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WHO reaffirms mpox outbreak in Africa still meets criteria for a public health emergency of international concern
The World Health Organization (WHO) declared the current mpox outbreak in Africa a public health emergency of international concern (PHEIC) on the 14th August 2024, and this was reaffirmed on 27 February 2025. PHEIC status aims to accelerate funding, research, and international public health measures and cooperation to contain a disease, and is the WHO’s highest level of alert possible.
The PHEIC has been declared due to the following reasons:
- An upsurge of mpox cases in parts of Africa
- Emergence of a new variant of mpox, known as clade Ib, which appears to be spread mainly by sexual transmission
- Rapid spread of the clade Ib variant in the Eastern Democratic Republic of the Congo (DRC) and reports of cases in several neighboring countries (e.g., Burundi, Kenya, Rwanda, Uganda)
- Potential to spread further across other countries in Africa, and possibly outside of Africa
In the past 12 months, over 23,000 laboratory-confirmed cases of mpox have been reported in Africa, including 98 deaths (as of 30 March 2025). The three countries with the majority of cases are the DRC, Uganda, and Burundi.
Although the epidemiology is not fully understood, the current spread of mpox in Africa is attributed to two distinct ongoing outbreaks in the DRC:
- A clade Ia outbreak primarily in mpox-endemic areas mainly affecting children.
- A clade Ib outbreak in the eastern part of the country that has been rapidly spreading and reaching neighboring countries that have not previously reported mpox cases. The outbreak is affecting both children and adults, and is spreading rapidly among adults through close contact including sexual contact identified within networks of sex workers and their clients.
Travel-related cases of clade Ib mpox have now also been reported in countries outside of Africa including India, Sweden, Thailand, Germany, the US, the UK, Belgium, Canada, and France.
Situation in the UK
- The first case of clade Ib mpox detected in the UK was reported on 30 October 2024. As of 10 February 2025, nine confirmed cases of clade Ib mpox had been reported in the UK. Most cases had a travel history to Uganda. However, three cases were detected in household contacts of the first case (who had recently travelled to countries in Africa currently experiencing mpox outbreaks).
- A single confirmed case with no reported travel history and no reported link with a previously confirmed case was reported in the UK in early April 2025. All contacts were followed up and no further cases were identified. Investigations into the source of the infection are ongoing.
- The wider risk to the UK general population remains low.
- Both clades of mpox (clade I and clade II) are no longer classified as a high consequence infectious disease (HCID) in the UK, as of March 2025.
Situation in the US
- The first case of clade Ib mpox detected in the US was reported on 16 November 2024. The infection was diagnosed in a person in California who recently travelled to the US from Eastern Africa.
- Three more cases have been reported since then (as of 1 April 2025). All cases were in people who had recently travelled to affected areas in Central and Eastern Africa, and the cases were not linked.
- The wider risk to the US general population remains low.
It is unclear at this time whether disease caused by the clade Ib variant differs from that of the clade II variant that caused the ongoing 2022 global outbreak, or whether current vaccines are effective against the new variant. However, the clinical presentation of clade Ib mpox appears to be similar to the signs and symptoms reported in the global clade II mpox outbreak, and differs from clade I outbreaks elsewhere in Africa.
Updated information on the situation is available from public health authorities.
This is the second time the WHO has declared an mpox outbreak to be a PHEIC, with the first one declared in July 2022 due to a global outbreak in countries that had not previously experienced cases. This outbreak was due to the clade IIb variant. The emergency was declared over in May 2023 as the number of cases had decreased significantly since their peak in August 2022. However, clade II mpox is still circulating globally with outbreaks in many countries.
Several outbreaks of mpox caused by different clades of the virus have occurred in different countries, with different modes of transmission and levels of risk. Outbreaks are ongoing in some countries. Mpox was first detected in humans in the DRC in 1970, and is endemic to countries in Central and West Africa.
