#17,800
Just over 10 days ago the WHO Reported the 1st Confirmed Cluster Of Sexually Transmitted MPXV Clade 1 in the DRC. Clade 1 Mpox is considered far more dangerous than clade IIb, which is currently spreading outside of Africa.
After presenting the evidence, the WHO warned that `The risk of mpox further spreading to neighbouring countries and worldwide appears to be significant.' and that it poses `. . . an additional risk of mpox outbreaks with potentially more severe consequences than the one which has been affecting the world since 2022.'.
Last week, in CDC EID Journal: Clade I–Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo, we looked at dispatch from the team in the DRC that discovered these clusters. They wrote:
Population movement and previously unreported routes of transmission could exacerbate global distribution of MPXV, which could be compounded by the lack of routine diagnostic testing or inadequate access to rapid point-of-care testing. In view of this investigation, epidemiologic and genomic surveillance for MPXV, in both endemic and nonendemic regions, should be improved and strengthened.
While obviously a concern, so far we've not seen any evidence of clade I transmission outside of the endemic regions of central Africa. To be fair, however, clade IIb was probably circulating internationally long before surveillance first identified it in the UK in May of 2022.
Today the ECDC has published a Risk Assessment for the EU on the spread of Clade I Mpox outside of Africa, where the currently set the overall risk for MSM with multiple sexual partners stemming from this outbreak in the DRC is low. The overall risk for the general population is also assessed as low.
First, the ECDC news release, followed by the Executive Summary and a link to the full risk assessment.
ECDC assesses risk associated with ongoing mpox epidemic in the Democratic Republic of the Congo
News story
5 Dec 2023
An outbreak of mpox is ongoing in the Democratic Republic of the Congo (DRC), with 12 569 cases reported between 1 January and 12 November 2023. The vast majority of infections are caused by Monkeypox virus (MPXV) clade I, which is generally considered to be more virulent than MPXV clade II, which has been driving the multi-country epidemic of mpox in 2022-23.
Currently, there is no evidence that MPXV clade I is circulating outside certain central African countries and available MPXV sequences do not suggest circulation in the EU/EEA.
According to ECDC, the likelihood of infection for the general EU population from the ongoing epidemic of mpox due to MPXV clade I is very low, while the impact from such infection is assessed as low, resulting in an overall low risk.
The likelihood of infection with clade I virus for the population of men who have sex with men (MSM) with multiple sexual partners in the EU/EEA is considered higher than that of the general population. However, it is still estimated as low, as immunity in this population due to prior infection with MPXV Clade II and/or vaccination in 2022-23 will probably decrease both the likelihood and the impact of such an infection. Therefore, the overall risk for MSM with multiple sexual partners stemming from this outbreak in the DRC is low. The overall risk for the general population is also assessed as low.
Public health authorities should continue efforts to increase awareness among clinicians about mpox. Contact tracing, testing and sequencing of samples from detected mpox cases should continue, along with sharing the detected sequences. In the event of mpox cases with increased severity and/or the detection of a MPXV clade I infection, the event should be promptly communicated at the EU level via EpiPulse - an online portal for European public health authorities and partner organisations to share disease and viral sequence data.
Implications for the EU/EEA of the outbreak of mpox caused by Monkeypox virus clade I in the Democratic Republic of the Congo
Assessment
5 Dec 2023
An outbreak of mpox is ongoing in the Democratic Republic of the Congo (DRC), with 12 569 cases reported between 1 January and 12 November 2023.
Executive summary
Download
- The vast majority of infections are caused by Monkeypox virus (MPXV) clade I, which is generally considered to be more virulent than MPXV clade II.
- A cluster of mpox cases from March 2023 was recently documented as the first detection of sexually transmitted MPXV clade I infections. The presumed index case of this cluster is a European traveller who reportedly developed mpox soon after his arrival in DRC.
- Currently, there is no evidence that MPXV clade I is circulating outside certain central African countries and available MPXV sequences do not suggest circulation in the EU/EEA.
- The likelihood of infection from the ongoing epidemic mpox due to MPXV clade I is assessed as very low for the general EU population and the impact from such an infection is assessed as low. The overall risk is assessed as low.
- The overall risk for men who have sex with men (MSM) with multiple sexual partners in the EU/EEA from this outbreak in the DRC is low. Although the likelihood of infection with clade I virus for this population is considered higher than that of the general population, it is still estimated as low, as it is attenuated by the immunity in this population due to prior infection with MPXV clade II and/or vaccination in 2022-23. The impact from such infection is also estimated to be low, also influenced by increased immunity and availability of vaccines and therapeutics in the EU/EEA.
- Public health authorities should continue efforts to increase awareness among clinicians about mpox.
- Contact tracing, testing and sequencing of samples from detected mpox cases should continue, along with sharing the detected sequences. In the event of mpox case(s) with increased severity and/or the detection of a MPXV clade I infection, the event should be promptly communicated at the EU-level via EpiPulse.
Implications for the EU/EEA of the outbreak of mpox caused by Monkeypox virus clade I in the Democratic Republic of the Congo - EN - [PDF-383.79 KB]
The likelihood for further spread of the virus is very low due to the moderate transmissibility of the virus. However, infections among close contacts cannot be excluded, as demonstrated by the infections described above.
A perfectly reasonable assessment given the facts available at the time. But it does remind us that all risk assessments have a shelf life, and as the virus changes, so do the risks.
