On August 14, World Health Organization officials classified the Mpox outbreak as a global health emergency. A new strain of the disease has spread beyond the Democratic Republic of the Congo for the first time, to at least 12 other African countries.
Monkeypox (MPOX) is a viral infection usually found in parts of Africa and spread through contact with infected animals as well as within households. It causes high fever, flu-like symptoms, and a rash of pus-filled blisters all over the body. In 2022, the disease, formerly known as monkeypox, has spread across the world, with cases appearing everywhere from Nigeria to the United States and Australia. A newly discovered strain of the virus, described by some researchers as the most dangerous yet, now threatens to spread beyond the Democratic Republic of the Congo to neighboring countries such as Rwanda, Burundi, and Uganda.
While there is still much that is unknown about this strain, Jean Claude Udahemuka, a professor at the University of Rwanda who has been studying the outbreak, reports mortality rates of about 5% in adults and 10% in children. The virus exhibits different transmission patterns and disproportionately affects children. On June 25, the World Health Organization highlighted the urgent need to address the rise in mpox cases in Africa.
The 2022 mpox outbreak was caused by a different, less severe form of the “clade II” virus. The new strain was first identified in April in Kamituga, a gold mining town in Congo’s South Kivu province. Researchers found that it was a new lineage of the virus, distinct from previously known mpox strains, which they named “clade Ib.” The clade Ib strain has reportedly mutated to become more efficient at transmitting between humans. This is causing concern about its potential for wider spread. Mpox has been circulating in humans for many years, but it also exists in wild animals in several African countries and occasionally jumps to humans, for example through the consumption of bushmeat.
Unlike the 2022 mpox outbreak, which occurred through sexual contact between men, the new strain is spreading through heterosexual contact, particularly among sex workers, who account for about 30% of reported cases. Researchers estimate that the outbreak began around mid-September 2023. As of May 26, 7,851 mpox cases and 384 deaths have been reported in Congo (although it is unclear how many are clade Ib infections, as there is likely more than one ongoing outbreak in the country).
In the Congo, the new strain is behaving very differently to other mpox strains, with cases suggesting transmission is through close (non-sexual) contact. Dr Udahemuka reports cases of household transmission, as well as an outbreak at a school. It is also as common in women as in men, and is reported to cause miscarriages. The risk of international spread appears to be high, as the strain has been detected in towns close to national borders. The new strain has also been found in sex workers in Rwanda and Uganda, a group that is normally quite mobile. With the arrival of the dry season, facilitating increased migration, experts fear it is only a matter of time before the virus begins to emerge in neighbouring countries and then spreads around the world through close contact at international airports.
In April, the Africa Centres for Disease Control and Prevention called for surveillance and contact tracing efforts to be stepped up. Some experts suggest that it would be worthwhile to distribute the smallpox vaccine to high-risk groups such as sex workers and health care workers, as it is known to offer cross-protection against the related mpox virus. However, the efficacy of the smallpox vaccine against this new strain is unknown. Trudie Lang, a research professor in global health at the University of Oxford, suggests that although there are uncertainties, the vaccine is safe, easy to use and worth trying. Trials are also underway with an antiviral drug known as tecovirimat, with results expected next year.
The situation in the region is complicated by war, displacement, and food insecurity. Containment efforts are further complicated by the likelihood of asymptomatic cases, where people do not know they are infected but can transmit the virus to others. Dr. Lang emphasizes that this, along with the number of mild cases of the infection, are the biggest unknowns of the current outbreak. Preventing this new strain of mpox from becoming another global health crisis requires rapid and coordinated action.
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From The Economist, published under license. The original content can be found at www.economist.com
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