Why the mpox outbreak in the Democratic Republic of Congo is worrying disease docs

The palms of a patient with mpox during an outbreak in the Democratic Republic of Congo in 1997. The country is now seeing a dramatic spike in mpox — with a strain that is deadlier than the one that sparked the global outbreak in 2022.CDC/BSIP/Universal Images Group via Getty Images

, the World Health Organization's technical lead and emergency manager for mpox."And we don't yet have all the countermeasures in place that we need in place."Last year, the DRC recorded more than 14,500 suspected cases of mpox, and more than 650 deaths. Those figures dwarf previous years – and the numbers continue to rise. In the first two months of this year, there have been more than 3,500 suspected mpox cases and more than 250 deaths.

The strain of the virus that's common in the DRC is called Clade I and it's 10 times more deadly than Clade II, which is found in West Africa and caused the global outbreak. And with Clade I, about two-thirds of the cases in the DRC are in children under the age of 15. With the number of cases and the number of children impacted, many experts worry about regional spread. Earlier this month, more than 40 mpox infections were reported on the other side of the Congo River in the

"This population is highly mobile," says Nachega, noting that when people move viruses move with them and Kamituga is not far from Rwanda, Burundi, Uganda and Tanzania."We are calling for urgent reinforcement." On top of all that, the specific strain circulating in the mining community has evolved, as viruses do. The part of the genome which the PCR test targets is not present in the current strain.

But the data about effectiveness comes from healthy adults in high-income settings. Earlier this month, the WHO's advisory group on immunizations grappled with how this data would apply to children and to adults who may be malnourished or face a different health profile than the one seen in high-income countries. The group ultimately recommended an off-label use in children, given the large number of kids affected by mpox in the DRC.

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