Dapagliflozin approved by FDA for treatment of type 2 diabetes in children
The sodium-glucose cotransporter-2 (SGLT2) inhibitor dapagliflozin has been approved by the US Food and Drug Administration (US FDA) to improve glycaemic control in paediatric patients with type 2 diabetes aged 10 years and older. Prior to this, dapagliflozin was approved only in adults with type 2 diabetes as an adjunct to diet and exercise to improve glycaemic control.
The approval in paediatric patients was based on results from T2NOW, one of the largest paediatric type 2 diabetes phase 3 trials to date. Data demonstrated a significant reduction in haemoglobin A1c (HbA1c) for patients treated with dapagliflozin compared with patients receiving placebo.The safety results in this patient population were consistent with those in adults with type 2 diabetes.
Dapagliflozin has also received approval from the European Medicines Agency (EMA) for use in children aged ≥10 years with uncontrolled type 2 diabetes as an adjunct to diet and exercise.
Latest UK asthma guidance provides minimal change to exacerbation management
The latest guideline update from NICE/BTS/SIGN on the management of Asthma has been released. While there are some significant changes in the approach to chronic asthma diagnosis and management, little has been changed in relation to the management of exacerbations of Asthma. The document continues to regularly link to the 2024 guidance, SIGN 158.
Updates of note relating to asthma exacerbations:
- Regular FeNO testing may lead to a reduction in exacerbations.
- In people who present with an exacerbation of undiagnosed asthma, it is recommended to start MART (Maintenance And Reliever Therapy) alongside any treatment for the acute symptoms. This is a combination of Inhaled Corticosteroid with Formoterol). This may be stepped down to ‘as needed’ post discharge.
Esketamine approved in the US as the first ever monotherapy for treatment-resistant depression in adults
For the first time, the Food and Drug Administration (FDA) has approved a ketamine-related drug as a standalone treatment for adults with major depressive disorder (MDD). Esketamine nasal spray is approved for patients who have treatment-resistant depression (TRD) - defined as an inadequate response to at least two oral antidepressants.
The approval follows a multicentre randomised controlled trial which demonstrated the rapid efficacy of esketamine monotherapy. Within the first 24 hours of the initial dose, participants experienced significant improvements in their Montgomery-Asberg Depression Rating Scale (MADRS) total score, with the effects persisting for at least 4 weeks. By the fourth week, 22.5% of patients receiving esketamine had achieved remission (MADRS total score ≤12), compared to 7.6% in the placebo group.
Until now, esketamine had been approved in the US exclusively as an adjunctive therapy alongside an oral antidepressant for two indications in adults: as a treatment for TRD, and for those with MDD experiencing suicidal ideation or behaviour.
This expanded indication makes esketamine accessible to individuals with TRD who are not on an antidepressant or who wish to discontinue their current one, which may help to overcome treatment barriers owing to negative experiences with oral antidepressants, such as poor tolerability.
Despite growing clinical adoption of esketamine, several questions remain. The optimal patient profile for treatment response, how long therapeutical effects might persist, and the appropriate duration of therapy all require further investigation. While no longer considered a last-resort treatment, esketamine is not a first- or second-line treatment.
Esketamine is approved only for use in an appropriate certified clinical setting under the supervision of a health care provider; typically this will mean referring to a designated treatment facility offering esketamine. A key practical consideration is the logistical and occupational commitments required of patients; for example, the need to take time away from work and to arrange necessary transport and support. The drug must be self-administered by the patient, who is supervised by a health care provider in a certified medical office, and the patient monitored for at least 2 hours because of the risk of sedation, respiratory depression, difficulty with attention, judgement and thinking (dissociation), suicidal thoughts and behaviours, and the potential for drug misuse. For these reasons, esketamine is only available via a restricted distribution programme in the US.
People with poorly controlled hypertension or pre-existing aneurysmal vascular disorders may be at increased risk for adverse cardiovascular or cerebrovascular effects. Esketamine is contraindicated in patients with aneurysmal vascular disease, arteriovenous malformation, or intracerebral haemorrhage.
Esketamine is available in Europe; however, it is not currently approved for monotherapy. Availability of esketamine varies according to the country of practice and relevant regulatory approval.
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