, those who may be eligible for vaccination include people who are gay, bisexual or transgender or nonbinary people who in the past six months have had:

• A new diagnosis of at least one sexually transmitted disease

• More than one sex partner

• Sex at a commercial sex venue

• Sex in association with a large public event in a geographic area where mpox transmission is occurring

• Persons who are sexual partners of the persons described above

• Persons who anticipate experiencing any of the situations described above.

[Reuters]