What can South Africa’s national mpox guidelines teach us about strengthening public health preparedness and response?

Mpox, historically a rare zoonosis confined to parts of Central and West Africa, has evolved into a global public health concern since 2022, with more than 175 000 confirmed cases reported across 142 countries by November 2025.

South Africa reported its first cases in 2022 and has since strengthened its surveillance and response systems for mpox. In August 2025, the National Department of Health released the Guidelines for the Clinical Recognition, Diagnosis, and Management of Mpox in South Africa to enhance national preparedness and clinical management.

The guidelines also address infection prevention and control, mental health impacts, and stigma reduction. Ongoing challenges include sustaining laboratory readiness, ensuring consistent national implementation, strengthening integration with HIV and sexual health services, and expanding surveillance approaches, including wastewater monitoring.

This reflection highlights the strengths, gaps, and implementation considerations of these guidelines. Key advances include standardised case definitions, improved clinical recognition of atypical presentations, integrated HIV/STI screening, clear diagnostic pathways centred on polymerase chain reaction testing, and risk-stratified clinical management guidance.

Key insights from the guidelines

• Strengthened case definitions and clinical recognition: Provides tiered, WHO-aligned mpox case definitions and highlights atypical presentations to improve detection and reduce misdiagnosis.
• Improved triage, screening, and infection prevention and control (IPC): Offers facility-level guidance on triage, screening, and PPE use to identify severe cases early, especially in high-risk groups.
• Clear diagnostic pathways and laboratory access: Emphasises PCR testing, integrated mpox–HIV–STI diagnostics, and strong lab networks for rapid outbreak detection.
• Comprehensive clinical management framework: Defines mild-to-severe mpox management, prioritises high-risk patients, and integrates HIV/STI services with tecovirimat use reserved for severe cases.

Considerations and recommendations for the guidelines

• Clinical capacity: Train and mentor healthcare workers in mpox recognition, IPC, and management.
• Laboratory readiness: Maintain PCR capacity and timely reporting across public and private labs.
• High-risk populations: Integrate screening, ensure ART and vaccination, evaluate tecovirimat.
• Community engagement: Promote health-seeking behaviors and reduce stigma via targeted outreach.
• Surveillance: Use integrated routine and wastewater surveillance for informed public health action.

Effective implementation will require coordinated clinical training, laboratory capacity strengthening, community engagement, and multisector collaboration to mitigate the risk of future mpox transmission in South Africa.

For a more in-depth look into this policy brief, download the full PDF below.