Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo

Nat Med. 2024 Oct;30(10):2791-2795. doi: 10.1038/s41591-024-03130-3. Epub 2024 Jun 13.

Abstract

Outbreaks of monkeypox (mpox) have historically resulted from zoonotic spillover of clade I monkeypox virus (MPXV) in Central Africa and clade II MPXV in West Africa. In 2022, subclade IIb caused a global epidemic linked to transmission through sexual contact. Here we describe the epidemiological and genomic features of an mpox outbreak in a mining region in eastern Democratic Republic of the Congo, caused by clade I MPXV. Surveillance data collected between September 2023 and January 2024 identified 241 suspected cases. Genomic analysis demonstrates a distinct clade I lineage divergent from previously circulating strains in the Democratic Republic of the Congo. Of the 108 polymerase chain reaction-confirmed mpox cases, the median age of individuals was 22 years, 51.9% were female and 29% were sex workers, suggesting a potential role for sexual transmission. The predominance of APOBEC3-type mutations and the estimated emergence time around mid-September 2023 imply recent sustained human-to-human transmission.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Democratic Republic of the Congo / epidemiology
  • Disease Outbreaks*
  • Female
  • Genome, Viral / genetics
  • Humans
  • Male
  • Middle Aged
  • Monkeypox virus* / genetics
  • Mpox, Monkeypox* / epidemiology
  • Mpox, Monkeypox* / transmission
  • Mpox, Monkeypox* / virology
  • Mutation
  • Phylogeny*
  • Young Adult