U.S. and international public health agencies are concerned about a deadlier strain of the mpox virus spreading from the Democratic Republic of the Congo.

The U.S. Centers for Disease Control and Prevention on Thursday issued a warning to clinicians and health departments about the subtype of the mpox virus, formerly referred to as monkeypox, called Clade I. Clade I is typically more infectious than the Clade II subtype that spread globally last year.

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The European Center for Disease Prevention and Control issued a similar warning on Friday.

New evidence has shown that for the first time Clade I can be transmitted through sexual contact, the primary mode of transmission for the less threatening form of the infection that broke out in the U.S., chiefly among men who have sex with men.

Mpox can also be transmitted from infected animals or among family members within households if a person comes in contact with fluid from mpox lesions.

The World Health Organization's mpox lead Rosamund Lewis told Reuters that her organization is "very worried" about Clade I mpox, which has already killed nearly 600 people, mostly children, in the DRC.

The DRC reported over 13,000 mpox cases in 2023, more than double the number during the last peak in 2020. Around 10% of Clade I mpox infections are fatal, according to the CDC. Infections of Clade II mpox, in comparison, are rarely fatal.

Although no Clade I cases have been reported in the United States to date, the CDC is recommending that clinicians take precautions for all patients who have traveled to the DRC, including sending lesion specimens for Clade-specific testing in patients suspected to have the more virulent disease.

The currently available mpox vaccine as well as existing smallpox treatments effective against mpox are believed to be effective against the Clade I subtype, according to CDC guidance.

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The CDC says only 1 in 4 Americans eligible for the vaccine have received both doses.

Lewis said that the WHO is working with the Democratic Republic of the Congo to overcome regulatory requirements to procure and accept donations of mpox vaccines.