The Panafpox project

Panafpox: understanding mpox in Central and West Africa

Watch the interview with Steve AHUKA MUNDEKE (INRB, Kinshasa, DRC) and Martine PEETERS (IRD, Montpellier, France).

What are the Panafpox project’s objectives?

Panafpox is a multidisciplinary project whose main objective is to provide new information on mpox viruses in African countries (Democratic Republic of Congo (DRC), Cameroon, Benin and Guinea) which have a high probability of emergence or re-emergence of zoonotic infections. The aim is to assess the risk of epidemics and their spread worldwide.

To achieve this, the Panafpox project has three specific objectives:

• To document the animal reservoir of the mpox virus in detail;
• To document the spreading of asymptomatic mpox virus infection in humans in endemic countries;
• To document the genetic diversity and evolution of the mpox virus in human samples in order to understand whether the different epidemics correspond to independent zoonotic transmissions or to unknown human-to-human transmission chains.

What are the results?

Here is an overview of the initial data and results for the three objectives:

• Documentation of the animal reservoir

Samples of rodents and bats were collected in the DRC, Cameroon and Guinea to analyse the circulation of the virus. Analyses were conducted in the laboratories of INRB, CREMER and CERFIG, respectively, where serological and molecular techniques were transferred. Rodents are considered the most likely reservoir of the mpox virus, and PCR tests are being carried out to confirm this hypothesis.

• Studies of asymptomatic infections in humans

Asymptomatic mpox virus infections appear to be frequent in endemic countries such as the DRC, where the burden of disease is highest. While case reporting on a clinical basis may overestimate the number of infections, confirmatory PCR tests alone underestimate the true rates due to variable sample quality. Using specific antibody tests, a study of 463 patients in the DRC found an mpox infection rate of 48.2%, compared with 33.9% using PCR alone, identifying 66 additional patients and 23 additional outbreaks (Kinganda-Lusamaki E et al, Pathogens 2023). This highlights the importance of serological testing to supplement PCR diagnosis and improve surveillance.

Epidemiological surveys also show that some cases of mpox go undiagnosed, with previous infections going unreported suggesting underestimated local spread. Studies in endemic regions such as Equateur province in the DRC have reported confirmed cases and their contacts by analysing dermatological lesions and blood samples for antibodies. This work is in progress to gain a better knowledge of the factors associated with asymptomatic infections.

• Evaluation of the genetic diversity and evolution of the mpox virus

Whole-genome sequencing of mpox virus samples from the DRC revealed significant genetic diversity in clade 1 viruses (divided between groups 2, 3 and 4, with distinct geographical differences between provinces). Group 2 samples showed the greatest diversity, with some closely related to rodent sequences, suggesting possible zoonotic transmissions. The genomes from groups 3 and 4 came mainly from the provinces of Tshopo, Sankuru and Maniema. Phylogenetic analysis also revealed a distinct lineage in the group 3.

Furthermore, the sequencing confirmed cases of sexual transmission of mpox in DRC. This highlights the importance of the sequencing process for understanding the evolution and diversity of the mpox virus in different geographical areas and zoonotic niches.

Panafpox scientific publications

• First imported Cases of MPXV Clade Ib in Goma, Democratic Republic of the Congo: Implications for Global Surveillance and Transmission Dynamics

