Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo.

Outbreaks of monkeypox (mpox) have historically resulted from zoonotic spillover of clade I monkeypox virus (MPXV) in Central Africa and clade II MPXV in West Africa. In 2022, subclade IIb caused a global epidemic linked to transmission through sexual contact. Here we describe the epidemiological and genomic features of an mpox outbreak in a mining region in eastern Democratic Republic of the Congo, caused by clade I MPXV. Surveillance data collected between September 2023 and January 2024 identified 241 suspected cases. Genomic analysis demonstrates a distinct clade I lineage divergent from previously circulating strains in the Democratic Republic of the Congo. Of the 108 polymerase chain reaction-confirmed mpox cases, the median age of individuals was 22 years, 51.9% were female and 29% were sex workers, suggesting a potential role for sexual transmission. The predominance of APOBEC3-type mutations and the estimated emergence time around mid-September 2023 imply recent sustained human-to-human transmission.

Vakaniaki EH ，Kacita C ，Kinganda-Lusamaki E ，O'Toole Á ，Wawina-Bokalanga T ，Mukadi-Bamuleka D ，Amuri-Aziza A ，Malyamungu-Bubala N ，Mweshi-Kumbana F ，Mutimbwa-Mambo L ，Belesi-Siangoli F ，Mujula Y ，Parker E ，Muswamba-Kayembe PC ，Nundu SS ，Lushima RS ，Makangara-Cigolo JC ，Mulopo-Mukanya N ，Pukuta-Simbu E ，Akil-Bandali P ，Kavunga H ，Abdramane O ，Brosius I ，Bangwen E ，Vercauteren K ，Sam-Agudu NA ，Mills EJ ，Tshiani-Mbaya O ，Hoff NA ，Rimoin AW ，Hensley LE ，Kindrachuk J ，Baxter C ，de Oliveira T ，Ayouba A ，Peeters M ，Delaporte E ，Ahuka-Mundeke S ，Mohr EL ，Sullivan NJ ，Muyembe-Tamfum JJ ，Nachega JB ，Rambaut A ，Liesenborghs L ，Mbala-Kingebeni P ... -  《-》

Clade I mpox virus genomic diversity in the Democratic Republic of the Congo, 2018-2024: Predominance of zoonotic transmission.

Recent reports raise concerns on the changing epidemiology of mpox in the Democratic Republic of the Congo (DRC). High-quality genomes were generated for 337 patients from 14/26 provinces to document whether the increase in number of cases is due to zoonotic spillover events or viral evolution, with enrichment of APOBEC3 mutations linked to human adaptation. Our study highlights two patterns of transmission contributing to the source of human cases. All new sequences from the eastern South Kivu province (n = 17; 4.8%) corresponded to the recently described clade Ib, associated with sexual contact and sustained human-to-human transmission. By contrast, all other genomes are clade Ia, which exhibits high genetic diversity with low numbers of APOBEC3 mutations compared with clade Ib, suggesting multiple zoonotic introductions. The presence of multiple clade I variants in urban areas highlights the need for coordinated international response efforts and more studies on the transmission and the reservoir of mpox.

Kinganda-Lusamaki E ，Amuri-Aziza A ，Fernandez-Nuñez N ，Makangara-Cigolo JC ，Pratt C ，Vakaniaki EH ，Hoff NA ，Luakanda-Ndelemo G ，Akil-Bandali P ，Nundu SS ，Mulopo-Mukanya N ，Ngimba M ，Modadra-Madakpa B ，Diavita R ，Paku-Tshambu P ，Pukuta-Simbu E ，Merritt S ，O'Toole Á ，Low N ，Nkuba-Ndaye A ，Kavunga-Membo H ，Shongo Lushima R ，Liesenborghs L ，Wawina-Bokalanga T ，Vercauteren K ，Mukadi-Bamuleka D ，Subissi L ，Muyembe-Tamfum JJ ，Kindrachuk J ，Ayouba A ，Rambaut A ，Delaporte E ，Tessema S ，D'Ortenzio E ，Rimoin AW ，Hensley LE ，Mbala-Kingebeni P ，Peeters M ，Ahuka-Mundeke S ... -  《-》

Monkeypox Outbreak in the Democratic Republic of Congo: A Comprehensive Review of Clinical Outcomes, Public Health Implications, and Security Measures.

