Non-sexual community transmission of mpox clade Ib in DR Congo
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Introduction
In September 2023, mpox clade Ib emerged in Kamituga, a mining zone in South Kivu, DR Congo, primarily through sexual transmission. This study investigates an mpox clade Ib outbreak in Uvira, an urban area 360 km from Kamituga, where the first case was reported in May 2024.
Methods
From June to October 2024, clinical and household data from suspected mpox cases were collected at Uvira hospital and household investigations. Mpox laboratory confirmation was performed via PCR. We analyzed demographic, exposure, and clinical data to characterize putative transmission patterns, severity, and risk factors.
Results
Among 973 suspected cases, 42.7% (415) had PCR results, with 77.6% (n=322) testing positive. The median age of suspected cases was 9 years (IQR: 3–20), with 63.7% under-15 (n=620) and 32.1% under-5 (n=312). Severe cases (≥100 lesions) were more frequent in children under 15 (25.6%, 142/554) than others (16.1%, 49/304; p<0.001). Acute malnutrition affected 12.2% (22/181) of children under-5. The case fatality ratio was 0.7% (7/973), rising to 4% (5/127) in infants under one year. Among HIV-tested individuals, 1.8% (6/329) were HIV-positive. Pregnant women accounted for 14.5% (19/131) of women aged 15-49 years. The vast majority reported exposures to other suspected mpox cases were in the household (67.9%), with limited sexual (6%) or healthcare-related occupational exposures (1.4%). Female sex workers represented 1.2% of cases. Animal exposures were predominantly domestic (97.4%, 38/39).
Conclusion
This child-centered outbreak, driven by non-sexual transmission, underscores the need for pediatric vaccines, nutritional support, and household interventions. Adult-focused responses alone may be insufficient.
