A dangerous monkeypox variant with a fatality rate as high as 10% is circulating in Central Africa and could possibly trigger new global outbreaks, researchers warned on Thursday, underlining the need for a truly global strategy to tackle the virus, curb its spread and prevent it from flaring into new outbreaks.
Monkeypox transmission in a remote part of the Democratic Republic of the Congo (DRC) is much higher than previously thought, researchers from the CDC, Kinshasa School of Public Health and the DRC’s Ministry of Public Health found after analyzing reports from 1,463 laboratory-confirmed cases between 2013 and 2017.
Outbreaks in the DRC, which are tied to a more severe strain of monkeypox virus than what is driving the global outbreak at the moment, have historically burnt themselves out because too few people are infected to keep transmission going.
The updated estimate from recent years suggests this could soon change and Dr. Kelly Charniga, one of the CDC researchers behind the report, warned transmission has been ”getting close to the point where it can cause large and sustained local outbreaks.”
The researchers also found evidence suggesting the monkeypox virus—which is believed to be harbored by rodents—is spilling over from animals into humans more frequently, which they said gives more opportunity for it to spread in a sustained way between people.
The uptick raises fresh concerns about monkeypox cases in African communities, the researchers said, which in turn increase the risks of new global outbreaks emerging.
Monkeypox is a relatively well-known entity, but until this year it has held a relatively low profile on the international stage and been ignored by much of the world. The virus—a close relative of variola, which causes smallpox—has caused sporadic outbreaks in parts of Central and Western Africa for decades and cases in Africa have been climbing in recent years, including the virus re-emerging in Nigeria after decades without a reported infection. Despite this, as well as warningsfrom experts that the world was vulnerable to monkeypox after smallpox vaccination was stopped following its eradication, monkeypox garnered little attention until it appeared in a number of countries where it is not normally found earlier this year. The outbreak, which almost exclusively spread among men who have sex with men, likely through sex itself, prompted the World Health Organization to declare a global health emergency and sparked global health and vaccination campaigns to smother transmission. The few shots and treatments used against monkeypox were, and still are, in very short supply and have largely gone to wealthy Western nations, primarily the U.S. The African communities that have struggled with monkeypox for years have received few vaccines and they continue to be overlooked.
The strain of monkeypox virus found in the DRC is not the same virus driving the global outbreak. The strain driving the outbreak, which can cause painful rashes but rarely kills, is descended from a strain of monkeypox found in West Africa known as “clade II (two)”. Clade II usually has a fatality rate of less than 3% and typically produces a milder form of the disease compared to clade I, the one found in the DRC. Clade I can have a fatality rate of up to 10% and is also more likely to lead to some of the severe complications associated with monkeypox like blindness.
Though global monkeypox cases are trending downwards, the virus is still causing trouble in parts of Africa. Surveillance is relatively poor and resources scarce, which hampers any effort to combat the virus and curb its spread. “The best way to prevent monkeypox from causing more outbreaks in DRC and from becoming a bigger global problem is to devote more attention to areas where it is clearly causing the most suffering today,” Charniga said.
77,573. That’s how many cases of monkeypox have been recorded in more than 100 locations around the world this year so far, according to CDC data. Fewer than 1,000 of these infections have been recorded in locations that have historically reported monkeypox. Thirty eight deaths have been linked to monkeypox, 13 of which were in locations that historically reported outbreaks. Cases, sickness and death from monkeypox likely go undocumented in parts of Africa.