Mpox Severity and Mortality in the Most Endemic Focus in Africa: A Systematic Review and Meta-Analysis (1970-2024)
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Mpox, caused by the Mpox virus, is a zoonotic disease historically endemic in Central and West Africa. The Democratic Republic of Congo (DRC) bears the highest burden, with evolving epidemiology and significant public health challenges. Understanding severity and mortality trends is critical for global control efforts.
Methods
This systematic review and meta-analysis followed PRISMA guidelines to synthesize evidence on Mpox severity and mortality in the DRC from 1970 to 2024. We searched PubMed, ScienceDirect, Web of Science identifying 22 eligible studies after screening 127 records. Data on confirmed and suspected cases, severe outcomes, and deaths were extracted. Random-effects models addressed high heterogeneity (I² > 75%), and subgroup analyses examined temporal trends (pre-1980 to 2024), regional differences (Western/Central vs. Eastern DRC), and healthcare settings (community vs. hospital). Meta-regression explored sources of heterogeneity, adjusting for study year, region, method, setting and design.
Results
The pooled severity rate among 3,282 confirmed cases was 42.82% (95% CI: 31.60-54.05), declining from 68.58% pre-1980 to 27.55% in 2022-2024. Western/Central regions had higher severity (46.81%) than Eastern regions (42.66%). Case fatality rates (CFRs) were 1.89% (95% CI: 1.39-2.40) for suspected cases and 4.18% (95% CI: 0.29-8.08) for confirmed cases, with Western/Central DRC again disproportionately affected (CFR: 11.37%). Community settings showed higher CFRs (6.66%) than hospitals (0.64%), underscoring healthcare access disparities. Meta-regression confirmed study year (p < 0.001), and region as significant predictors of outcomes heterogeneity (p = 0.03), with mortality declining over time but remaining elevated in resource-limited areas.
Conclusion
Mpox continues to impose a substantial burden in the DRC, with high severity and mortality rates, particularly in Western/Central regions and community settings. The observed temporal decline in severity and CFRs suggests the impact of strengthened surveillance and healthcare capacity. However, regional disparities persist, driven by inequitable healthcare access and potential differences in viral clades. Targeted interventions, including vaccination in high-risk areas, community education, and mobile health units, are urgently needed. Global collaboration must address diagnostic and treatment gaps in endemic countries to prevent cross-border outbreaks.
