Democratic Dangerous Mpox variant is spreading

Two years ago, more than 100 countries reported outbreaks of the infectious disease Mpox. The wave of the disease, once known as monkeypox, was ultimately mild.

But now a new variant is circulating. "It is without doubt the most dangerous of the known Mpox variants," said John Claude Udahemuka, lecturer at the University of Rwanda, at a recent information event.

Variant Ib (Roman 1b) spreads from person to person without sexual contact, causes more severe symptoms than other variants and is life-threatening for children, explained Udahemuka.

The virus variant is currently spreading in the Democratic Republic of the Congo. "Experts are alarmed because it is spreading uncontrollably in this remote region. It could also reach Europe," warns the World Health Organization (WHO). The disease used to be called monkeypox because it was first detected in monkeys in the 1950s.

For WHO Emergency Relief Coordinator Mike Ryan, the spread to Europe is not the biggest concern: rich countries showed during the Mpox outbreak in 2022 that they have the resources to contain the spread. "My biggest concern is that the disease will spread in populations that are affected by severe poverty, have little access to medical help and may have problems trusting authorities," said Ryan.

Disease worse with new variant

Infections with the so-called clade Ib cause a more severe rash all over the body and longer-lasting symptoms. Women suffer miscarriages and the disease is life-threatening for children, explained Leandre Murhula Masirika, research coordinator of the South Kivu health authority in Congo. He showed photos of women and children with pea-sized pustules all over their bodies, including on their heads. "We are very concerned about the outbreak," said WHO mpox expert Rosamund Lewis.

The WHO is running information campaigns in the border region with Rwanda, Burundi and Uganda to educate the population about the dangers.

Danger of spread - airport in Goma

The new variant has been spreading since September 2023 from the remote mining town of Kamituga in eastern Congo. In the meantime, cases have been reported from many places, including Goma, where there is an international airport. It is only a matter of time before the new variant spreads beyond the region, said Masirika.

Tip of the iceberg

It is not known how many Ib infections there have already been. Only severely ill people are visiting hospitals, said Trudie Lang, Professor of Global Health at Oxford University. "This is probably just the tip of the iceberg. It is possible that the incubation period is long, meaning that people can infect others without knowing it."

To date, Mpox has been transmitted either through contact with wild animals and their meat (clade I) or through sexual contact, especially between men who have sex with men (clade II). Although the new variant initially spread via sex workers, it is now spreading from person to person independently of such contact, said Udahemuka. In one school, for example, many children had become infected while playing with an infected person.

Smallpox vaccination gave herd immunity

Whether the vaccine against smallpox, which also protects against the previously known variants of Mpox, is effective against the new variant has not yet been researched, said Udahemuka.

Mpox cases in humans have been known since the 1970s, particularly in Central and West Africa. For a long time, vaccinations against smallpox resulted in herd immunity. Since smallpox was eradicated worldwide in 1980 and vaccination was discontinued, the number of Mpox cases has risen.

In 2022, outbreaks of clade IIb were reported in more than 100 countries, including Germany. In most countries, it was mainly men who have sex with men who were affected. Most had mild symptoms.

In biology, a "clade" refers to a closed community of descent that contains a common ancestor and all of its descendants.

Situation in Germany

According to the Robert Koch Institute (RKI), 3800 Mpox cases have been recorded in Germany so far, mostly in 2022. There were no deaths among them. Less than one percent of registered infections affected women, adolescents or children.

At the end of June, the RKI did not yet address the new variant in the Congo in an assessment of the situation. "The RKI currently assesses the risk to the health of the general population in Germany as low," it said.