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Research Project: Viral Ecology of Henipaviruses in Endemic Settings and Intervention Strategies to Prevent their Spread to Domestic Animals

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Title: Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo

Author
item Hensley, Lisa
item HASIVIRWE VAKANIAKI, EMMANUEL - Institute National Research Biomedical
item KACITA, CRIS - Ministry Of Public Health
item KINGANDA-LUSAMAKI, EDDY - Institute National Research Biomedical
item O'TOOLE, AINE - University Of Edinburgh
item WAWINA-BOKALANGA, TONY - Institute National Research Biomedical
item MUKADI-BAMULEKA, DANIEL - Institute National Research Biomedical
item AMURI-AZIZA, ADRIENNE - Institute National Research Biomedical
item MALYAMUNGU-BUBALA, NADINE - Kamituga General Hospital
item MWESHI-KUMBANA, FRANKLIN - Kamituga General Hospital
item MUTIMBWA-MAMBO, LEANDRE - Kamituga General Hospital
item BELESI-SIANGOLI, FREDDY - Provincial Health Division South Kivu
item MUJULA, YVES - Institute National Research Biomedical
item PARKER, EDYTH - Redeemer'S University
item MUSWAMBA-KAYEMBE, PAULINE-CHLOE - Institute National Research Biomedical
item NUNDU, SABIN - Institute National Research Biomedical
item LUSHIMA, ROBERT - Ministry Of Public Health
item MAKANGARA-CIGOLO, JEAN-CLAUDE - Institute National Research Biomedical
item MULOPO-MUKANYA, NOELLA - Institute National Research Biomedical
item PUKUTA-SIMBU, ELISABETH - Institute National Research Biomedical
item AKIL-BANDALI, PRINCE - Institute National Research Biomedical
item KAVUNGA, HUGO - Institute National Research Biomedical
item ABDRAMANE, OMBOTIMBE - Alliance For International Medical Action
item BROSIUS, ISABEL - Institute Of Tropical Medicine
item BANGWEN, EUGENE - Institute Of Tropical Medicine
item VERCAUTEREN, KOEN - Institute Of Tropical Medicine
item SAM-AGUDU, NADIA - University Of Cape Coast
item MILLS, EDWARD - McMaster University
item TSHIANI-MBAYA, OLIVER - Frederick National Laboratory For Cancer Research
item HOFF, NICOLE - University Of California (UCLA)
item RIMOIN, ANNE - University Of California (UCLA)
item KINDRACHUK, JASON - University Of Manitoba
item BAXTER, CHERYL - Stellenbosch University
item DE OLIVEIRA, TULIO - Stellenbosch University
item AYOUBA, AHIDJO - University Of Montpellier
item PEETERS, MARTINE - University Of Montpellier
item DELAPORTE, ERIC - University Of Montpellier
item SHUKA-MUNDEKE, STEVE - Institute National Research Biomedical
item MOHR, EMMA - University Of Wisconsin
item SULLIVAN, NANCY - Boston University
item MUYEMBE-TAMFUM, JEAN-JACQUES - Institute National Research Biomedical
item NACHEGA, JEAN - University Of Pittsburgh
item RAMBAUT, ANDREW - University Of Edinburgh
item LIESENBORGHS, LAURENS - Institute Of Tropical Medicine
item MBALA-KINGEBENI, PLACIDE - Institute National Research Biomedical

Submitted to: Nature Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/11/2024
Publication Date: 6/13/2024
Citation: Hensley, L.E., Hasivirwe Vakaniaki, E., Kacita, C., Kinganda-Lusamaki, E., O'Toole, A., Wawina-Bokalanga, T., Mukadi-Bamuleka, D., Amuri-Aziza, A., Malyamungu-Bubala, N., Mweshi-Kumbana, F., Mutimbwa-Mambo, L., Belesi-Siangoli, F., Mujula, Y., Parker, E., Muswamba-Kayembe, P., Nundu, S.S., Lushima, R.S., Makangara-Cigolo, J., Mulopo-Mukanya, N., Pukuta-Simbu, E., Akil-Bandali, P., Kavunga, H., Abdramane, O., Brosius, I., Bangwen, E., Vercauteren, K., Sam-Agudu, N.A., Mills, E.J., Tshiani-Mbaya, O., Hoff, N.A., Rimoin, A.W., Kindrachuk, J., Baxter, C., De Oliveira, T., Ayouba, A., Peeters, M., Delaporte, E., Shuka-Mundeke, S., Mohr, E.L., Sullivan, N.J., Muyembe-Tamfum, J., Nachega, J.B., Rambaut, A., Liesenborghs, L., Mbala-Kingebeni, P. 2024. Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo. Nature Medicine. 30:2791-2795. https://doi.org/10.1038/s41591-024-03130-3.
DOI: https://doi.org/10.1038/s41591-024-03130-3

Interpretive Summary: This paper describes MPOX sustained person to person transmission through close contact, including sexual contact. Previously Clad II had been reported to transmit sexually. This paper sounds the alarm that Clade I, which is often associated with more severe disease can be transmitted sexually.

Technical Abstract: Outbreaks of monkeypox (mpox) have historically resulted from zoonotic spillover of clade I monkeypox virus (MPXV) in Central Africa and clade II MPXV in West Africa. In 2022, subclade IIb caused a global epidemic linked to transmission through sexual contact. Here we describe the epidemiological and genomic features of an mpox outbreak in a mining region in eastern Democratic Republic of the Congo, caused by clade I MPXV. Surveillance data collected between September 2023 and January 2024 identified 241 suspected cases. Genomic analysis demonstrates a distinct clade I lineage divergent from previously circulating strains in the Democratic Republic of the Congo. Of the 108 polymerase chain reaction-confirmed mpox cases, the median age of individuals was 22'years, 51.9% were female and 29% were sex workers, suggesting a potential role for sexual transmission. The predominance of APOBEC3-type mutations and the estimated emergence time around mid-September 2023 imply recent sustained human-to-human transmission.