Community transmission of Mpox clade Ib not driven through sexual exposures in Uvira, eastern Democratic Republic of Congo, June – October 2024

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Abstract Introduction In September 2023, mpox clade 1b emerged in Kamituga, a mining zone in South Kivu, DR Congo, primarily through sexual transmission. This study investigates an mpox clade 1b outbreak in Uvira, 300 km from Kamituga, where the first case was reported in May 2024. Methods From June-October 2024, clinical and household data from suspected mpox cases were collected at Uvira hospital and through investigations. Laboratory confirmation was performed via PCR. We analyzed demographic, exposure, and clinical data to characterize transmission patterns, severity, and risk factors. Results Among 972 suspected cases, 42.2% (411) had PCR results, with 78.1% positive. The median age was 9 years (IQR: 3-20), with 63.8% under 15 (n=621) and 32.1% under 5 (n=312). Severe cases (≥100 lesions) were more frequent in children under 15 (25.6%, 142/555) than older individuals (16.2%, 49/303; p<0.001). Acute malnutrition affected 8.6% (14/162) of children under 5. The case fatality ratio was 0.7% (7/972), rising to 4% (5/127) in infants under 1 year. Among HIV-tested individuals, 1.8% (6/329) were HIV-positive. Pregnant women accounted for 14.5% (19/131) of cases. Household exposures dominated (67.9%), with limited sexual (6%) or healthcare worker (0.4%) exposures. Female sex workers represented 1.2% of cases. Animal exposures were predominantly domestic (97.4%, 38/39). Conclusion This child-centered outbreak, driven by household transmission, underscores the need for pediatric vaccines, nutritional support, and household interventions. Adult-focused responses alone may be insufficient.

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