Mpox outbreak escalates in Central Africa amid complex infection patterns

Central Africa, August 22 2024 : Disease investigators are grappling with a burgeoning mpox outbreak  in Central Africa, where they are encountering a multifaceted landscape of infection. The Democratic Republic of Congo (DRC) presents a particularly complex scenario. In the country’s eastern gold-rich regions, a newly mutated strain of the virus is predominantly spreading among adults through sexual contact. Conversely, in other areas, an older strain is transmitted from wildlife to humans, notably affecting children involved in hunting and handling infected animals. Both strains are also impacting patients’ household members and health workers.

International Spread and Increased Vulnerabilities

The virus is traversing international transport routes into neighboring countries, exacerbating the situation. Reports indicate that sexual violence is contributing to increased transmission, particularly among displaced Congolese in overcrowded camps. The World Health Organization (WHO) has classified the outbreak as an international health emergency, underscoring the urgent need to understand and control transmission patterns.

Diagnostic Testing and Genomic Sequencing Shortfalls

Diagnostic testing and genomic sequencing in Central Africa are significantly inadequate, hampering efforts to track and understand the spread of mpox. Unlike the sophisticated genomic sequencing that mapped the Covid-19 spread, current capabilities in the region fall short. The WHO reports that mpox is transmitted through close physical contact, including transactional sex, and may spread to family members and healthcare workers.

Current Situation and Reporting Challenges

Since the beginning of the year, Africa has recorded approximately 19,000 mpox cases and nearly 550 deaths, with the majority of cases occurring in the DRC. The country alone accounted for nearly three-quarters of the continent’s 1,405 new cases in the past week, according to the Africa CDC. The true number of cases is likely higher due to under-reporting and limited testing. Confirmatory tests have only been conducted on about 17% of new cases in the DRC, with the remainder meeting the disease definition. The outbreak mainly involves the clade I strain, which is historically severe and native to the Congo. The Ia subvariant is particularly deadly, with about 85% of deaths occurring among children. The Ib subvariant, meanwhile, is spreading among adults. Experts note that this evolving virus is becoming more aggressive, a trend seen previously with diseases like Ebola and Covid-19.

Community Engagement and Preventive Measures

Effective communication with affected communities is crucial. Jean-Jacques Muyembe-Tamfum, a leading microbiologist in the DRC, emphasizes the importance of educating children to avoid consuming bushmeat and promoting hygiene and safe sexual practices to curb transmission. Unlike the milder clade IIb strain that emerged in 2022, the current strains are spreading through various forms of sexual activity and close contact. Leveraging lessons learned from past epidemics will be critical in managing the current outbreak.

With the outbreak evolving rapidly, there is a pressing need to bolster diagnostic capabilities and enhance community engagement to control the spread of mpox in Central Africa. The international community’s support and improved response strategies are essential to addressing this escalating health crisis.