Mpox alert: what are the symptoms of the new clade 1b mutation and how concerned should we be as experts warn it could spread to Europe?

A new form of MPOX is spreading in the Democratic Republic of Congo (DRC), raising fears it could spread to Europe.

The clade 1b mutation, which experts call “the most dangerous yet”, is believed to be causing a wave of miscarriages and killing one in 10 of those infected.

Scientists monitoring the spread of the new strain have already warned that it appears to be the most transmissible strain yet and could even reach Europe.

So how concerned should we be, who is most at risk and what should we do to protect ourselves?

Here, MailOnline explains everything you need to know.

What is mpox?

Mpox, formerly known as monkeypox, is a viral infection that used to occur mainly in West and Central Africa.

It was transmitted to humans through direct contact with animals such as squirrels, which are known to harbor the virus.

However, it can also be transmitted through very close contact with an infected person.

The virus was first discovered when an outbreak of a smallpox-like disease occurred in monkeys kept for research in 1958, hence the former name.

The first human case was recorded in the Democratic Republic of Congo in 1970 and the infection has since been reported mainly in Central and West African countries.

In 2022, an outbreak in Europe and the US, largely affecting gay and bisexual men, prompted the World Health Organization (WHO) to declare a public health emergency.

It was the first time it was reported that mpox spread mainly through sexual contact.

What is the new species?

Clade 1b is a descendant of the deadly clade 1 species of mpox and differs from the milder version (clade 2) that spread to more than 20 countries, including the United Kingdom, by 2022.

Once again, sexual transmission appears to be the main way clade 1b spreads, and researchers believe the current outbreak started in a bar used by sex workers.

The disease first appeared during the rainy season, when roads were poor and there was limited movement of people between towns and villages.

Scientists warn that more infections could occur during the current dry season, especially during school holidays when people are out and about more.

At a briefing for journalists yesterday, Trudie Lang, professor of global health research at the University of Oxford, said that when the outbreak in the DRC was discovered last September, scientists had assumed it would be clade 2 because of sexual transmission.

However, genetic testing showed that it belonged to the more virulent strain.

Clade 1 has historically only been found in people who eat infected bushmeat, with transmission largely confined to the affected household.

How is it different from other species?

Scientists have warned that the species is ‘undoubtedly’ the ‘most dangerous species’ yet.

It is also not clear how quickly the new variant is spreading.

Like Clade 2, Clade 1b causes a severe blister-like rash at the site of the infection.

But the symptoms are more serious, with the rash often spreading to the entire body.

So far, about 600 patients with the mutated form of the virus have been identified in Kamituga – the city where it was first spotted.

Leandre Murhula Masirika, research coordinator at the health department of South Kivu province – in the east of the country – said 24 of the country’s 26 provinces have been affected by the outbreak.

However, experts warn that the real figure could be much higher as hospitals only record serious cases requiring advanced care.

The number of asymptomatic cases, or people with minimal symptoms, who could still spread the infection, is also still unknown.

Where was the mutant form of the virus found?

To date, all cases have been reported in DRC cities bordering the countries of Rwanda, Burundi and Uganda.

However, scientists said it is highly likely the virus has already reached these neighboring countries, although no cases have been confirmed anywhere other than the DRC.

John Claude Udahemuka, a lecturer at the University of Rwanda who is monitoring the outbreak in the DRC, said they believe the first person with the new strain was a man who had sex with a woman in the town of Kamituga.

He then met other women in different locations.

Sex workers regularly travel between the DRC and its neighboring countries, meaning this could be a possible route of transmission, the scientists warned.

How deadly is it?

Mpox is usually not serious and most patients recover within a few weeks without treatment. Yet the disease can be fatal.

Early estimates suggest the new mutant strain has a mortality rate of five percent for adults and 10 percent for children.

But another worrying aspect was that infections in pregnant women were causing an ‘alarming’ number of miscarriages.

Experts also said that some cases had even resulted in irreversible vision loss, as well as recurring skin rashes all over the body.

Earlier this month, the WHO said the MPOX outbreak in the DRC was “concerning.”

It pointed to limited public awareness of MPox, a lack of treatment kits and vaccines and the country’s many other health priorities as factors in the emergence of a new strain.

The risk associated with MPOX in the DRC “remains high,” the report said.

How does it spread?

Mpox is not classified as a sexually transmitted infection, although it can be transmitted through direct contact during sex.

Infectious lesions, through which infections are most likely to be passed on, can occur on any part of the body.

The infection can also be transmitted through contact with clothing or bedding used by an infected person.

What symptoms should people be aware of?

Initially, mpox causes a flu-like illness: fever, headache, muscle aches, back pain, swollen lymph nodes (glands in the neck, groin or under the arms) and fatigue.

Within one to five days, a rash appears, usually first on the face and then spreading to other parts of the body, including the genitals.

The rash resembles chickenpox. It starts as raised spots that then turn into small, fluid-filled blisters. These blisters turn into scabs, which eventually fall off.

The illness can last up to four weeks, but most cases resolve on their own without any treatment.

During the latest outbreak, the UK Health Security Agency advised anyone with unusual rashes or lesions on any part of the body – in particular gay or bisexual men, those who have been in contact with someone who has or may have MPox, and anyone who has traveled to West Africa in the past three weeks – to contact NHS 111 or call their local sexual health service.

What happens if someone in Britain tests positive?

In Britain, if someone is suspected of having monkeypox, they will usually be given a PCR test – similar to the tests used to detect Covid.

For this purpose, cotton swabs are taken from the skin and throat.

There are no specific treatments, and the NHS currently says that if symptoms are mild, patients may simply be advised to stay at home until they recover.

If the disease is more severe, patients may be offered treatment including antiviral drugs: Tecovirimat, which is designed against smallpox, and Cidofovir.

Will the current vaccine work against this?

After clade 2 raised global alarm among health officials in 2022, new infections gradually declined due to increased awareness of the disease and a rushed vaccination program.

At the time, Britain reported almost 4,000 cases, with NHS England vaccinating more than 68,000 people against the disease with the smallpox vaccine.

This works because the two viruses are closely related.

But experts said there was not yet enough evidence to suggest a vaccine would be effective against this new strain.

Trials will be needed to work this out, which will take time, she added.