Sierra Leone’s Silent Emergency: Unmasking the Mpox Outbreak

By Mohamed Ibrahim Justice Ganawah

Introduction: A Crisis Unfolding in Real Time

As much of the world remains focused on post-pandemic economic and social recovery, Sierra Leone is grappling with a quiet yet alarming public health crisis: a rapidly escalating Mpox outbreak (formerly monkeypox). What started with isolated suspected cases in January 2025, has surged to 1,387 confirmed infections, posing the most serious threat to national health infrastructure since the 2014 Ebola epidemic.

Despite the swift declaration of a public health emergency and intensified vaccination efforts, public awareness and behavioral responses remain dangerously insufficient. This brief provides an evidence-based analysis of the outbreak, leveraging the latest data from the National Public Health Agency (NPHA) and outlining urgent policy measures required to avert a broader catastrophe.

Current Status: Facts from the Latest Situation Report (No. 112, May 5, 2025)

Cumulative Epidemiological Summary

• Total confirmed cases: 1,387
• Active cases: 1,083
• Total deaths: 10 (Case Fatality Rate: 0.7%)
• Total recoveries: 294
• New confirmed cases (May 5): 9
  • By district: 7 in Bombali, 1 in Karene, 1 in Tonkolili
• New suspected cases: 12
• New recoveries: 0
• New deaths: 0

Demographics

• Male patients: 728
• Female patients: 659
• Children under 15: 2.5% of cases
• Pregnant women (childbearing age): 2.3% (15 out of 643 females)
• Infected healthcare workers: 0.2%

Vaccination and Monitoring Efforts

• Total vaccinated: 20,967 individuals
  • Composition: 51% male; 59% are healthcare workers
• Contacts traced: 2,196
  • Completed 21-day monitoring: 896

Geographic Hotspots: Western Area Remains the Epicenter

As of May 3, 2025:

• Western Urban: 897 cases
• Western Rural: 240 cases
  Together, these account for over 80% of the national case burden.

Additional districts with rising case counts:

• Bombali: 47
• Port Loko: 15
• Kenema: 13
• Bo: 14
• Kono: 10
• Tonkolili: 3

Emerging cases in remote districts like Falaba, Kailahun, and Koinadugu highlight the national transmission potential and the urgency of containment.

Mpox in Context: What Is It and Why It Matters

Mpox is a viral zoonotic disease transmitted through close contact with infected individuals, respiratory droplets, bodily fluids, or contaminated materials. Clinical symptoms include fever, rash, swollen lymph nodes, and profound fatigue.

Although less fatal than Ebola, Mpox remains a highly disruptive pathogen, especially within fragile health systems. It poses compound risks to public health, economic productivity, and social stability.

Key Threats from the Current Outbreak

Strained Health Infrastructure
With over 1,000 active cases, hospital capacities—especially in Freetown—are nearing overload. Healthcare personnel are overstretched.

Economic Vulnerability
Workforce absenteeism, fear-induced mobility restrictions, and resource reallocation may delay national development programs and economic recovery.

Regional and Global Risk
Sierra Leone’s porous land borders and maritime ports increase the risk of cross-border spread, particularly in the absence of robust screening.

Low Risk Perception Among the Public
Despite official alerts and public health bulletins, public compliance with preventive measures remains dangerously low, and misinformation persists.

Government Response to Date

• Public Health Emergency declared: January 11, 2025
• Emergency Coordination Level 1 activated
• Over 61,000 doses of MVA-BN vaccine procured
• Daily surveillance reports by NPHA
• Isolation and treatment centers deployed in hotspots, especially Western Area

Urgent National and International Actions Required

1. Mass Communication and Risk Education

• Utilize radio, mobile messaging (SMS/WhatsApp), community theater, and town criers.
• Collaborate with local influencers to debunk misinformation.

2. Expanded Testing and Community Surveillance

• Equip district teams with mobile diagnostic kits.
• Implement voluntary testing campaigns in schools, markets, and places of worship.

3. Accelerated Vaccination Rollout

• Target informal settlements, pregnant women, and immunocompromised individuals.
• Engage religious and traditional leaders in awareness campaigns.

4. Healthcare Worker Protection

• Guarantee adequate PPE, regular training, psychological support, and financial incentives.

5. Enhanced Global Support

• Continued engagement from WHO, Africa CDC, and development partners is essential.
• This outbreak must be treated as a potential regional emergency requiring technical and financial assistance.

Conclusion: The Cost of Inaction

Sierra Leone’s experience with Ebola underscores the critical importance of rapid and coordinated action. Though the Mpox case fatality rate is lower, its spread poses serious systemic risks.

Complacency is a threat multiplier. Urgency is the only viable response.
This is not solely a national issue—it represents a continental and global public health challenge.

For accurate updates and emergency contact, reach the Ministry of Health via the toll-free line 117 or visit www.npha.gov.sl.