An outbreak of Monkey Pox in the Democratic Republic of Congo which has been raging since 2023 has officially been declared to have ended by the Ministry of Public Health. During the course of the epidemic, 161 000 people are thought to have been infected with the disease in the Democratic Republic of Congo, with 37 000 cases confirmed by laboratory testing. A total of 2286 deaths have been attributed to the disease within the country, although only 127 of these were confirmed by laboratory testing. At the height of the epidemic the disease spilled over into several neighbouring, and internationally connected, countries, causing the World Heath Organization to declare a global emergency.
Monkeypox (or Mpox) is caused by a double-stranded DNA virus of the genus Orthopoxvirus, which is the same genus as the Viruses which cause Smallpox and Cow Pox. It causes a Chickenpox-like disease, with a distinctive rash with large blisters or sores on all parts of the body, as well as a fever, headaches, muscle and back aches, joint pain, chills, exhaustion, and swollen glands. Most patients recover within a few weeks, however it can cause more dangerous secondary symptoms, including pneumonia, sepsis, encephalitis, and blindness. Older and younger patients are particularly at risk, as are patients who have weakened immune systems or are pregnant. The disease typically has a case fatality ratio of about 1%.
Monkeypox is a zoonotic disease, with a wild reserve of the Virus found in several species of Primates and Rodents. Outbreaks usually start with an Animal-to-Human infection, although Humans at the blistering stage of the disease are capable of spreading it to other Humans. The Virus was first detected in Crab-eating Macaques, Macaca fascicularis, in a laboratory in Denmark in 1958, an outbreak which gave the disease its name (it is now thought to be more prevalent in Rodents than Primates). The first known Human infection with Monkeypox was reported from the Democratic Republic of Congo in 1970.
There are two main clades of Monkeypox, Clade I, which is predominantly found in Central Africa, and Clade II, which is predominantly found in West Africa. However, in May 2022 a cluster of cases was found in London, England, which is thought to have been brought to the country by a patient from Nigeria. These infections were caused by a new strain, which was apparently transmitted from Human-to-Human more readily than previously encountered variants, and was given the identifier Clade IIb (because it was a new clade derived from Clade II, which subsequently became referred to as Clade IIa. Notably, the spread of this strain has been linked to sexual activity. Clade IIb subsequently spread to 121 countries over the next two years, infecting more than 99 500 people and causing over 200 deaths.
In September 2023, another new and apparently more virulent variant, later named Clade Ib, was identified in the mining town of Kamituga in South Kivu Province, Democratic Republic of Congo. This spread from Human-to-Human more readily than previously known forms of the disease, and had a case fatality ratio of 3-4%, making it much deadlier than previously encountered variants. Unlike Clade IIb, Clade Ib appeared to spread largely among children, with 70% of reported cases and 85% of reported deaths being under the age of 15, although it has been suggested that this is in part because the disease has spread through several large refugee camps, where large numbers of children are also suffering from malnutrition, as well as other infectious diseases such as Cholera and Measles.
Clade Ib has subsequently been reported in 25 countries, although in most cases this has been single patients who developed symptoms of the disease after returning from travel to Central Africa. However, in neighbouring countries such as Burundi, Rwanda, and the Central African Republic, as well as Indonesia and the Philippines, the clade has begun to spread locally, leading to public health campaigns to contain it.
Fortunately, because Monkeypox is closely related to Smallpox, vaccines against that disease have been shown to be effective against its spread. Because the last recorded case of Smallpox was in 1977, and the disease was declared officially globally eradicated in 1980, few countries maintain a stock of the vaccine, and active vaccination programs against Smallpox have not been carried out for decades. However, the technology to produce these vaccines still exists, and manufacturers in the United States, Spain, and Denmark have been distributing the vaccines since 2024.
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