Mpox is spreading faster, showing new modes of transmission and affecting different populations. Scientists are calling for stronger global action.
A researcher from the University of Manitoba is playing a key role on a global team working to track and understand the concerning shifts in how mpox is spreading throughout the Democratic Republic of Congo (DRC). The team aims to gain insight into the virus’s ongoing and rapid evolution.
Mpox rapidly expanding across DRC
“The expansion of this virus is concerning. Viruses don’t have passports. They don’t respect international borders. We need to get things under control,” said team member Dr. Jason Kindrachuk, UM Canada Research Chair in molecular pathogenesis of emerging viruses and associate professor of medical microbiology and infectious diseases at the Max Rady College of Medicine, Rady Faculty of Health Sciences.
One of the team’s studies, which appeared on the cover of The Lancet earlier this year, examined 13 years of data and revealed that mpox has spread to almost every part of the Democratic Republic of Congo (DRC). In 2010, 18 out of 26 provinces reported cases, but by 2023, that number had risen to 24.
“The spread of mpox has changed rapidly over the last couple of years. Cases had been fairly focused within specific regions that were largely rural. Now mpox is a much broader problem across most of the DRC in both urban and rural locations,” said Kindrachuk, an international leader in mpox research who travels regularly to Africa.
Shift from wildlife to human transmission
Before 2023, most mpox infections were associated with direct contact with wildlife, particularly rodents, according to Kindrachuk. The virus primarily affected children under the age of 15.
However, a second study published in The Lancet earlier this year revealed a shift in transmission patterns in South Kivu province. Researchers identified the emergence of a new variant, known as subclade Ib, which showed signs of sustained human-to-human transmission and a rise in cases among individuals aged 15 to 34.
Kindrachuk, who also works with the Children’s Hospital Research Institute of Manitoba, noted that many of these adult cases involved numerous skin and genital lesions. This pattern suggests that the infections were likely linked to sexual activity, with several affected individuals identifying as sex workers or engaging in sex work.
New trends in disease severity and urban spread
The study also found that the overall disease severity was relatively low in South Kivu. They saw two deaths out of 403 hospitalized patients – a fatality rate of less than one per cent.
“The reality is that what we were seeing in South Kivu amongst those cases was actually different than what we’ve seen historically,” Kindrachuk said.
Looking back in the past, he said there typically weren’t many mpox cases in Kinshasa, the capital of DRC with a population of 17 million. This also changed.
“It’s concerning because our research that was published last week in The Lancet shows that it’s spreading in Kinshasa. This becomes an even bigger predicament in terms of response efforts because you’re not only dealing with spread across the majority of the country, but you also now have it embedded in this very large metropolis that is a major network for many other countries in Africa,” Kindrachuk said.
Transmission during pregnancy and future research
In a fourth study published in the prestigious publication The New England Journal of Medicine in June, the research team found that in three women, mpox was transmitted between mother and baby in utero, resulting in pregnancy loss or infection. The findings support the significance of preventive interventions, including vaccinations, in pregnant individuals, Kindrachuk said.
“We now need to conduct large-scale studies to better understand the outcomes associated with mpox in pregnancy and to help guide clinical management,” he said.
“For us, the complexity is increasing, but all the data that we are identifying in our studies helps inform our response and certainly the actions of other international individuals, organizations, and the Congolese on the ground who are leading the response efforts.”
References: “Suspected and confirmed mpox cases in DR Congo: a retrospective analysis of national epidemiological and laboratory surveillance data, 2010–23” by Eugene Bangwen, Ruth Diavita, Elise De Vos, Emmanuel Hasivirwe Vakaniaki, Sabin Sabiti Nundu, Annie Mutombo, Felix Mulangu, Aaron Aruna Abedi, Emile Malembi, Thierry Kalonji, Cris Kacita, Eddy Kinganda-Lusamaki, Tony Wawina-Bokalanga, Cécile Kremer, Isabel Brosius, Christophe Van Dijck, Emmanuel Bottieau, Koen Vercauteren, Adrienne Amuri-Aziza, Jean-Claude Makangara-Cigolo, Elisabeth Muyamuna, Elisabeth Pukuta, Beatrice Nguete, Didine Kaba, Joelle Kabamba, Christine M Hughes, Olivier Tshiani-Mbaya, Anne W Rimoin, Nicole A Hoff, Jason Kindrachuk, Niel Hens, Martine Peeters, Nicola Low, Andrea M McCollum, Robert Shongo, Daniel Mukadi-Bamuleka, Jean-Jacques Muyembe-Tamfum, Steve Ahuka-Mundeke, Laurens Liesenborghs and Placide Mbala-Kingebeni,01 Feburary 2025, The Lancet.
