MPOX-PROBE

The challenge

The natural animal reservoir of the mpox virus is not known with certainty, although it is suspected to be native to small mammals, including some types of squirrel. This knowledge gap makes it difficult to plan activities to minimise the risk of ‘spillover’ – the transmission of viruses from animals to people.

In addition, the lack of easy-to-use diagnostics makes it difficult to track the spread of new infections, as mpox symptoms overlap with those of other infections. 

These factors make it difficult to gain a clear picture of the emergence and spread of new mpox infections, hampering prevention and outbreak response measures.

The project

The MPOX-PROBE project is carrying out a diverse range of activities to enhance mpox surveillance, with a focus on the border between the DRC and the Republic of Congo. The two countries are separated by the Congo River, but there is considerable cross-border travel, which could facilitate the wider spread of the virus.

Key activities include:

• Enhanced mpox surveillance, focusing on three border sites. Surveillance activities will include trapping of animals and testing those with signs of disease for the presence of the mpox virus, to identify potential natural host species. In patients, blood samples will be analysed to characterise host responses to infection (through transcriptomics and assessment of inflammatory responses). Analysis of serum samples from the wider population will provide insights into the community prevalence of infection and potential for asymptomatic carriage. Analysis of air samples from a range of clinical and public spaces will shed light on the risk of airborne spread of the virus. Notably, studies will include children, pregnant women and people living with HIV.
• Development of a dynamic transmission model: Existing and new surveillance data will be used to develop a model of mpox transmission, which will highlight potential high-risk areas and enable the possible impact of control measures to be explored.
• Diagnostic development: A prototype mpox rapid diagnostic test will be developed using novel nanoparticle technology. It will be highly sensitive, able to discriminate between different mpox clades, and could potentially be converted into a point-of-care device.
• Knowledge, attitudes and practices: A survey and other tools will be used to gather insights from key groups, including members of the public and healthcare workers.
• Understanding risk factors for infection: A case-control study will compare patients with mpox infections (acquired from an animal source or by human-to-human transmission) with matched controls, to help identify key factors associated with an increased risk of mpox infection.

MPOX-PROBE 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 MPOX-PROBE project will generate substantial new evidence on the emergence and spread of mpox infections in the DRC and the Republic of Congo. It will:

• Identify potential animal reservoirs of the mpox virus.
• Provide a clearer picture of the emergence and transmission of the virus.
• Create new diagnostic tools for identifying and tracking infections.
• Clarify current knowledge and attitudes across key community groups.
• Develop a transmission model to support planning of public health responses.

Through its activities, the MPOX-PROBE project will provide policymakers with information and new tools to better understand the mpox outbreak, how the virus is being transmitted through populations, and how transmission might be affected by different control measures – better equipping policymakers to control the outbreak and protect public health.