{"doi":"10.1038/s41591-024-03130-3","title":"Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo","abstract":"Outbreaks of monkeypox (mpox) have historically resulted from zoonotic spillover of clade I monkeypox virus (MPXV) in Central Africa and clade II MPXV in West Africa. In 2022, subclade IIb caused a global epidemic linked to transmission through sexual contact. Here we describe the epidemiological and genomic features of an mpox outbreak in a mining region in eastern Democratic Republic of the Congo, caused by clade I MPXV. Surveillance data collected between September 2023 and January 2024 identified 241 suspected cases. Genomic analysis demonstrates a distinct clade I lineage divergent from previously circulating strains in the Democratic Republic of the Congo. Of the 108 polymerase chain reaction-confirmed mpox cases, the median age of individuals was 22 years, 51.9% were female and 29% were sex workers, suggesting a potential role for sexual transmission. The predominance of APOBEC3-type mutations and the estimated emergence time around mid-September 2023 imply recent sustained human-to-human transmission.","journal":"Nature Medicine","year":2024,"id":416095,"datarank":0.8866194966060792,"base_score":5.910796644040527,"endowment":5.910796644040527,"self_citation_contribution":0.8866194966060792,"citation_network_contribution":0.0,"self_endowment_contribution":0.8866194966060792,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":368,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9387,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1198962,"name":"Cris Kacita","orcid":"0009-0004-0227-7609","position":1,"is_corresponding":false},{"id":564679,"name":"Eddy Kinganda-Lusamaki","orcid":"0000-0001-9795-0165","position":2,"is_corresponding":false},{"id":231803,"name":"Áine O’Toole","orcid":"0000-0001-8083-474X","position":3,"is_corresponding":false},{"id":1198963,"name":"Tony Wawina-Bokalanga","orcid":"0000-0001-6659-0267","position":4,"is_corresponding":false},{"id":564680,"name":"Daniel Mukadi‐Bamuleka","orcid":"0000-0002-6836-8704","position":5,"is_corresponding":false},{"id":621531,"name":"Adrienne Amuri-Aziza","orcid":"0000-0002-5516-0779","position":6,"is_corresponding":false},{"id":1200151,"name":"Nadine Malyamungu-Bubala","orcid":null,"position":7,"is_corresponding":false},{"id":1200152,"name":"Franklin Mweshi-Kumbana","orcid":null,"position":8,"is_corresponding":false},{"id":1200153,"name":"Léandre Mutimbwa-Mambo","orcid":null,"position":9,"is_corresponding":false},{"id":1200154,"name":"Freddy Belesi-Siangoli","orcid":null,"position":10,"is_corresponding":false},{"id":1200155,"name":"Yves Mujula","orcid":null,"position":11,"is_corresponding":false},{"id":412061,"name":"Edyth Parker","orcid":"0000-0001-8312-1446","position":12,"is_corresponding":false},{"id":1200156,"name":"Pauline-Chloé Muswamba-Kayembe","orcid":null,"position":13,"is_corresponding":false},{"id":1198964,"name":"Sabin S. 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