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We examined 89 travel-related clade Ib monkeypox virus cases detected in 33 countries during August 2024-July 2025. Most cases were approximately men; about one third led to secondary transmission. Secondary transmission risk was highest among sexual, then household, contacts. Those groups should be the focus of response strategies and interventions.

We report clade Ib monkeypox virus infection in a patient who returned to Thailand from the Democratic Republic of the Congo, the subclade epicenter. Improved diagnostic testing, public health response, and surveillance systems for mpox are needed in Thailand, and preexposure mpox vaccination should be considered, especially for high-risk persons.

We used a sensitive and specific PCR to detect monkeypox virus clade Ib DNA from >3,000 wastewater samples collected prospectively across the United States. Monkeypox virus clade Ib DNA was detected in 1 sample from a location with a confirmed case; it was not detected in locations with no confirmed cases.

Mpox was first identified against the backdrop of the smallpox eradication campaign. Monkeypox virus (MPXV), the causative agent of mpox, has been maintained in animal reservoirs in the forested regions of West and Central Africa as 2 distinct clades; clade I has historically caused more severe infection in Central Africa than clade II, historically found in West Africa. However, rapid reemergence and spread of both MPXV clades through novel routes of transmission have challenged the known characteristics of mpox. We summarize mpox demographic distribution, clinical severity, and case-fatality rates attributed to genetically distinct MPXV subclades and focus on MPXV clade Ib, the more recently identified subclade. Broad worldwide assistance will be necessary to halt the spread of both MPXV clades within mpox endemic and nonendemic regions to prevent future outbreaks.

Monkeypox, a zoonotic virus in the Orthopoxvirus genus , has drawn global attention for its impact on public health. In the current Mpox outbreak, a novel clade, Ib, has emerged as a significant and potentially fatal threat. This review examines the dynamics of MPXV transmission, person-to-person spread, and infection mechanisms, highlighting key risk factors. We explore the clinical features of Mpox, focusing on symptomology, illness duration, and the distinguishing characteristics of clade Ib compared to other clades. A critical analysis addresses diagnostic techniques and emphasizes the need for robust surveillance, particularly for clade Ib detection. We review recent prevention and treatment strategies, including antiviral drugs and vaccines, with a focus on clade Ib containment. The conclusion underscores the urgency of global collaboration to prevent and prepare for emerging threats like clade Ib and identifies crucial research paths and knowledge gaps. This review offers a comprehensive overview of clade Ib, covering its emergence, genetic traits, epidemiological impact, transmission patterns, clinical features, the role of Artificial Intelligence (AI) in outbreak management, detection challenges, and implications for public health response.

The novel mpox clade Ib initially identified in the Domestic Republic of Congo has spread to its multiple neighbouring countries as well as countries beyond the African continent. We characterised the global risk of importation of mpox clade Ib, highlighting the need to ramp up surveillance capacity for early detection.

The ongoing mpox clade Ib outbreak was first detected in the eastern Democratic Republic of Congo (DRC) and was associated with sexual transmission. It emerged in Kamituga, a mining city and spread rapidly in surrounding health zones and reached cities like Bukavu and Goma. Here, we describe the clinical, epidemiological, and virological characteristics of the first case of clade Ib in Kinshasa, the capital city in the western DRC. The case involved a young adult woman from Kinshasa who reported unprotected sexual contact with an occasional partner, a former friend, and subsequently developed genital lesions, including vesicles and pustules. These lesions evolved and spread to the entire body, including the limbs, eyes, and soles. The diagnosis was confirmed by PCR and sequencing allowed us to assign clade Ib. We show that infection with mpox clade Ib through sexual transmission can lead to limbal nodular keratoconjunctivitis and focal conjunctivitis as complications. Importantly, these results suggest that clade Ib may have been circulating silently in Kinshasa prior to the official declaration by the Ministry of Health. This also raises concerns about the potential risk of global spread, as is currently being observed. Further studies are needed to investigate whether subsequent outbreaks of clade Ib in Kinshasa may have emerged independently of introductions from Kivu, pointing to a more complex pattern of co-circulation that could define the mpox epidemic in the capital.