Daniel Mukadi-Bamuleka, Eddy Kinganda-Lusamaki, Noella Mulopo-Mukanya, Adrienne Amuri-Aziza, Áine O’Toole, Brigitte Modadra-Madakpa, Guy Mutombo Ndongala, Emmanuel Hasivirwe Vakaniaki, Sydney Merritt, Cris Kacita, Gaston Lubambo Maboko, Jean-Claude Makangara-Cigolo, Michel Ngimba, Emmanuel Lokilo, Elisabeth Pukuta-Simbu, Gradi Luakanda, Tavia Bodisa-Matamu, Zephanie Paluku Kalimuli, Prince Akil-Bandali, Sifa Kavira, Daan Jansen, Adèle Kavira Kamaliro, Emile Muhindo-Milonde, Jeriel Mufungizi, Yves Birindwa Hamisi, Hugo Kavunga, Olivier Tshiani, Sabin S. Nundu, Laurens Liesenborghs, Nicole A. Hoff, Jean Nachega, Robert Shongo, Ahidjo Ayouba, Genay Pilarowski, Alain Kakule Mangolopa, Amos Kiuka Ebondo, Nicola Low, Souradet Y. Shaw, Sam Wilkinson, Sofonias Kifle Tessema, Lorenzo Subissi, Eric Delaporte, Koen Vercauteren, Tony Wawina-Bokalanga, Anne W Rimoin, Martine Peeters, Nicholas Loman, Andrew Rambaut, Jean-Jacques Muyembe-Tamfum, Lisa E. Hensley, Jason Kindrachuk, Placide Mbala-Kingebeni, Steve Ahuka-Mundeke. medRxiv 2024.09.12.24313188; doi: https://doi.org/10.1101/2024.09.12.24313188

• Clade I Mpox virus genomic diversity in the Democratic Republic of the Congo, 2018 – 2024: Predominance of Zoonotic Transmission

Eddy Kinganda-Lusamaki, Adrienne Amuri-Aziza, Nicolas Fernandez, Jean-Claude Makangara-Cigolo, Catherine Pratt, Emmanuel Hasivirwe Vakaniaki, Nicole A. Hoff, Gradi Luakanda, Prince Akil-Bandali, Sabin Sabiti Nundu, Noella Mulopo-Mukanya, Michel Ngimba, Brigitte Modadra-Madakpa, Ruth Diavita, Princesse Paku, Elisabeth Pukuta-Simbu, Sydney Merritt, Áine O’Toole, Nicola Low, Antoine Nkuba-Ndaye, Hugo Kavunga-Membo, Robert Shongo, Laurens Liesenborghs, Tony Wawina-Bokalanga, Koen Vercauteren, Daniel Mukadi-Bamuleka, Lorenzo Subissi, Jean-Jacques Muyembe, Jason Kindrachuk, Ahidjo Ayouba, Andrew Rambaut, Eric Delaporte, Sofonias Tessema, Eric D’Ortenzio, Anne W. Rimoin, Lisa E. Hensley, Placide Mbala-Kingebeni, Martine Peeters, Steve Ahuka-Mundeke . Cell. 2024 Oct 24:S0092-8674(24)01199-1. doi: 10.1016/j.cell.2024.10.017. Online ahead of print.

Co-circulation of Clade Ia and Ib monkeypox virus in Kinshasa Province, Democratic Republic of the Congo, July – August 2024.

Tony Wawina-Bokalanga, Prince Akil-Bandali, Eddy Kinganda-Lusamaki, Emmanuel Lokilo, Daan Jansen, Adrienne Amuri-Aziza, Jean-Claude Makangara-Cigolo, Elisabeth Pukuta-Simbu, Rilia Ola-Mpumbe, Cris Kacita, Princesse Paku-Tshambu, Pedro-Henrique L.F. Dantas, Gradi Luakanda, Antoine Nkuba-Ndaye, Meris Matondo, Junior Bulabula, Emmanuel Hasivirwe Vakaniaki, Áine O’Toole, Tessa De Block, Christian Ngandu, Nicole A. Hoff, Nicola Low, Lorenzo Subissi, Sydney Merritt, Jean-Jacques Muyembe-Tamfum, Laurens Liesenborghs, Martine Peeters, Eric Delaporte, Jason Kindrachuk, Anne W. Rimoin, Steve Ahuka-Mundeke, Andrew Rambaut, Dieudonné Mwamba, Koen Vercauteren, Placide Mbala-Kingebeni. Euro Surveill. 2024 Sep;29(38):2400592. doi: 10.2807/1560-7917.ES.2024.29.38.2400592.

• Presumed Transmission of 2 Distinct Monkeypox Virus Variants from Central African Republic to Democratic Republic of the Congo.

