This year, it is believed that 120 people have died from monkey pox in Congo. The harmful Clade I strain is probably the cause. Experts fear it will follow in the footsteps of the milder Clade II strain and spread around the world.
The monkeypox virus, which spread around the world this year, has already appeared in more than 100 countries. The new outbreak is the first that has also resulted in deaths outside Africa, where the disease has been prevalent for some time. The official death toll stands at 26, according to the World Health Organization WHO, but deaths in countries where few testing labs are available are not included.
African infections
According to the counts of affected countries themselves, the Democratic Republic of Congo is the worst affected by the misery. From January 1 to September 21, 2022, that country reported 120 deaths. According to the WHO, all victims in Congo probably died from the Clade I strain of monkeypox virus, previously known as the Congo Basin strain. The milder Clade II strain, formerly known as the West African strain, started spreading around the world earlier this year. Clade I has a mortality rate of 10.6 percent, while Clade II leads to death in 3.6 percent of cases.
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The Clade I strain has only appeared once before in a country where the virus had never occurred before: in 2005 it appeared in South Sudan. But the longer this variant circulates in Congo, the greater the risk that this virus strain will also spread around the world. “It’s certainly possible, given the ease with which we travel around the world,” says immunologist Stuart Isaacs, of the University of Pennsylvania.
The virus reproduces itself as it spreads, with mutations occurring. “The monkeypox virus can continue to mutate and is therefore better able to infect other people,” said epidemiologist Anne Rimoin of the University of California at Los Angeles.
Vaccination against the virus
It is unclear whether the high death toll in Congo is due to the high death rate of the Clade I tribe, or to the African country’s lack of health care compared to the rest of the continent. So says epidemiologist Andrea McCollum of the Centers for Disease Control and Prevention (CDC) in the United States. According to the WHO, Congo has not received any monkeypox vaccine this year, other than doses intended for clinical testing. The same goes for other African countries.
In Europe, the Jynneos vaccine (also known as Imvanex and Imvamune) is approved against monkeypox and common smallpox in people aged 18 years and older. 70,000 vaccines have been made available in the Netherlands.
The government of Congo is trying to contain the virus outbreak by locating and isolating infected people. However, according to virologist Mario Stevenson of the University of Miami in Florida, this is not enough to stop the disease.
Distribution
While everything points to Congo as the epicenter of a particularly serious monkeypox outbreak, the true burden of the virus in that country is still unclear. “We don’t have the capacity to patrol everywhere,” says Rimoin. ‘Certainly in the remote areas of Congo, where most infections take place, we cannot conduct laboratory tests.’
In May, the WHO announced that the worldwide outbreak mainly affects men who have sex with men. ‘It is currently unclear what part of the distribution in Africa [inclusief Congo] occurs among men who have sex with men,” says McCollum. The stigmatization of homosexuality in many of the affected countries in Africa, such as Congo, makes it difficult to map the spread of the virus, she adds.
The cause of the worldwide spread of the Clade II strain earlier this year has not yet been elucidated. According to Stevenson, this could be due to the mutations of the virus that make it easier to spread, but it could just as well be bad luck.
“We do know that monkeypox is a big problem in Congo, and we’re only putting ourselves at risk if we keep ignoring it,” Rimoin said. ‘I think we have short-term memory worldwide. We have to remind ourselves that an infection in one place has the potential to become an infection on a global scale.”