Can a deadly new mpox strain in Africa ignite another global outbreak?

A dangerous new strain of mpox, particularly lethal in children, is spreading rapidly in the Democratic Republic of Congo (DRC), prompting concerns among health experts and the World Health Organisation (WHO) about the potential for another global outbreak.

This new strain, a mutated form of the clade 1 mpox virus known as clade 1b, first emerged in September 2023 among sex workers in a DRC mining town. The virus, which was previously associated with animal contact, is now being transmitted through both sexual and non-sexual human contact, making it easier to spread and more dangerous.

How is this mpox outbreak different from others?

Mpox, formerly known as monkeypox, is a viral infection that causes symptoms like fever, chills, fatigue, and a characteristic pus-filled rash. The 2022 global outbreak, driven by clade 2b and largely transmitted among gay, bisexual, and other men who have sex with men, was brought under control through vaccination.

However, the current outbreak in the DRC involves clade 1b, which has a higher mortality rate of around 5 per cent in adults and 10 per cent in children, is causing an alarming number of miscarriages among pregnant women.

A child with mpox during the 2022 outbreak in the Democratic Republic of the Congo. File Image/Reuters

In a video call with journalists, John Claude Udahemuka, a lecturer at the University of Rwanda, described the variant as “undoubtedly the most dangerous of all the known strains of mpox, considering how it is transmitted, how it is spread, and the symptoms.”

Trudie Lang, professor of global health at Oxford University, stressed the need for urgent research to determine whether existing vaccines and treatments will be effective against this new strain.

What is the scope of the outbreak?

As of this year, nearly 8,000 mpox cases have been reported in the DRC, including 384 deaths, with children under 15 accounting for almost half of these fatalities. Last year saw more than 14,500 infections and 654 deaths in the country, the highest numbers ever reported and the highest among countries in the WHO’s African region.

The outbreak is particularly concerning in South Kivu province, near the borders with Rwanda, Burundi, and Uganda, where the virus has been detected in several cities, including Goma.

According to WHO, there have been nearly 8,000 mpox cases in DRC this year, which include 384 deaths, almost half of these deaths were children under 15. File Image/Reuters

The WHO has warned that the new strain represents “a renewed risk of cross-border and international spread, which may potentially lead to an increased risk of severe illness.”

The virus is spreading in schools, healthcare settings, and entire households, with reports of asymptomatic spread among people who are unaware they have the virus. The current case figures likely represent “the tip of the iceberg,” according to Lang, who highlighted that many non-severe cases might be hidden.

What is the risk of mpox spreading globally?

Experts are divided on the likelihood of another global mpox outbreak. Jake Dunning, an infectious disease physician and researcher, told Forbes that while another global outbreak is “possible,” it is “very hard to say” how likely one might be.

He stated the need for a good understanding of international movement and contact networks that could facilitate human-to-human transmission. Dunning noted that only some cases in the DRC appear to be spread through sexual contact but warned that it is possible for the virus to enter global sexual networks.

A doctor does his morning rounds, followed by nurses and trainee doctors at the Yakusu General Hospital, in Tshopo, Democratic Republic of Congo, October 5, 2022. File Image/Reuters

Lang highlighted the importance of monitoring vulnerable populations, such as pregnant women and young children, in Africa. She stated that there is not yet data to support a specific risk for men who have sex with men, though sex workers are at significant risk.

Lang also stressed the need for trials to determine whether current vaccines will protect against the new strain, a process that will take time.

What is being done to tackle the crisis?

The lack of access to vaccines and treatments in the DRC is a major concern. The WHO has pointed to limited public awareness, a lack of treatment kits, and the country’s numerous other health priorities as factors contributing to the outbreak.

Rosamund Lewis, the WHO’s technical lead for mpox, echoed the “critical need to address the recent surge in mpox cases in Africa.”

African researchers are calling for urgent action to improve research into the mpox virus and speed up the distribution of vaccines. The spread of the virus has been exacerbated by the ongoing rainy season, which has limited movement, but the dry season and upcoming school holidays could also see an increase in transmission.

A health worker prepares a dose of the mpox vaccine. File Image/AFP

Udahemuka urged countries to make preparations for the spread of the virus, stating, “Everyone should get prepared. Everyone should be able to detect the disease as early as possible. But more importantly, everyone should support the local research and local response so that it doesn’t spread.”

Also Read: What is monkeypox, how is it transmitted?

With the virus spreading through both sexual and non-sexual contact, and with a high mortality rate among children and pregnant women, the need for urgent action should be a top priority.

With inputs from agencies