Mpox cases in Central Africa have surged to over 21,000 in the past year, with the Democratic Republic of the Congo (DRC), Burundi, and Uganda reporting the highest numbers. The World Health Organization (WHO) warns that armed conflict, limited testing, and undetected spread are complicating efforts to control the outbreak, which now includes two distinct virus subclades circulating in the region.
The DRC alone accounted for 14,500 confirmed infections and 43 deaths between January 2024 and February 2025, making it the hardest-hit country. Uganda followed with 1,226 cases and seven deaths in the past six weeks, while Burundi recorded over 3,300 cases, primarily in Bujumbura and Gitega. The outbreak’s severity is compounded by the presence of both clade Ia—a strain historically tied to animal transmission—and clade Ib, which spreads almost exclusively through human contact, often in sexual networks.
The WHO has emphasized the need for better surveillance to track these differences, particularly as clade Ib cases have now been detected beyond Africa.
Violence in eastern DRC has worsened the crisis. Armed conflict in the region has displaced thousands and disrupted health services, leaving many communities without access to testing or treatment. A WHO spokesperson noted that insecurity is “exacerbating health crises” by hindering surveillance and response efforts. In some areas, suspected mpox cases are not properly confirmed, leading to potential overcounts in official reports. Meanwhile, testing capacity remains uneven, with delays in lab results slowing outbreak tracking.
Outside Africa, clade Ib has appeared in 13 countries, including the United Kingdom, the United States, Germany, and China, mostly linked to travel. The United Arab Emirates (UAE) reported its first confirmed case in February, though the WHO noted that at least seven additional cases tied to UAE travelers have been identified in other nations. This suggests possible undetected local transmission in the UAE, where only one case was officially recorded. Secondary transmission, where infected individuals spread the virus to others after arriving in a new country, has also been documented in Belgium, Thailand, and Sweden.
Public health responses have faced major hurdles. While 516,480 vaccine doses have been distributed to six African nations, uptake has been slow, and some countries have yet to launch large-scale campaigns. The DRC became the first to expand emergency vaccine authorization to children as young as one year old, reflecting growing concern over infections in younger age groups. In Burundi, where children under five were initially the most affected, recent data shows young adults aged 20 to 29 now account for the highest number of cases.
The WHO is working to address vaccine shortages by coordinating global distributions. In the latest allocation, Angola, Guinea, Sierra Leone, and Uganda were approved to receive an additional 238,300 doses. However, logistical challenges, including distribution delays and funding gaps, persist. Uganda, for instance, has ramped up public awareness campaigns and deployed community health workers to improve early detection, but experts warn that sustained funding and better vaccine access are critical to preventing further spread.
