A deadly new mpox variant has experts fearing the worst of the disease is yet to come

Key PointsThe WHO has warned of a new, more deadly mpox strain spreading in the Democratic Republic of Congo.There’s also been a significant uptick of new cases in Australia, with experts urging people to get vaccinated.The disease spreads through close contact, causing flu-like symptoms and pus-filled lesions.

Deadly new variants of mpox, formerly known as monkeypox, paired with a significant uptick of cases in Australia has experts fearing the worst is yet to come from the disease.

This week, the World Health Organization (WHO) has warned of a new, more deadly strain spreading in the South Kivu province of the Democratic Republic of Congo.

The Congo — one of the poorest countries in the world — has seen 20,000 cases and over 1,000 deaths from mpox, mainly among children, since last year.

Professor Andrew Grulich is from the Kirby Institute at the University of New South Wales, a world-leading research organisation working to eliminate infectious diseases.

He says Central Africa is struggling with mpox, especially a new subvariant of the disease or what’s known as a clade.

“There’s a lot of concern about what’s happening in central Africa with an ongoing and probably expanding epidemic.

“There is a different clade that is happening in Central Africa, which we think has higher mortality, but this is also in an area where there’s quite a lot of untreated HIV and that might explain some of the mortality.”

Congolese doctors have reported a fatality rate of about 5 per cent in adults and 10 per cent in children, as well as high rates of miscarriages.

Mpox usually mild, but can be fatal

While mpox was first detected in monkeys in 1956, the first known human case was seen in the Congo in 1970.

The disease is a viral infection that spreads through close contact, causing flu-like symptoms and pus-filled lesions.

The hands of an mpox patient in the Democratic Republic of the Congo during an outbreak of the disease there in 1997. Credit: AP

Most cases are mild but it can kill.

In 2022, an international outbreak of mpox marked the first time the disease had spread widely outside Africa.

A new mpox wave sweeps Australia

And now, in Australia, there’s been a significant uptick in cases over the last few months with 90 reported infections in 2024 according to the Department of Health’s disease surveillance system.

This is more than triple the 26 cases seen throughout the entirety of 2023.

The degree of local transmission is very concerning, said Simon Ruth, CEO of Thorne Harbour Health, one of Australia’s largest LGBTIQ+ community-controlled organisations.

“The current outbreak started around Anzac Day in Melbourne, so it’s been running for a couple of months now. Victoria’s up at 50 cases currently, and then there’s also been a significant number in Brisbane and then a few cases in Adelaide and in Sydney also,” Ruth said.

“The difference between the outbreak this year and then the one that we had 12 months ago, 12 months ago they were almost entirely overseas-acquired. Currently, they’re almost entirely locally acquired. So, we’ve got monkeypox in the community.”

Grulich says that, while mpox may not prove deadly for most, it often causes pain and disfigurement.

“The type of monkeypox we have in Australia — what’s called clade 2b — this has an extremely low mortality around the world but it certainly can cause a lot of pain and some disfigurement.

“Most people get pretty mild disease, but people who may get it more severely are those who have immune problems.”

A summer fling and 21 days in isolation

So far, the only Australians affected by the disease have been men and primarily those in the LGBTIQ+ community.

Jack Barlow was 26 years old in 2022 when he contracted mpox during his travels in the US amid the initial outbreak.

“I was on holiday and I went to Provincetown and I kind of had a romantic summer fling, and unfortunately I contracted mpox.

“Luckily, my symptoms kicked in once I had already returned back to Australia a few days into being home, and I was like my jet lag just wasn’t going anywhere. And that’s when some of the other symptoms started to appear.”

He spent 21 days in isolation as one of the first Australians to get the disease.

He considers himself lucky to have only had relatively mild symptoms but says it was a scary time.

“There wasn’t a whole lot known about it at the time, and I was kind of scared I was going to end up having quite the serious kind of response, which is being covered head to toe in sores.

“I was pretty lucky. I only had a few pox. I had a bit of fatigue and tiredness. So, I do consider myself one of the lucky ones.”

Advocates encourage people to get vaccinated

The main way to prevent mpox is the mpox vaccine, which is estimated to be about 85 per cent effective at preventing the disease after the two-shot course.

In 2023, 48 per cent of gay and bisexual men in Sydney and Melbourne reported having received at least one dose of mpox vaccine.

Simon Ruth from Thorne Harbour Health says we need to see those numbers increase.

“We would encourage people to come and get vaccinated. The vaccination is free, it’s readily available at a large number of clinics in Victoria and some pharmacies.”

He says the community needs to pull together to prevent the spread or else mpox may become a consistent presence in Australia.

“If you’re symptomatic, getting it checked out, trying to prevent onward transmission, if you have lesions, keep them covered so that the disease can’t spread onto further people. We really don’t want it to become endemic in Australia.

“It possibly is becoming endemic in some other parts of the world, particularly through sexual transmission. And it’s rare enough here that we can still get on top of it and prevent that.”

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