Mpox is Declared a Global Emergency Again. Here's What to Know

Updated 10:15 a.m. Thursday

The World Health Organization (WHO) declared the mpox outbreaks in Congo and elsewhere in Africa a global emergency last week on August 14, with cases confirmed among children and adults in more than a dozen countries and resulting in more than 500 deaths in 2024.

Earlier that week, the Africa Centers for Disease Control and Prevention (CDC) announced that the outbreaks of mpox — formerly known as monkeypox — were a public health emergency, calling for international help to stop the virus’ spread. The Africa CDC said mpox has been detected in 13 countries this year, and more than 96% of all cases and deaths are in Congo.

• Jump to: Why the mpox detected in Bay Area wastewater is a less dangerous strain

Mpox mostly spreads via close contact with infected people, including through sex. There is a vaccine for the disease, but few doses are available on the African continent.

“This is something that should concern us all … The potential for further spread within Africa and beyond is very worrying,” WHO director-general Tedros Adhanom Ghebreyesus said.

The CDC recommends that any person who has traveled to Congo or any bordering countries in the last 21 days and who develops a new, unexplained skin rash should seek medical evaluation and avoid physical contact with others.

On Thursday, Thailand’s Department of Disease Control confirmed that an mpox case detected in that country was the more infectious form of the virus first seen in Congo. This case in Thailand is now the second such confirmed detection outside of the African continent, after Swedish health officials announced Aug. 15 that they’d identified a case of a person with this more dangerous form of mpox.

The Bay Area experienced its own mpox outbreak in 2022, but the strain of the virus now spreading from Congo is different in several ways. Keep reading for what you need to know about mpox in 2024, including the the symptoms of mpox, where to find an mpox vaccine in the Bay Area and understanding this global emergency declaration.

Understanding the two different strains of mpox

In 2022, WHO declared mpox to be a global emergency after it spread to more than 70 countries that had not previously reported mpox, mostly affecting gay and bisexual men. In that outbreak, fewer than 1% of people died. Before this outbreak, the disease had mostly been seen in sporadic outbreaks in central and West Africa when people came into close contact with infected wild animals.

• Jump to: Where to find an mpox vaccine in the Bay Area

The 2022 mpox global outbreak in the United States — which particularly affected gay and bisexual men as well as trans and nonbinary people who have sex with men — was caused by a version of the mpox virus known as “clade II.”

The mpox outbreak spreading from Congo is caused by another type of the virus, called “clade I,” which causes more severe illness and higher fatality rates than the clade II type that’s been circulating in the U.S. — albeit at low levels — since the 2022 outbreak.

Data from Stanford University’s WastewaterSCAN project, which monitors the presence of viruses including  mpox in human sewage across the U.S., shows that two years after the initial 2022 outbreak, this clade II strain of mpox is still occasionally detected in the Bay Area’s wastewater. Most recently, clade II mpox has been detected as recently as Aug. 18 at San Francisco’s two wastewater plants, but WastewaterSCAN’s Ali Boehm confirmed that these detections were “low level” and not related to the the clade I outbreak spreading in Congo.

• Jump to: What are the symptoms of mpox?

So far, in 2024, there have been almost 19,000 cases of clade I from the Congo outbreak, and over 500 people have died. Cases are up 160% and deaths are up 19% compared with the same period last year. Salim Abdool Karim, a South African infectious diseases expert who chairs the Africa CDC emergency group, said the new version of mpox spreading from Congo appears to have a death rate of about 3%-4%.

Where has clade I mpox spread globally?

So far there have been only two clade I cases detected outside of the African continent, and none of them are in the United States.

On Thursday, Thailand’s Department of Disease Control confirmed that an mpox case detected in that country was the more infectious form of the virus first seen in Congo. Thai health officials said that the patient was a European man who had arrived in Thailand last week from an unnamed African country where the disease was spreading.

On Aug. 15, the Swedish public health agency said that the clade I case identified in that country was a patient who recently sought health care in Stockholm after traveling to “the part of Africa where there is a major outbreak,” according to the agency. Officials said the risk to the general public was considered “very low” and that they expected sporadic imported cases to continue.

Individual cases of mpox reported in the Philippines and Pakistan were confirmed this week to in fact be the less dangerous clade II mpox.

Understanding mpox in the Bay Area

According to data from multiple local health departments, the overwhelming majority of mpox cases in the Bay Area during the 2022 outbreak were reported among gay men and other men who have sex with men. At the peak of the 2022 outbreak, San Francisco health officials saw dozens of new mpox cases each week in July of that year.

