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.