Mpox risk in Manitoba low, country better prepared, U of M virologist says

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This article was published 25/11/2024 (341 days ago), so information in it may no longer be current.

One of the country’s leading virologists says Canada is far better prepared for a resurgence in mpox cases than it was just a couple of years ago.

The Public Health Agency of Canada confirmed the first case of a more severe type of the virus, formerly known as monkeypox, in Manitoba Friday.

Dr. Jason Kindrachuk, Canada research chair in emerging viruses, said Monday the risk remains low for the general population in the province.

A member of the Consortium for Intercepting Emerging Diseases in Africa, Kindrachuk, who is at the University of Manitoba, said a more significant issue is ensuring that vaccinations reach central and western Africa where, for decades, the virus has been endemic.

“When you leave these things unchecked, they don’t just stay contained,” Kindrachuk said. “Unfortunately, what we’re seeing is not surprising. The reality is we’re going to see more of these as the situation (in Africa) continues to expand.”

The case found in Winnipeg, said to be travel-related, was identified quickly and health officials were able to conduct contact tracing to reduce the risk of the virus spreading further. The individual is isolating.

Symptoms of the virus include fever, headache, muscle aches and back aches, exhaustion and a painful rash on the face, inside the mouth or on other parts of the body.

Kindrachuk, who was in the Congo earlier this year and is heading back in January, said it’s important to highlight the change in handling cases of mpox, especially in light of the lack of understanding of the disease during the 2022 global outbreak.

“Now, when we identify a new case, especially of a different type of mpox infection, we have a very early warning system and surveillance system to identify those cases quickly,” he said.

“Contact tracing gets undertaken quickly. You have good community engagement and good knowledge, especially among groups at risk for infection.

“All of that stuff puts us in a better position than we were in 2022.”

Kindrachuk pointed to other jurisdictions where the mpox virus has emerged but hasn’t spread.

Last week, the first case in the United States was identified in California.

“Not to say it can’t happen… but all of the countries that have identified cases haven’t seen onboard expansion,” Kindrachuk said. “That’s good. That tells us we’re in a very good position, in terms of early detection.

Mpox, clinically very similar to smallpox in how the infection presents, was first identified in the 1970s in the Democratic Republic of the Congo before spreading to West Africa.

The virus has two types: clade 1, which is endemic or regularly occurring in central Africa, including the Congo, and has two subtypes (1a and 1b); and clade 2, which is prevalent in the western areas of the continent.

Historically, most infections came from contact with wildlife, largely rodents, with people becoming infected after hunting and trapping.

The virus’s spread had been limited, as close contact was required to transfer from person to person.

“All of that has changed, unfortunately,” Kindrachuk said. “We still don’t fully understand what happened and why the virus suddenly expanded when it did, but we saw a big increase in cases. And unfortunately, while we’ve seen historically (that) most cases were driven through contact with wildlife in the Congo, we have now seen sustained human-to-human transmission most prominently through close, intimate contact.”

In 2022, clade 2 was the dominant virus that spread around the world, emanating in Nigeria and circulating mainly through sexual contact.

The case found in Manitoba Friday was confirmed as clade 1b, a relatively new lineage of the virus first discovered last April, which showed more rapid human-to-human transfer, especially among sex workers in the Congo.

“The situation is changing very quickly,” Kindrachuk said.

Case-fatality rates with mpox have been as high as 10 per cent in some cases, with those tending to be found most in children under the age of 15 and, most prominently under the age of five, especially in the Congo and nearby Burundi.

When the virus spread rapidly across high-income countries in 2022, case-fatality rates dropped south of one per cent, with roughly 10 per cent of cases requiring hospitalization.

Kindrachuk, meanwhile, said that the world needs to focus less on patching the hose when it springs a leak and, instead, shut off the taps.

Vaccine acceptance in the Congo, which has a population of approximately 109 million, has varied, with stigma and other factors playing a role.

“The problem is, as the public health emergency continues to unfold in central Africa, until we get containment of that we’re going to be at risk of additional cases,” Kindrachuk said.

“Good to have an early warning system, but let’s try to turn off the tap at the source. That’s about getting good surveillance on the ground in endemic areas and getting vaccine out to communities.”

Kindrachuk said recent modelling done at Yale University showed that if vaccinations were targeted for children under the age of 15, there would be a 50-60 per cent reduction in fatal infections.

“But we’re talking about tens of millions of doses you have to get on the ground,” he said, adding the current situation is nowhere close to those numbers.

The first mpox vaccine for children was approved by the World Health Organization last week and requires only a single dose.

“It’s a game-changer once it starts moving on the ground and gets distributed,” Kindrachuk said.

scott.billeck@freepress.mb.ca