Around the same time, the city declared a public health emergency — the first city in the country to do so. The White House soon followed suit and declared mpox a public health emergency in August, when more than 6,000 cases had been confirmed in the U.S.

In 2022, organizers from the LGBTQ+ community quickly mobilized to pressure public health officials at every level of government to make vaccines and treatment widely available to this vulnerable population. The San Francisco AIDS Foundation (SFAF) helped spearhead these efforts and has continued to provide free mpox vaccines. (Jump straight to where to find an mpox vaccine in the Bay Area.)

“We are aware of the mpox health emergency in Africa, and although mpox rates in the Bay Area are currently at low levels, we know that infection rates can change or increase — sometimes rapidly,” said Jorge Roman, senior director of clinical services at SFAF in a statement to KQED.

Soon after the WHO declared the global emergency on Wednesday, San Francisco public health officials confirmed that the risk of this new strain remains relatively low in the Bay Area.

In a statement, the San Francisco Department of Public Health (SFDPH) said that “the overall risk to the general population in the United States is considered to be very low.” The agency said it will continue “to closely monitor the situation alongside our federal and state partners.”

Cases of clade II mpox “remain low” in San Francisco, SFDPH said, “and we will continue to update the community if further actions are needed to protect health.” The current rolling 7-day average of new mpox cases per day in San Francisco is zero.

‘A failure of the global community’

Officials at the Africa CDC said nearly 70% of cases in Congo are in children younger than 15, who also accounted for 85% of deaths.

Jacques Alonda, an epidemiologist working in Congo with international charities, said he and other experts were particularly worried about the spread of mpox in camps for refugees in the country’s conflict-ridden east.

“The worst case I’ve seen is that of a 6-week-old baby who was just two weeks old when he contracted mpox,” Alonda said, adding the baby has been in their care for a month. “He got infected because hospital overcrowding meant he and his mother were forced to share a room with someone else who had the virus, which was undiagnosed.”

Earlier this year, scientists also reported the emergence of a new form of the deadlier clade I form of mpox, which can kill up to 10% of people in a Congolese mining town that they feared might spread more easily.

Unlike in previous mpox outbreaks, where lesions were mostly seen on the chest, hands and feet, the new form causes milder symptoms and lesions on the genitals. That makes it harder to spot, meaning people might also sicken others without knowing they’re infected.

Michael Marks, a professor of medicine at the London School of Hygiene and Tropical Medicine, said declaring these latest mpox outbreaks in Africa an emergency is warranted if that might lead to more support to contain them.

“It’s a failure of the global community that things had to get this bad to release the resources needed,” he said.

The U.N. health agency said mpox was recently identified for the first time in four East African countries: Burundi, Kenya, Rwanda and Uganda. All of those outbreaks are linked to the one in Congo. In Ivory Coast and South Africa, health authorities have reported outbreaks of the less dangerous clade II version of mpox that spread worldwide in 2022.

What to know about mpox symptoms and how the virus spreads

The mpox virus spreads through close contact with someone who is infected. This could be direct contact with the infectious rashes or scabs someone with mpox develops, scabs, having intimate physical contact with someone who has mpox, such as kissing, cuddling or sex. Coming into contact with infected bodily fluids or items that have been touched by rashes or fluids from an infected person can also expose you to the virus.

Mpox symptoms often start as flu-like conditions, SFPDH said — which is worth bearing in mind during this current COVID-19 surge.

The mpox virus also appears as a rash or sores or spots that can resemble pimples or blisters on the skin anywhere on the body, including the face, inside the mouth, hands, feet, chest, genitals and anus. These spots often start as red, flat spots that then become bumps before the bumps become filled with pus and turn into scabs when they break. These symptoms can be extremely painful. If you’re unsure about recognizing an mpox rash, the CDC has a photo guide.

Mpox can have a long incubation period — that is, the time between when you’re exposed to mpox and when you start to develop symptoms — that can range from three to 17 days, according to the CDC.

If you suspect you might have mpox symptoms — even if they’re subtle — see your health care provider right away or consult one of SFPDH’s clinics for mpox testing. See more on what to do if you suspect you have mpox.

Where you can find an mpox vaccine in the Bay Area

The two-dose mpox vaccine is available to anybody in the Bay Area, with no eligibility requirements to meet. (In the early days of the 2022 outbreak, public health officials were originally only offering vaccines to people who’d been exposed to mpox or were categorized as being in a specific group more at risk from mpox, but rest assured that those criteria are no longer in effect.)

