and pride event Plans are underway around the world in the coming weeks as U.S. officials prepare for a resurgence in the measles epidemic, formerly known as monkeypox, that struck tens of thousands of gay and bisexual men worldwide in 2022 man. A combination of behavioral changes and vaccinations have quelled outbreaks, but most at-risk groups have not yet been vaccinated.
On Thursday, the U.S. Centers for Disease Control and Prevention warned that a deadlier form of MPOX is raging in the Democratic Republic of Congo and urged people at high risk to get vaccinated as soon as possible.No cases of this subtype have been found yet outside africa So far. But experts say Congo’s escalating outbreak still poses a global threat, just as infections in Nigeria triggered the 2022 outbreak.
“This is a very important example of how an infection anywhere can be an infection everywhere, and why we need to continue to improve global disease surveillance,” said UCLA epidemiologist Anne Rimoin.
Dr. Rimoin has been studying MPOX in Congo for more than 20 years and first warned of its potential global spread in 2010.
The CDC is focused on encouraging Americans most at risk to get vaccinated before a resurgence of the virus occurs.The agency’s outreach efforts include engaging with advocacy groups and social media influencer They have broad appeal among the LGBTQ community. In December, the agency Clinicians are urged to Be alert to possible cases in travelers from Congo.
There are two main types of mpox: clade I (the type that dominates in Congo) and clade II (a version that caused the global outbreak in 2022). (A clade is a group of viruses that are genetically and clinically distinct.) Both clades have circulated in Africa for decades, with occasional outbreaks.
People with mpox may develop fever, severe headache and back pain, followed by a rash. Many patients also develop painful ulcers, often at the site of infection. People with weakened immune systems, including people with HIV, most likely to become seriously ill Then die.
The version of MPOX that caused the 2022 outbreak, called Clade IIb, caused more than 30,000 cases in the United States that year. The epidemic calmed down in 2023, with only about 1,700 cases, but is now showing signs of resurgence: There are nearly twice as many cases in the United States this year than at this time last year.
In Congo, the Clade I virus has caused approximately 20,000 cases and nearly 1,000 deaths since January 2023 as of April 14. The mortality rate for Clade I infection is approximately 5%, while the mortality rate for Clade IIb infection is less than 0.2%.
Most cases among Congolese children are thought to be caused by direct contact with infected animals (such as monkeys, prairie dogs, squirrels and shrews) or by eating contaminated bushmeat. Children may live in crowded households and generally suffer from poor health.
The country is plagued by armed conflict, floods, poverty, malnutrition and infectious diseases such as cholera, measles and polio.
“Different living habits in the Democratic Republic of Congo may lead to higher rates of transmission among children,” said Dr. Jennifer McQuiston, deputy director of the High Consequence Pathogens Division at the CDC.
Adult cases in Congo have similarly been attributed to interactions with infected animals or close, sustained contact with infected people. But last year, scientists discovered for the first time sexual transmission of type I mpox among male and female sex workers and their contacts.
In an outbreak in the Congolese mining town of Kamituga, heterosexual prostitution at the bar Seems to be the main form of communication. genetic analysis Research suggests that sometime around September, the virus mutated in a way that allowed it to spread more easily among people.
Marion Koopmans, a virologist at the Erasmus Medical Center, said the transmission chain appeared to be a second different outbreak in the country, caused by a new version of the virus called type Ib. Caused by, the proportion of cases in young men and women is about the same. Rotterdam, Netherlands.
“I do think there’s more than one outbreak going on and it’s important to continue to evaluate what that means,” Dr. Koopmans said. “We can’t assume” that all forms of MPOX behave the same way, she said.
The development also alarmed scientists because miners and sex workers in the area are transient and could spread the virus to neighboring countries such as Rwanda, Burundi, Uganda and Tanzania.
In many of these countries, access to testing, vaccines and treatments is limited, giving the virus ample opportunity to multiply and evolve. The vast majority of mpox cases can be diagnosed based on symptoms alone.
Some countries rely on tests that only detect Clade I or Clade IIb. According to one person, the tests may not detect the new version of Clade Ib that emerged in September. A recent study.
Dr. Rosamund Lewis, who leads the WHO’s MPOX response, said the findings prompted the WHO to remind countries to review their testing procedures “and make sure they don’t miss diagnoses.”
In the United States, a test approved by the Food and Drug Administration can detect all versions of mpox but cannot distinguish between them. Dr. McQuiston said positive results from this test should be followed by more specific testing to identify clades.
At least so far, existing vaccines and antiviral drugs are expected to be effective against all forms of the virus. The 2022 outbreak began in Europe in May and intensified in the United States during and after Pride Month in June.
In the early days of the epidemic, there were Shortage of two-dose MPOX vaccine, called Jynneos. But many gay and bisexual men are used to following public health messages about HIV, limit their sexual activityprecipitate a Fewer cases Even before vaccines are widely available.
However, declining numbers may create a false sense of security.
“There’s a sense of complacency because it’s not something that people need to worry about on an ongoing basis, and we’re seeing vaccination rates drop rapidly,” said Dr. Boguma Titanji, a virologist and infectious disease doctor at Emory University.
Behavioral changes are difficult to sustain, so vaccination is important for long-term control of the virus, Dr. Titanji said.
According to reports, two doses of the vaccine are more effective than one dose, with an efficacy rate of up to 90% an analysis 16 studies in the last month. Even if the vaccine doesn’t prevent infection, it can reduce the severity and duration of the disease.
still less than one in four americans Those at risk received two doses of the vaccine.
“We continue to saturate the information landscape, but acceptance hasn’t really changed that much,” said Dr. McQuiston, who suggested a more creative approach was needed.
In 2022, the vaccine was only available in the United States through federal agencies and was plagued by the following issues: Delivery issueslimiting its availability; right now commercially available. The World Health Organization, which recommends vaccines for African countries, has been slow to approve vaccines and has not even started the approval process.
Still, the World Health Organization’s Advisory Group on Immunization recommends that, where possible, vaccines be used to protect adults and children at risk of MPOX, Dr. Lewis said.
In addition to preparing for measles’ return to the United States, CDC is supporting Congo’s efforts to obtain vaccines and medicines and contain the outbreak.
“It’s better to help them control the outbreak before it spreads to other areas and becomes a global risk,” Dr. McQuiston said. “And, ethically, it’s the right thing to do.”
