That's Life, I Swear

Mpox Outbreak in Sweden Raises Concerns of Wider Spread in Europe

• Rick Barron • Season 3 • Episode 133

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Just when Europe thought it was clear from its nightmare with COVID, a single case of Mpox in Sweden reignited fears of a potential outbreak across the continent.

supporting links

1.     Virulence differences of Mpox [PNAS]

2.     Mpox (monkeypox) [World Health Organization]

3.     Deadlier strain of mpox spreads to multiple African countries [Science]

4.     The Swedish Government’s efforts to fight Mpox [Government Offices of Sweden]


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Just when Europe thought it was clear from its nightmare with COVID, a single case of Mpox in Sweden was reported on August. 15, 2024, reigniting fear of a potential outbreak across the continent. As travel links with Africa remain strong, experts warn that this might be just the beginning. With the risk level creeping up from 'very low' to 'low,' what does this mean for Europe? What might it mean for the world? 

Welcome to That's Life, I Swear.  This podcast is about life's happenings in this world that conjure up such words as intriguing, frightening, life-changing, inspiring, and more. I'm Rick Barron your host. 

That said, here's the rest of this story  

Global health authorities were caught off guard when Sweden reported a case of the newly renamed Mpox virus [formerly known as monkeypox] on August 15th, marking its first appearance outside of Africa. This development came on the heels of the World Health Organization's declaration of a global health emergency, prompted by the escalating crisis in the Democratic Republic of Congo.

The Swedish case, involving an individual recently visiting an affected region, confirmed experts' predictions that the virus would inevitably spread beyond its original epicenter. In response, the European Center for Disease Prevention and Control issued a stark warning, anticipating a high likelihood of additional imported cases due to the frequent travel between Europe and Africa.

Mpox cases have surged by 160 percent in Africa during the first seven months of 2024, compared to the same period in 2023. This year, more than 15,600 cases have been recorded, with 537 fatalities, the majority of which have tragically involved children. The virus, which primarily spreads through close physical contact, remains a significant public health concern across the continent.

The European center urged member nations to bolster their preparedness measures to mitigate the risk. Additionally, they recommended the issuance of travel advisories, encouraging individuals planning trips to affected areas to explore vaccination options if eligible.

This unexpected emergence of Mpox in Europe has heightened concerns among health officials worldwide, underscoring the need for increased vigilance and proactive measures to contain its spread.

Why does this matter? Supplies of vaccines and tests could be quickly squeezed if there's a major outbreak, prompting appeals for donations — and for researchers to look for new vaccines.

Another potential problem, could be a temptation for rich countries to start hoarding mpox vaccine stockpiles for their own populations; a situation that should be avoided at all costs. 

The global health community is on high alert following recent statements by Dr. Pamela Rendi-Wagner, who heads the European Centre for Disease Prevention and Control (ECDC). In a interview, she emphasized that the uncontrolled outbreak in Africa poses a significant threat to Europe and North America.

"The rapid proliferation and expanding reach of this disease in Africa inevitably increases the chances of cases surfacing in European and American territories," Dr. Rendi-Wagner cautioned. Her words reflect growing concern among health experts about the potential for cross-continental spread.

The ECDC has revised its risk assessment for EU citizens in response to these developments. While the overall risk has been upgraded from "very low" to "low," the agency stresses that individuals traveling to and from affected African regions face a considerably higher risk. The ECDC strongly advises such travelers to exercise extreme caution and take necessary precautions.

This shift in risk evaluation underscores the evolving nature of the outbreak and the need for heightened vigilance on a global scale.

Understanding the Swedish Mpox Case

The recent Mpox case in Sweden has brought attention to a new strain of the virus. Experts classify Mpox into distinct genetic groups or clades. Clade I, prevalent in Congo, represents a newer variant, while Clade II includes the form responsible for the 2022 global outbreak.

Additional data to reference here is:

  • Mpox is a zoonotic disease, meaning it can be spread from people to animals. Both strains spread via close contact with an infected person or animal or contact with contaminated materials.
  • Both strains have similar symptoms, including flu-like symptoms and a rash can initially resemble pimples or blisters.

Sweden's case marked a significant milestone - the first Clade I diagnosis beyond African borders. Magnus Gisslen, a state epidemiologist with Sweden's Public Health Agency, reported that the patient received prompt medical attention in Stockholm. Health authorities swiftly implemented isolation measures and began tracing potential contacts.

Despite no additional cases being identified, the incident has sparked public concern. "The situation evokes memories of the Covid-19 pandemic," Dr. Gisslen noted. He mentioned an influx of anxious inquiries from individuals with travel plans to affected areas.

