CDC concerned about spread of deadlier mpox strain
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Key takeaways:
- The CDC has raised concern about an increase in clade I mpox cases in Africa.
- No cases have been reported in the U.S. and the strain has not been detected in wastewater.
The CDC advised clinicians for a second time to be on alert for possible mpox cases in travelers from the Democratic Republic of the Congo who may be infected with a deadlier strain of the virus than the one that caused an outbreak in 2022.
Writing this week in MMWR, researchers from the CDC and the DRC’s National Public Health Institute warned that recent increases in the spread of clade I mpox in the DRC raises the risk that it will spread globally, similar to how clade II emerged in 2022, leading to nearly 96,000 mpox cases globally, including more than 32,000 cases and 58 deaths in the United States.
In December, the CDC issued a health advisory about clade I mpox, which can cause more serious illness than clade II. Clade I is generally associated with higher case fatality rates — potentially greater than 10% — compared with clade II. Both can be transmitted sexually.
No cases of clade I have been reported in the U.S. or any other country without endemic transmission, and the lack of direct commercial passenger flights from the DRC to the U.S. means the threat for travelers is low, the agency said.
“The increasing number of reported suspected clade I mpox cases in the DRC poses a global threat for potential spread,” Jennifer H. McQuiston, DVM, deputy director of the CDC’s Division of High Consequence Pathogens and Pathology, and colleagues wrote.
According to McQuiston and colleagues, the 2022 global mpox outbreak revealed missed opportunities by the public health community to recognize the threat of person-to-person spread of the virus.
From Jan. 1, 2023, to April 14, 2024, the DRC reported multiple province-level outbreaks of mpox comprising 19,919 suspected clade I cases — an “unprecedented” number of infections — and 975 deaths, according to McQuiston and colleagues. Two-thirds of suspected cases and more than three-quarters of suspected deaths have occurred in children aged 15 years or younger.
Although no cases of clade I have been detected outside of countries in central Africa where mpox is endemic, the CDC is raising concern because of increases in reported mpox cases in countries that border the DRC and the potential for it to spread beyond endemic regions.
In the U.S., in addition to available vaccines and treatments, the CDC added clade-specific mpox testing of wastewater at 186 sites in 32 jurisdictions, none of which have reported clade I virus. Additionally, the CDC tested 282 wastewater samples from U.S. airports between Dec. 22, 2023, and April 11, 2024, detecting no mpox.
“U.S. clinicians and public health practitioners should be alert for possible cases in travelers from DRC and request clade-specific testing,” McQuiston and colleagues wrote. “Appropriate medical treatment is critical given the potential for severe illness, and contact tracing and containment strategies, including isolation, behavior modification and vaccination, will be important to prevent spread if any U.S. clade I mpox cases occur.”
References:
- CDC. Mpox: Ongoing 2022 global outbreak cases and data. https://www.cdc.gov/poxvirus/mpox/response/2022/index.html. Updated March 5, 2024. Accessed May 17, 2024.
- McQuiston JH, et al. Morb Mortal Wkly Rep. 2024;doi:10.15585/mmwr.mm7319a3.
Perspective
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Our experience with COVID-19 and the mpox outbreak in 2022 has significantly raised awareness about the importance of pandemic preparedness among both officials and the general public. This heightened awareness has led to better understanding and support for the development and stockpiling of vaccines and treatments. However, there are still several areas of concern.
A recent report issued by the National Academies of Sciences, Engineering, and Medicine concluded that action is needed to enhance U.S. readiness for smallpox and related diseases, including mpox, as well as to improve diagnostics, vaccines and therapeutics that could be used in response to an outbreak. Additionally, the growing anti-vaccine movement poses a serious risk, potentially undermining efforts to control vaccine-preventable diseases. Resistance to public health measures like quarantine and isolation, along with significant workforce shortages in public health and health care, further weaken our readiness.
These issues need urgent attention to ensure we are fully prepared for future outbreaks of mpox and other infectious diseases with a comprehensive set of medicines, inclusive of vaccines and antivirals, to treat patients.
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