The Monkeypox virus (MPXV), a member of the Orthopoxvirus genus, is responsible for the zoonotic disease known as MPX. Primarily found in western and central Africa, emerging studies indicate a shift in transmission dynamics. Ongoing MPX outbreaks in the Democratic Republic of Congo (DRC) have escalated into significant public health concerns. This review endeavors to provide a comprehensive analysis of the public health implications, clinical consequences, and preventive measures related to the current MPX outbreak in the DRC. It focuses on the epidemiology, clinical manifestations, and public health responses to this global health challenge. The research synthesizes data regarding MPX outbreaks in the DRC, drawing from academic journals, public health reports, and case studies through a narrative review approach. The recent outbreak in the DRC has identified approximately 12,569 suspected MPX cases, resulting in 581 fatalities, which corresponds to a case fatality rate (CFR) of 4.6%. These cases have been documented across 156 health sectors in 22 out of 26 provinces, representing the highest case count recorded to date. The epidemic has also encroached upon previously unaffected regions. Hospitalization rates have varied between 4% and 10%, with a significant percentage of cases attributed to sexual transmission. Analysis of demographic and geographic data revealed distinct patterns in viral spread. Clinical outcomes have varied, with an average CFR close to 10%, influenced by factors such as timely diagnosis and access to healthcare services. Rural areas have accounted for over 70% of the cases, highlighting the necessity for targeted public health interventions. Control measures have focused on community awareness campaigns and immunization programs, reaching approximately 50% of the at-risk population; however, challenges related to resource limitations and political instability have impeded effective response strategies. The ongoing MPX outbreak in the DRC poses a substantial public health challenge. While progress has been made in managing the epidemic, it remains imperative to address resource deficiencies and enhance public health systems. Strengthening international collaboration, expanding healthcare access, and improving surveillance capabilities are critical to mitigating the risk of future outbreaks.

Salomon I ，Hamitoglu AE ，Hertier U ，Belise MA ，Sandrine U ，Darius B ，Abdoulkarim MY ... -  《Immunity Inflammation and Disease》

A retrospective genomic characterisation of the 2022 mpox outbreak in Belgium, and in vitro assessment of three antiviral compounds.

Since the beginning of May 2022, cases of mpox have been reported in several European and American countries where the disease is nonendemic. We performed a retrospective genomic characterisation of the 2022 mpox outbreak in Belgium, and assessed the in vitro sensitivity of three antiviral compounds to a monkeypox virus (MPXV) strain from the 2022 outbreak. We sequenced the complete genomes of MPXV isolated from skin-, throat-, anorectal- and genital swab samples using the Oxford Nanopore Technologies (ONT) GridION. We subsequently analysed high-quality complete MPXV genomes and conducted a genomic analysis of MPXV complete genomes from this study with all other complete MPXV genomes available on GISAID up to October 28th, 2022. The in vitro activity of tecovirimat, brincidofovir, and cidofovir was also tested in human and monkey cell lines. We produced 248 complete MPXV genomes. Phylogenetic analysis of the complete MPXV genomes revealed that they all belong to MPXV Clade IIb B.1. Surprisingly, through phylogeographic analysis we identified a minimum number of 79 introduction events into Belgium, along with sustained local transmission. We also demonstrated the superior in vitro efficacy and selectivity of tecovirimat to the 2022 MPXV clinical strain. The number of sequences provides sufficient information about the MPXV lineages that were circulating in Belgium. The 2022 mpox outbreak, in Belgium, was mainly characterised by many introduction events that were promptly contained and resulted in limited human-to-human transmission of MPXV. The in vitro efficacy of antivirals against a 2022 MPXV Belgian strain highlights the potent activity and specificity of tecovirimat and its ability to prevent the formation of the extracellular enveloped viruses. None.

Wawina-Bokalanga T ，Vanmechelen B ，Logist AS ，Bloemen M ，Laenen L ，Bontems S ，Hayette MP ，Meex C ，Meuris C ，Orban C ，André E ，Snoeck R ，Baele G ，Hong SL ，Andrei G ，Maes P ... -  《EBioMedicine》

Mpox Clinical Presentation, Diagnostic Approaches, and Treatment Strategies: A Review.

Titanji BK ，Hazra A ，Zucker J 《-》