Preprint, 2024
Epidemiology, clinical characteristics, and transmission patterns of a novel Mpox (Monkeypox) outbreak in eastern Democratic Republic of the Congo (DRC): an observational, cross-sectional cohort study
medRxiv,
Page 2024.03.05.24303395,
10.1101/2024.03.05.24303395
Contributors
Masirika, Leandre Murhula
[1]
[2]
Udahemuka, Jean Claude
0000-0001-8370-7113
[3]
Ndishimye, Pacifique
[4]
[5]
Martinez, Gustavo Sganzerla
0000-0002-7656-0579
[5]
[6]
Kelvin, Patricia
[5]
[6]
Nadine, Maliyamungu Bubala
[7]
Steeven, Bilembo Kitwanda
[7]
Mweshi, Franklin Kumbana
[7]
Mambo, Léandre Mutimbwa
[8]
Munnink, Bas B Oude
0000-0002-9394-1189
[9]
Mbiribindi, Justin Bengehya
[10]
Siangoli, Freddy Belesi
[10]
Lang, Trudie
[11]
Malekani, Jean Mukulire
[12]
Aarestrup, Frank Møller
0000-0002-7116-2723
[13]
Koopmans, Marion
[9]
Schuele, Leonard
[9]
Musabvimana, Jean Pierre
[4]
Umutoni, Brigitte
[3]
[14]
Toloue, Ali
[5]
Hewins, Benjamin
[5]
Dutt, Mansi
[5]
[6]
Kumar, Anuj
[5]
[6]
Kelvin, Alyson Ann
0000-0003-0940-0847
[15]
Lukusa, Jean-Paul Kabemba
[16]
Gortázar, Christian
0000-0003-0012-4006
[1]
Kelvin, David Joseph
0000-0002-3702-954X
(Corresponding author)
[5]
[6]
[17]
Flores, Luis
[2]
[16]
[18]
[19]
Affiliations
- [1]
University of Castilla-La Mancha
[NORA names:
Spain; Europe, EU; OECD];
- [2]
Centre de Recherche en Sciences Naturelles de Lwiro, Sud -Kivu, DS Bukavu, RDC
[NORA names:
DR Congo; Africa];
- [3]
University of Rwanda
[NORA names:
Rwanda; Africa];
- [4]
Stansile Research Organization, Kigali, Rwanda
[NORA names:
Rwanda; Africa];
- [5]
Dalhousie University
[NORA names:
Canada; America, North; OECD];
(... more)
- [6]
BioForge Canada Limited, . Halifax, NS, Canada
[NORA names:
Canada; America, North; OECD];
- [7]
Hospital General de Reference de Kamituga, Sud- Kivu, RDC
[NORA names:
DR Congo; Africa];
- [8]
Zone de Santé de Kamituga, Sud- Kivu, RDC
[NORA names:
DR Congo; Africa];
- [9]
Erasmus MC
[NORA names:
Netherlands; Europe, EU; OECD];
- [10]
Division Provinciale de la Santé, Sud- Kivu, RDC
[NORA names:
DR Congo; Africa];
- [11]
University of Oxford
[NORA names:
United Kingdom; Europe, Non-EU; OECD];
- [12]
University of Kinshasa
[NORA names:
DR Congo; Africa];
- [13]
Technical University of Denmark
[NORA names:
DTU Technical University of Denmark;
University; Denmark; Europe, EU; Nordic; OECD];
- [14]
African Institute for Mathematical Sciences
[NORA names:
Rwanda; Africa];
- [15]
University of Saskatchewan
[NORA names:
Canada; America, North; OECD];
- [16]
Volunteers for the Conservation of Fauna and Flora (VCFF)
- [17]
Department of Pediatrics, Izaak Walton Killam Health Center, Canadian Center for Vaccinology, Halifax, NS, Canada
[NORA names:
Canada; America, North; OECD];
- [18]
Centre de Rehabilitation des Primates de Lwiro, Lwiro, Sud Kivu, DS Bukavu, RDC
[NORA names:
DR Congo; Africa];
- [19]
One Health Conservation Initiative, Katana, Kabare, Sud Kivu province, Democratic Republic of the Congo
[NORA names:
DR Congo; Africa]
(less)
Abstract
Summary (abstract) Background In August 2023, an outbreak of mpox was reported in the eastern part, South Kivu Province, of Democratic Republic of the Congo. In this study, we aimed to investigate the origin of this outbreak and to assess how monkeypox virus spread among humans in the city of Kamituga. Methods We performed an observational cohort study by recruiting hospitalized patients with mpox-like symptoms. Furthermore, we compared structured, de-identified case report forms and interviews were conducted to determine the possible origins and modes of transmission of the mpox outbreak. We describe the clinical characteristics and