Children make up half of mpox cases in Guinea-Bissau as epidemic spreads

West African country reports 46 suspected cases in outbreak declared in July, amid fears virus may be spreading undetected

More than half of the mpox cases reported in Guinea-Bissau have been among children, local authorities have said, almost two months since the country announced an epidemic.

A national outbreak was declared on 4 July, just over a week after a 27-year-old woman became the first confirmed case of mpox in the west African country. Since then, there have been seven confirmed cases and 46 suspected cases. Half of those patients have been children, with 16 under the age of four.

In a statement on Thursday, Unicef warned that because the country’s health surveillance systems were fragile, the virus is probably spreading undetected, leaving even more children at risk.

Sandra Martins, the country’s deputy representative for Unicef, said: “This is the first time mpox cases have been reported in Guinea-Bissau, making even a small outbreak a major public health event.”

Mpox is an infectious viral disease that can be transmitted through close contact. There have been more than 2,000 mpox-related deaths among tens of thousands of cases recorded across east, central and west Africa since January 2024.

Health workers say the Clade variants are consistent with viruses circulating in neighbouring countries, meaning that a risk of cross‑border transmission in the region remains strong. The vast majority of confirmed cases are in the Bissau autonomous sector, where the capital is, while one case is in the nearby Biombo area. No deaths have been reported to date.

Dr Magda Robalo, a former health minister who led the country’s Covid-19 response, said that to eliminate the “biggest gaps in the health system right now”, increased surveillance would have to be prioritised and frontline capacity reinforced.

“Even though the numbers are small, new cases have appeared intermittently over several weeks, which means transmission is ongoing,” said Robalo, who is also co-founder of the Institute for Global Health and Development and former director of communicable diseases for the World Health Organization.

The outbreak comes as the country grapples with infrastructure challenges and the aftermath of the suspension of last November’s presidential election by the military, which remains in power. There was no electricity throughout Thursday in Bissau for instance because of petrol scarcity since the weekend.

Many public health laboratories in the region lack equipment to deal with epidemics but have institutional knowledge from handling other crises.

In Guinea-Bissau, that is no different but there is also a sense of urgency, with primary schools scheduled to reopen across the country in September. After the outbreak was declared, community health workers immediately began a door-to-door public awareness campaign with megaphones and translated leaflets, supported by the health ministry and international agencies.

These grassroots initiatives are seen as vital for building public trust in the public health sector. Earlier this year, the country suspended a controversial US-funded trial on hepatitis B vaccinations for newborns, citing ethical concerns and procedural flaws. The decision was lauded by many across the continent and has highlighted sensitivities around emergency health interventions.