KINSHASA, Congo – Congo is struggling to contain its largest mpox outbreak, and scientists say a new form of the disease detected in a mining town could spread more easily between people.
Since January, Congo has reported more than 4,500 suspected cases of mpox and nearly 300 deaths, numbers that have nearly tripled from the same period last year, according to the World Health Organization. Congo recently declared the country-wide outbreak an emergency sanitary.
An analysis of patients hospitalized between October and January in Kamituga, eastern Congo, suggests that recent genetic mutations in mpox are the result of its ongoing transmission in humans; This is happening in a city where people have little contact with the wild animals believed to naturally transmit the disease.
“We are in a new phase of mpox,” said Dr. Placide Mbala-Kingebeni, the study’s principal investigator, who said it will soon be submitted to a journal for publication. Mbala-Kingebeni runs a laboratory at Congo’s National Institute for Biomedical Research that studies the genetics of disease.
The lesions reported by most patients are milder and occur on the genitals, Mbala-Kingebeni said, making diagnosis of the disease more difficult. In previous outbreaks in Africa, lesions were seen mainly on the chest, hands and feet. He also said the new form appears to have a lower mortality rate.
In a report on the global mpox situation this week, the WHO said the new version of the disease may require a new testing strategy to detect mutations.
With experts pointing out that less than half of people in Congo with mpox are tested, Mbala-Kingebeni said: “The risk is that unless patients come forward themselves, we will have silent transmission of the disease and no one will know.”
Mbala-Kingebeni said most people were infected through sex, with about a third of mpox cases found in sex workers. It was only in the global emergence of mpox in 2022 that scientists established that the disease was spread through sex, with the majority of cases in gay or bisexual men. In November, the WHO confirmed sexual transmission of mpox in Congo for the first time.
There are two types, or clades, of mpox, which is related to smallpox and is endemic to Central and West Africa. Clade 1 is more serious and can kill up to 10% of infected people. Clade 2 triggered the 2022 outbreak; More than 99% of infected people survived.
Mbala-Kingebeni and colleagues said they have identified a new form of clade 1 that may be responsible for more than 240 cases and at least three deaths in Kamituga, a region with a significant transient population that travels to other parts of Africa and beyond.
Boghuma Titanji, an infectious disease expert at Emory University who is not associated with the research, said the new mutations are concerning.
“This suggests that the virus is adapting to spread efficiently in humans and could cause some pretty consequential outbreaks,” she said.
While mpox epidemics in the West have been contained with the help of vaccines and treatments, almost none have been available in the Congo. Congo’s health minister has authorized the use of vaccines in high-risk provinces, said Cris Kacita Osako, coordinator of Congo’s Monkeypox Response Committee. He said authorities are in talks with donor countries such as Japan to help buy the shots.
“As soon as a sufficient quantity of vaccines is available… vaccination will be implemented as part of the response,” said Kacita Osako.
Dimie Ogoina, an mpox expert at the University of the Niger Delta, said the new investigation is a disturbing reminder of an earlier but different outbreak.
“The notable spread among sex workers is reminiscent of the early stages of HIV,” he said, explaining that prejudices associated with the treatment of sexually transmitted infections and the reluctance of people with mpox to come forward were concerning.
WHO emergencies chief Dr. Michael Ryan said last week that despite the continued spread of mpox in Africa and elsewhere, “there has not been a single donor dollar invested.”
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Cheng reported from London. Mark Banchereau in Dakar, Senegal, contributed to this report.
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