1887
  1. Home
  2. Eurosurveillance
  3. Volume 30, Issue 50, 18/Dec/2025
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

BACKGROUND

In September 2023, monkeypox virus (MPXV) clade Ib emerged in Kamituga, a mining zone in South Kivu, Democratic Republic of the Congo (DRC), primarily through sexual transmission.

AIM

We aimed to investigate cases in a MPXV clade Ib outbreak in Uvira, eastern DRC.

METHODS

From June to October 2024, we collected demographic, exposure and clinical data from suspected mpox cases at Uvira hospital and in households. The virus was identified by PCR. We investigated putative transmission patterns, disease severity and risk factors.

RESULTS

We identified 973 suspected cases: 415 (42.7%) were tested with PCR and 322 (77.6%) were confirmed. The median age of suspected cases was 9 years (interquartile range (IQR): 3–20 years), with 620 (63.7%) aged < 15 and 344 (35.4%) < 5 years. Severe disease (≥ 100 lesions) was more common in cases aged < 15 years (25.6%; 142/554) than others (16.1%; 49/304; p < 0.001). Twenty-two (12.2%) of 181 cases aged < 5 years had acute malnutrition. Seven cases died; the overall case-fatality ratio was 0.7%, and in infants (aged < 1 year) it was 3.9% (5/127). Of 329 suspected cases tested for HIV, six (1.8%) were positive. Nineteen (14.5%) of 131 females aged 15–49 years were pregnant. Most reported exposures to suspected mpox cases occurred in households (67.9%; 298/439). Sexual (6.0%; 19/318) or healthcare-related occupational exposures (1.4%; 6/417) were less common. Animal exposures were few (5.0%; 39/776) and predominantly domestic (97.4%; 38/39).

CONCLUSION

This child-centred outbreak, driven by non-sexual transmission, underscores the need for paediatric vaccines, nutritional support and household interventions. Adult-focused responses alone may be insufficient to control the outbreak.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2025.30.50.2500280
2025-12-18
2026-02-08
/content/10.2807/1560-7917.ES.2025.30.50.2500280
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/30/50/eurosurv-30-50-3.html?itemId=/content/10.2807/1560-7917.ES.2025.30.50.2500280&mimeType=html&fmt=ahah

