A dangerous strain of mpox that kills children and causes miscarriages in the Democratic Republic of the Congo is the most transmissible yet and could spread internationally, scientists have warned.
The virus appears to spread from person to person through both sexual and non-sexual contact, in places ranging from brothels to schools.
Hundreds of people with the disease, formerly known as monkey pox, have attended the hospital in the mining town of Kamituga, South Kivu province, in what is likely to be the “tip of the iceberg” of a larger outbreak, doctors say.
Mpox is a virus from the same family as smallpox, and causes flu-like symptoms and pus-filled lesions.
Two years ago, an outbreak in Europe and the US centered on the gay community prompted the World Health Organization to declared a public health emergency. This was the first time mpox was spread through sexual contact.
This outbreak was caused by smudge II of the virus, one of three recognized groupings of mpox and one that is a relatively low death rate.
The new DRC outbreak is a mutated form of clade I mpox. Doctors report a death rate of about 5% in adults and 10% in children, as well as high rates of miscarriage among pregnant women.
Clade I has historically been found in humans eating infected bushmeat, with transmission largely limited to the affected household.
Researchers believe the current outbreak started in a bar used by sex workers. Trudie Lang, professor of global health research at Oxford University, told journalists at a briefing that when the DRC outbreak was detected last September, scientists assumed it would be clade II due to sexual transmission until genetic testing revealed has that to the more virulent strain.
It was an “incredibly worrying” situation, Lang said. While smallpox vaccines and treatments have helped bring the 2022 outbreak under control, they are not yet available in the DRC.
South Kivu is on the border with Burundi and Rwanda and close to Uganda, and there is frequent cross-border travel by local people.
Lang said it was unclear how many asymptomatic or mild cases there were, with the long incubation time of the virus increasing the risk of transmission before people realize they are sick.
John Claude Udahemuka, a lecturer at the University of Rwanda, who is involved in the medical response to mpox, said: “It is undoubtedly the most dangerous of all the known strains of mpox, considering how it is transmitted, how it spread, and also the symptoms.”
He said countries must make preparations for the spread of the virus. “Everyone must be prepared. Everyone should be able to detect the disease as early as possible. But more importantly, everyone needs to support the local research and local response so it doesn’t spread.”
