Gustavo Sganzerla Martinez, Dalhousie University

Luis Flores Giron, Gustavo Sganzerla Martinez, Baganda Ntahuma Daniel, Alfred Kesheni Bisimwa, Nkonzi Pacific, Georges Assumani Martin, Jean Christian Amini Kabwana, Anuj Kumar, Ali Toloue Ostadgavahi, Mansi Dutt, Kawaya Lusante Bénite, Mangura Hamuli Damien, Christian Gortázar, Bahaa Abu-Raya, Alyson A Kelvin, Kaleme Kiswele Prince, David J Kelvin Lwiro Primate Rehabilitation Center (LPRC) South Kivu, DRC. Centre de Recherche en Sciences Naturelles de Lwiro (CRSN-LWIRO), Kabare Territory, Democratic Republic of the Congo. One Health Conservation Initiative (OHCI), DRC. Department of Immunology, Shantou University Medical College, Shantou, Guangdong, People's Republic of China Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. Department of Nutrition and Health, Natural Sciences Research Center (CSRN) Lwiro, South Kivu, DRC. SaBio IREC Universidad de Castilla La Mancha, Ciudad Real, Spain. Canadian Center for Vaccinology, Dalhousie University, Izaak Walton Killam (IWK) Health Centre and the Nova Scotia Health Authority, Halifax, NS, Canada. Department of Pediatrics, Dalhousie University, Halifax, NS, Canada. Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada, T2N 1N4 Institut Superieur des Techniques Medicales (ISTM) de Bukavu, South Kivu, DRC Department of Pediatrics, IWK Health Center, Canadian Center for Vaccinology (CCfV), Halifax, Nova Scotia, Canada. Joint PhD Program, Department of Biomedical Sciences, University of Sassari, Sassari, Italy Université du Cinquantenaire, Lwiro, Democratic Republic of the Congo

Discovering & Evolving

Mpox is a public health concern in DR Congo as it causes substantial numbers of hospitalizations. Here, we aim to describe the clinical presentation of hospitalized participants infected with monkeypox virus (MPXV) subclade Ib/2023sh in Lwiro, DR Congo. Patients admitted with suspect mpox infection were recruited if, during admission, they had skin lesions compatible with mpox. Patients without lesions that had contact with a suspect case of mpox infection in the last 21 days and had one of the symptoms: fever, cervical lymphadenopathy, or pharyngitis, were also recruited. MPXV subclade Ib/2023sh was detected in 494 (77%) of 643 participants with a median age of 9. A higher proportion of female (290 [59%]) participants tested positive for DNA presence of MPXV subclade Ib/2023sh and were older (median 16 years) than male participants (median age 4 years). 300 (61%) of 494 participants were aged ≤15 years. Fever (90%), skin lesion/rash (79%), and dysphagia (56%) were the most prevalent symptoms. 117 (24%) participants had lesions in the oral cavity. Oral swabs rendered detectable MPXV subclade Ib/2023sh DNA in the absence of assayable skin lesions. Given the higher proportion of children and adolescents aged ≤15 years, we hypothesise a demographic shift in the target population that contributes to the community spread of mpox in the South Kivu region of DR Congo. Targeted public health measures should consider ways for reducing transmission among children and adolescents.