Abstract
Abstract Background The mpox public health emergency of international concern that emerged in 2022, driven by clade IIb mpox infections in high-income nations, was declared over by the WHO in May 2023, while the more virulent clade I mpox, continues to spread endemically in Central Africa. In November 2023, the Democratic Republic of Congo (DRC) reported its highest ever annual clade I mpox cases, reaching 12,569 with a 4.6% case fatality rate (CFR). The DRC lacks rollout of approved mpox vaccines but has two vaccine trials among healthcare personnel ongoing. The US saw a 78% increase in clade IIb incidence in the first 11 weeks of 2024 compared to the same period in 2023. Only 25% of the eligible US population has completed the two-dose vaccine regimen; waning immunity may leave the population more susceptible to clade I infection should it be imported. Travel is increasing from the DRC and the Congo to the US, particularly within the past year, highlighting the need for enhanced surveillance and vaccination. Methods Three vaccination scenarios for the DRC, beyond the baseline of no vaccines received, were built: 1) vaccinating the public who have not received the smallpox vaccine, 2) vaccinating the high-risk GBMSM (gay, bisexual and other men who have sex with men) population aged 18-40 years and 3) vaccinating children, another high-risk group. Direct and indirect international travel volumes from the DRC to the US were analysed and forecasted to assess risk of the introduction of clade I in the US. Results Our data suggest that if clade I mpox spreads similarly to clade IIb in 2022, the expected death toll could be > 5000 deaths globally (CFR 5.69%) and ∼ 1800 in the US. A GBMSM-targeting vaccine campaign could avert ∼ 9000 infections and > 250 deaths in the DRC. The number of travellers from the DRC to the US is forecasted to reach a high of > 5600 passengers between April-August 2024, with indirect travel also posing a risk. The top three countries with travel to the US include the UK, France and India; France sees the highest levels of travel from the Congo and the DRC, increasing the risk of onward clade I transmission if an introduction were to occur. Conclusion Vaccinating the GBMSM in the DRC could significantly reduce infection rates and reduce the clade I risk posed to nations, such as the US, via international travel. Disclosures All Authors: No reported disclosures
Published Version
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