In a new risk assessment, the European Centre for Disease Prevention and Control (ECDC) estimates that it is “very likely” that there will be more imported cases of mpox in the European Union and the European Economic Area (EU/EEA) caused by the new variant circulating in Africa, such as the one in Sweden, but says that the likelihood of sustained transmission in Europe is “very low”, provided that imported cases are promptly diagnosed and control measures are implemented.
Due to the frequent and close travel links between the EU/EEA and Africa, ECDC recommends that Member States issue travel advice to persons visiting or returning from areas affected by the outbreak. The probability of infection for persons from the EU/EEA travelling to areas with the highest disease impact and having close community contacts is “high”. In addition, there is a high risk of contagion among close contacts of imported cases. In all cases, the severity of the disease should be “low”.
However, within this same group, the severity of the disease is considered moderate in people with underlying pathologies, especially in immunocompromised people. In general, the risk for these populations is moderate and high, respectively.
The probability of infection for persons with multiple sexual partners who were not infected with MPOX or vaccinated during the 2022 outbreak is considered moderate. This assessment is based on the difficulty of controlling the spread of infection during the 2022 outbreak in this risk group. Although the severity of the disease is mild in most cases, immunocompromised persons and those infected with untreated HIV may have moderate clinical severity. Overall, the risk for these populations is moderate.
“Due to the rapid spread of this epidemic in Africa, ECDC has increased the risk level for the general population in the EU/EEA and for travellers to affected areas. Due to the close links between Europe and Africa, we need to be prepared for the importation of more clade I cases,” says Pamela Rendi-Wagner, Director of ECDC.
ECDC predicts that the impact of mpox clade I in Europe will be “low” thanks to strengthened surveillance and preparedness activities, as well as strong healthcare and response capacity in EU and EEA Member States.
It therefore recommends that EU/EEA public health authorities maintain “a high level of preparedness planning and awareness activities“to enable rapid detection and response to any further cases of MPOX clade I that may reach Europe.
“Ensuring effective surveillance, laboratory testing, epidemiological investigations and contact tracing capabilities will be essential to detect MPOX clade I cases on the continent and activate any response,” they reiterated.
Furthermore, according to the ECDC, raising awareness among physicians and establishing effective case management processes once a suspected case has been identified will be “essential” to detect new cases of MPOX clade I in the EU/EEA and prevent secondary infections.
Symptoms of monkeypox
If an infection with this new variant is detected, the event should be promptly communicated at EU level via “EpiPulse” or “EWRS”. ECDC recommends that those travelling to epidemic areas consult their primary care physician about their eligibility for mpox vaccination.
Symptoms of mpox They usually appear between 6 and 13 days (up to 21 days) after infection.. The clinical manifestation of the disease includes general febrile symptoms, a distinct rash (papules) and sores on the mucous membranes, back pain and muscle pain. The rash can spread rapidly throughout the body within three days of the first symptoms. Most people have mild to moderate symptoms that usually last two to four weeks, followed by a complete recovery.
New risk evolution
The new risk assessment follows the declaration of a continental security public health emergency by the Africa CDC and the declaration of a public health emergency of international concern by the World Health Organization.
The outbreak in Africa is distinct from the global outbreak of MPOX clade IIb that occurred in 2022 and continues to circulate at low levels in Europe and globally.
Since November 2023, the Democratic Republic of Congo (DRC) has experienced a significant increase in MPOX cases and the emergence of a new MPOX clade I variant. The country reported more than 16,000 new cases and 511 deaths in 2024.
In recent weeks, Nine new countries have reported confirmed cases of mpox. Among them, eight countries bordering the DRC (Burundi, Central African Republic, Congo, Rwanda and Uganda), as well as Kenya. Although genetic sequencing is not available in all countries, the presence of the new clade I variant has been confirmed in Rwanda, Uganda and Kenya.
ECDC experts have been working closely with their partners at Africa CDC to support their response to the outbreak. ECDC experts are contributing to a rapid literature review to help identify knowledge gaps on the Impox clade variant and guide future research.
They also support an action review of the response to the MPOX outbreak in the DRC to inform preparedness and response activities. The EU Health Task Force (EUHTF) has sent an epidemiologist to the country to contribute to MPOX surveillance, field research and research projects.
