Manila:

The Philippines has confirmed two more mpox virus infections of the milder clade 2 variety, its health ministry said Monday, bringing the number of active cases to three.

“We continue to see local transmission of mpox clade II here in the Philippines, in Metro Manila in particular,” Health Minister Teodoro Herbosa said in a statement.

The newly confirmed cases were a 37-year-old male in Metro Manila who had rash on his body last week and was brought to a government hospital, and a 32-year-old male from the capital who had skin lesions on his body.

The Philippines announced last week it had detected a case of the mpox virus’ milder variant in a 33-year-old male who had no travel history outside the Philippines.

The three cases this year means the Philippines has had 12 laboratory-confirmed case since July 2022.

The World Health Organization earlier this month declared mpox a global public health emergency, its highest form of alert, for the second time in two years, because of an outbreak in the Democratic Republic of Congo that had spread to neighbouring countries.

A new form of the virus has triggered global concern as it seems to spread easily though routine close contact.

The disease, caused by the monkeypox virus, leads to flu-like symptoms and pus-filled lesions. It is usually mild but can kill, with children, pregnant women and people with weakened immune systems, such as those with HIV, all at higher risk of complications.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

Photo taken for illustration purpose onluy.
| Photo Credit: Reuters

A World Health Organization official stressed on Tuesday that mpox, regardless of whether it is the new or old strain, is not the new COVID, as authorities know how to control its spread.

“We can and must tackle mpox together,” said Hans Kluge, WHO regional director for Europe, in a media briefing.

“So will we choose to put the systems in place to control and eliminate mpox globally? Or we will enter another cycle of panic and neglect? How we respond now and in the years to come will prove a critical test for Europe and the world,” he added.

Mpox, a viral infection that causes pus-filled lesions and flu-like symptoms, is usually mild but can kill.

Kluge said that the focus on the new clade 1 strain gives Europe a chance to refocus on the less severe clade 2 variety, including better public health advice and surveillance.

About 100 new cases of the clade 2 mpox strain are now being reported in the European region every month, added Kluge.

Poxviruses have long been a cause of fear as well as curiosity for humankind. One particularly infamous poxvirus, smallpox, alone may have killed more than 500 million people in the last century.

Smallpox didn’t discriminate between rich, poor, young, old, and killed a third of the individuals whom it infected. The turning point came with evidence of the efficacy of the smallpox vaccine. Thus followed a concerted effort worldwide to administer the vaccine and eventually eradicate the dread disease. This feat has stood as a testament to the power of sustained global public health initiatives.

Mpox’s 15 minutes

Another poxvirus, mpox, was recently in the headlines after a rapidly expanding global outbreak in 2022-2023. The virus was previously called ‘monkeypox’ after a spillover event in a research facility involving monkeys in 1958; the name is considered both wrong and inappropriate today: since then, researchers have identified mpox in many sporadic outbreaks among humans. They have also found multiple mpox lineages have been circulating in humans, adapting by accumulating mutations modulated largely by the APOBEC proteins.

But it wasn’t until 2022 that the disease became widely known, thanks to outbreaks in more than 118 countries and the World Health Organisation (WHO) quickly declaring it a public health emergency. To date, this outbreak has infected almost 100,000 people. Based on WHO data, infections have a mortality rate of 1-10%.

The outbreak was due to one clade (strains of the virus descended from a common ancestor) — called IIb — having developed very high human-to-human transmission through close contact and spread through the sexual route. While the rate of new infections has been dropping, mpox continues to circulate among unvaccinated individuals worldwide. This increases the chance that a more virulent and transmissible strain might emerge and become endemic somewhere.

Expanding, contracting as required

Mpox, like all poxviruses, are DNA viruses. The mpox genome has about 197 kilobases (kb). The core genes are those closely conserved (i.e. preserved during evolution) by various poxviruses plus two sections about 6.4 kb long, one at each end of the genome. Researchers don’t yet know what function these sections serve but suspect they influence how well the poxviruses can infect different hosts.

The mpox genome also has a sequence of bases repeating in a pattern, which researchers believe play a role in the virus’s evolution.

The mpox family of viruses is also known to be able to evade selective evolutionary pressures. It does this by duplicating genes and/or accumulating mutations and expanding its genome significantly — or contracting its genome by deleting gene stretches or inactivating them. Such rhythmic expansions and contractions are called genomic accordions.

Find the accordion

In a study published on April 18 by Nature Communications, researchers at the Icahn School of Medicine in New York and multiple institutions in Spain extensively sequenced the genome of the mpox virus implicated in the 2022 outbreak. They used advanced genome sequencing technologies to piece together a comprehensive genome of the mpox virus from scratch.

They found that the 6.4-kb-long sections of the virus strongly influenced the virus’s human-to-human transmissibility. They also reported that variations in three genes in particular could affect the virus’s evolution. Importantly, 6.4-kb-long sections, which scientists had previously considered to be not so informative, were actually found to be the virus’s genomic accordions.

All mpox genomes can be divided into two distinct yet broad clades: I and II. Clade I is thought to have a higher mortality. Each clade has sub-clades, or lineages, defined by specific evolutionary processes. Researchers have also found evidence of significantly different mpox virulence in animal models. The new study, like others like it, further the idea that the 2022 outbreak largely involved a new lineage of the virus, clade IIb, that was even better adapted to human-to-human transmission than clades I or IIa.

The outbreak in the DRC

Between September 2023 and February 2024, health workers detected a large mpox outbreak detected in the Democratic Republic of the Congo (DRC), centred on a mining village and quickly spreading to a number of regions within the country. This outbreak was associated with a significantly larger spread as well as mortality. Researchers soon confirmed mpox clade I was responsible.

This outbreak differed from earlier ones, which were sporadic and self-contained spillover events, by spreading through human-to-human contact and affecting young adults rather than children. A preprint paper, uploaded by researchers from Belgium, Canada, the DRC, France, Ghana, Nigeria, South Africa, and the U.S., on April 14 describes the genomes of virus samples obtained from 241 individuals suspected to have been infected during the outbreak.

The genomic data suggests a distinct lineage of clade I being associated with human-to-human transmission. The researchers also found evidence — in fragments of the genome that closely resembled viruses isolated and sequenced in recent years — of the hypothesis that this lineage emerged from a very recent zoonotic spillover.

One eye on the genome

As with any viral infection, without urgent intervention, the outbreak has the potential to spread rapidly across national, and even continental, boundaries and emerge as another global outbreak.

To prevent such an outcome, genome sequences from before and during mpox outbreaks have provided well-lit glimpses of the evolutionary dynamics the virus uses to invent new ways to move between and survive in different populations of animals and people.

Thus, through rigorous genomic investigations and coordinated public health efforts, we can mitigate the threat of emerging pathogens and the world’s health security.

The authors are senior consultants at the Vishwanath Cancer Care Foundation and Adjunct Professors at Indian Institute of Technology Kanpur. All opinions expressed are personal.