Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo.
Emmanuel Hasivirwe VakaniakiCris KacitaEddy Kinganda LusamakiÁine O'TooleTony Wawina-BokalangaDaniel MukadiAdrienne Amuri AzizaNadine Malyamungu-BubalaFranklin Mweshi-KumbanaLéandre Mutimbwa-MamboFreddy Belesi-SiangoliYves MujulaEdyth ParkerPauline-Chloé Muswamba-KayembeSabin S NunduRobert S LushimaJean-Claude Makangara-CigoloNoella Mulopo-MukanyaElisabeth Pukuta-SimbuPrince Akil-BandaliHugo KavungaOmbotimbe AbdramaneIsabel BrosiusEugene BangwenKoen O A VercauterenNadia Adjoa Sam-AguduEdward J MillsOlivier Tshiani-MbayaNicole A HoffAnne W RimoinLisa E HensleyJason KindrachukCheryl BaxterTulio de OliveiraAhidjo AyoubaMartine PeetersEric DelaporteSteve Ahuka-MundekeEmma L MohrNancy J SullivanJean-Jacques Muyembe-TamfumJean B NachegaAndrew RambautLaurens LiesenborghsPlacide Mbala-KingebeniPublished in: Nature medicine (2024)
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.