Clade Ib mpox is more virulent and better adapted for human-to-human transmission, allowing it to spread silently between individuals
Published Jul 09, 2024 • 4 minute read
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The different stages of a monkeypox skin lesion.Photo by United Kingdom Health Security Agency
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The discovery of a new mpox strain amid a rise in cases in the Democratic Republic of the Congo (DRC) has raised concerns about its potential to spread internationally and spark global outbreaks.
Mpox is a disease resulting from infection with the mpox virus. It was previously known as monkeypox, but the World Health Organization (WHO) changed its name after an outbreak in 2022 that spread to Europe, Canada and the United States. Characterized by a distinctive rash, this viral infection was first identified in humans in 1970 in the DRC. As of Sept. 29, 2023, Canada hasreported a total of 1,515 mpox cases. Here’s what you need to know about this new strain of mpox.
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There are two types of the mpox virus: Clade I and Clade II. Clade I, which is endemic to Central Africa, leads to more severe illness, including death, when compared to Clade II. Clade II, found mainly in West Africa, triggered the global outbreak starting in 2022. This variant is milder in its impact.
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Canadian researchers identified Clade Ib in the DRC in October 2023 and have been tracking the mpox outbreak. Clade Ib, a variant of Clade I, is currently spreading in the DRC and is causing concerns due to its ability to spread more easily among humans.
Where did Clade Ib come from?
According to other researchers, starting from September 2023, cases of Clade Ib mpox initially appeared among sex workers in Kamituga, DRC. Clade Ib mpox has now reached towns near the Rwanda border, near Burundi, and Uganda.
What makes it different from earlier mpox strains?
Previous mpox strains have limited transmission. Dr. Austin Zygmunt, a public health physician with Public Health Ontario said Clade I is “normally transmitted from animals to humans, and through close contact between humans.”
Clade II which spread globally in 2022, is primarily sexually transmitted, mostly affecting men who have sex with men.
Researchers report that in 2023, the Clade Ib strain initially spread through sexual transmission in the local sex work industry in DRC. However, it later spread within households from mothers to children, eventually reaching people outside households without sexual contact. Researchers believe it is more easily transmitted, making it potentially more dangerous.
What are the symptoms?
According to the WHO, mpox symptoms typically start within a week but can appear anywhere from one to 21 days after exposure. Common symptoms include a rash, fever, sore throat, head and muscle aches, back pain, low energy and swollen lymph nodes. A rash is a common first symptom, however, others may experience different symptoms first. These symptoms can last from two to four weeks. The rash develops into a painful pustule (lesions filled with yellowish fluid) and as it heals, lesions form scabs that fall off.
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Why is there concern?
Concern for a possible international spread continues due to the virus’s high transmissibility. Dr. Placide Mbala-Kingebeni, lead researcher of the Kamituga outbreak,shared with CBC News that this clade is more virulent and better adapted for human-to-human transmission, allowing it to spread silently between individuals and potentially sustain itself globally.
Leandre Murhula Masirika, research coordinator at the local DRC health department,stated in a briefing that over 600 cases have been identified so far, and those are only severe cases that have made it to the hospital.
What can be done to prevent spread?
The WHO reports that the DRC’s ministry of public health, hygiene and prevention created a budgeted national plan for mpox preparedness and response. They established an emergency operations center and incident management team in February 2023.
WHO advises, “All countries, including their health authorities and clinicians/health-care workers, should take note that the global mpox outbreak is ongoing; and, furthermore, the occurrence of sexual transmission of the Clade I virus has been confirmed. Infection with Clade I MPXV may lead to an increased risk of severe illness.”
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Though Clade I mpox has not been reported outside Africa, Zygmunt noted that there has been an increase in Clade II mpox cases in Ontario. He emphasized that those at risk should get vaccinated and stay alert for signs and symptoms to help prevent the spread of mpox.
Individuals can check with local public health units or sexual health clinics in Canadian cities or provinces to determine their eligibility for the vaccine. Most provinces offer the vaccine to three main groups of people who are typically at higher risk: men who have sex with men, individuals who identify as a sex worker, regardless of their sex or gender, and individuals who work at a “sex on premises” venue.
To prevent the spread of mpox, individuals should discuss sexual health with their partners and monitor for symptoms. If someone notices lesions or other symptoms, they should cover the lesions with clothing or a bandage, avoid close contact with others, and seek medical care from their physician.
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