South Africa's Mpox Cases Climb to 26 as Vaccine Stock Runs Down: What Health Officials Are Doing Next

CAPE TOWN — South Africa has confirmed 26 mpox cases so far in 2026, with 20 of them detected since August and most concentrated in the Western Cape, according to the National Institute for Communicable Diseases (NICD). Health officials say a limited stock of donated vaccine remains available, and they are reviewing whether more doses will be needed.

As of 27 October 2026, the confirmed cases were spread across five provinces: 18 in the Western Cape, three in Gauteng, two in the Eastern Cape, two in the Free State and one in KwaZulu-Natal, Dr Jacqueline Weyer, head of the NICD Centre for Emerging Zoonotic and Parasitic Diseases, told Spotlight in a report published on 2 November 2026. Seven people have been hospitalised, and no deaths have been reported so far this year.

Almost all of this year's cases were in men aged 23 to 50, with one case in a woman aged 35 to 44, Spotlight reported. Officials stress that mpox can affect anyone who has close contact with an infected person, and they urge people not to make assumptions about who can acquire the infection.

This article is general information only, not medical advice. Anyone with an unexplained rash, fever or swollen lymph nodes, or a possible exposure, should seek medical assessment promptly.

Illustration: A public health clinic in South Africa preparing mpox vaccination — an illustration, not a photograph of a real clinic or patient.

What Happened

Spotlight's 2 November report describes a small but distinct uptick. After sporadic cases in earlier years, South Africa has seen 20 cases since August 2026, enough for public health officials to describe the current situation as an outbreak — a term that, Weyer explained, does not necessarily mean a large number of people are affected, but rather cases occurring in a particular place and period that warrant investigation and a public health response.

"We cannot rule out the possibility of further cases, particularly while investigations are ongoing and local transmission has occurred previously," Weyer told Spotlight. She added that the risk of further spread depends on how quickly cases are detected, the number and nature of contacts, transmission within affected networks, and the effectiveness of public health measures.

The NICD approach, she said, is to remain alert without creating unnecessary alarm: strengthening surveillance, laboratory investigation, contact tracing, vaccination of eligible priority groups and public awareness. "We have the opportunity to intervene early, identify additional cases and reduce the likelihood of further spread," she said.

At first, South Africa's mpox cases were traced back to international travel. In 2024 and 2025, officials began seeing local transmission, and for the current cases local transmission is "implied", Weyer said, with investigations still ongoing. Contact links between cases and the same viral clade and sub-lineage identified in cases so far support that assessment. A few people diagnosed this year had recently travelled abroad — one to Spain and another to Belgium — while in two other cases international travellers arrived in South Africa already carrying the virus.

Background

Mpox was first identified in humans in 1970 and was mostly observed in central, east and west Africa, with the Democratic Republic of the Congo particularly affected. In 2022 the virus spread rapidly to multiple countries for the first time. Around 140 countries have reported mpox cases since 2022, with more than 190,000 laboratory-confirmed cases and more than 536 deaths to date, according to the World Health Organization's mpox dashboard cited by Spotlight.

South Africa's overall total remains low. Spotlight's calculation puts the total confirmed number since 2022 at 71. The NICD dashboard lists 66 cases and three deaths between 2024 and 2026, with no reported cases in 2023 and five cases identified in 2022.

The virus has two clades, clade I and clade II, with several sub-clades. This year's South African cases are a mix: of the 26 cases, 19 were sub-clade Ib, four were sub-clade IIb, and three had no sub-clade information available, according to the NICD dashboard. Sub-clade IIb drove the 2022 outbreak, while sub-clade Ib — first identified in the DRC in 2023 — spread internationally by 2024 and was first detected in South Africa in 2025. Weyer said there is currently no evidence of additional clades or sub-clades circulating in the country, and knowing the clade does not change how an individual illness is managed; it helps scientists track outbreaks and viral evolution.

Illustration: A map of South Africa highlighting the Western Cape, where most 2026 mpox cases were reported — an illustration, not an official case map.

Why It Matters

The vaccine arithmetic is the most pressing practical question. Last year, the Africa Centres for Disease Control and Prevention (Africa CDC) donated just over 10,000 doses of the MVA-BN vaccine — known by the brand names Imvanex and JYNNEOS — to South Africa's National Department of Health. Between September 2025 and September 2026, 2,365 doses were administered, health department spokesperson Foster Mohale told Spotlight.

There are currently 3,865 doses still available for use, expiring on 31 August 2027, according to Mohale. Spotlight notes that about 4,000 further doses are unaccounted for in the figures provided, and the department had not yet replied to its question about the remainder. When asked whether additional vaccines will be procured or donated, Mohale said the department is reviewing procurement options, dependent on recommendations from the Incident Management Team and the National Advisory Group on Immunisation.

Vaccine doses are distributed to provinces as required, depending on "disease outbreak and response", Mohale said. Vaccination is recommended for people at high risk of acquiring the virus and at risk of severe disease, and it can also be considered as post-exposure prophylaxis for people who have been in contact with someone who has mpox.

