South Africa: Factsheet – What You Need to Know About South Africa’s Latest Mpox Outbreak

South Africa is currently experiencing a resurgence in cases of mpox, the disease formerly known as monkeypox. These cases are part of a global outbreak which began in 2022. South Africa had only detected five cases of the disease, in 2022, until 8 May 2024, when a new case was found.

Africa Check debunked several false claims related to the disease when this outbreak began, as did other fact-checking and public health organisations.

These claims ranged from outright conspiracy theories – that the outbreak was entirely fabricated to hide the side effects of Covid-19 vaccines – to misunderstandings about how the disease spreads.

With 22 cases and three deaths reported in South Africa at time of publication, we’re revisiting what we know about mpox and the false claims that spread alongside it.

In short, yes. In 2022, the World Health Organization (WHO) recommended that the name mpox replace monkeypox. This was largely due to instances of “racist and stigmatising language” based on the old name.

This name change had been under consideration for many years, as part of a general move to bring the names of viral diseases in line with the WHO’s best practices for the naming of diseases. Published in 2015, these guidelines suggest naming diseases in a way that avoids unnecessary offence or negative impact to animal welfare, travel, trade, and more.

Mpox is caused by a virus which is still known as monkeypox virus. The most prominent symptom of the disease is a rash. However, mpox can also cause fever, headache, swollenlymph nodes and fatigue, and some of these symptoms develop before the rash.

Dr Jacqueline Weyer, head of the centre for emerging zoonotic and parasitic diseases at the National Institute for Communicable Diseases (NICD), warned that there were “different rashes which have different causes and different management approaches”. Not every rash is necessarily mpox.

“It is recommended that those that are affected by acute, undiagnosed skin rash consult their health care provider for diagnosis and treatment,” she told Africa Check. A diagnosis can be confirmed with laboratory tests.

Mpox is mostly spread through physical contact with an infected person; this has been the primary means of transmission in this global outbreak. It can also be passed on by contaminated objects, such as clothes and bedding, and can be passed from animals to humans. (This is the source of its original name, although monkeys aren’t the only animal that can spread mpox.)

Prof Yunus Moosa, head of infectious diseases at the University of KwaZulu-Natal, advised that anyone who had mpox cover up rash lesions to prevent contamination. “Abstain from close contact with anyone until the rash has completely healed. If possible, isolate until better,” he said.

Options for vaccination and treatment of mpox are limited. The US Centers for Disease Control and Prevention says that there are two vaccines which can be used to prevent mpox. One of these, Jynneos (also known as Imvamune or Imvanex), is a smallpox and mpox vaccine which has proven to be effective at preventing mpox during the current global outbreak.

The other is the smallpox vaccine ACAM2000. This vaccine is expected to provide protection against mpox as other smallpox vaccines do, but has not been widely used during the current mpox outbreak, in part because it has more side effects than Jynneos.

While mass vaccination is currently not recommended to combat mpox, South African health minister Joe Phaahla said in a 12 June 2024 speech that the country was trying to source vaccines to protect high-risk groups. Bloomberg reported that these would be Jynneos vaccines, under the name Imvanex, donated by countries with stockpiles of excess vaccines.

In the meantime, an antiviral drug called Tecovirimat has been acquired to treat severe mpox cases. It is not, as some news outlets have implied, a vaccine. It was developed as a treatment for smallpox and was shown to be effective against similar diseases in studies on animals. The WHO allows for the use of Tecovirimat as an emergency treatment for mpox, and small trials have shown that it is safe and effective for this purpose.

Tecovirimat is not a registered treatment for mpox in South Africa. However, it has been approved for use under section 21 of South Africa’s Medicines and Related Substances Act, which allows for the sale of unregistered medications under strict regulations and in special circumstances. These include cases in which all other treatment options have failed or are inaccessible.

Anyone can catch mpox, although there are some factors which might make a person more or less likely to contract the disease.

For example, anyone who has been vaccinated against smallpox is likely to have some protection against mpox. This is because the two diseases are caused by very similar viruses and are part of the same family. However, South Africa stopped smallpox vaccinations in 1980, because smallpox had been successfully eradicated. So South Africans born after this date would not have received the vaccination.

Certain groups are also more vulnerable to mpox.

The South African health department has prioritised men who have sex with men (MSM), sex workers, health workers and lab workers for vaccination against mpox, because they are more likely to be exposed to the disease.

Weyer said: “Skin-to-skin contact is the most efficient mode of transmission and during the multi-country outbreak the predominant mechanism of skin-to-skin transmission has been sexual transmission.” This outbreak has particularly affected MSM.

According to WHO data on the global outbreak, “among cases with known data on sexual behaviour, 85.7% identified as men who have sex with men”. This pattern has been consistent in South Africa, with five out of the country’s first seven cases diagnosed in MSM.

