{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:45:20Z","timestamp":1785775520218,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), and the World Health Organization (WHO) followed with a second Public Health Emergency of International Concern (PHEIC), in response to the rapid expansion of clade Ib monkeypox virus (MPXV) across eastern Democratic Republic of the Congo (DRC) and neighboring countries. Both declarations have since been lifted (September 2025 and January 2026), yet clade Ib transmission and severe outcomes in pregnant women and children persist. We argue that closing these emergency mechanisms marks not the end of the epidemic but the start of a harder phase: sustaining surveillance, care, and research amid shrinking donor support, including the dissolution of the United States Agency for International Development (USAID). We contend that integrating mpox into existing HIV, sexually transmitted infection (STI), and reproductive health platforms is the most realistic route to durable routine care, while pregnancy, paediatric disease, severe cases, and zoonotic spillover still need dedicated pathways. Sustainable management ultimately depends on domesticated financing, stronger institutions, genuine community engagement, and action on the ecological drivers of spillover.<\/jats:p>","DOI":"10.3390\/v18080844","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:51:23Z","timestamp":1785772283000},"page":"844","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sustaining Mpox Surveillance, Research, and Care Integration in a Post-PHEIC, Resource-Constrained World"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0553-201X","authenticated-orcid":false,"given":"Patrick D. M. C.","family":"Katoto","sequence":"first","affiliation":[{"name":"Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu P.O. Box 285, Democratic Republic of the Congo"},{"name":"Cochrane South Africa, South African Medical Research Council, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliane Nsuli","family":"Byamungu","sequence":"additional","affiliation":[{"name":"Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu P.O. Box 285, Democratic Republic of the Congo"},{"name":"Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4013, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"key":"ref_1","unstructured":"Africa Centres for Disease Control and Prevention (2024). Africa CDC Declares Mpox a Public Health Emergency of Continental Security, Africa CDC. Available online: https:\/\/africacdc.org\/news-item\/africa-cdc-declares-mpox-a-public-health-emergency-of-continental-security-mobilizing-resources-across-the-continent\/."},{"key":"ref_2","unstructured":"World Health Organization (2026, July 27). WHO Director-General Declares Mpox Outbreak a Public Health Emergency of International Concern, Available online: https:\/\/www.who.int\/news\/item\/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern."},{"key":"ref_3","unstructured":"World Health Organization (2026, July 27). Second Meeting of the IHR (2005) Emergency Committee Regarding the Multi-Country Outbreak of Monkeypox, Available online: https:\/\/www.who.int\/news\/item\/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox."},{"key":"ref_4","unstructured":"Africa Centres for Disease Control and Prevention (2026). Lifting of Mpox as a Public Health Emergency of Continental Security (PHECS), Africa CDC. Available online: https:\/\/africacdc.org\/news-item\/lifting-of-mpox-as-a-public-health-emergency-of-continental-security-phecs\/."},{"key":"ref_5","unstructured":"World Health Organization (2026, July 27). Multi-Country Outbreak of Mpox: External Situation Report No. 67, Available online: https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-mpox--external-situation-report--67---26-june-2026."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1038\/s41591-024-03130-3","article-title":"Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo","volume":"30","author":"Vakaniaki","year":"2024","journal-title":"Nat. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1038\/s41591-025-03582-1","article-title":"Epidemiological and genomic evolution of the ongoing outbreak of clade Ib mpox virus in the eastern Democratic Republic of the Congo","volume":"31","author":"Masirika","year":"2025","journal-title":"Nat. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101059","DOI":"10.1016\/j.onehlt.2025.101059","article-title":"Mpox: A case study for a One Health approach to infectious disease prevention","volume":"20","author":"Hayman","year":"2025","journal-title":"One Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2400106","DOI":"10.2807\/1560-7917.ES.2024.29.11.2400106","article-title":"Ongoing mpox outbreak in Kamituga, South Kivu Province, associated with monkeypox virus of a novel clade I sub-lineage, Democratic Republic of the Congo, 2024","volume":"29","author":"Masirika","year":"2024","journal-title":"Euro Surveill."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e354","DOI":"10.1016\/S1473-3099(24)00287-1","article-title":"Shifting transmission patterns of human mpox in South Kivu, DR Congo","volume":"24","author":"Katoto","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Schwartz, D.A. (2026). Mpox (Monkeypox) in pregnant women, the placenta and fetus: Correlation with maternal\u2013fetal transmission, pathology and strain differences from MPXV clades Ia, Ib, IIa, and IIb. Viruses, 18.","DOI":"10.3390\/v18040453"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1512","DOI":"10.1016\/S2214-109X(25)00241-4","article-title":"Mpox in Africa: Funding cuts and delayed global actions fuelling new epicentres","volume":"13","author":"Mithi","year":"2025","journal-title":"Lancet Glob. Health"},{"key":"ref_13","unstructured":"World Health Organization (2026, July 27). Fifth Meeting of the IHR (2005) Emergency Committee on the Multi-Country Outbreak of Mpox (Monkeypox), Available online: https:\/\/www.who.int\/news\/item\/11-05-2023-fifth-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-on-the-multi-country-outbreak-of-monkeypox-(mpox)."