In response to this development, several European nations have taken action. Sweden, Italy, and the United Kingdom have all issued public health alerts and outlined strategies to address potential outbreaks.

This case underscores the ongoing global health challenges and the importance of international vigilance in disease monitoring and control.

Comparing the Current Mpox Situation to the 2022 Outbreak

The Mpox landscape has evolved significantly since 2022, presenting what Dr. Paul Hunter, an epidemiologist at Norwich University in England, describes as "two distinct epidemics."

The 2022 outbreak primarily involved Clade IIb, which spread mainly through sexual contact, particularly affecting men who have sex with men. Behavioral changes and vaccination efforts helped curb its spread, though new cases continue to emerge. The World Health Organization reported 100 new infections in Europe and 175 in the Americas in June of 2024.

Clade I manifest in two subtypes with different transmission patterns and vulnerable populations:

  1. Clade Ia: Spreads through household contact, animal exposure, and sexual contact. Young children appear most susceptible.
  2. Clade Ib: Primarily transmitted through heterosexual intercourse. The recent case in Stockholm confirmed this subtype.

Mpox symptoms mimic common respiratory illnesses before progressing to a distinctive rash on the mouth, extremities, or genitals. Transmission occurs through close physical contact, infected bodily fluids, or contaminated items.

Health experts believe the Jynneos vaccine, effective against the 2022 variant, should protect against all Mpox strains. Generally, individuals with robust immune systems are less likely to experience severe Mpox symptoms.

This evolving situation underscores the importance of continued vigilance and adaptability in global health responses.

Currently, Sweden stands alone outside Africa in confirming a case of the new Mpox variant. This isolated incident has alerted global health authorities, prompting increased surveillance worldwide.

In a parallel development, Pakistan reported a new Mpox case recently this year. The patient, a 34-year-old individual with recent travel history to a Persian Gulf state, represents the country's first reported case this year. However, health officials in Peshawar are still working to determine the specific Mpox variant involved.

Dr. Giovanni Rezza, formerly Italy's director general for prevention and now a public health professor at San Raffaele University in Milan, offers a nuanced perspective. While he views the latest Mpox outbreak as primarily a "regional emergency" centered in Africa, Dr. Rezza emphasizes the need for global preparedness.

"Europe must remain vigilant," Dr. Rezza cautions, underscoring the importance of proactive measures and heightened awareness across the continent. His statement reflects a growing consensus among health experts that while the new variant's spread remains limited, the potential for wider transmission necessitates ongoing attention and readiness from health systems worldwide.

This evolving situation highlights the interconnected nature of global health and the critical importance of international cooperation in disease surveillance and control.

European Strategies to Combat Mpox Proliferation

European nations are adopting a two-pronged approach to tackle the Mpox challenge, focusing on domestic and international efforts.

On the home front, countries are intensifying their response through several key measures:

  1. Enhancing awareness among healthcare providers
  2. Ensuring swift treatment for infected individuals
  3. Implementing rigorous testing protocols for those in close contact with confirmed cases

However, recognizing the global nature of the threat, European countries are also extending their efforts beyond their borders, particularly to Africa, the epicenter of the current outbreak.

In a significant move, the European Union has pledged to provide over 175,000 Mpox vaccine doses to African nations. This initiative is part of a broader international effort to bolster Africa's defenses against the disease. Complementing this, Bavarian Nordic, a key vaccine manufacturer, has committed to donating 40,000 doses, which will be distributed under the backing of the Africa Centers for Disease Control and Prevention.

The United States has also joined this collaborative effort, promising 50,000 vaccine doses. Additionally, France has announced its intention to contribute vaccine supplies to affected African countries.

These coordinated international actions underscore the global health community's recognition that combating Mpox requires a united, cross-border approach. By supporting Africa's fight against the disease, European nations aim to assist those directly affected and reduce the risk of further global spread. 

As this podcast was being produced, news broke out that on August, 21, 2024, Thailand reported a case of mpox in a traveler who recently arrived from Africa. Authorities are conducting tests to determine if the patient is infected with the new strain of the virus. If confirmed, this would mark Thailand's first case of Clade Ib mpox. 

What can we learn from this story?  What's the takeaway?

We must not underestimate the pandemic potential of mpox. If cases were to take hold in Europe, it could lead to rapid and sustained transmission across the region.

Immediate and coordinated action is essential, particularly in ensuring equitable vaccine distribution. The lessons from COVID-19 and numerous previous health crises have shown that complacency and delays endanger everyone.

Well, there you go, my friends; that's life, I swear

For further information regarding the material covered in this episode, I invite you to visit my website, which you can find on Apple Podcasts/iTunes, for show notes and the episode transcript.

As always, I thank you for the privilege of you listening and your interest. 

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