The World Health Organisation has announced the highest level of alert for mpox. This follows an upsurge of mpox in the Democratic Republic of the Congo (DRC) and a growing number of countries in Africa. Sweden’s public health agency has also recently recorded what it says is the first case of the more dangerous type of mpox outside the African continent.

Professor Tom Solomon CBE, Director of The Pandemic Institute (TPI) as well as the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections shares this message:

“Mpox, formerly known as monkeypox, is a viral disease that can be passed from person to person by close physical contact, and causes a range of symptoms including fever, headache and skin lesions.

“Mpox belongs to the same virus family that causes smallpox, both diseases are caused by different types of poxviruses within the Poxviridae family. Mpox was discovered in humans in the 1970’s, but has been causing large outbreaks since 2017.

“In 2022 there was a large epidemic of the less deadly variant (Clade 2) of mpox which spread internationally, during which The Pandemic Institute launched a £500K rapid response fund to help tackle the growing threat. This included studies investigating transmission and spread, development of rapid diagnostics, investigation of the body’s immune response to help vaccine development, studies of new drug treatments, and understanding of stigma around the disease.

“The WHO’s declaration of this public health emergency of international concern (PHEIC) and its presence in Africa and Sweden, indicates a need for us to continue working with partners to tackle the virus together. While the emergence of new diseases is worrying, we are in a much better position than we were in 2020 when we faced the COVID-19 pandemic, with organisations like The Pandemic Institute able to rapidly mobilise funding for essential research.”

Liverpool’s mpox research:

Taking learnings from COVID-19

Researchers led Professor Julian Hiscox from the University of Liverpool’s Institute of Veterinary and Ecological Sciences, and a member of The Pandemic Institute, on the research project DECIPHER-Mpox. The project is led by Dr Misaki Wayengera at Makerere University in Uganda and co-ordinated by Dr Jacqueline Weyer at the Centre for Emerging Zoonotic and Parasitic Diseases in South Africa with research groups in the DRC. The work aims to understand why the new Clade 1b variant of pox is a more concerning disease than previous versions of the virus.

Together they are analysing samples from infected individuals to understand the new variant and how this impacts the way people respond to infection with mpox. The group specialise in understanding virus evolution and in characterising blood and other samples to correlate changes in host biomarkers with disease progression and outcome. Their approach was developed during the 2014 -16 Ebola virus outbreak in West Africa and honed during the COVID-19 pandemic.

Professor Julian Hiscox, Respiratory and Emerging Viruses Group said: “Mpox represents a global threat and challenge. We were honoured to be approached by our African colleagues to support this research project which we hope will make a significant contribution to international efforts to address the virus. This collaboration illustrates the power of working across continents, giving us the opportunity to further knowledge and expertise at a time when it is more needed.”

DECIPHER-Mpox is funded by the EuGlobal Health EDCTP3 Joint Undertaking, part of Horizon Europe.

Immune response

Much of our knowledge into the body’s immune response against poxviruses comes from studying the smallpox vaccine (vaccinia). There continues to be gaps in our understanding of how specialised white blood cells (called T cells) respond to mpox.

Dr Krishanthi Subramaniam, a Lecturer at the Institute of Infection, Veterinary and Ecological Sciences at the University of Liverpool, has been using TPI funding to investigate how our immune system responds to mpox infection: “Our research has been seeking to understand how the immune system responds to mpox, what part of the mpox virus it targets, and whether the immune response differs between people infected with the virus and people who have been vaccinated with the smallpox vaccine. Understanding how the immune system responds is crucial to future control strategies.’

How it spreads

Dr Ana Karina Pitol García, a microbiologist Research Associate at Liverpool School of Tropical Medicine, was awarded funding from TPI, NIHR and WHO to look at transmission routes of the mpox virus: “Mpox virus is most commonly transmitted through direct skin-to-skin contact. However, the virus can also be transmitted through contact with contaminated items such as surfaces, clothing and linens. Using TPI funding we investigated how long the virus survives on the skin and different materials, and how much is transferred by these routes. This information is crucial going forward to help control the spread of the disease and the results from our work are being utilised by the WHO to inform guidelines and practices in mpox endemic countries.”

Oropouche virus

Also this week, the Oropouche virus has been in the news. Sometimes called the ‘sloth fever’ virus, the European Centre for Disease Prevention and Control announced 19 imported cases to Europe. The virus can be found in sloths and is spread by biting midges and mosquitos. It has caused large outbreaks in South America, with symptoms including fever, headaches and muscle pain.

The Pandemic Institute has just this week released a new funding call in partnership with the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (HPRU EZI) to address critical research gaps in Oropouche virus knowledge.

Professor Alain Kohl, Chair in Virology at the Liverpool School of Tropical Medicine, said this of the new funding scheme: “The recent developments and questions on Oropouche virus following its wider emergence – beyond areas where it was known to occur historically – raise important questions on its ability to cause disease and its transmission, but also on diagnostics and treatment. This will require specialist knowledge across disciplines, and the UK virology community has excellent expertise to tackle such a challenge. Access to rapid funding is always critical when we need to move fast and mobilise manpower and resources to ultimately help those affected, by medical interventions but also support information campaigns with up-to-date science.”