References

  1. Jezek Z, Grab B, Szczeniowski MV, Paluku KM, Mutombo M. Human monkeypox: secondary attack rates. Bull World Health Organ. 1988;66(4):465-70. PMID: 2844429 
  2. Breman JG, Kalisa-Ruti, Steniowski MV, Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970-79. Bull World Health Organ. 1980;58(2):165-82. PMID: 6249508 
  3. Bangwen E, Diavita R, De Vos E, Vakaniaki EH, Nundu SS, Mutombo A, et al. Suspected and confirmed mpox cases in DR Congo: a retrospective analysis of national epidemiological and laboratory surveillance data, 2010-23. Lancet. 2025;405(10476):408-19.  https://doi.org/10.1016/S0140-6736(24)02669-2  PMID: 39892912 
  4. Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141.  https://doi.org/10.1371/journal.pntd.0010141  PMID: 35148313 
  5. Sanchez Clemente N, Coles C, Paixao ES, Brickley EB, Whittaker E, Alfven T, et al. Paediatric, maternal, and congenital mpox: a systematic review and meta-analysis. Lancet Glob Health. 2024;12(4):e572-88.  https://doi.org/10.1016/S2214-109X(23)00607-1  PMID: 38401556 
  6. Gessain A, Nakoune E, Yazdanpanah Y. Monkeypox. N Engl J Med. 2022;387(19):1783-93.  https://doi.org/10.1056/NEJMra2208860  PMID: 36286263 
  7. Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, et al. Monkeypox. Lancet. 2023;401(10370):60-74.  https://doi.org/10.1016/S0140-6736(22)02075-X  PMID: 36403582 
  8. Vakaniaki EH, Kacita C, Kinganda-Lusamaki E, O’Toole Á, Wawina-Bokalanga T, Mukadi-Bamuleka D, et al. Sustained human outbreak of a new MPXV clade I lineage in eastern Democratic Republic of the Congo. Nat Med. 2024;30(10):2791-5.  https://doi.org/10.1038/s41591-024-03130-3  PMID: 38871006 
  9. Mukadi-Bamuleka D, Kinganda-Lusamaki E, Mulopo-Mukanya N, Amuri-Aziza A, O’Toole Á, Merritt S, et al. First imported cases of MPXV clade Ib in Goma, Democratic Republic of the Congo. Commun Med (Lond). 2025;5(1):496.  https://doi.org/10.1038/s43856-025-01203-z  PMID: 41258006 
  10. Nizigiyimana A, Ndikumwenayo F, Houben S, Manirakiza M, van Lettow M, Liesenborghs L, et al. Epidemiological analysis of confirmed mpox cases, Burundi, 3 July to 9 September 2024. Euro Surveill. 2024;29(42):2400647.  https://doi.org/10.2807/1560-7917.ES.2024.29.42.2400647  PMID: 39421954 
  11. World Health Organization (WHO). WHO Director-General declares mpox outbreak a public health emergency of international concern. Geneva: WHO; 14 Aug 2024. Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern
  12. Kibungu EM, Vakaniaki EH, Kinganda-Lusamaki E, Kalonji-Mukendi T, Pukuta E, Hoff NA, et al. , International Mpox Research Consortium. Clade I-associated mpox cases associated with sexual contact, the Democratic Republic of the Congo. Emerg Infect Dis. 2024;30(1):172-6.  https://doi.org/10.3201/eid3001.231164  PMID: 38019211 
  13. Brosius I, Vakaniaki EH, Mukari G, Munganga P, Tshomba JC, De Vos E, et al. Epidemiological and clinical features of mpox during the clade Ib outbreak in South Kivu, Democratic Republic of the Congo: a prospective cohort study. Lancet. 2025;405(10478):547-59.  https://doi.org/10.1016/S0140-6736(25)00047-9  PMID: 39892407 
  14. Masirika LM, Nieuwenhuijse DF, Ndishimye P, Udahemuka JC, Steeven BK, Gisèle NB, et al. Mapping the distribution and describing the first cases from an ongoing outbreak of a new strain of mpox in South Kivu, Eastern Democratic Republic of Congo between September 2023 to April 2024. medRxiv. 2024 https://doi.org/10.1101/2024.05.10.24307057 
  15. World Health Organization (WHO). Mpox - Democratic Republic of the Congo. Geneva: WHO; 14 Jun 2024. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON522
  16. Masirika LM, Udahemuka JC, Schuele L, Nieuwenhuijse DF, Ndishimye P, Boter M, et al. Epidemiological and genomic evolution of the ongoing outbreak of clade Ib mpox virus in the eastern Democratic Republic of the Congo. Nat Med. 2025;31(5):1459-63.  https://doi.org/10.1038/s41591-025-03582-1  PMID: 39933565 
  17. World Health Organization Regional Office for Africa (WHO/Africa). Mpox in the WHO African Region. Weekly Regional Situation Report #12. Brazzaville: WHO/Africa; 10 Nov 2024. Available from: https://iris.who.int/bitstream/handle/10665/379531/AFRO-Mpox%20bulletin-%2010%20November%202024.pdf
  18. Koyuncu A, Bugeme PM, Dent J, Hutchins C, Xu H, Gallandat K, et al. Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo. BMJ Public Health. 2025;3(1):e001035.  https://doi.org/10.1136/bmjph-2024-001035  PMID: 40017972 
  19. De Keyzer ELR, Masilya Mulungula P, Alunga Lufungula G, Amisi Manala C, Andema Muniali A, Bashengezi Cibuhira P, et al. Local perceptions on the state of the pelagic fisheries and fisheries management in Uvira, Lake Tanganyika, DR Congo. J Great Lakes Res. 2020;46(6):1740-53.  https://doi.org/10.1016/j.jglr.2020.09.003 
