New mpox strain emerges in China as global efforts against outbreak continue

As China grapples with surging Human Metapneumovirus (HMPV) cases, the East Asian nation's health authorities on Thursday announced the detection of a new mutated mpox strain, dubbed clade Ib.

While the discovery marks another milestone in detection and managing the spread of emerging viruses, it brings to the fore the magnitude and challenges in the global fight against outbreak of diseases if the Covid-19 pandemic is anything to go by.

According to China’s Center for Disease Control and Prevention (CDC), a cluster outbreak of the Ib subclade which began with a traveler from the Democratic Republic of Congo (DRC), has already infected four others through close contact. Clade 1b has genetic and epidemiological characteristics that favour human-to-human transmission.

This development comes as the World Health Organisation (WHO) raises the alarm over the virus's spread, particularly in Africa, where the situation remains "especially concerning."

The continent has recorded 13,769 confirmed cases across 20 countries, with 60 deaths reported as of December 15, 2024. The DRC, which is the mpox outbreak epicentre, accounts for 9,513 of these cases.

The virus exists in two primary forms: Clade 1 and clade 2. The newer clade 1b variant, first detected in the Eastern DRC in September 2023, has proven particularly worrisome due to its enhanced transmissibility and higher mortality rate of 3.6 per cent.

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The clade Ib variant appears to spread more easily through routine close contact, including sexual contact.

The strain has since spread from DRC to neighbouring countries, including Burundi, Kenya, Rwanda and Uganda. This has triggered the emergency declaration from the WHO.

This strain has also been detected in eight countries outside Africa, including Sweden and Thailand, suggesting a concerning pattern of global spread.

"Geographical expansion of clade 1b mpox virus (MPXV) continues to be reported outside the DRC," the WHO said.

"Much remains to be understood about the transmissibility and sustainability of transmission of the clade 1b MPXV," said the WHO, which specified earlier that the mortality rate of the clade 1b MPXV was estimated at 3.6 per cent, much higher than previous strains.

The Africa CDC reports that clade 1 has been identified in Kenya, Burundi, the Central African Republic, Congo, the Democratic Republic of Congo, Rwanda, and Uganda. Clade 2 has been reported in Côte d'Ivoire, Liberia, Nigeria, and South Africa. Clade 1 and clade 2 have been detected in Cameroon, while the specific clade in Gabon has not yet been identified.

WHO declared an emergency for the more lethal clade 1 due to its increasing spread of cases in Africa, including areas where it had never been detected before, and the emergence of a new subtype dubbed 1b.

Kenya has emerged as another hotspot, with 28 confirmed cases spread across 12 counties. The Ministry of Health reports that the distribution shows particular concentration in Nakuru (5 cases) and Mombasa (4 cases), with other affected areas including Kajiado, Bungoma, Nairobi, and Taita Taveta. The country has reported one fatality.

Health authorities are actively monitoring 204 contacts, with 147 completing the required 21-day follow-up period.

“Currently, eight individuals are under management while 17 have fully recovered,” said Health Cabinet secretary Deborah Barasa in a recent statement.

In August 2024, the Director General for Health, Patrick Amoth, assured the public that healthcare facilities are fully prepared to diagnose and manage the disease.

China has implemented stringent measures, classifying mpox as a Category B infectious disease.

While the DRC, the outbreak's locus, has seen a relatively stable epidemic trend in recent weeks, WHO still warned that the plateauing and declining trends should be interpreted cautiously, given possible reporting delays.

This designation allows officials to impose emergency measures, including restricting gatherings and suspending work and school when necessary. The country has also enhanced screening of people and goods at entry points.

The WHO emphasises that while Mpox typically presents with mild symptoms such as skin rash, blisters, and flu-like conditions, it can prove fatal in rare cases.

The virus spreads through close physical contact with infected individuals, contaminated materials, or infected animals.

With over 2.2 million travelers screened at various entry points since July 2024 in Kenya alone, the global health community remains on high alert, working to contain the evolving threat.

“To reduce stigma and prevent the spread of the disease, we shall continue to share important information through our official social media accounts, the press, and other public health forums countrywide,” Dr Amoth emphasized that there is no need for panic.

While DRC remains in the grip of a convoluted conflict that has made its eastern regions ungovernable with broken health systems, regional integration and travel have led to the spread of viral diseases that were traditionally domiciled in the nation.