lA public health emergency of international concern was declared in August by the World Health Organization (WHO) due to an unprecedented outbreak of mpox in eastern Democratic Republic of the Congo (DRC), in Kivu and in bordering countries previously free of the disease. A new subclade 1b of the virus has emerged in the area, confirming the now strictly person-to-person transmission of this disease, formerly known as “monkeypox”. Since September 2023, the start of the current epidemic, the Democratic Republic of the Congo has reported more than 15,000 suspected cases of mpox, far from the 4,000 cases reported in previous years.
Although this epidemic is a cause of concern for the international community, it is not the first time that mpox, a disease that has so far been neglected, has emerged from its African cradle.
In 2003, cases of mpox appeared in children in the United States, with lesions on their hands and a case of encephalitis. The investigation allowed the chain of contamination to be traced back to prairie dogs, which were themselves contaminated in a pet shop by Gambian rats from Ghana. The virus was therefore identified in animals from a country where no cases of mpox had been reported in animals or humans. This revealed the involvement of the trade in live animals in the emergence and spread of viruses.
Crossing the species barrier
The global mox epidemic of 2022 surprised the international community and then convinced it that it was a primarily zoonotic disease that occurs in forested areas of Africa. This time, the epidemic was spreading within the Western gay community. Since 2017, in Nigeria, genital forms of this disease have also appeared in young men in urban areas: an epidemiological change that has been insufficiently taken into account at the international level.
In 2017, a first case was detected in Port Harcourt, a palm oil-producing city in the south, thirty-nine years after the last human case of mpox occurred in this country. Genomic studies suggest that the crossing of the species barrier occurred as early as 2014 in two Nigerian regions characterized by oil palm plantations. This intensive exploitation causes a massive simplification of ecosystems, with extinctions of specialized species and proliferation of opportunistic species such as rodents. Indeed, palm nuts are very popular among small tree squirrels that are suspected to be mpox reservoirs.
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