epidemiology observed in reported infections. Findings During the study period (24 September 2023 to 29 January 2024), 164 patients were admitted to the Kamituga hospital, 51 individuals were enrolled in the study and interviewed, and 37 (73%) of 51 individuals received a molecularly confirmed mpox diagnosis. The median age for males was 24 years (IQR 18-30; range 14-36) and 19 years for females (IQR 17-21; range 1-59). The cohort was comprised of 47 (92%) of 51 individuals who identified as heterosexual, and two (4%) of 51 as bisexual, with 31 (61%) of 51 individuals sexually active with more than one partner within the last six months. The direct transmission routes are unknown; however, it is expected that the majority of infections were transmitted via occupational exposures. Out of the 51 individuals, 24 (47%) were professional sex workers (PSWs), while five (10%) were gold miners, 6 (12%) were students, and four (8%) were farmers; the remaining individual occupations were unknown. The most common symptoms associated with clinical mpox diagnosis were fever, which was described in 38 (75%) of 51 individuals, and rash, which was described in 45 (88%) of 51 individuals. Among those with a rash, 21 (41%) of 51 individuals experienced oral lesions, and 32 (63%) of 51 presented anogenital lesions. Mpox viral DNA was detected by qPCR from vaginal, penile, and oral swabs in 37 (73%) of 51 enrolled individuals. Two deaths were reported. Interpretation In this observational cohort study, mpox virus infection caused symptoms in a wide age range of participants with most cases presenting in sexually active individuals. Symptoms included fever, cough, lymphadenopathy, sore throat, chills, headache, back pain, muscle pain, vomiting, nausea, conjunctivitis, and rash (oral and anogenital). Heterosexual partners dominated human-to-human contact transmission suggesting that heterosexual close contact is the main form of transmission in this outbreak. Furthermore, Professional Sex Workers (PSWs) were the dominant occupation among infected individuals, indicating that PSWs and clients may be at higher risk for developing mpox virus infections.
Keywords
Abstract,
Congo,
DNA,
DRC,
Democratic Republic,
Kamituga,
Kivu province,
Republic,
South,
South Kivu province,
active individuals,
age,
age range,
anogenital lesions,
back,
back pain,
case report forms,
cases,
characteristics,
chilling,
city,
clients,
clinical characteristics,
close contacts,
cohort,
cohort study,
conjunction,
contact,
contact transmission,
cough,
cross-sectional cohort study,
death,
democratization,
diagnosis,
dominant occupation,
eastern Democratic Republic,
eastern part,
epidemiology,
exposure,
farmers,
females,
fever,
findings,
form,
gold,
gold mineralization,
headache,
heterosexual partners,
high risk,
hospital,
hospitalized patients,
humans,
individual occupants,
individuals,
infected individuals,
infection,
interpretation,
interviews,
lesions,
lymphadenopathy,
male,
median age,
minerals,
mode,
mode of transmission,
monkeypox virus,
months,
mpox,
mpox outbreak,
muscle,
muscle pain,
nausea,
observational cohort study,
occupation,
occupational exposure,
oral lesions,
oral swabs,
origin,
outbreak,
pain,
participants,
partners,
parts,
patients,
patterns,
penile,
period,
professional sex workers,
professionals,
province,
qPCR,
range,
rash,
report forms,
risk,
route,
sex workers,
sexuality,
sexually active individuals,
students,
study,
study period,
swabs,
symptoms,
transmission,
transmission patterns,
transmission routes,
viral DNA,
virus,
virus infection,
vomiting,
workers,
years
Funders
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