MBOTE-SK

The challenge

In late 2023, mpox cases began to be detected in Kamituga, a densely populated mining area in the east of the Democratic Republic of the Congo (DRC). These were found to be caused by a novel ‘clade Ib’ strain of mpox, which was being transmitted by sexual and other close person-to-person contact. 

When cases of mpox began to rise significantly, the MBOTE consortium, already established and with partners in the DRC and Europe, supported initial efforts to understand and respond to this outbreak in eastern DRC. Much was unknown about the spread and impact of clade Ib mpox, hampering efforts to provide optimal care and control its spread.

The project

The MBOTE-SK project combines support for immediate response to the clade Ib outbreak with research studies that will enhance clinical care and inform control strategies.

The project team is working across five areas, each of which integrates response-support activities as well as associated research studies:

• Understanding transmission: Carrying out case-finding activities and mapping cases to clarify mpox epidemiology and provide health authorities with up-to-date information about the spread of infection. Research activities will also explore potential drivers of transmission.
• Genomic surveillance: Introducing regional genome sequencing capacity in eastern DRC to genomically characterise isolates and shed light on the transmission and evolution of the new strain.
• Case management and diagnostics: Documenting the full clinical impact of clade Ib in different groups, tracking outcomes and identifying risk factors for particular impacts. The project is also supporting the introduction of decentralised molecular diagnostic tools at the local hospital and providing a platform for evaluating rapid diagnostics for mpox.
• Community attitudes: Community engagement activities will raise awareness of mpox and generate insights into community knowledge and attitudes, including stigmatisation. This work will help to reveal hidden cases of mpox in the community.
• Supporting vaccination: The project’s epidemiological analyses will inform the targeting of vaccination strategies at high-risk populations. The project is also evaluating the impact of vaccine campaigns and assessing vaccine effectiveness.

MBOTE-SK is one of nine projects funded through an emergency call for proposals launched in response to the mpox outbreak in the DRC and other sub-Saharan African countries, which was declared a Public Health Emergency of International Concern (PHEIC) by WHO and a Public Health Emergency of Continental Security (PHECS) by Africa CDC in 2024.

Impact

The MBOTE-SK project is making a critical contribution to the response to the mpox outbreak in the eastern DRC. It will:

• Provide policymakers with key information on the local spread of clade Ib, to inform the planning of control strategies.
• Identify the full range of clinical impacts of clade Ib, to ensure optimal clinical management.
• Provide insights into community attitudes and ‘invisible’ transmission in the community, to shape public health interventions and communication strategies.
• Help to target vaccination strategies and generate evidence of their impact.

Collectively, the project’s work will support the immediate response to the clade Ib outbreak and generate evidence needed to improve care and control the spread of infection over the longer term.