The U.S. Department of Health and Human Services said in a statement that people who have received both doses of the mpox vaccine — along with people who have already had clade II mpox — “are expected to be protected against severe illness from clade I mpox” as well.

“We recommend that all people who may be at risk of mpox receive both doses of the Jynneos mpox vaccine,” Roman of the San Francisco Aids Foundation said. “Vaccines are plentiful and easily available at this point in time, from San Francisco AIDS Foundation and other City and community partners.” Mpox vaccination is not recommended at this time for those who have previously been infected.

Who is recommended to get the mpox vaccine?

SFDPH said that previous mpox outbreaks have predominantly affected communities of gay and bisexual men and men who have sex with men (MSM), as well as trans and nonbinary people who have sex with men. City health officials also especially recommend the mpox vaccine for all people living with HIV and anyone taking or eligible to take HIV PrEP.

Public health officials also recommend that sex workers, people who’ve been diagnosed with a bacterial sexually transmitted disease (like chlamydia, gonorrhea or syphilis) in the last three months and folks with certain job-related risks of mpox seek the free vaccine. See SFDPH’s full list of people who may be at higher risk of getting mpox.

The mpox vaccine was also originally only available for people aged 18 and older, but in 2022 the Food and Drug Administration (FDA) issued an emergency-use authorization that allows providers to also give the vaccine to young people aged under 18 who are “determined to be at high risk” of infection.

The vaccine currently available in the U.S. (brand name: Jynneos) is a two-dose series, with roughly a month between doses. Maximal immunity will build two weeks after your second dose.

If you’ve already had both doses of the mpox vaccine, even back in 2022:

You’re all up to date — and you don’t need to get another mpox vaccine in 2024. There’s no recommendation at this time to get an mpox booster.

If you haven’t already had the mpox vaccine:

Go ahead and get your first dose as soon as possible, then get your second dose around 28 days later. But if you forget or get overwhelmed by events, don’t stress too much about timing: Just go get your mpox vaccine when you can.

If you already have your first dose but forgot to get your second, go get that last dose as soon as possible — even if you got Dose 1 back in 2022.

Locations offering the mpox vaccine in the Bay Area

Your mpox vaccine will be 100% free, and you don’t need health insurance to receive one. As with the COVID-19 vaccine, receiving an mpox vaccine won’t make you a public charge or affect any future immigration processes you may enter into, and you won’t be asked about your immigration status to receive the mpox vaccine.

If you have a regular health care provider, SFDPH recommends you ask them first about getting the mpox vaccine. Your vaccine will be free, but you may be charged a regular copay for seeing your provider.

If you don’t have a regular health care provider or insurance, you can find the mpox vaccine free at clinics around the Bay Area. You can opt to schedule an appointment or choose a walk-in clinic, depending on what works best for you.

If you live in or near San Francisco:

See a full list of mpox vaccine sites near you in San Francisco. SFDPH confirms that you don’t have to be a city resident to get vaccinated for mpox in San Francisco.

Mpox vaccination sites elsewhere in the Bay Area and California:

• Find an mpox vaccine clinic near you using the CDC’s Vaccine Locator
• Find an mpox vaccine clinic near you using the state’s myturn.ca.gov site

SFAF will also administer free first and second doses of the vaccine at the upcoming Castro Street Fair on Oct. 6, with no appointment needed. You can find the SFAF booth at 470 Castro St., San Francisco.

Can I get my mpox vaccine at a pharmacy?

Some pharmacies offer mpox vaccination appointments online, along with other vaccines like COVID and flu. But if you choose this route, you’ll be asked for insurance details — and it’s important to verify with your insurer first that they’ll cover you receiving the mpox vaccine at a pharmacy like CVS or Walgreens, as the out-of-pocket costs you’ll be quoted may be steep.

If you get your health care through a health system like Kaiser Permanente, it’s unlikely you’ll be able to get your mpox vaccine covered by insurance at a pharmacy — the way you can’t get your COVID or flu shot covered by Kaiser at a pharmacy either — and may have to seek it directly from a Kaiser provider.

If you’re able to make an appointment online at a pharmacy for your mpox vaccine, you should consider calling that location ahead of time to verify that they do indeed have supply in stock. A CVS spokesperson told KQED by email that in San Francisco, CVS pharmacies have “limited supply of the monkeypox vaccine in our pharmacies, but a pharmacist can order the vaccine if requested by a patient.”

Associated Press writers Gerald Imray in Cape Town, South Africa, Christina Malkia in Kinshasa, Congo and Mark Banchereau in Dakar, Senegal contributed to this report, as well as KQED’s Nisa Khan.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.