At the end of last year, I reported that the Centers for Disease Control and Prevention (CDC) warned that a more infectious mpox (i.e., the rebranded monkeypox) virus strain had been found in the Democratic Republic of the Congo (DRC). It was spreading, and had a higher infection fatality rate than previous strains of the virus that had spread during 2022’s “Monkeypox Emergency“.

Now the World Health Organization is also sounding the alarm about the DRC mpox outbreak.

The still emerging outbreak of mpox had been on the rise since December 2023, with over 4,000 cases, 27 deaths, and the highest fatality rate in the world. More than 65 percent of suspected cases and around 85 percent of suspected deaths in the country were among children under 15 years of age. Youngest children were most susceptible to death.

A threat of mpox spreading to neighbouring countries was growing, and the outbreak was growing among sex workers and men having sex with men.

…Dr. Rosamund Lewis, Technical Lead for mpox at the World Health Organization (WHO), emphasized that the expanding geography of mpox, high fatality rate, and increasing sexual transmission of the virus were all reasons of concern. WHO continued to monitor and respond to the global outbreak, as close to 30 countries had reported cases in February 2024. WHO was working closely with the DRC authorities on case prevention, control, and treatment.

The new mpox strain has now spread through the DRC’s neighbor, the Republic of Congo.

The Republic of Congo has recorded its first cases of mpox in several regions, the health ministry said, an indication of how the disease may be spreading across Africa since sexual transmission was first confirmed on the continent last year.

…The World Health Organization said in November it had confirmed sexual transmission of mpox in neighboring Congo for the first time. African scientists warned this could make the disease difficult to contain.

The Republic of Congo’s health ministry published its report on Wednesday. The report said some 43 cases had been reported to the ministry, including in nine out of the country’s 12 departments. The government has not issued any further comment on the publication, which was not officially distributed to the media and appears to have been intended for internal use.

It is also being reported that the mpox tests being used to diagnose an infection are not reliable for the new strain.

As of November 12, 12,569 suspected cases of the primarily sexually transmitted infection had been reported, with an estimated case-fatality rate of 4.6% and cases diagnosed in DRC regions without a history of mpox, such as South Kivu and Kinshasa.

Of the 10 study patients, nearly complete mpox genomic sequences were available for 6. All were categorized as clade 1 but were a distinct substrain from all other clade 1 sequences, which the authors said suggests that the South Kivu outbreak resulted from a separate viral introduction, probably of animal origin. The six sequences had several mutations, pointing to ongoing circulation over some time.

A check to determine whether commonly used mpox polymerase chain reaction (PCR) tests could detect the mutated sequences showed that while the generic primers and probe maintained their function, the specific clade 1 PCR target gene was absent.

“Due to the deletion, the rapid US CDC [Centers for Disease Control and Prevention] method to identify Clade I in newly diagnosed mpox cases is most likely not reliable for detection of the novel sub-lineage identified in the current study,” the researchers wrote.

Now, the CDC is issuing alerts directed at people who have recently visited the DRC:

There is an #mpox outbreak in the DRC. If you were in the DRC within the last 21 days and you have a rash or lesions, seek medical care immediately and avoid contact with others. Know the symptoms of mpox:  https://t.co/VpoWvVLzBc

— CDC Emerging Infections (@CDC_NCEZID) March 19, 2024

It is interesting to note that Volunteers in the United Kingdom are now being sought to test a new mRNA vaccine for monkeypox.

The vaccine trial – from the National Institute for Health and Care Research (NIHR) and pharmaceutical firm Moderna – will see whether the jab can offer good protection in people who have not been previously infected.

…Scientists now hope to offer another choice in the form of an mRNA jab for mpox and smallpox.

Volunteers in the mPower Trial will be randomly selected to receive one of three dose levels of the vaccine, or a placebo.

The trial is recruiting people from sites across the UK and will be led by the University Hospitals Bristol and Weston NHS Foundation Trust.

Dr Rajeka Lazarus, national co-ordinating investigator for the new study, said: “Mpox is a global public health threat and more vaccines are urgently needed to prevent future outbreaks.

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