Monkeypox health alert in Uganda: A public health challenge,a call to action

In humans, Monkeypox presents in two distinct stages. The first stage is the incubation phase, lasting 7–14 days after exposure. During this phase, the symptoms such as fever, headache, fatigue, muscle pain, and lymphadenopathy occur. These symptoms can often be nonspecific, resembling those of other viral infections. Following the eruptive phase, where characteristic skin rashes begin to appear typically starts from the face and gradually spread to other areas of the body, including the hands, feet, and genitals. The rash progresses from flat, red spots to raised, fluid-filled blisters, which eventually turn into pustules and then crust over as they heal.^1,2

In Uganda, the first confirmed Monkeypox cases were reported on July 24, 2024, in two women at Bwera Hospital in Kasese District near the DR Congo border. In response, the Ugandan government classified 23 of the 147 districts as high-risk areas. By late 2024, approximately 153 cumulative cases had been reported, with Kampala and Nakasongola being among the most affected districts. ³

The spread of the virus is fueled by several factors, such as frequent cross-border movements, particularly with DR Congo, and risky sexual behaviors, particularly among fishing communities. Additionally, urban areas like Kampala, with high population density, have facilitated transmission. ⁴

Preventive measures including enhanced surveillance, public awareness campaigns, and the isolation of confirmed cases have been implemented to control the spread of virus. Additionally, Rapid management of suspected cases and targeted vaccination for individuals at high risk are also being implemented to reduce further transmission.^1,4

However, Uganda’s health infrastructure faces significant challenges. The country is experiencing a shortage of medical resources, trained personnel, and diagnostic tools, hampering the effectiveness of the response efforts. Furthermore, the vaccine shortage remains a major obstacle, with only 200,000 doses available, far fewer than the 10 million needed for sufficient coverage. ⁵ To address these issues, the Ugandan government developed a national preparedness and response plan for Monkeypox, which includes public education campaigns to emphasize the importance of vaccination. These campaigns aim to raise awareness about the virus’s transmission and encourage individuals, especially those in high-risk areas, to get vaccinated to prevent further outbreaks. ³

Beyond health concerns, the epidemic has had significant socioeconomic impacts. The visible symptoms such as skin lesions, has led to the stigmatization of infected individuals, resulting in social isolation and discouraging people from seeking medical care. Additionally, attendance at market and social gatherings has declined, disrupting livelihoods, particularly in the informal sector, where workers depend on these activities for income. ⁴

International cooperation is crucial in managing the outbreak. Organizations such as the Africa Center for Disease Control and Prevention (Africa CDC) have supported Uganda with technical expertise, vaccines, and public health resources. However, sustained efforts from both local and international stakeholders are necessary to reduce the spread of the virus and address the broader challenges.^3,4

Compared to other African countries affected by monkeypox outbreaks such as the Democratic Republic of Congo, Nigeria, and Cameroon Uganda’s situation is moderate in terms of incidence but more constrained by limited vaccine availability. While Uganda has reported around 150 confirmed cases since mid-2024, neighboring DR Congo continues to record thousands annually, reflecting its role as the regional epicenter. Uganda has implemented effective surveillance, case isolation, and targeted vaccination strategies similar to those used elsewhere; however, vaccine shortages (only 200,000 doses available vs an estimated 10 million needed) and limited diagnostic capacity hinder a robust response. In contrast, countries like Nigeria have benefited from earlier access to vaccines and stronger laboratory networks. Despite these challenges, Uganda’s proactive preparedness plan and collaboration with Africa CDC place it within the regional average for prevention efforts but below optimal capacity for vaccine coverage.^3–5

In conclusion, the Monkeypox epidemic in Uganda presents a major public health and economic challenge. While efforts in surveillance, isolation, and vaccination are essential, these efforts are hindered by limited infrastructure and vaccine shortages. The epidemic’s economic consequences such as stigmatization and income loss further highlight the need for a coordinated response to mitigate both the health and socio-economic impacts. Strengthened collaboration among the government, health professionals, and international organizations will be key in overcoming this crisis and protecting vulnerable populations.

Christian Tague Department of Research, Medical Research Circle (MedReC), Goma, DR Congo Sana Rasheed Department of Medicine, Jinnah Sindh Medical University College, Pakistan Hermann Yokolo Department of Research, Medical Research Circle (MedReC), Goma, DR Congo Dujardin Makeda Department of Research, Medical Research Circle (MedReC), Goma, DR Congo Joshua Ekouo Department of Research, Medical Research Circle (MedReC), Goma, DR Congo Nathan Mugenyi Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda Department of Pharmacy, Faculty of Health Sciences, Victoria University, Kampala, Uganda Amos Kipkorir Langat Pan African University for Basic Sciences Technology and Innovation, Nairobi, Kenya Aymar Akilimali Department of Research, Medical Research Circle (MedReC), Goma, DR Congo International Veterinary Vaccinology Network, The Roslin Institute University of Edinburgh, Edinburgh, UK Marceline Djuidje Ngounoue Department of Biochemistry, Faculty of Science, University of Yaoundé 1, Cameroon