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Mpox outbreak in South Africa

The International Health Regulations (IHR) National Focal Point (NFP) of the Republic of South Africa notified WHO of 20 confirmed mpox cases between 8 May and 2 July 2024, including three deaths (case fatality ratio (CFR) of 15%).

These cases were reported in three of nine provinces: Gauteng (10 cases; 1 death), Western Cape (1 case), and KwaZulu-Natal (9 cases; 2 deaths). These are the first cases of mpox reported in South Africa since 2022 when the country had reported five cases, none of which were severe, and no deaths. The persons affected are men aged between 17 and 43 years old, and of the first 16 cases, 11 self-identified as men who have sex with men (MSM).

At least 15 cases are living with HIV with unmanaged or only recently diagnosed HIV infection, and have advanced HIV disease (AHD), and one case has diabetes. The type of exposure contact reported by cases is sexual contact. Eighteen of the patients required hospitalization. Several response measures have been put in place by national health authorities with the support of WHO. The sudden appearance of these cases none of whom reported any history of international travel, the extremely high HIV prevalence among confirmed cases, and the high case-fatality ratio suggest that the confirmed cases are only a small proportion of all cases that might have occurred, and that community transmission is ongoing. The risk to human health for the general public remains low in the country.

risk for gay men, bisexual men, other men who have sex with men, trans and gender-diverse people, and sex workers is moderate. There is potential for increased health impact should wider dissemination among these and other vulnerable groups in South Africa and neighbouring countries continue. This event emphasizes that the global mpox outbreak linked to clade IIb monkeypox virus (MPXV) is still ongoing, and the risk of cross-border and international spread persists in all WHO regions.

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