There is a complication: no mpox vaccine is currently registered in South Africa, nor are other treatment options, so any vaccine or treatment used must be supplied through a Section 21 request, which allows unregistered medicines to be brought in. Smallpox vaccines, caused by a closely related virus, can offer some protection, and three vaccines can be used against mpox — LC16m8, MVA-BN and ACAM2000, the last only registered for limited use in the United States.

For treatment, an antiviral called tecovirimat is occasionally used in severe cases. More than 40 containers of tecovirimat capsules remain available in South Africa, sourced through the WHO and Africa CDC's Access and Allocation Mechanism, Mohale said, though he did not say how many treatment courses are in a container. There are currently no plans to procure more, dependent on recommendations from the Incident Management Team and the National Essential Medicines List Committee. A 2025 national guideline suggests tecovirimat only for severe, hospitalised disease, because the drug has not been shown to make a significant difference in most cases — a phase 3 study published in the New England Journal of Medicine earlier this year found no evidence that it shortened time to clinical resolution, reduced pain or increased viral clearance among adults with clade II mpox.

What Happens Next

Three decisions will shape the next phase. First, the Incident Management Team and the National Advisory Group on Immunisation must advise whether South Africa should procure additional vaccine doses before the current stock runs down or expires in August 2027. Second, contact tracing and laboratory sequencing will determine whether the post-August cluster keeps growing or stabilises — and whether local transmission chains can be broken early. Third, public communication will matter: officials emphasise early diagnosis, appropriate clinical care, monitoring contacts, vaccinating eligible groups, and sharing accurate information without stigmatising affected individuals or communities.

Mpox is mainly spread through close contact with someone who has the virus, or through contact with material such as bedding or clothing that has touched an infected person. It can cause flu-like symptoms — headache, sore throat, fever and muscle aches — as well as a distinct and often painful rash that can appear on the palms, soles, face, mouth and throat, and sometimes the genital areas. The rash starts as a flat sore, becomes a blister, then dries, crusts and falls off. The incubation period is five to 21 days, usually seven to 14 days. A person is considered contagious until the rash has completely gone away and the scabs have healed, and diagnosed people are advised to self-isolate until then.

Diagnosis is normally made by swabbing lesions from the rash and testing with a PCR test that looks for the virus's DNA. While the overall case fatality for mpox is typically below 1 percent, people who are immunocompromised, pregnant women and children face a much higher risk of severe illness, complications and death. In most cases symptoms can be managed at home, with rash-related pain a particular challenge, while severe cases require hospitalisation.

For now, Weyer said, the central priorities remain the same regardless of which viral sub-clade is circulating: early diagnosis, appropriate clinical care, identifying and monitoring contacts, vaccination of eligible target groups, and communicating accurate information without stigma. People who develop an unexplained rash, particularly with fever, swollen lymph nodes or a history of possible exposure, should seek medical assessment, avoid close physical contact while awaiting guidance and testing, and know that mpox is preventable and that early care matters.

Illustration: A laboratory scientist examining samples for mpox testing — an illustration, not a photograph of a real laboratory or patient sample.

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FAQ

How many mpox cases has South Africa confirmed in 2026?

As of 27 October 2026, 26 cases had been confirmed, with 20 detected since August. Eighteen were in the Western Cape, three in Gauteng, two in the Eastern Cape, two in the Free State and one in KwaZulu-Natal. Seven people were hospitalised and no deaths were reported.

How much mpox vaccine does South Africa have left?

Of just over 10,000 MVA-BN doses donated by Africa CDC last year, 2,365 were administered between September 2025 and September 2026, and 3,865 doses remain, expiring on 31 August 2027. The health department is reviewing procurement options for additional doses.

Who is recommended to receive the mpox vaccine?

Vaccination is recommended for people at high risk of acquiring the virus and at risk of severe disease, and it can be considered as post-exposure prophylaxis for contacts of someone with mpox. Distribution to provinces depends on outbreak and response needs.

How is mpox spread and diagnosed?

Mpox spreads mainly through close contact with an infected person or with contaminated material such as bedding or clothing. Diagnosis is normally by PCR testing of swabs from rash lesions. The incubation period is usually seven to 14 days, within a range of five to 21 days.

What should someone do if they develop a possible mpox rash?

Seek medical assessment promptly, avoid close physical contact while awaiting guidance and testing, and self-isolate until the rash has completely gone and scabs have healed. Most cases can be managed at home, but severe cases require hospitalisation.

Sources

• Spotlight, "Donated mpox vaccine stock will be deployed as needed, says health dept as cases climb to 26", 2 November 2026
• National Institute for Communicable Diseases (NICD), mpox dashboard, via Spotlight, 30 October 2026
• World Health Organization, mpox dashboard, via Spotlight
• South Africa National Department of Health, mpox guideline document (2025), via Spotlight
• New England Journal of Medicine, phase 3 tecovirimat study, via Spotlight