Europe’s disease prevention agency has warned that more imported cases of a more severe strain of mpox, currently circulating in Africa, are “highly likely” in Europe in the coming weeks.
The European Centre for Disease Prevention and Control (ECDC) said in an Aug. 16 statement that it has raised its risk alert level for sporadic cases of the clade I mpox—formerly monkeypox—virus in the 27 European Union (EU) member states plus Iceland, Liechtenstein, and Norway, to “moderate.”
Despite raising the risk alert level, the agency said that the likelihood of sustained transmission remains “very low,” provided that swift diagnosis and control measures are in place.
ECDC says it has strengthened surveillance and preparedness activities in the EU member states plus the three countries that are in the European Free Trade Association—known collectively as members of the European Economic Area (EEA).
“As a result of the rapid spread of this outbreak in Africa, ECDC has increased the level of risk for the general population in the EU/EEA and travellers to affected areas. Due to the close links between Europe and Africa, we must be prepared for more imported clade I cases,” Pamela Rendi-Wagner, director of ECDC, said in a statement.
The agency called on public health authorities in individual EU/EEA member states to maintain high levels of preparedness planning and awareness-raising activities to detect any newly imported clade I mpox cases.
“Ensuring effective surveillance, laboratory testing, epidemiological investigation and contact tracing capacities will be vital to detecting cases of MPXV clade I on the continent and activating any response,” the agency said.
It comes a day after a case of clade I mpox was discovered in Sweden, an EU member state. This is the first case of the more severe strain outside Africa.
The ECDC’s heightened alert follows the rapid spread of the more severe strain of the virus in Africa, particularly in the Democratic Republic of Congo, where an outbreak involving both an endemic form and a newly emerged offshoot, clade Ib, has raised global concerns. This clade I subvariant has been spreading from Congo to countries that have never reported mpox cases, such as Kenya and Uganda.
“A genetic mutation has been causing uninterrupted human-to-human transmission of the virus for months,” the medical charity Doctors Without Borders said in an Aug. 15 report on the outbreak in Congo, while calling the acceleration of the epidemic “worrying.”
The charity said that the main source of transmission is sexual, but the disease is also transmitted in other ways, including through direct or indirect contact with blood, body fluids, skin lesions, or mucous membranes of infected animals.
“There is a real risk of explosion, given the huge population movements in and out,” Dr. Louis Massing, the group’s medical director for Congo, said in a statement at the end of July.
The World Health Organization recently declared the outbreak a public health emergency of international concern, while the Africa Centre for Disease Control and Prevention (Africa CDC) has declared mpox a public health emergency of continental security.
So far this year, 12 African countries have reported more than 17,500 mpox cases, including 517 deaths, per the Africa CDC. That represents a 160 percent increase by the end of July compared with the same period in 2023. Congo has reported the highest number of cases, accounting for about 97 percent of the fatalities.
The United States continues to see only clade II cases of mpox, which is a less severe variant that 99.9 percent of infected people survive, according to the U.S. Centers for Disease Control and Prevention (CDC).
The clade I variant causes more severe illness and is more infectious, with the CDC stating that some outbreaks have killed up to 10 percent of people who get sick.
The CDC said in an Aug. 15 mpox update that the risk to Americans from the ongoing outbreak in Africa remains very low because of the limited travel between central Africa and the United States.
The agency recommends that people consider vaccination as a protective measure. Additional precautions include avoiding contact with people showing symptoms of mpox, steering clear of wild animals in regions where the virus is present, and refraining from consuming meat from wild animals.
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