Mpox clinical and epidemiological patterns in the Central African Republic: a systematic review and meta-analysis
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Background
Mpox remains a critical public health challenge in Central Africa, where endemic circulation of the virulent Clade I virus persists through zoonotic and human-to-human transmission. This systematic review and meta-analysis synthesize 40 years of evidence (1984-2024) to characterize Mpox epidemiology, vaccination gaps and clinical pattern in the Central African Republic (CAR), informing targeted control strategies for this re-emerging threat.
Methods
Following PRISMA guidelines, we conducted a comprehensive search of PubMed, Scopus, ScienceDirect, Web of science, Embase, Cochrane Library, and AJOL for studies reporting laboratory-confirmed Mpox cases in CAR. Pooled estimates were calculated using random/fixed-effects models with R Software version 4.4.2 with subgroup analysis conducted for period, region, participants and disease burden. Heterogeneity ( I 2 ) and publication bias (funnel plots, Egger’s and Begg’s tests) were rigorously assessed. The confidence intervals (CIs) were estimated at 95% level of confidence. A p -value ⍰5% was considered statistically significant.
Results
Analysis of seven studies (1984-2023) found a pooled severity rate of 60.9% (95%CI: 48.5-77.7), peaking at 77.3% (95%CI: 55.6-90.2) in Health Region 6. Before the global mpox outbreak, the CFR for confirmed cases was 11.54% (95% CI: 6.11-20.71). Eastern Health Regions had a higher CFR of 11.11% (95% CI: 5.08-22.60), while Western Regions reported 0.00% (95% CI: 0.00-100.00). For suspected cases, the CFR was 12.77% (95% CI: 7.39-21.15), slightly declining to 9.09% (95% CI: 0.23-41.28) post-2022. This geographic disparity remained, with Eastern Regions at 10.17% (95% CI: 4.64-20.84) and Western Regions at 5.26% (95% CI: 0.74-29.39). Vaccination uptake in CAR was only 20.00% (95% CI: 10.33-35.17). The clinical profile included fever (91.1% (95%CI: 42.9-99.3)), rash (85.5% (95%CI: 75.7-91.8)), and lymphadenopathy (57.0% (95%CI: 34.3-77.1)).
Conclusion
The CAR faces a disproportionate Mpox burden characterized by high severity, elevated mortality, and suboptimal vaccine coverage, particularly in eastern regions. These findings suggest the urgent need for: (1) enhanced surveillance systems with genomic sequencing capacity; (2) prevention of disease lethality through early case detection and appropriate care provision; (3) strengthening vaccine distribution prioritizing high-risk populations; and (4) context-specific interventions, including community education and healthcare worker training, to curb future outbreaks.