Background Mpox-associated ocular disease, including keratitis, is an emerging, vision-threatening complication. Management is challenging because no anti-viral therapy has yet been approved to prevent permanent corneal scaring or blindness. Case presentation We describe a 43-year-old female Ugandan health worker who acquired a Clade Ib mpox infection following occupational exposure during clinical examination of a patient with confirmed mpox attending a health facility in Kampala, Uganda. She developed severe ulcerative keratitis, with persistent epithelial defects and progressive stromal involvement despite standard-of-care treatment, including topical trifluridine and supportive therapy. Diagnostic confirmation of mpox was made by real-time polymerase chain reaction (PCR) from lesion swabs, and Clade Ib was identified. The keratitis remained active and vision-threatening for more than four months after symptom onset. Because of ongoing deterioration and high risk of irreversible vision loss, the treating team initiated topical cidofovir 0.5% ophthalmic drops under emergency compassionate use. Subsequent improvement included epithelial closure, decreased stromal inflammation, and visual recovery after 8 weeks of treatment and has since remained stable for to date. Conclusions Topical cidofovir 0.5% may provide therapeutic benefit in severe, refractory mpox keratitis when trifluridine fails, and when no other effective, approved alternative exists. Controlled clinical evaluation and structured compassionate-use frameworks for cidofovir are urgently warranted given the risk of permanent blindness in mpox keratitis.

New clades and lineages emerged with the globally prevalent of Mpox virus (MPXV), accompanied by changing clinical symptoms, pathogenesis and transmission dynamics in associated with specific clades and lineages. Here, we developed a two tube multiplex real-time fluorescent quantitative PCR (mrt-qPCR) assay for simultaneous differentiation of MPXV clades Ia, Ib, II, and innovative binding lock nucleic acid (LNA) probes to detect A.1, B.1 and C.1 lineages within the clade IIb. The assay demonstrated high sensitivity (33-69 copies/reaction) and specificity with expected linearity and stability. The intra-assay and intre-assay coefficients of variations (CV) were below the acceptable threshold of 5%, and the mrt-qPCR method has good stability and reproducibility. Clinical validation using 109 qPCR positive, 1 clade IIb B.1 virus strain and 15 negative specimens revealed 100% concordance for the differentiation of the three clade II and 97.60% for the differentiation the three lineages. The two tube multi-test system streamlined workflows, enabling efficient screening of diverse clinical samples (swabs from skin lessions, oropharynx and rectum, saliva and plasma). We have established a two-tube multiplex qPCR method for detecting different clades and lineages of the MPXV. This method addresses the issue of false-negative detection of MPXV clade Ib caused by gene fragment deletion, and has also enabled the development of a rapid detection approach for the predominantly circulating clade IIb (including lineages A.1, B.1, and C.1). This cost-effective assay provides an important tool for accurate diagnosis, typing and epidemiological surveillance of MPXV.

During infectious disease outbreaks, acquiring genetic data across various kingdoms offers essential information to tailor precise treatment methodologies and bolster clinical, epidemiological, and public health awareness. Metagenomics sequencing has paved the way for personalized treatment approaches and streamlined the monitoring process for both co-infections and opportunistic infections. In this study, we conducted long-read metagenomic DNA sequencing on mpox-like lesion pustules from six suspected patients who were positive and confirmed to be infected with MPXV during the MPXV subclade Ib outbreak in the Eastern Democratic Republic of the Congo. The sequenced data were taxonomically classified as bacterial, fungal, and viral in composition. Our results show a wide spectrum of microorganisms present in the lesions. Bacteria such as Corynebacterium amycolatum, Gardnerella vaginalis, Enterococcus faecium, Enterobacter clocae, Staphylococcus epidermidis, and Stenotrophomonas maltophilia were found in the lesions. The viral classification of the reads pointed out the absolute predominance of the monkeypox virus. Taken together, the outcomes of this investigation underscore the potential involvement of microorganisms in mpox lesions and the possible role that co-infections played in exacerbating disease severity and transmission during the MPXV subclade Ib outbreak.