A concerning strain of the monkeypox virus has spread rapidly across Central Africa in the past few months. The outbreak prompted the Africa Centres for Disease Control and Prevention (Africa CDC) to declare its first-ever public-health emergency on 13 August, and, minutes ago, officially declared a public health emergency.

The moves reflect scientists’ deep worry that the outbreak of mpox, the disease caused by the monkeypox virus, could evolve into an epidemic that spreads across the continent — and possibly beyond. They note that the virus is making an alarming appearance not just in rural regions, but also in densely populated areas.

During the past month, mpox infections have surged in Central Africa, affecting locations including Bukavu, a city in the Democratic Republic of the Congo (DRC) that has more than 1 million residents, and four countries in the region have reported mpox infections for the first time. These infections are probably connected to an outbreak that began in late 2023 in South Kivu province, a region of the DRC that has been ravaged by violent conflict.

Evidence from past outbreaks indicates that the viral strain spreading in Central Africa is more lethal than the strain that sparked the 2022 global mpox outbreak, which has since infected more than 95,000 people and killed more than 180.

The moves reflect scientists’ deep worry that the outbreak could evolve into an epidemic that spreads across the continent — and possibly beyond.

“I hope that we’ve long gotten over the idea that something that is happening somewhere far away can’t affect us,” says Anne Rimoin, an epidemiologist at the University of California, Los Angeles, who has worked on mpox outbreaks in the DRC since 2002. “An infection anywhere is potentially an infection everywhere, and we’ve seen this idea come to bear many times.”

African countries have already reported more confirmed and suspected mpox infections in 2024 than in all of 2023: 17,500 this year, compared with about 15,000 in 2023. Children are particularly vulnerable: around two-thirds of infections in the DRC are in people under the age of 15.

The novel clade I variant, labeled ’clade Ib,’ appears to spread efficiently via sexual contact.

Some of these infections have been traced to a strain called clade II, which caused the 2022 outbreak. But over the past few months, an increasing proportion of reported infections have been attributed to a strain called clade I. Clade I has for decades caused small outbreaks in Central Africa, often limited to a few households or communities.

And while the death rate for clade I mpox is known to be higher than that of clade II mpox, it is hard to pin down the reason, says Espoir Bwenge Malembaka, an infectious-disease epidemiologist at the Catholic University of Bukavu.

In April, researchers who analysed samples collected in South Kivu in late 2023 and early 2024 revealed that they had identified1 a clade I variant, called clade Ib, that seems to spread effectively between people through means including sexual contact. Since then, the virus has spread to densely populated areas, presumably carried by highly mobile populations such as sex workers, and to neighbouring countries. 

African countries have already reported more confirmed and suspected mpox infections in 2024 than in all of 2023.

Burundi, Kenya, Rwanda and Uganda have all reported their first-ever mpox infections in the past month, and in a single week in early August, the DRC reported nearly 2,400 suspected infections and 56 deaths.

see also, “Public health officials can’t say why Mpox cases remain elevated in 2024” (Crane’s New York, August 14, 2024); “Gay members of Congress worried about Mpox outbreak ask for data in letter to President Biden” (The Advocate, June 27, 2024), “NYC Declares End To Mpox Outbreak After Nation-Leading Response,” (NYC.gov, February 1, 2023)

Mike Barr, a longtime Poz Contributing Editor and founding member of and scribe for the Treatment Action Group (TAG), is a functional medicine practitioner and herbalist in NYC. Reach out to him here. Or sign up for his curated (and 20-25% discounted) professional grade supplement dispensary here.