preprint · medRxiv
An outbreak investigation in the Kamituga mining region of the Democratic Republic of the Congo documented the rapid spread of a novel monkeypox virus lineage. Between October 2023 and January 2024, surveillance and hospital records identified 241 suspected cases, of which 108 were confirmed through molecular testing. Sexual contact served as a primary transmission route, with sex workers accounting for 29 per cent of confirmed cases. Genomic sequencing identified the pathogen as a distinct Clade Ib lineage, clearly separated from previously recorded Clade I strains in the country. The predominance of APOBEC3-type mutations points to sustained human-to-human transmission, with an estimated emergence around mid-September 2023. Containing this outbreak requires immediate intervention, including expanded surveillance, rigorous contact tracing, clinical management support, and targeted vaccination programmes.
Clade I monkeypox virus typically causes more severe disease and higher mortality than Clade II viruses. The emergence of a novel Clade Ib lineage capable of sustained human-to-human transmission, driven substantially by sexual networks, presents serious public health and pandemic risks. Identifying its transmission patterns and genetic markers is critical for directing immediate containment measures, updating diagnostic tests, and guiding targeted vaccination efforts.
This research is early-stage genomic and epidemiological intelligence rather than a commercial product. However, the sequence data directly enables diagnostic developers to validate and update molecular assays to ensure accurate detection of Clade Ib strains. It also provides essential evidence for vaccine manufacturers and public health procurement bodies seeking to prioritise targeted vaccination programmes, although deployment remains dependent on health agency coordination and public sector adoption.
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ABSTRACT Background Monkeypox virus (MPXV) attracted global attention in 2022 during a widespread outbreak linked primarily to sexual contact. Clade I MPXV is prevalent in Central Africa and characterized by severe disease and high mortality, while Clade II is confined to West Africa and associated with milder illness. A Clade IIb MPXV emerged in Nigeria in 2017, with protracted human-to-human transmission a forerunner of the global Clade II B.1 lineage outbreak in 2022. In October 2023, a large mpox outbreak emerged in the Kamituga mining region of the Democratic Republic of the Congo (DRC), of which we conducted an outbreak investigation. Methods Surveillance data and hospital records were collected between October 2023 and January 2024. Blood samples and skin/oropharyngeal swabs were obtained for molecular diagnosis at the National Institute of Biomedical Research, Kinshasa. MPXV genomes were sequenced and analyzed using Illumina NextSeq 2000 and bioinformatic tools. Results The Kamituga mpox outbreak spread rapidly, with 241 suspected cases reported within 5 months of the first reported case. Of 108 confirmed cases, 29% were sex workers, highlighting sexual contact as a key mode of infection. Genomic analysis revealed a distinct MPXV Clade Ib lineage, divergent from previously sequenced Clade I strains in DRC. Predominance of APOBEC3-type mutations and estimated time of emergence around mid-September 2023 suggest recent human-to-human transmission. Conclusions Urgent measures, including reinforced, expanded surveillance, contact tracing, case management support, and targeted vaccination are needed to contain this new pandemic-potential Clade Ib outbreak.
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DOI: 10.1101/2024.04.12.24305195
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