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

Emmanuel Hasivirwe Vakaniaki^#^{1

2}, Cris Kacita^#³, Eddy Kinganda-Lusamaki^{1

4

5}, Áine O'Toole⁶, Tony Wawina-Bokalanga^{1

2

4}, Daniel Mukadi-Bamuleka^{1

4

7}, Adrienne Amuri-Aziza¹, Nadine Malyamungu-Bubala⁸, Franklin Mweshi-Kumbana⁸, Léandre Mutimbwa-Mambo⁹, Freddy Belesi-Siangoli¹⁰, Yves Mujula¹, Edyth Parker¹¹, Pauline-Chloé Muswamba-Kayembe¹, Sabin S Nundu¹, Robert S Lushima³, Jean-Claude Makangara-Cigolo^{1

4}, Noella Mulopo-Mukanya⁷, Elisabeth Pukuta-Simbu¹, Prince Akil-Bandali¹, Hugo Kavunga^{1

7}, Ombotimbe Abdramane¹², Isabel Brosius², Eugene Bangwen², Koen Vercauteren², Nadia A Sam-Agudu^{13

14

15}, Edward J Mills¹⁶, Olivier Tshiani-Mbaya¹⁷, Nicole A Hoff¹⁸, Anne W Rimoin¹⁸, Lisa E Hensley¹⁹, Jason Kindrachuk²⁰, Cheryl Baxter²¹, Tulio de Oliveira²¹, Ahidjo Ayouba⁵, Martine Peeters⁵, Eric Delaporte⁵, Steve Ahuka-Mundeke^{1

4}, Emma L Mohr²², Nancy J Sullivan²³, Jean-Jacques Muyembe-Tamfum^{1

4}, Jean B Nachega^{24

25

26}, Andrew Rambaut⁶, Laurens Liesenborghs^{2

27}, Placide Mbala-Kingebeni^{28

29}

Affiliations

¹ Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
² Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
³ Hemorrhagic Fever and Monkeypox Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo.
⁴ Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
⁵ TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes), Université de Montpellier, French National Research Institute for Sustainable Development (IRD), INSERM, Montpellier, France.
⁶ Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK.
⁷ Rodolphe Merieux INRB-Goma Laboratory, Goma, Democratic Republic of the Congo.
⁸ Kamituga General Hospital, South Kivu, Democratic Republic of the Congo.
⁹ Kamituga Health Zone, South Kivu, Democratic Republic of the Congo.
¹⁰ Provincial Health Division, South Kivu, Democratic Republic of the Congo.
¹¹ African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria.
¹² Medical Department, The Alliance for International Medical Action, Goma, Democratic Republic of the Congo.
¹³ Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
¹⁴ International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
¹⁵ Global Pediatrics Program and Division of Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁶ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹⁷ Frederick National Laboratory, Leidos Biomedical Research, Clinical Monitoring Research Program Directorate, Frederick, MD, USA.
¹⁸ Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA.
¹⁹ US Department of Agriculture, Manhattan, KS, USA.
²⁰ University of Manitoba, Winnipeg, Manitoba, Canada.
²¹ Centre for Epidemic Response and Innovation, Stellenbosch University, Cape Town, South Africa.
²² Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, Madison, WI, USA.
²³ National Emerging Infectious Diseases Laboratory, Boston University, Boston, MA, USA.
²⁴ Department of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA. jbn16@pitt.edu.
²⁵ Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jbn16@pitt.edu.
²⁶ Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa. jbn16@pitt.edu.
²⁷ Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
²⁸ Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo. mbalaplacide@gmail.com.
²⁹ Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo. mbalaplacide@gmail.com.

^# Contributed equally.

PMID: 38871006
PMCID: PMC11485229
DOI: 10.1038/s41591-024-03130-3

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

Emmanuel Hasivirwe Vakaniaki et al. Nat Med. 2024 Oct.

. 2024 Oct;30(10):2791-2795.

doi: 10.1038/s41591-024-03130-3. Epub 2024 Jun 13.

