The Centers for Disease Control and Prevention (CDC) has issued a notice about a more infectious strain of mpox that has emerged in the Democratic Republic of the Congo (DRC).
As Reuters reported, the World Health Organization (WHO) is “very worried” about the spread of the strain, called clade I, which has killed nearly 600 people this year in the DRC. Clade I has not yet been detected in the United States, and the CDC has issued a level two advisory out of a possible four. This means that travelers are encouraged to “practice enhanced precautions,” like avoiding close contact with sick people, including those with skin or genital lesions, as well as clothing or bedding used by anyone with those symptoms. The CDC also recommends avoiding contact with live or dead wild animals, and eating and preparing meat from wild game.
DRC has reported 12,569 suspected mpox cases since January 1, with 581 deaths, according to the CDC. This represents a “substantial increase” over the median 3,767 suspected mpox cases in the country between 2016 and2021. According to Science, clade I has not previously been linked to sexual transmission, instead spreading mostly through contact with infected squirrels and other rodents. However, in this most recent outbreak, two studies from the CDC and the journal Emerging Infectious Diseases have identified two clusters among men who have sex with men and sex workers. Researchers note, though, that a lack of resources and stigma around mpox make it difficult to determine whether or not sexual transmission is a major driving factor behind the outbreak.
The mpox vaccine is not yet available in DRC outside of clinical trials. According to a report from Reuters, vaccines and mpox treatments have yet to be allowed into DRC because of “stigma, regulatory hurdles and competing disease outbreaks.” Oyewale Tomori, a Nigerian virologist, told Reuters that the DRC’s outbreak is “taking place in an environment hostile to homosexual activities. This is likely to hamper field investigations… and formulation of appropriate response and control measures.”
Mpox has been endemic to Central and West Africa for decades. Last year, however, there was an outbreak of mpox in countries where it is not normally detected. The virus was first detected in the U.S. in May 2022; cases were largely concentrated among men who have sex with men and their sexual networks, though transmission can occur through any close, non-sexual contact. Vaccines became available in the U.S. in late June 2022, and the WHO declared the outbreak a public health emergency of international concern in July 2022. In May of this year, the WHO stated that mpox was no longer a global public health emergency of international concern, as cases had fallen sharply.
Still, inequities persist in the treatment and prevention of mpox. Mpox has been largely non-fatal in the U.S., with 38 deaths linked to the virus from May 2022 to March 2023, per the CDC. However, a staggering 87% of mpox-related deaths in the U.S. from May 2022 to March 2023 occurred among Black patients and 24 of those deaths were in people with weakened immune systems due to advanced HIV. A March analysis from the Human Rights Campaign also found that only 11% of people who received at least one dose of the mpox vaccine in the U.S. are Black, despite making up a disproportionate number of cases. As with other public health concerns, these inequities are largely the result of structural barriers to care.
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