The multifaceted mpox outbreaks in the Democratic Republic of the Congo, January 2024 – August 2025
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The Democratic Republic of the Congo has experienced the largest recorded mpox epidemic, driven by clade Ib and clade Ia monkeypox virus. We analyzed over 131,000 suspected and 32,819 confirmed mpox cases reported between January 2024 and August 2025. Clade Ib was detected in 13 provinces, while clade Ia persisted in endemic areas, with lineage Ia/sh2024 spreading in Kinshasa. Transmission in newly affected areas initially spread rapidly among young adults (Rt up to 1.5) before widening more to children, whereas Kinshasa maintained transmission mainly in young adults. Endemic provinces reported increasing suspected cases, largely among children, amid limited testing. First mpox vaccination was implemented, although incidence was already declining. Mortality was low in clade Ib–affected provinces (0.13%) and Kinshasa (0.3%), and higher in endemic areas (2.5%), which accounted for most deaths. These findings highlight the heterogeneous epidemiology of mpox in the country and the need for context-specific control strategies.
