Sexual transmission of clade I mpox virus in DR Congo raises alarm bells

There has been a two-fold increase in the number of suspected mpox cases reported in the Democratic Republic of Congo (DRC) so far this year as compared to 2020, which marked the year for the most reports of the virus, WHO has said.

Just as worrisome, DRC has been the first country globally to see confirmed reports of sexual transmission of clade 1 of the virus, which is known to be the most deadly with fatality rates as high as 10%. And the circle of mpox transmission more generally has expanded significantly, to include cases as far west as the capital Kinshasa and south Kivu in the eastern part of the country.

From 1 January to 12 DRC reported 12 569 suspected mpox cases, as compared to 6216 in 2020, the highest annual number previously reported.

“The reasons for this expansion, affecting men, women and children, remain unknown,” stated the WHO Disease Outbreak News.

Eleven of the 26 provinces of the Democratic Republic of the Congo are endemic for mpox, but in recent years the number of provinces reporting mpox has been expanding, to 22 provinces as of November 2023, WHO stated.

Sexual transmission now reported in DRC of deadlier clade 1

Since 2022, an epidemic of the milder clade II of mpox has been ongoing globally, affecting many countries outside of Africa that had never reported mpox previously. “The spread of this epidemic was mainly driven by transmission via sexual contact among men who have sex with men,” WHO noted.

The first-ever globally confirmed case of sexual transmission of clade 1 was reported in March. It involved a Belgium resident who tested positive for the virus during a visit to the DRC, where he had also had multiple sexual contacts at men’s clubs and elsewhere.

“Thereafter, sexual contacts of this case in the Democratic Republic of the Congo also tested positive for clade I MPXV [severe mpox infection], with closely related viral sequences. This is the first time that reported clade I MPXV infection is linked to sexual transmission within a cluster. Another outbreak in the country is also being reported with multiple cases of mpox among sex workers,” stated WHO.

In July, another case was reported in Kenge [Kwango province], involving a man who had sex with men – and with apparently no links to the first cluster. Then in August, local transmission of the first severe mpox (MPXV) cases were confirmed in Kinshasa for the first time. Since then, some 102 suspected cases have been reported, two-thirds among men, and with a fatality rate for confirmed cases of 5.6%.

As of 22 November 2023, a total of 80 suspected and 34 confirmed cases of mpox (including 20 sex workers) of mpox have been reported in South Kivu – with no deaths. “Currently South Kivu province is grappling with conflict, displacement, food insecurity, and challenges in providing adequate humanitarian assistance, all of which have a profound impact on the local population, especially vulnerable groups, and might represent fertile ground for further spread of mpox.”

Read the full story at Heath Policy Watch.