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, ScienceDirect, Cochrane Library, and Scopus for studies reporting laboratory-confirmed Mpox cases in CAR. Pooled estimates were calculated using random/fixed-effects models with R Statistics 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.
Results
Among 15 included studies representing 1984-2024 surveillance data, the pooled severity rate was 60.9% (95%CI:47.5-72.8) - highest in Health Region 6 (77.3%, 95%CI: 55.6-90.2). The Case fatality rate (CFR) among confirmed cases was 10.9% (95% CI: 5.9-19.0). There was non-significant decrease in CFR from 11.5%; (95% CI: 6.1-20.7) before 2022 to 7.14% (95% CI: 0.7-1.9) from 2022 on. There was a persistent post-2022 CFR elevations in high-burden areas (13.5% for >10 cases). Higher mortality was observed in Eastern Health Regions (11.11%; 95% CI: 5.08-22.60) compared to Western Health Regions with no reported death. Among suspected cases, the CFR was 10.7% (95%CI: 6.6-17.0). Vaccination uptake was low (20.0%, 95%CI: 10.3-35.2). The clinical profile included fever (91.1%, 42.9-99.3), rash (85.5%, 95%CI: 75.7-91.8), lymphadenopathy (57.0%, 95%CI: 34.3-77.1). Severe manifestations like hemorrhagic lesions (22.2%) and mucosal involvement (oral:59.2%; genital:57.4%) were also reported.
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.
