The mpox outbreak in Congo has taken a concerning turn, with the UN health agency confirming for the first time that the disease is spreading through sexual transmission in the country. Cases have surged in recent weeks, sparking fears that the outbreak could spiral out of control.
Over 1,000 Cases Reported This Year
Congo has recorded over 1,000 mpox cases this year, the highest ever registered in the country. While the mpox strain circulating in Congo is less transmissible and fatal compared to the strain behind last year’s outbreak in Europe and North America, health experts are worried.
"We are very concerned about the growing number of cases in Congo," said Dr Matshidiso Moeti, WHO Regional Director for Africa. "It’s the first time we have documented significant community transmission of mpox in Central and West Africa."
|2023 (up to Nov 23)
The table above shows the sharp rise in mpox cases in Congo this year compared to 2022.
Evidence of Sexual Transmission
Genetic sequencing has indicated that the flare-up in Congo’s capital Kinshasa is linked to spillover from infected animals like rodents and monkeys. However, recent trends show the disease is now spreading through sex among gay and bisexual men in Congo.
Of the 1037 cases this year, 95% are men, and around 40% reported having more than one sexual partner in the 20 days preceding symptoms onset. This points to sex between men as the main driver behind the current outbreak.
Potential to Spread Across Africa
Congo borders nine countries including the Central African Republic and Cameroon, raising the risk of cross-border spread if containment measures fall short.
Compared to western countries, testing and surveillance capabilities in Africa are already weak. This, combined with patchy health infrastructure, could fan uncontrolled community transmission.
"There is reason to fear that monkeypox will establish itself across the African continent," said Dr Dimie Ogoina, a professor of medicine at Niger Delta University in Nigeria.
Global Risk Also Rises
The mpox outbreak across Europe and the Americas was declared over earlier this month. However, WHO officials warn the flare-up in Africa serves as an uncomfortable reminder that the threat still lingers.
"As long as the virus continues to circulate anywhere, there is a risk of spread," said WHO Chief Tedros Adhanom Ghebreyesus.
The Congo outbreak involves the less lethal Clade I strain native to Africa, compared to the Clade II variant behind last year’s global outbreak. Nonetheless, scientists fear the virus could mutate to become more efficient at human-to-human spread if left unchecked. This heightens the urgency for concerted prevention and containment efforts.
WHO experts have been deployed to support Congo’s outbreak response, providing medical supplies and helping trace contacts. However, gaps remain, with the agency warning many newly diagnosed patients are not isolate. Ramping up testing and surveillance are also crucial priorities.
Looking ahead, the recent developments underscore the critical need for rolling out mpox vaccines across Africa. Currently, over 90% of the global vaccine supply has gone to rich countries. WHO is urging nations that stockpiled shots to share doses with poorer African countries before the outbreak expands further. Swift action today could nip the spread in the bud and prevent the nightmare scenario where mpox becomes endemic in parts of Africa and eventually sparks a third global wave.
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