Discussion
To conclude, this rapid parsimonious mpox sequencing strategy in 148 mpox-infected patients provides a unique insight into the genomic variability of an epidemic DNA virus. The existence among the mpox strains identified in France of a mutational pattern specific to the 2022 epidemic was confirmed, and showed the overall low genomic variability of circulating strains. The fact that the majority of the substitutions were transitions (G>A and C>T) suggests a role of the human APOBEC3 enzyme editing in mpox sequences, known to target G and C in specific nucleotide contexts for other viruses as an innate immune response 16.
This study also highlights that, although rare, mpox can circulate in Europe far from epidemics and should be included in differential diagnosis of other sexually transmitted infections in particular in MSMs.