A team of Canadian and international scientists working on the ground in the Democratic Republic of the Congo (DRC) has identified a new lineage of the mpox virus that is linked to efficient human-to-human transmission. Urgent action is now being called for to prevent another global mpox outbreak.

The researchers began tracking a large mpox outbreak in the Kamituga mining region in DRC in October 2023. Within five months, over 240 suspected infections were identified, with approximately 100 confirmed cases. Interestingly, a third of the confirmed cases were among sex workers.

Mpox, previously known as monkeypox, first gained global attention in 2022 when it spread to numerous countries through sexual networks, primarily impacting men who have sex with men. Infections can cause painful lesions, sepsis, lung nodules, and even death in severe cases.

The recent genomic analysis of the Kamituga outbreak revealed a new and distinct clade Ib lineage of the mpox virus. These mutations are known to enhance efficient transmission between humans, leading the lead researcher, Dr. Placide Mbala-Kingebeni, to describe the finding as "alarming."

It is crucial to note that the research has not yet been peer-reviewed as it was published online this week as a pre-print. However, the researchers draw parallels between the ongoing situation in Kamituga and the 2017-2018 outbreak of clade IIb mpox in Nigeria, which preceded the unprecedented global spread of the disease.

Dr. Mbala-Kingebeni stated that the worldwide mpox spread in 2022 involved a less severe form of the virus. However, due to underreporting of cases, it remains difficult to determine the precise differences between each clade. The concern now lies in the possibility that this more virulent clade, adapted to human-to-human transmission, could silently spread and be sustained globally.

To contain this potential pandemic, the researchers emphasize the need for urgent measures including expanded surveillance, contact tracing, and targeted vaccination efforts. The Kamituga region, known for being densely populated and lacking healthcare infrastructure, heightens the risks of a large-scale outbreak. Additionally, the high mobility of the mining population makes the situation even more challenging, with a substantial risk of the outbreak spreading across borders.

Dr. Isaac Bogoch, a Toronto-based infectious diseases specialist not directly involved in the research, commends the team for identifying a genetic difference in the mpox virus samples from Kamituga. However, he urges caution in interpreting the results, as they do not conclusively prove higher transmissibility or the ability to evade existing treatments and vaccines.

Further research is needed to better understand the mpox virus, which has caused massive outbreaks in Africa and is circulating locally in Canada. In fact, more than 20 cases have been reported in Toronto alone this year. Dr. Bogoch also highlights the importance of a coordinated global response, as there is still no vaccine or therapeutic available to contain the spread of the virus.

With the ongoing mpox outbreak in DRC and the potential for a different lineage of the virus to jump internationally, there is an urgent need for heightened global awareness and preparedness to combat this infectious disease.

In Summary, a new lineage of the mpox virus capable of efficient human-to-human transmission has been identified in the DRC. Researchers are calling for immediate action to prevent another global outbreak. The Kamituga region's demographics and lack of healthcare infrastructure, combined with its status as a travel hub, increase the risk of the disease spreading beyond its current area and across borders. Further research is needed to fully understand the implications of this new lineage, and a coordinated global response is essential to combat the ongoing mpox outbreak.