In a recent notice, the Centers for Disease Control and Prevention (CDC) has raised concerns about a highly infectious strain of mpox that has surfaced in the Democratic Republic of the Congo (DRC). The World Health Organization (WHO) has expressed worry over the spread of this new strain, known as clade I, which has already claimed the lives of nearly 600 individuals in the DRC this year. While clade I has not been detected in the United States yet, the CDC has issued a level two advisory to travelers, urging them to exercise enhanced precautions.

According to the CDC, DRC has reported a significant increase in suspected mpox cases since the start of this year. With 12,569 suspected cases and 581 deaths recorded, these figures far surpass the median number of cases reported between 2016 and 2021. The spread of clade I, which typically transmits through contact with infected squirrels and rodents, has shown some unusual patterns. Recent studies from the CDC and the journal Emerging Infectious Diseases have identified clusters among men who have sex with men and sex workers. However, researchers highlight the challenges of determining if sexual transmission is a primary driver due to limited resources and the stigma surrounding mpox.

The mpox vaccine remains unavailable in the DRC, apart from clinical trials, as vaccines and treatments face hurdles in gaining approval and entry into the country due to stigma, regulatory barriers, and competing disease outbreaks. Oyewale Tomori, a Nigerian virologist, highlighted the hostile environment towards homosexual activities in the DRC, which could hamper field investigations and the formulation of appropriate response measures.

While mpox has been endemic to Central and West Africa for many years, there was an unprecedented outbreak in countries where it is not usually detected last year. The virus was first identified in the United States in May 2022, predominantly affecting men who have sex with men and their sexual networks, though transmission can occur through close non-sexual contact as well. Vaccines became available in the US in late June 2022, and the WHO declared the outbreak a public health emergency of international concern in July 2022. However, by May of this year, the WHO determined that mpox was no longer a global public health emergency, as cases had significantly declined.

Addressing the treatment and prevention of mpox, disparities persist. While mpox cases in the US have been primarily non-fatal, with the CDC recording 38 deaths from May 2022 to March 2023, disturbing trends emerge when considering the demographics. A staggering 87% of mpox-related deaths during this period occurred among Black patients, and of those deaths, 24 individuals had weakened immune systems due to advanced HIV. Additionally, a March analysis by the Human Rights Campaign revealed that only 11% of the US population receiving at least one dose of the mpox vaccine were Black, despite accounting for a disproportionate number of cases. These disparities can be attributed to structural barriers to care, highlighting the need for equitable access and healthcare provision.

As the global health community continues to grapple with the challenges posed by the mpox outbreak and the emergence of the more infectious clade I strain in the DRC, efforts must be intensified to ensure adequate resources, education, and access to vaccines and treatments for all populations at risk.