Two distinct mpox strains are now spreading simultaneously in Central Africa—one in rural households, another in cities and among sex workers—and no one yet knows which version has reached Angola or why Burundi’s cases are concentrated in young children. This matters because the region is already stretched thin by Ebola, Marburg, and cholera outbreaks, and vaccination has only begun in parts of the Democratic Republic of the Congo. Without data on who is transmitting the virus and where, limited vaccine doses cannot be targeted effectively. The project fills that gap by combining four approaches: mathematical modelling of spread and vaccine impact across sub-national regions in DRC and Burundi; digitised clinical records to trace transmission routes and risk factors for severe disease; a pilot blood-test survey in Burundi to measure past exposure and household spread; and genomic sequencing of the first 100 mpox cases in Angola to identify the circulating strain and track viral evolution. If successful, the work will directly inform vaccine allocation decisions and outbreak response strategies for local health agencies, WHO, and the African CDC. The training workshops and fellowships will also leave Central African scientists and public health officials with the skills to manage future epidemics independently—strengthening a response system that currently faces repeated, overlapping crises.
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Context Mpox, caused by the monkeypox virus (MPXV), has been spreading rapidly in Central Africa. In August 2024, the World Health Organization (WHO) declared a Public Health Emergency of International Concern due to rising cases, particularly in the Democratic Republic of the Congo (DRC) and neighbouring countries, including Burundi and, more recently, Angola. While parts of DRC have begun vaccinating against mpox, Burundi and Angola have yet to introduce vaccines. The region faces many other health threats, including outbreaks of Ebola, Marburg virus disease, and cholera, which are exacerbated by ongoing conflict and population displacement in DRC. The Challenge Two mpox strains (clades) are spreading in DRC under different circumstances. Clade Ia, historically present, circulates mainly in rural areas via zoonotic and household transmission. Clade Ib, a more recently emerged strain, is spreading in cities, and disproportionately affecting sex workers. In Burundi, however, clade Ib presents differently, with a higher fraction of cases in young children. The reasons for this are unclear: potential explanations include differences in transmission patterns, or underreporting of adult cases due to isolation policies - many cases of mpox may go, making it important to estimate population exposure. In Angola, the mpox clade(s) circulating, and extent of spread, remain unknown. With limited resources, optimising mpox vaccine allocation is essential. Data-driven evidence is needed to determine the priority population groups for vaccination to reduce transmission and severe outcomes. Aims and Objectives This project will generate such evidence for the mpox response as well as transferable knowledge and methodologies applicable to other outbreaks. First, researchers will use modelling to estimate mpox spread and assess potential vaccine impact across different sub-national regions in DRC and Burundi, informing vaccine distribution strategies. Second, clinical records on patients and their contacts will be digitised and analysed to identify likely transmission routes and risk factors for severe disease. Third, a pilot serological (blood test) study will determine the feasibility of a larger survey measuring how many people have antibodies against mpox in Burundi and better understand household transmission. Fourth, a genomic study will be conducted to sequence the first 100 mpox cases in Angola to determine which strain(s) are circulating, how the virus is spreading, and how it is evolving over time. Finally, local expertise will be strengthened through a combined training workshop and hackathon in Burundi and research training fellowships bringing Central African scientists to the UK. Public health professionals, data scientists, and policymakers will receive hands-on training in outbreak data analysis, modelling, genomic epidemiology, and digital tools to improve epidemic response. Potential Applications and Benefits This project will improve outbreak control, inform vaccine decisions, and strengthen response systems in a region experiencing frequent and severe public health threats, thus improving global pandemic preparedness. Findings will be shared with local public health agencies, WHO and the African CDC to ensure direct public health impact. Via knowledge-sharing, bi-directional training, and capacity-strengthening, researchers in DRC, Burundi, Angola and the UK will be equipped with the skills needed to manage future health crises more effectively.
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