We are writing to alert you to a recent increase in mpox transmission in the Democratic Republic of the Congo (DRC). While 11 of the 26 provinces in the DRC historically have been considered to be endemic for mpox, the number of provinces reporting mpox cases has expanded to 22 as of November 2023. This outbreak is clade I (previously designated as the Congo Basin clade) which is different from Clade II (Clade IIb has been responsible for the global epidemic that begin in 2022). Clade I historically has been associated with more severe disease and a higher case fatality rate. An added twist is recent evidence of possible sexual transmission of clade I associated with a Belgian visitor to the DRC and an outbreak among sex workers there. Thus far this year, there have been more than 12,500 suspected cases of mpox identified in the DRC. More details can be found at (there will also be a CDC Health Alert Network coming out in the next few days on this topic):
http://promedmail.org/promed-post/?id=8713353
http://wwwnc.cdc.gov/eid/article/30/1/23-1164 article
Please be on the alert for potential mpox cases in travelers to the DRC. Any new locally acquired cases might be a result of the ongoing global epidemic of clade IIb but now there is a risk of clade I exportation. If possible, please obtain a clinical specimen (pox lesions tend to have high viral loads so these are an excellent source of samples) and ask your lab to save positive specimens for sequencing (PCR does not differentiate between the clades so sequencing is required for this purpose). If your case is travel-related, please alert the GeoSentinel OPI by email or by entering the case into the GeoSentinel database. If your local public health lab cannot perform genotyping, we can arrange for testing at the CDC when appropriate.
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We are writing to alert you to a recent increase in mpox transmission in the Democratic Republic of the Congo (DRC). While 11 of the 26 provinces in the DRC historically have been considered to be endemic for mpox, the number of provinces reporting mpox cases has expanded to 22 as of November 2023. This outbreak is clade I (previously designated as the Congo Basin clade) which is different from Clade II (Clade IIb has been responsible for the global epidemic that begin in 2022). Clade I historically has been associated with more severe disease and a higher case fatality rate. An added twist is recent evidence of possible sexual transmission of clade I associated with a Belgian visitor to the DRC and an outbreak among sex workers there. Thus far this year, there have been more than 12,500 suspected cases of mpox identified in the DRC. More details can be found at (there will also be a CDC Health Alert Network coming out in the next few days on this topic):
http://promedmail.org/promed-post/?id=8713353
http://wwwnc.cdc.gov/eid/article/30/1/23-1164 article
Please be on the alert for potential mpox cases in travelers to the DRC. Any new locally acquired cases might be a result of the ongoing global epidemic of clade IIb but now there is a risk of clade I exportation. If possible, please obtain a clinical specimen (pox lesions tend to have high viral loads so these are an excellent source of samples) and ask your lab to save positive specimens for sequencing (PCR does not differentiate between the clades so sequencing is required for this purpose). If your case is travel-related, please alert the GeoSentinel OPI by email or by entering the case into the GeoSentinel database. If your local public health lab cannot perform genotyping, we can arrange for testing at the CDC when appropriate.