  20. United Nations International Children’s Emergency Fund (UNICEF). Democratic Republic of the Congo Humanitarian Situation Report No. 1. New York: UNICEF; 22 Aug 2024. Available from: https://www.unicef.org/media/160561/file/DRC-Humanitarian-SitRep-30-June-2024.pdf
  21. Mugisho GM, Swedi DP, Enock PM, Kalembu MI, Lukeba FN, Ngezirabona SV. Urban anthropization: community vulnerability and resilience to flood hazards in eastern Democratic Republic of Congo. Environ Res Commun. 2024;6(2):025003.  https://doi.org/10.1088/2515-7620/ad23f3 
  22. World Health Organization (WHO). Surveillance, case investigation and contact tracing for mpox: Interim guidance, 27 November 2024. Geneva: WHO;6 Dec 2024. Available from: https://www.who.int/publications/i/item/B09169
  23. World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF). WHO child growth standards and the identification of severe acute malnutrition in infants and children A Joint Statement by the World Health Organization and the United Nations Children’s Fund. Geneva: WHO and New York: UNICEF; 1 Jan 2009. Available from: https://iris.who.int/bitstream/handle/10665/44129/9789241598163_eng.pdf
  24. Harshani HBC, Liyanage GA, Ruwan DVRG, Samaraweera UKIU, Abeynayake JI. Evaluation of the diagnostic performance of a commercial molecular assay for the screening of suspected monkeypox cases in Sri Lanka. Infect Med (Beijing). 2023;2(2):136-42.  https://doi.org/10.1016/j.imj.2023.05.002  PMID: 38077827 
  25. Li D, Wilkins K, McCollum AM, Osadebe L, Kabamba J, Nguete B, et al. Evaluation of the GeneXpert for human monkeypox diagnosis. Am J Trop Med Hyg. 2017;96(2):405-10.  https://doi.org/10.4269/ajtmh.16-0567  PMID: 27994107 
  26. World Health Organization (WHO). Muyembe-Tamfum. Clinical Aspects of Monkey Pox in DR Congo: Monkeypox epidemiology, surveillance, and laboratory capacity in DRC. Geneva: WHO; 2 Jun 2022. Available from: https://cdn.who.int/media/docs/default-source/blue-print/day-1_jean-jacques-muyembe_drc_monkeypox-meeting_02june2022.pdf?sfvrsn=d133676a_3
  27. Myatt M, Guevarra E. Package “zscorer”. Vienna: R Foundatio; 21 Jul 2025. Available from: https://cran.r-project.org/web/packages/zscorer/zscorer.pdf
  28. World Health Organization (WHO). Arm circumference-for-age. Geneva: WHO. [Accessed: 27 Oct 2025]. Available from: https://www.who.int/tools/child-growth-standards/standards/arm-circumference-for-age
  29. Bugeme PM, Bugale PK, Mashauri JZ, Kapalata AI, Bugwaja L, Mukika TF, et al. Disseminated mpox in an immunocompromised patient in DR Congo: a call for a shift from disease-focused to person-centred outbreak response. Lancet Infect Dis. 2025;25(3):e124-5.  https://doi.org/10.1016/S1473-3099(25)00009-X  PMID: 39862871 
  30. Jezek Z, Marennikova SS, Mutumbo M, Nakano JH, Paluku KM, Szczeniowski M. Human monkeypox: a study of 2,510 contacts of 214 patients. J Infect Dis. 1986;154(4):551-5.  https://doi.org/10.1093/infdis/154.4.551  PMID: 3018091 
  31. Jezek Z, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987;156(2):293-8.  https://doi.org/10.1093/infdis/156.2.293  PMID: 3036967 
  32. Spangerla Martinez G, Kumar A, Kiganda-Lusamaki E, Dutt M, Wawina-Bokalanga T, Ostadgavahi AT, et al. Mpox virus pangenomics reveals determinants of subclade Ib. medRxiv. 2025.  https://doi.org/10.1101/2024.10.31.24315917 
  33. Hudson PN, Self J, Weiss S, Braden Z, Xiao Y, Girgis NM, et al. Elucidating the role of the complement control protein in monkeypox pathogenicity. PLoS One. 2012;7(4):e35086.  https://doi.org/10.1371/journal.pone.0035086  PMID: 22496894 
  34. Muyembe JJ, Pan H, Peto R, Diallo A, Touré A, Mbala-Kingebene P, et al. , Ebola Ring Vaccination Team in the DRC. Ebola outbreak response in the DRC with rVSV-ZEBOV-GP ring vaccination. N Engl J Med. 2024;391(24):2327-36.  https://doi.org/10.1056/NEJMoa1904387  PMID: 39693543 
  35. Ratnayake R, Finger F, Azman AS, Lantagne D, Funk S, Edmunds WJ, et al. Highly targeted spatiotemporal interventions against cholera epidemics, 2000-19: a scoping review. Lancet Infect Dis. 2021;21(3):e37-48.  https://doi.org/10.1016/S1473-3099(20)30479-5  PMID: 33096017 
  36. Palich R, Burrel S, Monsel G, Nouchi A, Bleibtreu A, Seang S, et al. Viral loads in clinical samples of men with monkeypox virus infection: a French case series. Lancet Infect Dis. 2023;23(1):74-80.  https://doi.org/10.1016/S1473-3099(22)00586-2  PMID: 36183707 
  37. Joint United Nations Programme on HIV/AIDS (UNAIDS). Democratic Republic of the Congo. Geneva: UNAIDS. [Accessed: 9 Dec 2025]. Available from: https://www.unaids.org/en/regionscountries/countries/democraticrepublicofthecongo
  38. Institut National de la Statistique. Enquête Démographique et de Santé EDS-RDC III 2023-24. [Survey of demography and health EDS-RDS III 2023-24]. Kinshasa: Institut National de la Statistique; Jun 2024. Available from: https://dhsprogram.com/pubs/pdf/PR156/PR156.pdf
