Many mpox cases in SA still undiagnosed – specialist

As South Africa this week recorded two additional confirmed cases of mpox – bringing the total to 22 since the outbreak began in May – a leading infectious disease specialist has cautioned that there were more cases in the community, with current statistics representing an underestimate.

The latest cases include a 40-year-old Joburg man, diagnosed last week at a private facility in Durban.

The other was a 26-year-old man from Nqutu in KwaZulu-Natal, who presented with an mpox-like rash.

Despite the number of deaths remaining at three, the department of health has advised the public to remain cautious.

Only severe cases diagnosed

Tygerberg Hospital infectious disease specialist and University of Stellenbosch academic Dr Jantjie Taljaard said the number of diagnosed cases only reflected “the more severe, presenting for medical care”.

“Most people with mpox have a mild transient illness and do not present for medical care – hence remaining undiagnosed.

“There are most certainly more cases in the community and the current number is an underestimate of the current outbreak,” said Taljaard.

“Mpox transmits through direct contact with the skin lesions – in this outbreak, mostly through intimate sexual contact. “

Sars-CoV-2 transmits through the air and does not need close skin contact to transmit. “ Initially , nobody had SarsCoV-2 immunity and everyone – especially the elderly – were highly susceptible to become ill,” he said.

Taljaard said most elderly people vaccinated against Covid would have immunity against mpox. “Mpox does not usually cause pneumonia – needing oxygen therapy or ICU (intensive care unit), like Covid did in the first or second year of the pandemic.

“There are vaccines and treatment available for mpox, which was not the case in the early phases of the Covid pandemic.

“Mpox is of moderate public health concern with a low likelihood of causing major disruption,” added Taljaard.

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On whether the country’s public education on mpox was effective, he said: “We will only know and measure effectiveness when the outbreak is under control – when someone does a proper survey to establish if people are well-informed.”

He said National Institute for Communicable Diseases had developed and disseminated clinical, diagnostic and treatment protocols to all provinces and private institutions.

“Training of health care personnel is ongoing. Most academic and private laboratories have been capacitated to diagnose mpox.

“Prevention strategies are currently focusing on general information to the public and more specific measures for high-risk target groups.

“Vaccine stock is limited globally, but government has managed to obtain small quantities to target close contacts of people with confirmed mpox.

“Some countries have stockpiled large quantities of the vaccine in fear of mpox being used as a biological warfare agent,” he said.

Department says it’s possible

Department of health spokesperson Foster Mohale conceded that there was a possibility that “the number of cases could be more than 22, because the disease is transmitting at a community level”.

Mohale said the department was working with various stakeholders in the health sector to intensify its public education drive in affected communities – “using various platforms, including media and community engagement activities”.

“We do not think mpox can reach Covid proportions, because the two diseases differ in terms of transmission and severity.

“That’s why the World Health Organisation doesn’t recommend travel restrictions due to mpox,” said Mohale.

In its latest report on mpox, the WHO found the risk to human health for the general public, remained low in South Africa.

“The 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,” said the WHO.

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