Emergence and Global Spread of Mpox Clade Ib: Challenges and the Role of Wastewater and Environmental Surveillance
By
Ananda Tiwari
Thierry Kalonji
Taru Miller
Tim Van Den Bossche
Adriana Krolicka
Hypolite Muhindo-Mavoko
Patrick Mitashi
Marc Christian Tahita
Rolf Lood
Tarja Pitkänen
Vivi Maketa
February 10, 2025
Clinical Scorecard: Global Rise of Mpox Clade Ib: Addressing Challenges and the Importance of Wastewater and Environmental Monitoring
At a Glance
Category Detail
Condition Mpox caused by mpox virus, Orthopoxvirus genus Key Mechanisms Human-to-human transmission, zoonotic transmission, environmental exposure; clade Ib more transmissible with APOBEC3-type mutations Target Population People in affected African countries, including children and adults aged 20–30 years; both men and women Care Setting Public health and clinical settings in affected African countries and international travel hubs
Key Highlights
Mpox clade Ib outbreak escalating in Democratic Republic of Congo, Burundi, Uganda, with international spread risks Clade Ib shows higher transmissibility and similar high case fatality rate (1.8%) compared to clade Ia; differs from clade IIb Wastewater and environmental surveillance (WES) underutilized but critical for early hotspot detection and outbreak response Guideline-Based Recommendations
Diagnosis
Use molecular diagnostics and genomic sequencing to identify mpox clades and monitor mutations Enhance specimen collection and testing capacity to overcome current challenges and improve outbreak assessment Management
Implement coordinated response involving governments, WHO, Africa CDC, academia, and NGOs Focus on medical care, vaccination, infection prevention, and resource delivery including food and protective equipment Monitoring & Follow-up
Integrate wastewater and environmental surveillance to detect hotspots and enable rapid public health response Conduct genomic surveillance to track clade-specific transmission dynamics and mutations Risks
High transmissibility of clade Ib increases risk of spread in urban and international travel hubs Transmission through sexual contact, close human contact, zoonotic and environmental exposure complicates control Children and diverse age groups affected, with potential for household and community spread Patient & Prescribing Data
Individuals infected with mpox clade Ib in African countries and international cases linked to travel
Current efforts focus on vaccination and infection prevention; detailed treatment protocols not specified in source
Clinical Best Practices
Prioritize enhanced diagnostic testing and genomic sequencing for accurate clade identification Adopt integrated surveillance approaches including wastewater and environmental monitoring Coordinate multi-sectoral response for resource allocation and outbreak management Address transmission risks in diverse populations including children and urban communities Support continuous data collection and research on clade Ib pathogenicity and transmission References
