Weaknesses and strengths in the emergency response and management of the first mpox case in The Gambia

Abstract

Mpox is a zoonotic virus that can infect humans and animals. The director general of the World Health Organization (WHO) declared the mpox outbreak a public health emergency of international concern on 14 August 2024, with the greatest burden in Africa. The Gambia registered its first case of mpox on 18 July 2025. This case study, therefore, assesses the weaknesses and strengths in the emergency response and management of the first mpox case in The Gambia. The patient is a 26-year-old female Gambian, who presented with a two-day history of a skin rash which was associated with fever, headache and myalgia. This patient was seen at the health centre, and swab samples were collected for mpox testing before she returned home. The samples were delivered to the National Public Health Laboratories (NPHL) a day later, and the polymerase chain reaction tests were conducted 8 days later, which confirmed the presence of mpox virus infection. The confirmed mpox case initially presented challenges with compliance, as the patient could not be readily located for isolation and treatment. However, through the coordinated efforts of the police, mobile operators, the village health worker (VHW), field investigators, surveillance officers, public health officers, regional health directorate staff, the head of the village or community, and the nurse at the Fajikunda Health Centre (FJKHC), the case was successfully traced. The assessment of the emergency response and management of the first mpox case in The Gambia revealed notable strengths and weaknesses. Surveillance efforts at the primary healthcare level were effective, leading to the detection of the case and a well-coordinated overall response. However, significant challenges emerged in the laboratory analysis of collected samples, including delays in processing as a result of an unreliable electricity supply and gaps in appropriate infection prevention and control measures.