Heightened mpox vigilance urged by EU as deadly virus spreads

Countries should consider advising mpox vaccinations for people visiting areas affected by the more deadly version of the virus, Europe’s disease agency warned, as health services ready for cases.

In a new risk assessment released on Friday, the European Centre for Disease Prevention and Control (ECDC) also said it is “highly likely” that Europe will see more cases of the more dangerous strain of mpox, after a first case was detected in Sweden.

“ECDC recommends travellers to epidemic areas consult their health care provider or travel health clinic regarding eligibility for vaccination against mpox,” the agency said.

The World Health Organization declared a global public health emergency on Wednesday following the rapid spread of the more dangerous strain of mpox, which has been circulating in the Democratic Republic of the Congo and neighboring countries, especially affecting children. It has killed at least 517 people with more than 17,000 suspected cases across Africa so far this year.

Sweden reported the first confirmed case outside Africa on Thursday, prompting the government to hold a press conference to explain what action has been taken to prevent an outbreak from this case.

“We take the outbreak of clade I mpox very seriously,” said Sweden’s chief epidemiologist, Magnus Gisslén. He added that, while the sole case does not require additional infection control measures, they are “continuously assessing whether new measures are needed.”

The ECDC said on Friday that while the risk of the variant spreading among the wider population in Europe is low, the severity of the disease is considered “moderate” among those with underlying conditions, particularly people with weaker immune systems.

The new global emergency is largely driven by clade I of mpox, which is associated with more severe illness and higher fatality rates than clade II. The latter strain was widespread during the 2022 outbreak that affected Europe and North America.

Several European countries have already issued statements on the new variant, some with guidance for health care workers and their public health systems — a stark difference compared with the somewhat lethargic response to the mpox global emergency in 2022.

But this time, Europe is more prepared. Notably, it has vaccines.

Vaccines in Europe

Ireland has access to enough supplies of Bavarian Nordic’s Imvanex shot through the European Commission’s joint procurement program to meet likely demand over the next few months, the Health Service Executive said. And it will consider the need for a new vaccination program and which groups should be in line for jabs, the executive added.

It’s a similar story in Italy. A senior official at the health ministry said the country had a “sufficient” stock of vaccines and would establish an intergovernmental group to combat the spread of the virus.

A nurse vaccinates a patient against mpox at a Centre gratuit d’information, de dépistage et de diagnostic (CeGIDD) in Montpellier, southern France. | Pascal Guyot/AFP via Getty Images

Dutch Health Minister Fleur Agema, meanwhile, told the country’s parliament she would wait to ensure the Netherlands has enough vaccines stockpiled before making a decision on a donation to Africa.

The country has approximately 100,000 doses stockpiled, a spokesperson for the ministry told POLITICO. Spanish health officials also told POLITICO they had enough vaccines for at-risk groups.

The Czech government also appears to have shots. It said that anyone traveling to an affected area should consider getting vaccinated against mpox.

One as-yet unknown, however, is who would be eligible for vaccination. While the 2022 outbreak circulated predominantly among men who have sex with men, the clade I outbreak is more prevalent among children — for whom Imvanex is not authorized in Europe.

Be prepared

But it’s not only vaccines that will prevent and contain an outbreak in Europe.

The U.K. government issued an “urgent public health message” to health care providers and clinicians to ensure they have enough personal protective equipment (PPE), and that relevant staff are trained in its use for the assessment and treatment of patients presenting suspected clade I infection.

Meanwhile in Denmark, its infectious diseases institute said that it was “following the development closely,” but added that the risk in Denmark had been assessed as “very small.”

Europe’s health security committee will meet on Aug. 19 to discuss “next steps and support member states in ensuring a coordinated response at EU level,” the European Commission told POLITICO. This committee comprises EU countries’ health ministry reps, as well as some national public health institutes.

The ECDC said its experts have been working with partners at Africa CDC to support their outbreak response, looking to identify gaps in the knowledge of the clade I mpox variant and guide future research. 

They are also supporting an in-action review of the mpox outbreak response in the DRC to inform preparedness and response activities.