},{"key":"ref_14","unstructured":"World Health Organization (2026, July 27). WHO Director-General Declares the End of the Mpox Public Health Emergency of International Concern, Available online: https:\/\/www.who.int\/news-room\/speeches\/item\/who-director-general-s-opening-remarks-at-the-media-briefing---5-september-2025."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"597","DOI":"10.4269\/ajtmh.20-0642","article-title":"Responding to the challenge of the dual COVID-19 and Ebola virus disease outbreaks in the Democratic Republic of the Congo","volume":"103","author":"Nachega","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_16","unstructured":"World Health Organization (2026, July 27). International Health Regulations (2005), Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241580496."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kasongo-Mulenda, F., Lundi-Kizela, S., Kalonji-Tshilomba, S., Nsambayi-Lukusa, D., Iteke, M., Nkwembe-Mpileng, R., Muswibwe, A., Matondo-Kuamfumu, M., Makaka, A., and Bulabula-Penge, J. (2025). Clade Ib mpox in the Democratic Republic of the Congo (DRC): Clinical and virological report of the first case in Kinshasa, the capital city. Viruses, 17.","DOI":"10.3390\/v17101327"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Orkin, C., Torgler, R., Dawson, R., Holloway, I.W., and Hoffmann, C. (2025). Mpox: Exploring epidemiology, disease outcomes, and preventative vaccination among people with HIV during the ongoing outbreaks. Viruses, 17.","DOI":"10.3390\/v17121526"},{"key":"ref_19","unstructured":"World Health Organization (2026, July 27). Strategic Framework for Enhancing Prevention and Control of Mpox 2024\u20132027, Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240099142."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e001427","DOI":"10.1136\/bmjgh-2019-001427","article-title":"Integrated Disease Surveillance and Response (IDSR) strategy: Current status, challenges and perspectives for the future in Africa","volume":"4","author":"Fall","year":"2019","journal-title":"BMJ Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1146\/annurev-publhealth-032013-182354","article-title":"Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness","volume":"35","author":"Perry","year":"2014","journal-title":"Annu. Rev. Public Health"},{"key":"ref_22","unstructured":"World Health Organization, and Global Advisory Committee on Vaccine Safety (2026, July 27). Safety of Mpox Vaccines, Available online: https:\/\/www.who.int\/groups\/global-advisory-committee-on-vaccine-safety."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1080\/14760584.2024.2397006","article-title":"Vaccines against mpox: MVA-BN and LC16m8","volume":"23","author":"Grabenstein","year":"2024","journal-title":"Expert Rev. Vaccines"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Williamson, A.-L. (2025). Approaches to next-generation capripoxvirus and monkeypox virus vaccines. Viruses, 17.","DOI":"10.3390\/v17020186"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Danladi, N.P., Agboola, P., Olaniyi, P., Eze, S., Oladapo, O., Obiwulu, D., Akano, O.S., Adeola, O.A., Olawale, K., and Adiatu, A.I. (2024). Challenges in global distribution and equitable access to monkeypox vaccines. Viruses, 16.","DOI":"10.20944\/preprints202410.2179.v1"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wayengera, M., Kyobe-Bosa, H., Muttamba, W., Olu, O.O., Gueye, A.S., Ndembi, N., Kamara, N., Folayan, M.O., Kirenga, B., and Luo, S. (2025). Mpox epidemics: A call to restore humanity\u2019s lost herd immunity to orthopoxviruses. Viruses, 17.","DOI":"10.3390\/v17091257"},{"key":"ref_27","unstructured":"Africa Centres for Disease Control and Prevention (2024). Africa Pathogen Genomics Initiative (Africa PGI 2.0), Africa CDC. Available online: https:\/\/africacdc.org\/news-item\/africa-cdc-launches-initiatives-to-advance-molecular-diagnostics-and-genomic-surveillance-in-africa\/."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"The PALM007 Writing Group (2025). Tecovirimat for clade I MPXV infection in the Democratic Republic of Congo. N. Engl. J. Med., 392, 1484\u20131496.","DOI":"10.1056\/NEJMoa2412439"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/S0140-6736(24)02669-2","article-title":"Suspected and confirmed mpox cases in DR Congo: A retrospective analysis of national epidemiological and laboratory surveillance data, 2010\u201323","volume":"405","author":"Bangwen","year":"2025","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"982","DOI":"10.4269\/ajtmh.12-0758","article-title":"Detection of human monkeypox in the Republic of the Congo following intensive community education","volume":"88","author":"Reynolds","year":"2013","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S0140-6736(25)00047-9","article-title":"Epidemiological and clinical features of mpox during the clade Ib outbreak in South Kivu, Democratic Republic of the Congo: A prospective cohort study","volume":"405","author":"Brosius","year":"2025","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1056\/NEJMp2410045","article-title":"Mpox in pregnancy\u2014Risks, vertical transmission, prevention, and treatment","volume":"391","author":"Nachega","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Gashema, P., Musafiri, T., Ndahimana, F., Iradukunda, H., Saramba, E., Nyakatswau, S.T., Gahamanyi, N., Iradukunda, P.G., Ahmed, A., and Dzinamarira, T. (2024). Mpox in East Africa: Learning from COVID-19 and Ebola to strengthen public health responses. Viruses, 16.","DOI":"10.3390\/v16101578"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ngongo, N., Gaye, A.B., Folefack, G., Dereje, N., Kaseya, J., and Boum, Y. (2025). Integration as a legacy of Africa\u2019s mpox response. PLoS Glob. Public Health, 5.","DOI":"10.1371\/journal.pgph.0004932"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/8\/844\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:54:41Z","timestamp":1785772481000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/8\/844"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["v18080844"],"URL":"https:\/\/doi.org\/10.3390\/v18080844","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}