Community transmission of mpox clade Ib not driven through sexual exposures, Uvira, eastern Democratic Republic of the Congo, June to October 2024
Abstract
BACKGROUNDIn September 2023, monkeypox virus (MPXV) clade Ib emerged in Kamituga, a mining zone in South Kivu, Democratic Republic of the Congo (DRC), primarily through sexual transmission.AIMWe aimed to investigate cases in a MPXV clade Ib outbreak in Uvira, eastern DRC.METHODSFrom June to October 2024, we collected demographic, exposure and clinical data from suspected mpox cases at Uvira hospital and in households. The virus was identified by PCR. We investigated putative transmission patterns, disease severity and risk factors.RESULTSWe identified 973 suspected cases: 415 (42.7%) were tested with PCR and 322 (77.6%) were confirmed. The median age of suspected cases was 9 years (interquartile range (IQR): 3-20 years), with 620 (63.7%) aged textless 15 and 344 (35.4%) textless 5 years. Severe disease (≥ 100 lesions) was more common in cases aged textless 15 years (25.6%; 142/554) than others (16.1%; 49/304; p textless 0.001). Twenty-two (12.2%) of 181 cases aged textless 5 years had acute malnutrition. Seven cases died; the overall case-fatality ratio was 0.7%, and in infants (aged textless 1 year) it was 3.9% (5/127). Of 329 suspected cases tested for HIV, six (1.8%) were positive. Nineteen (14.5%) of 131 females aged 15-49 years were pregnant. Most reported exposures to suspected mpox cases occurred in households (67.9%; 298/439). Sexual (6.0%; 19/318) or healthcare-related occupational exposures (1.4%; 6/417) were less common. Animal exposures were few (5.0%; 39/776) and predominantly domestic (97.4%; 38/39).CONCLUSIONThis child-centred outbreak, driven by non-sexual transmission, underscores the need for paediatric vaccines, nutritional support and household interventions. Adult-focused responses alone may be insufficient to control the outbreak.
Patrick Musole Bugeme
PhD student
My research explores the seroepidemiology of infectious diseases and the translation of evidence into actionable public health policies.
Megan O'Driscoll
Postdoctoral Fellow
Javier Perez-Saez
Research Scientist
I am interested in infectious disease dynamics and epidemiology with a focus on methods development and application.
Levi Bugwaja
Research Coordinator
My research interests include infectious disease dynamics and translation to decision makers.
Jules V. Jackson
Research Analyst
Jules is a Research Data Analyst with the Infectious Disease Dynamics group at the Johns Hopkins Bloomberg School of Public Health.
Elizabeth C. Lee
Research Scientist
I am interested in understanding the mechanisms behind the surveillance data we observe and improving their applications to public health policy.
Espoir Bwenge Malembaka
Research Scientist
My research interests include infectious disease dynamics and translation to decision makers.