Vakaniaki EH, Kinganda-Lusamaki E, Merritt S, Kasongo F, Malembi E, Lunyanga L, Linsuke S, Halbrook M, Kalthan E, Pukuta E, Aziza AA, Cigolo JCM, Lumembe R, Kabamba G, Anta Y, Bolunza P, Kanda I, Ngazobo R, Kalonji T, Nsio J, Matoka P, Mwamba D, Ngandu C, Shaw SY, Shongo R, Madinga J, Boum Y, Liesenborghs L, Delaporte E, Ayouba A, Low N, Mundeke SA, Hensley LE, Tamfum JM, Nakoune E, Peeters M, Hoff NA, Kindrachuk J, Rimoin AW, Mbala-Kingebeni P. Emerg Infect Dis . 2024 Oct;30(10):2128-2134. doi: 10.3201/eid3010.241118.

• Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo.

Vakaniaki EH, Kacita C, Kinganda-Lusamaki E, O’Toole Á, Wawina-Bokalanga T, Mukadi-Bamuleka D, Amuri-Aziza A, Malyamungu-Bubala N, Mweshi-Kumbana F, Mutimbwa-Mambo L, Belesi-Siangoli F, Mujula Y, Parker E, Muswamba-Kayembe PC, Nundu SS, Lushima RS, Makangara-Cigolo JC, Mulopo-Mukanya N, Pukuta-Simbu E, Akil-Bandali P, Kavunga H, Abdramane O, Brosius I, Bangwen E, Vercauteren K, Sam-Agudu NA, Mills EJ, Tshiani-Mbaya O, Hoff NA, Rimoin AW, Hensley LE, Kindrachuk J, Baxter C, de Oliveira T, Ayouba A, Peeters M, Delaporte E, Ahuka-Mundeke S, Mohr EL, Sullivan NJ, Muyembe-Tamfum JJ, Nachega JB, Rambaut A, Liesenborghs L, Mbala-Kingebeni P. Nat Med . 2024 Oct;30(10):2791-2795. doi: 10.1038/s41591-024-03130-3.

• Co-Circulating Monkeypox and Swinepox Viruses, Democratic Republic of the Congo, 2022.

Kalonji T, Malembi E, Matela JP, Likafi T, Kinganda-Lusamaki E, Vakaniaki EH, Hoff NA, Aziza A, Muyembe F, Kabamba J, Cooreman T, Nguete B, Witte D, Ayouba A, Fernandez-Nuñez N, Roge S, Peeters M, Merritt S, Ahuka-Mundeke S, Delaporte E, Pukuta E, Mariën J, Bangwen E, Lakin S, Lewis C, Doty JB, Liesenborghs L, Hensley LE, McCollum A, Rimoin AW, Muyembe-Tamfum JJ, Shongo R, Kaba D, Mbala-Kingebeni P. Emerg Infect Dis. 2024 Apr;30(4):761-765. doi: 10.3201/eid3004.231413.

• Clade I-Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo.

Kibungu EM, Vakaniaki EH, Kinganda-Lusamaki E, Kalonji-Mukendi T, Pukuta E, Hoff NA, Bogoch II, Cevik M, Gonsalves GS, Hensley LE, Low N, Shaw SY, Schillberg E, Hunter M, Lunyanga L, Linsuke S, Madinga J, Peeters M, Cigolo JM, Ahuka-Mundeke S, Muyembe JJ, Rimoin AW, Kindrachuk J, Mbala-Kingebeni P, Lushima RS; International Mpox Research Consortium. Emerg Infect Dis. 2024 Jan;30(1):172-176. doi: 10.3201/eid3001.231164. Epub 2023 Nov 29.

• Use of Mpox Multiplex Serology in the Identification of Cases and Outbreak Investigations in the Democratic Republic of the Congo (DRC).

Kinganda-Lusamaki E, Baketana LK, Ndomba-Mukanya E, Bouillin J, Thaurignac G, Aziza AA, Luakanda-Ndelemo G, Nuñez NF, Kalonji-Mukendi T, Pukuta ES, Nkuba-Ndaye A, Lofiko EL, Kibungu EM, Lushima RS, Ayouba A, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Delaporte E, Peeters M, Ahuka-Mundeke S. Pathogens. 2023 Jul 7;12(7):916. doi: 10.3390/pathogens12070916.