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Swedish officials said Thursday they have detected a version of mpox that only a day earlier prompted global health authorities to declare a health emergency, marking the first time that variant has been discovered outside of Africa.
The World Health Organization sounded an alarm Wednesday about the viral ailment amid a growing outbreak in Africa concentrated in the Democratic Republic of Congo that has spread to countries that had never reported mpox cases before.
The ongoing African outbreak is driven by versions of the virus known as clade 1, including the offshoot clade 1b. Those versions have been associated with more severe illness and deaths than the clade 2 version responsible for the 2022 global outbreak.
Swedish officials said the patient was infected during a stay in a part of Africa where clade 1 is circulating and was diagnosed with that variant after seeking care in the Stockholm region. That patient has received care, said Magnus Gisslen, state epidemiologist at the Public Health Agency of Sweden.
Swedish officials said the risk to the public is considered low, in line with an assessment from the European Center for Disease Prevention and Control. But they said a new assessment is expected soon, with occasional cases related to travel anticipated.
“The fact that we now see a case in Sweden or outside the African continent is by no means unexpected,” Gisslen said in a news conference. “You should not overestimate the risks, but also do not underestimate them because there are many uncertainties and that is why we take this very seriously.”
During the earlier global outbreak, Sweden identified about 300 clade 2 cases.
Public health officials have stressed that the highest death rates associated with clade 1 versions may reflect infections striking more vulnerable people, including children, in areas with weak health-care systems, rather than differences in the virus. The emergence of clade 1b has raised concerns because it is spreading sexually, the most efficient way for the virus to be transmitted and cross borders.
The 2022 outbreak mostly affected men who have sex with men, but the epidemiology of the growing African outbreak is different. In Congo, clade 1 cases are largely among children who are contracting mpox through contact with infected animals or inside their households. The Congolese children are considered at higher risk because they live in crowded households or displacement camps in a conflict-ridden country where it is harder for patients to self-isolate or seek medical care.
Clade 1b infections in areas that have previously not reported mpox are spreading sexually in female sex workers and their male customers, as well as men who have sex with men, officials say. Experts worry that people in those groups may not seek medical care or vaccination because homosexuality and sex work are stigmatized and, in some places, illegal.
Jennifer McQuiston, incident manager for the clade 1 mpox response at the U.S. Centers for Disease Control and Prevention, said the world is much better prepared to control mpox if the clade 1 variants keep spreading outside Africa.
During the first global outbreak, the virus was largely off the public health radar, and authorities had limited capacity to test for cases and deploy vaccines.
Now, officials are on alert for mpox and have better surveillance systems and testing to identify the clade responsible for an infection. When people test positive, disease investigators have more experience contact tracing to identify people who have been exposed and prevent onward spread. And there are higher levels of immunity because of prior infection and vaccination in gay communities that faced elevated risk of contracting mpox.
“We are in a different place now than we were in 2022, and it gives up a leg up, maybe, on thwarting spread after a traveler introduces it,” McQuiston said. “It’s going to require a lot of vigilance to make sure we are able to continue that.”
