European health authorities warned on Friday that it is “highly likely” Europe will see more imported cases of mpox due to the virus’ spread in multiple African countries.

The European Centre for Disease Prevention and Control (ECDC) said, however, that “the likelihood of sustained transmission in Europe is very low” if imported cases are diagnosed quickly and measures are taken to control them.

The change to Europe’s risk assessment also came a day after Sweden detected the first case of a new variant, that is likely more transmissible, outside Africa.

“We have seen, a worsening of the epidemiological situation in Africa with transmission occurring in neighbouring countries of the Democratic Republic of the Congo (DRC),” Bruno Ciancio, head of surveillance at the ECDC, told Euronews Health, adding that the number of cases there is likely underestimated.

“This means there is an increased risk that cases coming from Africa are imported into Europe,” he added.

“This is basically why we have updated our risk assessment to make sure that we are prepared, that the European Community is prepared, to rapidly identify imported cases and prevent any further transmission”.

More than 500 mpox deaths

Mpox has been spreading since last year in the DRC and has been detected in multiple African countries. The virus has so far killed more than 500 people, mostly in the DRC.

The World Health Organization (WHO)declared the mpox outbreak in Africa a global health emergency earlier this week, calling for a coordinated international effort to address the crisis.

In a new risk assessment for Europe on Friday, the ECDC recommended that European Union and European Economic Area (EEA) countries issue travel advice for people visiting areas impacted by mpox.

“The likelihood of infection for people from the EU/EEA travelling to affected areas who have close contact with affected communities is high,” the ECDC said in a statement.

“Additionally, there is a moderate risk for close contacts of possible or confirmed imported cases into the EU/EEA,” the health agency added.

There are two subtypes of the mpox virus. Clade I, which is endemic in central Africa, is thought to cause more severe illness and higher mortality than clade II, which caused the 2022 global mpox outbreak and continues to circulate in EU countries.

Multiple African countries are currently dealing with an outbreak of clade I and a new strain related to it called clade Ib.

“What we know is that mpox clade I has been circulating in Africa for several decades, but it was only recently that we observed these very large outbreaks around the epicentre and in neighbouring areas and countries. So this may imply a change in the level of transmissibility which may be related to the genetic evolution of the virus,” Ciancio told Euronews Health.

He added that while historically clade I has been seen as more severe, it could be that only the severe cases are being tested and that more information about the virus is needed.

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Impact ‘low’ but Europe should be prepared

Sweden’s public health agencyreported the first imported case of clade Ib in Europe this week.

“As a result of the rapid spread of this outbreak in Africa, ECDC has increased the level of risk for the general population in the EU/EEA and travellers to affected areas,” Pamela Rendi-Wagner, director of the ECDC, said in a statement.

“Due to the close links between Europe and Africa, we must be prepared for more imported clade I cases”.

While European health authorities say that the impact of clade I will be low in Europe, they recommend “high levels of preparedness planning and awareness-raising activities” to handle cases that reach Europe.

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This includes effective surveillance, testing, and contact tracing to detect cases of mpox in Europe.

The ECDC also recommends that travellers to areas impacted by mpox look into getting vaccinated.

Clinicians should be made aware of the possibility of seeing mpox cases, according to Ciancio, as the disease is not endemic in Europe.

He highlighted, however, that the risk should not be overestimated.

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“We are dealing with a disease that we already know, for which there [is] a vaccine, which has proven effective and safe,” he said.

This story has been updated with quotes from an interview with an ECDC expert.