Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo
Emmanuel Hasivirwe Vakaniaki, Cris Kacita, Eddy Kinganda-Lusamaki, Áine O’Toole, Tony Wawina-Bokalanga, Daniel Mukadi‐Bamuleka, Adrienne Amuri-Aziza, Nadine Malyamungu-Bubala, Franklin Mweshi-Kumbana, Léandre Mutimbwa-Mambo, Freddy Belesi-Siangoli, Yves Mujula, Edyth Parker, Pauline-Chloé Muswamba-Kayembe, Sabin S. Nundu, Robert Shongo Lushima, Jean-Claude Makangara-Cigolo, Noëlla Mulopo-Mukanya, Elisabeth Pukuta-Simbu, Prince Akil-Bandali, Hugo Kavunga, Ombotimbe Abdramane, Isabel Brosius, Eugene Bangwen, Koen Vercauteren, Nadia A. Sam‐Agudu, Edward J. Mills, Olivier Tshiani-Mbaya, Nicole A. Hoff, Anne W. Rimoin, Lisa E. Hensley, Jason Kindrachuk, Cheryl Baxter, Túlio de Oliveira, Ahidjo Ayouba, Martine Peeters, Éric Delaporte, Steve Ahuka‐Mundeke, Emma L. Mohr, Nancy Sullivan, Jean‐Jacques Muyembé‐Tamfum, Jean B. Nachega, Andrew Rambaut, Laurens Liesenborghs, Placide Mbala‐Kingebeni
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.