Authors

Affiliations

¹ Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.
² Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
³ Hemorrhagic Fever and Monkeypox Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo.
⁴ Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
⁵ TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes), Université de Montpellier, French National Research Institute for Sustainable Development (IRD), INSERM, Montpellier, France.
⁶ Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK.
⁷ Rodolphe Merieux INRB-Goma Laboratory, Goma, Democratic Republic of the Congo.
⁸ Kamituga General Hospital, South Kivu, Democratic Republic of the Congo.
⁹ Kamituga Health Zone, South Kivu, Democratic Republic of the Congo.
¹⁰ Provincial Health Division, South Kivu, Democratic Republic of the Congo.
¹¹ African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria.
¹² Medical Department, The Alliance for International Medical Action, Goma, Democratic Republic of the Congo.
¹³ Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
¹⁴ International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
¹⁵ Global Pediatrics Program and Division of Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁶ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
¹⁷ Frederick National Laboratory, Leidos Biomedical Research, Clinical Monitoring Research Program Directorate, Frederick, MD, USA.
¹⁸ Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA.
¹⁹ US Department of Agriculture, Manhattan, KS, USA.
²⁰ University of Manitoba, Winnipeg, Manitoba, Canada.
²¹ Centre for Epidemic Response and Innovation, Stellenbosch University, Cape Town, South Africa.
²² Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, Madison, WI, USA.
²³ National Emerging Infectious Diseases Laboratory, Boston University, Boston, MA, USA.
²⁴ Department of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA. jbn16@pitt.edu.
²⁵ Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. jbn16@pitt.edu.
²⁶ Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa. jbn16@pitt.edu.
²⁷ Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
²⁸ Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo. mbalaplacide@gmail.com.
²⁹ Service de Microbiologie, Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo. mbalaplacide@gmail.com.

^# Contributed equally.

PMID: 38871006
PMCID: PMC11485229
DOI: 10.1038/s41591-024-03130-3

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.

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Conflict of interest statement

None of the authors declare competing interests.

Figures

**Fig. 1. Mapping number of reported mpox cases and genomics analysis, Kamituga, DRC.**
a, Map of the DRC with provinces colored by the number of reported cases. MPXV genomes available are indicated by colored circles (31 January 2024). These are placed at the centroid of the town, the health zone or the province depending on the precision of the recorded location. b, Maximum likelihood phylogeny of clade I genomes, including those from the present study (indicated as 2023/24 and Kamituga samples), with all previously sequenced genomes publicly available on GenBank. A version of this phylogeny where individual tips are labeled with accession numbers, locations and dates can be found in Supplementary Figs. 1 and 2. c, The Kamituga cluster with reconstructed mutations indicated on the branches. Mutations are colored by whether they are consistent with APOBEC3 deamination (dark blue) or not (green). sub/site, substitutions per site.

**Fig. 2. Epidemiologic curve and mpox cases disaggregated by age and sex, Kamituga, DRC.**
a, Epidemiologic curve of Kamituga mpox outbreak (October 2023 to March 2024), DRC. b, Counts of suspected mpox cases disaggregated by age and sex (male in blue, female in pink).

See this image and copyright information in PMC

References

1. Van Dijck, C. et al. Emergence of mpox in the post-smallpox era—a narrative review on mpox epidemiology. Clin. Microbiol Infect.29, 1487–1492 (2023). - PubMed
1. Bunge, E. M. et al. The changing epidemiology of human monkeypox—a potential threat? A systematic review. PLoS Negl. Trop. Dis.16, e0010141 (2022). - PMC - PubMed
1. Ogoina, D. et al. The 2017 human monkeypox outbreak in Nigeria—report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. PLoS ONE14, e0214229 (2019). - PMC - PubMed
1. 2022–24 mpox (monkeypox) outbreak: global trends. World Health Organization (2024); https://worldhealthorg.shinyapps.io/mpx_global/
1. Isidro, J. et al. Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus. Nat. Med.28, 1569–1572 (2022). - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical