Emerging Threat: New Monkeypox Variant Just Got More Dangerous. What You Need to Know.

This Isn't the Monkeypox You Heard About in 2022- Harder to Detect, More Transmissible and Potentially Deadlier

Apr 17, 2024

A concerning development has emerged in the Democratic Republic of Congo: a new strain of monkeypox, known as clade 1b, has surfaced, sparking alarm among global health experts. With over 100 cases reported in a mining town, this variant is raising concerns. Scientists fear its potential to trigger a pandemic, given its increased severity compared to the 2022 monkeypox virus, its potential for heightened transmissibility, and its ability to evade current detection methods. In response, there is a pressing need for enhanced surveillance, contact tracing, and targeted vaccination efforts to curb the threat.

In this article, we'll delve into the latest scientific findings on the new monkeypox strain. We'll explore the symptoms of each phase, potential complications, the characteristics of the monkeypox virion, its modes of transmission, available vaccines, their effectiveness, and a comprehensive timeline tracing the history of monkeypox since its discovery in 1958. It will provide TACT’s overview of the current situation at the end.

Stay Informed, Stay Empowered: Independent Coverage

By subscribing, you'll gain access to:

Unbiased reporting: We cut through the noise and deliver critical information you need to make informed decisions about your health.
In-depth analysis: TACT goes beyond headlines to uncover details and the true impact of COVID, Bird Flu, Monkeypox, and other emerging or evolving diseases.
Empowering insights: We translate complex scientific data into actionable knowledge, putting you in control of your well-being.

Support Independent Journalism - Subscribe Today!

Human-to-Human Transmission Routes (1)

After exposure to respiratory droplets (Airborne potential?)
Oral secretions
Contact with lesions
Fomites
Direct/sexual contact
Monkeypox can also be transmitted from the infected mother to the fetus through the placenta leading to congenital infection. (1)

Symptoms: 2 Phases (2 to 3-week incubation period)

Phase I: First week

Fever
Lymphadenopathy: the enlargement or swelling of lymph nodes, which are small, bean-shaped structures found throughout the body as part of the lymphatic system. Lymph nodes play a crucial role in filtering and trapping harmful substances, such as bacteria and viruses, from the lymphatic fluid. Note: In smallpox, measles, and chickenpox lymphadenopathy is generally absent. (1)
Arthralgia: pain in one or more joints of the body.
Myalgia: Muscle pain or discomfort that can occur in one or more muscles of the body. Symptoms of myalgia may include:
- Muscle tenderness or soreness
- Stiffness
- Swelling
- Weakness
- Limited range of motion
Severe Asthenia: significant and debilitating weakness or fatigue that affects the body's ability to perform daily activities or tasks. Asthenia is a term used to describe generalized weakness or lack of energy, often accompanied by feelings of fatigue, tiredness, or exhaustion.
Phase II: (2 to 3 weeks)
Cropping rash caused by monkeypox virus is similar to varicella (chickenpox) Note: This similarity may hinder the clinical diagnosis of monkeypox patients.
The skin eruption phase starts after fever with rashes found more on the face and extremities and mildly on the trunk.
In most cases, the face is affected followed by soles, palms, oral cavity, genitals, cornea, and conjunctiva. The rash of monkeypox emerges sequentially from macules to papules, vesicles, pustules, and crusts.

A single patient infected by the monkeypox virus may have several thousands of lesions in the body (Figure 4).

For most people, monkeypox infection will resolve on its own within 3-4 weeks

Complications:

Sepsis
Pneumonia
Loss of vision due to corneal scarring
Spread to vital organs in the body leading to death

Two distinct genetic MPXV clades:

Clade I is predominantly found in Central Africa, particularly in the Democratic Republic of the Congo (DRC), and is characterized by severe clinical symptoms and high mortality of up to 11%.
Clade II, confined to West Africa until the 2022 global epidemic, causes less severe illness and lower mortality of <4%.
Virion Size and Description
“The virion consists of complex symmetry, 400 nm x 250 nm size, brick-shaped with outer irregular ridges, lateral bodies, and a core with double-stranded (ds) DNA as genetic material.” (1)

Evolution or Mutational Ability

Slower than COVID-19, an RNA virus. The viral DNA genome does not easily undergo significant mutations over some time, unlike RNA viruses

Monkeypox Virus (MPXV) History:

1958: Monkeypox was first discovered in laboratory monkeys in the Democratic Republic of the Congo (DRC).
1970: The first human case of monkeypox was reported in the DRC.
1971: Monkeypox cases were reported outside of Africa, with outbreaks in the United States and other countries due to the importation of infected animals.
1980s-2000s: Monkeypox outbreaks continued to occur sporadically in Central and West Africa, mainly affecting rural communities.
2003: An outbreak of monkeypox occurred in the United States, primarily in the Midwest, with cases linked to pet prairie dogs imported from Africa.
2005: Another outbreak of monkeypox occurred in the United Kingdom, associated with the importation of African rodents as pets.
2016: Monkeypox cases were reported in Nigeria, leading to concerns about the potential for larger outbreaks in densely populated urban areas.
2017: Clade II B MPXV emerged in Nigeria in 2017, with protracted human-to-human transmission.
2018-2019: Monkeypox cases were reported in several countries in Central and West Africa, including Nigeria, Cameroon, and the Central African Republic.
2021: Monkeypox cases were reported in the United Kingdom, marking the first cases in the country since 2018.
2022: Global Clade II B.1 lineage outbreak. The monkeypox virus (MPXV) attracted global attention in 2022 during a widespread outbreak linked primarily to sexual contact.
October 2023: Clade I B outbreak in the Kamituga mining region of the Democratic Republic of the Congo (DRC). Monitored by researchers in a report published April 14, 2024, from between October 2023 and January 2024.
March 2024: Study on Clade I and II circulation in Cameroon from 1979-2022. They found “Clade I originated from eastern regions close to neighboring monkeypox-endemic countries in Central Africa; clade II was prevalent in western regions close to West Africa.” “Our findings suggest that MPXV re-emerged after a 30-year lapse and might arise from different viral reservoirs unique to ecosystems in eastern and western rainforests of Cameroon.”
April 14, 2024: (pre-print) Novel Clade IB Lineage found in the Democratic Republic of Congo. It may be more contagious. (see below)

New Monkeypox Strain: 'Clade 1b' in DRC Raises Alarm

“Sustained Human Outbreak of a New MPXV Clade I Lineage in Eastern Democratic Republic of the Congo” (published April 14, 2024)

The monkeypox outbreak in Kamituga has seen a rapid escalation, with 241 suspected cases reported within just 5 months of the initial case being reported. Of the 108 confirmed cases, 29% were among sex workers, highlighting a potential risk factor.

Genomic analysis unveiled a unique MPXV Clade Ib lineage, distinct from previously identified strains in the Democratic Republic of Congo (DRC). The presence of APOBEC3-type mutations and the estimated emergence around mid-September 2023 indicate recent human-to-human transmission.

Urgent action is imperative, including bolstered surveillance, expanded contact tracing efforts, enhanced case management support, and targeted vaccination campaigns to curb the spread of this potentially pandemic Clade Ib outbreak.

Link to the study HERE

Vaccination

JYNNEOS® (IMVANEX®) for monkeypox was approved in September 2019.
JYNNEOS®/IMVANEX® is a live vaccine made from the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) strain. This strain is an attenuated, non-replicating orthopoxvirus manufactured by Bavarian Nordic in Hellerup, Denmark. Being a replication-deficient vaccine, it is suitable for vaccinating individuals aged 18 years and older who have certain immune deficiencies or conditions, such as HIV or atopic dermatitis.(2)

Note: It was previously shown that vaccination may only be 85% protective against monkeypox. It’s not clear how long the protection lasts. (2)

Note 2: It may not be as effective against the new Clade IB MPXV

TACT’s Overview:

While the emergence of the Clade 1b monkeypox strain in the DRC is concerning due to its increased transmissibility, greater ability to evade detection, and potential for increased severity and deadliness, there are reasons for cautious optimism. Unlike the Clade IIb strain responsible for the 2022 global outbreak, Clade 1b appears to be geographically contained for now. The existing monkeypox vaccine, though potentially less effective against this new strain, can still offer a fairly high level of protection. Due to its slower evolutionary rate, there is time to update vaccines that will likely remain effective for a much longer duration than we have seen with the COVID vaccines.

Stringent public health measures like enhanced surveillance, contact tracing, and targeted vaccination campaigns are crucial to prevent this clade from establishing itself more broadly. International collaboration and continued research are also essential to fully understand the Clade 1b strain and develop more effective diagnostics and therapeutics if needed. We will watch this closely and provide updates when new information becomes available.

Refer a friend

Please share your thoughts, insights, and ideas by leaving a comment.