This year’s global outbreak of monkeypox has seen cases in more than 100 countries, and deaths have occurred outside of the virus’ countries in West and Central Africa for the first time.
for the outbreak as of 7 October stands at 26, but this excludes large numbers of suspected deaths in countries where there is little laboratory testing.
According to , the Democratic Republic of the Congo (DRC) is by far the worst-hit country, with 120 suspected deaths from 1 January to 21 September.
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All the DRC deaths in the ongoing outbreak have probably been caused by a variant of the monkeypox virus called Clade I, previously known as the Congo Basin clade, a spokesperson for the World Health Organization (WHO) told żěè¶ĚĘÓƵ. The milder Clade II, previously the West African clade, began spreading across the globe earlier this year.
Historically, , compared with 3.6 per cent for Clade II.
The only time Clade I has been reported outside of an endemic country was in . However, the longer this variant is allowed to circulate in the DRC, the greater the risk it may spread to the rest of the world.
“It’s certainly possible given how travel around the world has become so commonplace,” says at the University of Pennsylvania.
The virus also replicates as it spreads, increasing the risk of mutations. “Monkeypox can continue to mutate and become more capable of transmission from person to person more efficiently,” says at the University of California, Los Angeles.
Ultimately, it is unclear whether the DRC’s disproportionately high number of monkeypox deaths is down to Clade I’s case-fatality rate or the nation’s less-advanced healthcare system compared with other African countries, says at the Centers for Disease Control and Prevention in the US.
Like every country in Africa, the DRC hasn’t received a single vaccine dose against monkeypox this year, outside of a clinical trial, says the WHO spokesperson.
As of 20 September, of the vaccine Jynneos (also known as and Imvamune), which is approved in Europe for preventing monkeypox and smallpox in people aged 18 and over. In the US, . Since 9 August, as part of an emergency use authorisation.
DRC officials are attempting to control the outbreak by isolating infected individuals and using contact tracing. According to at the University of Miami in Florida, this isn’t enough to stop monkeypox.
While all the evidence points towards the DRC being in the centre of a particularly severe monkeypox outbreak, the true extent of the virus’ burden there is unclear.
“We don’t have the capacity to be able to go out and do all the surveillance that needs to be done,” says Rimoin. “Especially in remote areas of the DRC where the vast majority of cases are, we don’t have the ability to do lab analyses.”
In May, that the ongoing global outbreak is mainly spreading among men who have sex with men.
“It’s not clear at this point how much of the spread in Africa [including the DRC] may be due to sex between men,” says McCollum.
The stigmatisation of homosexuality in many affected countries across Africa, such as the DRC, makes it difficult to understand the true pattern of monkeypox’s transmission across the continent, she says.
When it comes to the global outbreak, it is unclear what caused Clade II to spread internationally earlier this year. According to Stevenson, it could be bad luck or the virus may have mutated, enabling it to spread more easily.
“We certainly know monkeypox is a problem in the DRC and it’s at our own peril that we continue to ignore this problem,” says Rimoin.
“I think we have a short-term memory globally and what we need to be able to do is remember that an infection anywhere is potentially an infection everywhere,” she says.
