Congo grapples with its most significant mpox outbreak yet, as scientists warn of a potentially more transmissible strain detected in a mining town.
A New Chapter in the Monkeypox Saga
Since January, Congo has seen over 4,500 suspected mpox cases and nearly 300 fatalities, marking a threefold increase from the same period last year, reports the World Health Organization. Recently, Congo declared a nationwide health emergency in response to the outbreak.
Analysis of patients hospitalized between October and January in Kamituga, eastern Congo, indicates recent genetic mutations in mpox likely stem from sustained human-to-human transmission. This phenomenon is occurring in an area where residents have limited contact with the wild animals traditionally associated with the disease’s natural reservoir.
“We’re witnessing a new stage of mpox,” stated Dr. Placide Mbala-Kingebeni, the study’s lead researcher, noting that the findings will soon undergo publication review. Dr. Mbala-Kingebeni heads a laboratory at Congo’s National Institute of Biomedical Research dedicated to studying disease genetics.
Concerns Arise Over Genetic Mutations
Dr. Mbala-Kingebeni noted that most patients now report milder lesions primarily on their genitals, posing challenges in diagnosis. Unlike previous African outbreaks where lesions typically appeared on the chest, hands, and feet, this shift complicates identification. Moreover, the new variant appears to have a lower mortality rate.
In its recent assessment of the global mpox landscape, the WHO highlighted the potential necessity for revised testing strategies to detect these mutations.
With less than half of mpox cases in Congo undergoing testing, experts emphasize the risk of silent transmission unless patients actively seek diagnosis. Dr. Mbala-Kingebeni warned, “Without proactive patient reporting, the disease could spread unnoticed.”
He further highlighted that most transmissions occur through sexual contact, with approximately a third of mpox cases involving sex workers. It wasn’t until the 2022 global mpox emergency that scientists confirmed sexual transmission, primarily among gay or bisexual men. In November, the WHO officially acknowledged sexual transmission of mpox in Congo for the first time.
Challenges in Vaccination Efforts in Congo
There are two distinct clades, or genetic variants, of mpox, a virus related to smallpox and prevalent in central and west Africa. Clade 1 tends to be more severe, resulting in fatalities for up to 10% of those infected, while Clade 2, responsible for the 2022 outbreak, has a survival rate exceeding 99%.
Dr. Mbala-Kingebeni and collaborators have identified a novel strain of Clade 1, potentially linked to over 240 cases and at least three fatalities in Kamituga. This area hosts a sizable transient population with frequent travel within Africa and beyond.
Dr. Boghuma Titanji, an infectious diseases specialist at Emory University unaffiliated with the study, expressed concern over the new mutations.
“These findings suggest the virus is adapting to facilitate human-to-human transmission and could lead to significant outbreaks,” she cautioned.
Resonances of HIV Concerns
While the mpox outbreaks in the Western world were managed through vaccines and treatments, such resources have been scarce in Congo. Cris Kacita Osako, coordinator of Congo’s Monkeypox Response Committee, mentioned that the Minister of Health has sanctioned vaccine usage in high-risk provinces. Efforts are underway to secure vaccine supplies through discussions with donor nations like Japan.
“Once an adequate supply of vaccines is secured… vaccination will be incorporated into the response efforts,” stated Kacita Osako.
Dr. Dimie Ogoina, an mpox specialist at Niger Delta University, emphasized that the recent research evokes unsettling parallels with a previous, albeit distinct, outbreak.
“The notable transmission among sex workers brings to mind the early stages of the HIV epidemic,” he remarked, highlighting concerns regarding stigma associated with treating sexually transmitted infections and the hesitancy of mpox-infected individuals to seek medical attention.
Dr. Michael Ryan, WHO’s Head of Emergencies, noted last week that despite the ongoing spread of mpox in Africa and beyond, there has been a lack of significant donor investment.
