In a concerning development, scientists have identified a new form of mpox in a mining town in eastern Congo, raising fears that the disease may now more easily spread among people. The ongoing mpox outbreak in Congo has become the country's largest and most challenging to contain, with over 4,500 suspected cases and nearly 300 deaths reported since January, according to the World Health Organization (WHO).

The new strain of mpox was discovered through an analysis of patients hospitalized between October and January in Kamituga, a town where individuals have limited contact with wild animals traditionally believed to carry the disease. Dr. Placide Mbala-Kingebeni, the lead researcher of the study from Congo's National Institute of Biomedical Research, stated that recent genetic mutations in the mpox virus indicate ongoing transmission within the human population, suggesting a new phase of the disease.

According to Dr. Mbala-Kingebeni, most patients with the new strain of mpox display milder lesions, primarily appearing on the genitals rather than the chest, hands, and feet as seen in previous outbreaks. Furthermore, the new form of the disease seems to have a lower death rate compared to previous strains. WHO has highlighted the need for a new testing strategy to effectively detect these mutations, especially considering that less than half of the people with mpox in Congo are currently tested.

The risk of a silent transmission of the disease is a considerable concern voiced by Dr. Mbala-Kingebeni. He emphasized that unless individuals affected by mpox come forward, the disease could continue to spread unnoticed. Sexual transmission is believed to be the primary mode of infection, with around a third of mpox cases found in sex workers. It was only during the 2022 global emergency that scientists established the link between mpox and sexual transmission, primarily among gay or bisexual men. In November, WHO confirmed sexual transmission of mpox in Congo for the first time.

Mpox, closely related to smallpox and endemic to central and west Africa, has two known clades. Clade 1 is more severe, causing up to 10% mortality in infected individuals, while Clade 2 triggered the current outbreak, with more than 99% survival rate among those infected. However, the new research conducted by Dr. Mbala-Kingebeni and his colleagues has identified a new form of Clade 1, responsible for over 240 cases and at least three deaths in Kamituga. This region, hosting a transient population traveling across Africa and beyond, poses an increased risk of spreading the disease.

Dr. Boghuma Titanji, an infectious diseases expert at Emory University, expressed concern over the newly identified mutations, suggesting that the virus may be adapting to facilitate more efficient human-to-human transmission, potentially leading to significant outbreaks. The lack of available vaccines and treatments in Congo has exacerbated the challenges in containing the epidemic. However, Congo's Ministry of Health has authorized the use of vaccines in high-risk provinces and is in discussions with donor countries, including Japan, to secure vaccine supplies.

Dr. Dimie Ogoina, an mpox expert at Niger Delta University, drew parallels between the significant spread among sex workers and the early stages of the HIV epidemic, highlighting the importance of combatting socio-cultural stigmas surrounding sexually transmitted infections to prevent further transmission. WHO's emergencies chief, Dr. Michael Ryan, noted the absence of substantial funding from donors despite the continued spread of mpox in Africa and other regions, underscoring the urgent need for financial support to address the crisis.

As the mpox outbreak in Congo enters a critical phase, health authorities face the challenge of controlling the new strain's spread. Improved testing strategies, widespread vaccination, and raising awareness and accessibility to healthcare services will be crucial in curbing the disease and preventing its silent transmission. International support and funding are imperative to combat this growing health emergency effectively.