DOI: 10.1016/S0140-6736(24)02669-2
“Epidemiological and clinical features of mpox during the clade Ib outbreak in South Kivu, Democratic Republic of the Congo: a prospective cohort study” by Isabel Brosius, Emmanuel Hasivirwe Vakaniaki, Guy Mukari, Papy Munganga, Jean Claude Tshomba, Elise De Vos, Eugene Bangwen, Yves Mujula, Achilleas Tsoumanis, Christophe Van Dijck, Aimé Alengo, Léandre Mutimbwa-Mambo, Franklin Mweshi Kumbana, Jenestin Babingwa Munga, Divin Mazambi Mambo, James Wakilongo Zangilwa, Steeven Bilembo Kitwanda, Sarah Houben, Nicole A Hoff, Jean-Claude Makangara-Cigolo, Eddy Kinganda-Lusamaki, Martine Peeters, Anne W Rimoin, Jason Kindrachuk, Nicola Low, Patrick D M C Katoto, Espoir Bwenge Malembaka, John H Amuasi, Olivier Tshiani-Mbaya, Dally Muamba Kambaji, Richard Kojan, Cris Kacita, Daniel Mukadi-Bamuleka, Steve Ahuka-Mundeke, Koen Vercauteren, Tony Wawina-Bokalanga, Jean-Jacques Muyembe-Tamfum, Sabin Sabiti Nundu, Laurens Liesenborghs and Placide Mbala-Kingebeni, 29 January 2025, The Lancet.
DOI: 10.1016/S0140-6736(25)00047-9
“Epidemiology and phylogenomic characterisation of two distinct mpox outbreaks in Kinshasa, DR Congo, involving a new subclade Ia lineage: a retrospective, observational study” by Tony Wawina-Bokalanga, Sydney Merritt, Eddy Kinganda-Lusamaki, Daan Jansen, Megan Halbrook, Áine O’Toole, Elisabeth Pukuta-Simbu, Emmanuel Hasivirwe Vakaniaki, Rilia Ola-Mpumbe, Papy Kwete-Mbokama, Prince Akil-Bandali, Cris Kacita, Ange Ponga-Museme, Nelson Mapenzi-Kashali, Adrienne Amuri-Aziza, Olivier Tshiani-Mbaya, Princesse Paku-Tshambu, Pedro H L F Dantas, Tessa De Block, Emmanuel Lokilo-Lofiko, Chloé Muswamba-Kayembe, Jean-Claude Makangara-Cigolo, Gradi Luakanda-Ndelemo, David J Kelvin, Catherine Pratt, Ahidjo Ayouba, Sofonias Tessema, Antonio Mauro Rezende, Lisa E Hensley, Eric Delaporte, Dieudonné Mwamba, Lorenzo Subissi, Laurens Liesenborghs, Nicole A Hoff, Martine Peeters, Nicola Low, Steve Ahuka-Mundeke, Jean-Jacques Muyembe-Tamfum, Anne W Rimoin, Jason Kindrachuk, Koen Vercauteren, Andrew Rambaut and Placide Mbala-Kingebeni, 5 July 2025, The Lancet.
DOI: 10.1016/S0140-6736(25)00294-6
“Three Cases of Vertical Transmission of Clade Ib Mpox Virus” by Emmanuel Hasivirwe Vakaniaki, Nono-Raymond Swar Kuispond, Yuichiro Hirata, Eugene Bangwen, Isabel Brosius, Eddy Kinganda-Lusamaki, Seiya Ozono, Harutaka Katano, Laurent Gabanga Ndunge, Noella Mulopo-Mukanya, Jean-Claude Tshomba, Elise De Vos, Christophe Van Dijck, Papy Munganga, Guy Mukari, Yves Mujula, Divin Mazambi Mambo, Steeven Bilembo Kitwanda, Nadine Maliyamungu-Bubala, Léandre Mutimbwa-Mambo, Ian Crozier, Lori E. Dodd, Olivier Tshiani-Mbaya, Bienvenu Massamba Lebwaze, Espoir Bwenge Malembaka, Isaac Barhishindi, Susanne Krasemann, Robert Colebunders, Patrick D.M.C. Katoto, Sheila Makiala-Mandanda, Jason Kindrachuk, Anne W. Rimoin, Jean-Jacques Muyembe-Tamfum, Daniel Mukadi-Bamuleka, Tony Wawina-Bokalanga, Sabin Sabiti Nundu, Tadaki Suzuki, Raphaël Bulakali Chirimwami, Laurens Liesenborghs and Placide Mbala-Kingebeni, 18 June 2025, New England Journal of Medicine.
DOI: 10.1056/NEJMc2503347
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