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On August 14, World Health Organization officials classified the ampox outbreak as a global health emergency. A new strain of the disease has spread beyond the Democratic Republic of Congo for the first time and into at least 12 other African countries.
MPOX is a viral infection commonly found in parts of Africa and spreads through contact with infected animals as well as within households. It causes severe fever, flu-like symptoms and pus-filled blisters all over the body. In 2022 the disease, formerly known as monkeypox, has spread worldwide – with cases reported everywhere from Nigeria to the US and Australia. A newly discovered strain of the virus, described by some researchers as the most dangerous to date, now threatens to spread beyond the Democratic Republic of Congo to neighbouring countries such as Rwanda, Burundi and Uganda.
Although much remains unknown about this strain, Jean Claude Udahemuka, a lecturer at the University of Rwanda who has been studying the outbreak, reports a case fatality rate of about 5% in adults and 10% in children. The virus exhibits different transmission patterns and disproportionately affects children. On 25 June the World Health Organization stressed the urgent need to tackle the surge of ampox cases in Africa.
The 2022 ampox outbreak was caused by a different and less severe form of the virus, a “clade II” variant. The new strain was first identified in April in the gold mining town of Kamituga in Congo’s South Kivu province. Researchers found that it was a new lineage of the virus, distinct from previously known ampox strains, which they termed “clade Ib”. The clade Ib strain has reportedly mutated to become more efficient at human-to-human transmission. This is raising concerns about its potential for widespread spread. ampox has been circulating in humans for many years, but it is also present in wild animals in several African countries and occasionally passes to humans, for example through the consumption of bushmeat.
Unlike the 2022 ampox outbreak, which was driven by male-to-male sexual contact, the new strain is spreading through heterosexual contact, particularly among sex workers, who account for about 30% of recorded cases. Researchers estimate the outbreak began in mid-September 2023. As of May 26, Congo has recorded 7,851 ampox cases and 384 deaths (though it is unclear how many are clade Ib infections, as there is likely more than one outbreak in the country).
The new strain in Congo appears to be behaving quite differently from other strains of ampox, and there are cases that are also spreading through close (non-sexual) contact. Dr Udahemuka has reported cases of household infection as well as an outbreak in a school. It is as common in women as men, and is reportedly causing miscarriages. With the strain found in towns near national borders, the risk of international spread appears to be high. The new strain has also been found in sex workers in Rwanda and Uganda, a group that is usually quite mobile. With the arrival of the dry season facilitating more migration, experts fear it is only a matter of time before the virus begins to emerge in neighbouring countries and then spread around the world through close contact at international airports.
In April, the Africa Centres for Disease Control and Prevention called for increased surveillance and contact-tracing efforts. Some experts suggest that it would be worthwhile to deploy the smallpox vaccine among high-risk groups such as sex workers and healthcare workers, as it has been known to provide cross-protection against ampox, a related virus, in the past. However, the effectiveness of the smallpox vaccine against this new strain is unknown. Trudy Lang, a professor of global-health research at the University of Oxford, suggests that although there are uncertainties, the vaccine is safe, easy to use and worth trying. An antiviral drug called tecovirimat is also undergoing trials, with results expected next year.
The situation in the region is complicated by war, displacement and food insecurity. Containment efforts are made even more difficult by the possibility of asymptomatic cases, where a person may not know they are infected but can still spread the virus to others. Dr. Lang emphasizes that this, along with the number of mild cases of infection, are the biggest unknowns in the current outbreak. Rapid and coordinated action is needed to prevent this new ampox strain from becoming another global health crisis.
© 2024, The Economist Newspaper Ltd. All rights reserved.
From The Economist, published under license. Original content can be found at www.economist.com.
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