The current Monkeypox (Mpox) outbreak has caused various national bodies to collaborate and issue a response strategy which aims to stop the outbreak in its tracks. The Preparedness, Readiness and Response Plan (SPRP) lists three objectives, with RDi offering an additional couple of insights.
Here, we formulate a present and updated guide to the ongoing monkeypox outbreak and the history of the epidemiology, transmission, diagnosis and prevention of the infectious disease. At a glance, recent news pin points these major progressions of spread:
- Over 106,000 laboratory-confirmed Mpox cases reported by August 2024
- India confirmed its first case of Mpox in a 35 year old male in September 2024
- A total of 122 countries reported Mpox cases, including 115 with no previous cases in October 2024
- The first case of Clade Ib Mpox variant recorded in US in November 2024
“It is time to act decisively to prevent history from repeating itself”. A pioneering message from the Chair of the International Health Regulations (IHR) Emergency Committee 2024. Paying homage to the second rapid increase in detected cases and new Mpox strains in the last two years, Dimie Ogoina definitively refers to current affairs as ‘’an emergency, not only for Africa, but for the entire globe.’’
2024 sees the case of Monkeypox reach 20,000 with over 580 fatalities, specifically across 13 reported African Union Member States. From within the upsurge of cases, the detection of a new strain is the cause of the Monkeypox outbreak, namely DRC, clade 1b.
As a result, the WHO has declared the mpox outbreak a public health emergency of international concern (PHEIC) from the Democratic Republic of Congo (DRC) and the surrounding countries.
‘Monkeypox outbreak’ defined
Monkeypox is a contagious, viral illness caused by the monkeypox virus, which is responsible for multiple clades, specifically clade I (with subclades Ia and Ib) and clade II (with subclades IIa and IIb).
Transmitted via sexual contact predominantly, however, touching, talking and breathing close to someone with monkeypox can generate infectious respiratory particles which are confirmed to be contagious.
Effective public health measures, including enhanced disease surveillance, careful contact tracing, tailored risk communication and community engagement, and risk reduction measures
The first case of monkeypox was reported in 1970, since then the WHO have been working with a broad range of international, regional, national and local partners and networks to enhance coordination in a bid to interrupts human to human transmission. From the 2022 outbreak, we can see proactivity and urgency are paramount in confronting the latest 2024 PHEIC, India has already confirmed their first case detected in a 38 year old man who recently returned from a trip to Dubai.
Across key areas of preparedness, readiness and response, we’ll discuss the newly launched global response plan and the below crucial three strategy steps you need to know:
Step 1 – Interrupt human-human transmission
Emergency Coordination
This highlights ambitions for robust coordination mechanisms at all levels to ensure seamless collaboration among stakeholders, efficient resource allocation, and rapid adaptation to changing circumstances.
Strengthened surveillance and detection
This emphasises a multi-faceted approach that integrates existing surveillance systems and enhances diagnostic capacity to enable the early identification and swift containment of outbreaks. This focuses on enhancing laboratory capacity, particularly in underserved areas, and equipping workers with PPE and MPXV PPR testing supplies and sampling materials.
This involves deployment of point-of-care diagnostics and establishing efficient sample referral networks.
Step 2 – Protect vulnerable groups at risk
Equitable access to medical countermeasures
This involves a harmonious approach for research, scalable manufacturing, innovative financing and efficient distribution systems to guarantee that diagnostics, vaccines, and therapeutics accessible to all populations, particularly in high-risk, low-resource settings.
Enhancing decision-making and collaboration across various supply sources, is essential, as well as ensuring compliance with standards through sound specifications and safeguarding coordinated demand forecasting and planning.
Enhanced community protection
This approach focuses on encouraging communities through tailored risk communication, effective participation, reducing stigma, and ensuring access to vaccines and public health measures.
Step 3 – Minimise zoonotic transmission
Safe and Scalable care
This focuses on optimising clinical care pathways and maintaining essential health services, to enhance healthcare infrastructure, ensuring the availability of essential medicines and supplies, protecting health and care workers. This includes ensuring availability of essential supplies through optimised supply chain management.
More detail of the SPRP from the WHO can be found here.
RDi’s additional steps for Mpox outbreak response strategy
The WHO has urged that rapid access to Mpox diagnostic tests be at the forefront of proactive treatment, with this comes the invite to manufacturers to join the mission. In vitro diagnostic manufacturers can submit an expression of interest for Emergency Use Listing (EUL). Many of RDi’s clients operate in the diagnostic sector, which is why we understand that diagnostic testing is key for people to get treatment.
Step 4 – Enabling timely and accurate methods for confirmation of infection
Identifying Mpox can be challenging due to its similarity to conditions such as chickenpox, measles, bacterial skin infections, etc. It is this roadblock in accurate confirmation infection and early detection that quickly contributes to an over-night outbreak.
WHO currently recommends viral DNA detection by polymerase chain reaction (PCR) as the preferred laboratory test, given its accuracy and sensitivity.
While antigen RDTs are available, they have shown insufficient accuracy in evaluations. POC PCR-based solutions are also available; however, there is a limit on manufacturing capacity with high costs associated, in addition to their inability to differentiate between clades. This function is necessary for understanding clade-specific epidemiology, transmission, and disease severity.
High-volume Mpox test kit production
RDi’s Mpox sample collection kit ensures accurate detection of Mpox (clades I and II), taking advantage of our pre-established, efficient and automated production lines. Here we aim to curate a minimum of 150,000 compliant, quality-assured kits per day.
Supporting multi-site sample collection from each patient, each Mpox test kit is comprised of two sterile synthetic swabs, a Virus Transport Medium and secondary packaging for compliant and secure onward sample transportation.
RDi’s production lines are an entryway to production scalability for various diagnostic businesses as they aim to meet large volume demands with the most refined turnaround times. Camera verification technology is integrated at an individual kitting level to ensure compliance to international standards across each production line.
Step 5 – Cementing a resilient supply chain for detection
Once an appropriate method of identification of Mpox infection has been concluded, Mpox test kits must be easily accessible and readily available as part of a robust onward healthcare system. How can we ensure these Mpox test kits reliably reach global concentrations of high-risk populations? Through RDi’s robust logistics and distribution networks.
Prompted by the rapid development of commercial kits, network links are already forming between facilities, laboratories and commercial diagnostics. To simplify this multi-channel response to the 2024 Monkeypox outbreak, there is a clear need for more streamlined supply and ongoing management of decentralised testing and the associated remote sample collection.
Mpox test kit supply chain management, analytics and surveillance
By integrating data collection with our sample kits, RDi can automate the unique ID associations of kits to their respective end-user or receiver. This ignites our post analytical technology which can be utilised during the Mpox outbreak to improve surveillance data collection, case investigation and contact tracing.
Our supply chain can gather behavioural insights, including the geographical distribution of Mpox cases, mapping kit delivery to key outbreaks sites and identifying potential hotspots.
Following sample collection and reception, analysis must be conducted in appropriately equipped laboratories by staff trained in technical and safety procedures, following a risk-based approach and under proper biosafety conditions. Sample integrity of swabs can be monitored to coordinate detection rates and successful diagnosis.
Our capabilities enable seamless collaboration with global health organisations, supporting both sample collection and global supply chain efforts.
By strengthening current methods of collecting samples for PCR diagnosis, RDi can strengthen infection detection across the globe. This will allow for more progress to be made in Stages 1 to 3, which account for treatment and prevention responses, from prequalifying the first vaccine against Mpox, in September 2024, to refining the target product profiles to work towards automated assays for diagnostics.