  39. Grellety E, Golden MH. Weight-for-height and mid-upper-arm circumference should be used independently to diagnose acute malnutrition: policy implications. BMC Nutr. 2016;2(10):10.  https://doi.org/10.1186/s40795-016-0049-7 
  40. Hombach J, Lewis R, Holten JV, Scott JA, Neuzil KM. Breastfeeding mothers in DR Congo should have access to the mpox vaccine. Lancet Glob Health. 2024;12(12):e1932.  https://doi.org/10.1016/S2214-109X(24)00478-9  PMID: 39577965 
  41. World Health Organization (WHO). Smallpox and Mpox (orthopoxviruses): WHO position paper, August 2024. Geneva: WHO; 23 Aug 2024. Available from: https://www.who.int/publications/i/item/who-wer-9934-429-456
  42. Marcela MR, Marcela D, Yazmín RP, Paula AM, Carlos FM, Hector RM, et al. Monkeypox virus infection in pregnancy: description of two cases reported to the Colombian National Institute of Health. APMIS. 2025;133(1):e13488.  https://doi.org/10.1111/apm.13488  PMID: 39726259 
  43. Cikomola FG, Bisimwa AW, Nyalundja AD, Barthélemy EJ, Matabaro BS, Mukamba FM, et al. Prevalence and risk of occurrence of visible birth defects in mining areas in South Kivu: A hospital-based cross-sectional study. PLoS One. 2024;19(10):e0309004.  https://doi.org/10.1371/journal.pone.0309004  PMID: 39374258 
  44. Van Brusselen D, Kayembe-Kitenge T, Mbuyi-Musanzayi S, Lubala Kasole T, Kabamba Ngombe L, Musa Obadia P, et al. Metal mining and birth defects: a case-control study in Lubumbashi, Democratic Republic of the Congo. Lancet Planet Health. 2020;4(4):e158-67.  https://doi.org/10.1016/S2542-5196(20)30059-0  PMID: 32353296 
Community transmission of mpox clade Ib not driven through sexual exposures, Uvira, eastern Democratic Republic of the Congo, June to October 2024
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Patrick+Musole+Bugeme&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bugeme Patrick Musole</a>, <a href="/search?value1=Patrick+Kazuba+Bugale&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bugale Patrick Kazuba</a>, <a href="/search?value1=Trust+Faraja+Mukika&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mukika Trust Faraja</a>, <a href="/search?value1=Megan+O%E2%80%99Driscoll&option1=author&noRedirect=true" class="nonDisambigAuthorLink">O’Driscoll Megan</a>, <a href="/search?value1=Javier+Perez-Saez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Perez-Saez Javier</a>, <a href="/search?value1=Levi+Bugwaja&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bugwaja Levi</a>, <a href="/search?value1=Salomon+Mashupe+Shangula&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Shangula Salomon Mashupe</a>, <a href="/search?value1=Willy+Kasi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kasi Willy</a>, <a href="/search?value1=Justin+Bengehya&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bengehya Justin</a>, <a href="/search?value1=Stephanie+Ngai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ngai Stephanie</a>, <a href="/search?value1=Antonio+Isidro+Carrion+Martin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Martin Antonio Isidro Carrion</a>, <a href="/search?value1=Jules+Jackson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jackson Jules</a>, <a href="/search?value1=Patrick+Katoto&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Katoto Patrick</a>, <a href="/search?value1=Esto+Bahizire&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bahizire Esto</a>, <a href="/search?value1=Noella+Mulopo-Mukanya&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mulopo-Mukanya Noella</a>, <a href="/search?value1=Justin+Lessler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lessler Justin</a>, <a href="/search?value1=Jackie+Knee&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Knee Jackie</a>, <a href="/search?value1=Pauline+Vetter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vetter Pauline</a>, <a href="/search?value1=Elizabeth+C+Lee&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lee Elizabeth C</a>, <a href="/search?value1=Daniel+Mukadi-Bamuleka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mukadi-Bamuleka Daniel</a>, <a href="/search?value1=Andrew+S+Azman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Azman Andrew S</a>, <a href="/search?value1=Espoir+Bwenge+Malembaka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Malembaka Espoir Bwenge</a></span>. Community transmission of mpox clade Ib not driven through sexual exposures, Uvira, eastern Democratic Republic of the Congo, June to October 2024. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(50):pii=2500280. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.50.2500280" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.50.2500280</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 19 Apr 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Aug 2025 </span> </p>
/content/10.2807/1560-7917.ES.2025.30.50.2500280
/content/10.2807/1560-7917.ES.2025.30.50.2500280
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error