This does not mean that mpox spreads faster among or targets MSM. “Somehow the virus slipped into these sexual networks and is doing the rounds,” Moosa told Africa Check. Women are not immune, he said, and “if it gets into the vulnerable heterosexual population, it’s likely to take off”.

Weyer told Africa Check: “Immunocompromised individuals will be most vulnerable to severe clinical presentation of mpox.” This includes those with “undiagnosed HIV and unmanaged HIV”.

HIV, or human immunodeficiency virus, is an infection that targets the immune system – the body’s system for preventing and fighting disease. At its most advanced stage, HIV causes a condition called acquired immunodeficiency syndrome or Aids. Because HIV targets the immune system, people with untreated HIV are much more vulnerable to other diseases, including mpox.

South Africa has especially high rates of HIV and Aids, despite a long decline in new case numbers. This seems to have compounded the risks of mpox in the South African population. Of the 16 South African cases reported to the WHO by 26 June 2024, 11 were in patients “with either unmanaged or only recently diagnosed HIV infection”.

South Africa’s first case of this outbreak was reported on 8 May. Moosa told Africa Check that the virus was of the same strain as the global outbreak, indicating that it had been reintroduced to South Africa recently.

“One cannot be sure but the most logical explanation is that someone with a mild disease – assuming someone with more severe symptoms is less likely to travel – was returning to South Africa or visiting South Africa from a place where the virus is circulating.”

However, the cases that have been detected since were not linked to travel from outside of the country, suggesting that mpox has begun spreading locally.

As of 30 July, 22 cases had been reported, including three deaths. All those affected were male, aged between 15 and 44. Most cases were recorded in the provinces of Gauteng (11 cases) and KwaZulu-Natal (10 cases). One case was recorded in the Western Cape province.

Almost all cases required hospitalisation, most of them complicated by conditions such as HIV. On 18 July, the South African department of health said that the outbreak was “under control” with “16 recoveries, 3 deaths, and 3 active cases”.

An earlier WHO report contained more detail. It said 11 of the 16 South African cases reported to the WHO as of 26 June were reported in “gay, bisexual or other men who have sex with men, and the most commonly reported context of likely exposure was sexual contact”. The three deaths which had been reported at that time represented a case fatality ratio of around 19%. (This ratio is a measure of how severe a disease is among diagnosed cases.) This was much higher than the global case fatality ratio of 0.2% for the same strain of mpox.

This was attributed in part to the “disproportionate burden of HIV” in the country. The WHO said that this high rate of deaths also showed that mpox in South Africa was “likely circulating in the community and has reached the most susceptible individuals”.

Previous false claims about mpox give some indication of what to look out for during the current outbreak.

One very popular claim is that mpox spreads faster among or only affects MSM. It is true that this global outbreak has mainly affected MSM and spread among this demographic; this is why MSM will be one of the first groups prioritised for vaccination. But anyone can catch mpox through skin-to-skin contact. There is no reason to believe that other demographics are protected against the disease.

This claim can feed into existing stigmas about HIV, sexual intercourse between men, and mpox. UNAids, the United Nations-coordinated effort to combat HIV/Aids, issued a statement of concern as far back as May 2022 that “some public reporting and commentary on [mpox] has used language and imagery, particularly portrayals of LGBTI and African people, that reinforce homophobic and racist stereotypes and exacerbate stigma”. UNAids warned that these kinds of stigma could undermine public health responses to the disease.

Weyer told Africa Check: “These misunderstandings and false claims have detrimental effect on public health responses during the multi-country outbreak, but may also affect individuals and their health seeking behaviour when presenting clinically with possible mpox.”

Journalists, health officials, public figures and social media users must ensure that they share accurate information about mpox which does not reinforce these stigmas.

Another common claim is that the disease simply doesn’t exist. This was often tied to conspiracy theories about the Covid-19 pandemic. For example, one false claim alleged that the global mpox outbreak was actually caused by Covid-19 vaccines. There is overwhelming evidence for the safety and effectiveness of Covid-19 vaccines, as years of scientific studies with millions of participants will attest. And yet these claims persist.

It’s unclear how the change of name – from monkeypox to mpox – will affect these claims, but confusion or lack of information is unlikely to help.

Health misinformation could undermine trust in public health officials, and can also discourage people from seeking treatment. Even if these claims do not appear exactly as they have before, it is likely that similar claims will emerge to cast doubt on the reliability of public health efforts, treatments and more. As usual, be careful to verify breaking news and other claims before sharing them.

Seek information from trustworthy expert sources, like the South African NICD and department of health, the WHO, or trusted medical experts like doctors.