Children and vulnerable communities are at the sharp end of an expanding outbreak of mpox in Eastern and Southern Africa. More than 200 confirmed cases have been detected across five countries (Burundi, Rwanda, Uganda, Kenya, South Africa), UNICEF reported today.

The new variant of the mpox virus (clade Ib) has been identified in all affected countries except South Africa, which is causing concern due to its potential for wider transmission across age groups, particularly young children.

Burundi is reporting the highest number of infections across the region. As of 20 August 2024, 170 confirmed Mpox cases have been detected across 26 out of the 49 districts in the country, of whom 45.3 per cent are female. Children and adolescents below 20 years of age constitute nearly 60 per cent of cases detected, with children under 5 comprising 21% of cases.

The risks for children in Burundi are heightened because of the simultaneous occurrence of measles outbreaks due to low routine childhood immunization and high malnutrition rates. Although the response is ongoing, the country continues to face multiple challenges including a shortage of diagnostic test kits and medicines, low community awareness, high operational costs, and risks of disruption to the continuity of essential healthcare services.

“The new strain of Mpox is a serious threat to vulnerable children and families. Aside from immediate lifesaving response, risk communication efforts & cross border collaboration, investments in overall Health System Strengthening, continuity of essential services and targeted focus on programmes that support overall child wellbeing must be prioritized,” said UNICEF Regional Director for Eastern and Southern Africa, Etleva Kadilli.

Beyond the direct effects of the disease, concerns remain over the secondary impact of Mpox outbreaks on children and adolescents, including stigma, discrimination and disruptions to schooling and learning. For women and girls, the risk/threat of gender-based violence (including sexual abuse and exploitation) remains high as their burden of care includes caring for sick family members and supporting the basic needs for their families’ survival, as seen in previous public health emergencies. Drawing from experiences gained during responses to HIV, COVID-19 and Ebola outbreaks, there must be a collective effort to prioritize plans for supporting survivors, combating stigma and facilitating continuity of basic social services especially learning and children’s reintegration into school and community.

In addition to the immediate concerns posed by the virus, Kenya, Burundi and Uganda have been struggling with multiple emergencies including drought and floods.

"In the fight against the Mpox outbreak, prioritizing the needs of children is not just necessary—it's urgent," said Kadilli. "Their heightened vulnerability requires that we dedicate our full attention and resources to ensure their protection and well-being in this critical response phase.”

Across the region, UNICEF is responding to the Mpox outbreak alongside WHO and Africa CDC, as part of government response plans with local partners. For example, UNICEF is supporting local communities to intensify risk communication and community engagement through local media and awareness interventions. This includes prioritizing care and proper personal hygiene as an effective infection prevention and control measure.

UNICEF is currently appealing for an urgent $16.5 million to scale up the response and preparedness across the region. The funding needs will be revised on a regular basis as the situation is fast evolving.