If 2022 was the year mpox infections exploded globally, 2023 was the year much of the world stopped paying attention.
Yet Canadian researchers, in collaboration with scientists working on the ground in hot spots such as Nigeria and the Democratic Republic of the Congo (DRC), are still shining a spotlight on the virus that sparked last year’s unprecedented global outbreak — and one that still seems capable of new surprises.
One joint Canadian-DRC research team, co-led by Jason Kindrachuk from the University of Manitoba, has documented what Kindrachuk calls a “massive red flag”: the first known cases of a deadlier strain of mpox spreading through sexual contact.
“This is a real concern for us in regard to the potential for the disease to spread broadly,” he said.
The World Health Organization (WHO) announced the finding in its latest mpox report, and CBC News has obtained the forthcoming paper in which Kindrachuk — and a team of other Canadian, Congolese and international researchers — further outline a cluster of clade I infections linked to sexual transmission.
There are two main forms of mpox virus: clade I and clade II. The global outbreak in 2022 involved clade IIb, which typically leads to milder illness. By year’s end there had been roughly 87,000 infections and more than 100 deaths after the virus spread widely through sexual networks, with the majority of the cases among men who have sex with men.
Infections of that form of mpox leads to an array of painful and sometimes debilitating symptoms, including both internal and external lesions, but relatively few deaths.
Until now, it was also thought to spread mainly through close contact, including surface-based transmission.
5 individuals tested positive
The paper from Kindrachuk’s team outlines how a Congolese man, identified by WHO as a resident of Belgium, had sexual contact with another person in Europe. After arriving in the DRC, the man then tested positive for clade I mpox, and reported that he had sexual contact with nine additional partners, including six men and three women.
Five contacts in total ended up testing positive, and all required outpatient treatment and pain control, the research team reported.
Followup investigations also looked at other possible transmission chains involving 120 additional contacts — including other sexual contacts and family members — but none of those individuals developed mpox during 21 days of follow up.
“We have a tiny piece of the puzzle suggesting something is different now,” Kindrachuk said, noting the new finding raises fresh questions about just how often sexual transmission is already happening within the DRC.
Given the increased disease severity associated with this mpox clade, the researchers stressed sexual transmission could impact broader geographical spread of mpox across both clades of the virus.
WHO said another outbreak in the DRC is also being reported, involving multiple cases of mpox among sex workers. These new instances of sexual transmission raise concerns about the rapid expansion of mpox within the country and beyond, given its “internationally mobile” population, the organization continued in its latest report.
A child with mpox sits on his father’s lap while receiving treatment at the centre of the International medical NGO Doctors Without Borders in the Central African Republic. The World Health Organization has declared an end to the global public health emergency for mpox, yet some scientists warn there’s still cause for concern. (Charles Bouessel/AFP)
DRC experiencing largest annual outbreak
The DRC has been particularly hard hit by the deadlier form of mpox this year. It has been linked to more than 12,000 suspected cases and nearly 600 deaths since the start of the year — the highest number of annual cases ever reported in the Central African nation, WHO figures show.
Worldwide transmission of the milder clade is still simmering as well.
Though WHO ended its emergency designation for mpox in May, and case reporting in many regions has been scaled back since then, hundreds of clade IIb cases were still reported across dozens of countries this fall.
More than a year into the global outbreak, burning scientific questions about how mpox operates remain unanswered, while hot spots throughout Africa that have endured outbreaks for years still don’t have access to vaccines.
“In Congo this year, there are thousands and thousands of cases of mpox, and not a vaccine dose to be found … it’s such a slap in the face to our colleagues [in Africa],” said Kindrachuk.
“We shouldn’t just be responsive when these types of infectious diseases move into our regions or across our borders and start to present a much greater threat.”
A patient receives an mpox vaccination at a clinic in southern France in August 2022. While global cases of the virus are now dropping, some scientists warn mpox will remain a global threat, with future outbreaks a near certainty. (Pascal Guyot/AFP/Getty Images)
The world only became interested in mpox when cases appeared beyond the African continent, said Toronto-based infectious diseases physician Dr. Isaac Bogoch, who is working on DRC mpox research alongside Kindrachuk.
“This [is] an infection that has been recurring and increasing in frequency over the last couple of decades as the smallpox vaccine programs started to wind down,” he said, noting that endemic regions of Africa still lack both vaccines and treatment options.
In contrast, many higher-income countries made vaccines and therapeutics widely available during last year’s outbreak.
Vaccine campaigns launched throughout Canada used a smallpox/mpox vaccine manufactured by Bavarian Nordic, for instance, and health-care providers here have also prescribed the smallpox treatment TPOXX off-label for mpox patients.
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Canada-Nigeria team also studying mpox transmission
In Nigeria, where the less-virulent clade II version of mpox has been circulating for years, there is also limited access to vaccines. The country’s largest outbreak took place in 2017, with 228 suspected cases and 60 confirmed infections.
Audu said researchers are collecting samples from multiple sources — including symptomatic sex workers and household pets living with people who had prior mpox infections — to get a better sense of the virus’ transmission patterns and which animals can carry and spread it. It’s already known to infect certain mammals, such as squirrels and monkeys, but scientists aren’t yet sure just how many other species may be susceptible.
“We’re spreading our tentacles wide,” Audu said.
Ongoing research, increased vaccine access, and continued collaboration between international clinicians and virologists are all crucial steps toward understanding and containing this potentially-deadly virus, according to Audu.
“The world is a global village and things can move very easily from one country to another … so I think the best thing to do is just to be vigilent,” she said.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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