Brosius Isabel, Vakaniaki Emmanuel Hasivirwe, Mukari Guy, Munganga Papy, Tshomba Jean Claude, De Vos Elise, Bangwen Eugene, Mujula Yves, Tsoumanis Achilleas, Van Dijck Christophe, Alengo Aimé, Mutimbwa-Mambo Léandre, Kumbana Franklin Mweshi, Munga Jenestin Babingwa, Mambo Divin Mazambi, Zangilwa James Wakilongo, Kitwanda Steeven Bilembo, Houben Sarah, Hoff Nicole A, Makangara-Cigolo Jean-Claude, Kinganda-Lusamaki Eddy, Peeters Martine, Rimoin Anne W, Kindrachuk Jason, Low Nicola, Katoto Patrick D M C, Malembaka Espoir Bwenge, Amuasi John H, Tshiani-Mbaya Olivier, Kambaji Dally Muamba, Kojan Richard, Kacita Cris, Mukadi-Bamuleka Daniel, Ahuka-Mundeke Steve, Vercauteren Koen, Wawina-Bokalanga Tony, Muyembe-Tamfum Jean-Jacques, Nundu Sabin Sabiti, Liesenborghs Laurens, Mbala-Kingebeni Placide
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo.
Lancet. 2025 Feb 15;405(10478):547-559. doi: 10.1016/S0140-6736(25)00047-9. Epub 2025 Jan 29.
Clade Ib, a new strain of clade I monkeypox virus, emerged in eastern DR Congo, sparking an international outbreak. Comprehensive studies are needed to assess its transmission dynamics and clinical presentation.
We did a prospective observational cohort study at Kamituga General Hospital in South Kivu, DR Congo, between May 2 and Oct 9, 2024. Sociodemographic, exposure, and clinical data were collected from mpox-suspected cases. Cases were confirmed by Xpert Mpox PCR and followed through hospitalisation and on days 29 and 59 after diagnosis.
Of the 510 suspected cases included, 407 (80%) tested positive via PCR. Among the 407 confirmed cases, 196 (48%) were women. Age distribution was bimodal, with 58 (14%) children younger than 5 years, and 267 (66%) individuals aged 15-34 years. Most cases (237 [58%] of 406) reported contact with a suspected or confirmed mpox case; primarily colleagues, spouses or sexual partners in adults, and parents or siblings in children. Self-reported comorbidities were rare (18 [5%] of 400), including 6 (2%) people infected with HIV. Prodromal symptoms were present in 331 (88%) of 375 patients, active skin lesions in 394 (97%) of 407 patients, mucosal lesions in 324 (82%) of 394 patients, and lymphadenopathy in 288 (73%) of 394 patients. In adults, 280 (89%) of 314 had genital skin lesions and mean lesion density was highest in the genital area. In contrast, only 35 (42%) of 84 children had genital lesions, as part of a more uniform rash. Among 403 hospitalised patients, two (<1%) deaths occurred. Among 296 patients with detailed hospital follow-up, complications were primarily genito-urinary (169 [57%]) or cutaneous (121 [41%]). Four (67%) of six pregnant women with recorded outcome had adverse pregnancy outcomes. On days 29 and 59, few sequelae were reported other than scars.
Clade Ib infections in Kamituga showed distinct clinical patterns compared with clade Ia outbreaks elsewhere in the country and the global clade IIb outbreak. In adults, the disease primarily affected the genito-urinary system, compatible with sexual transmission, whereas children mostly manifested extragenital lesions. These findings highlight the need for updated case definitions and targeted public health interventions to address evolving transmission dynamics and mitigate risks for vulnerable groups, including pregnant women and young children.
European & Developing Countries Clinical Trials Partnership (EDCTP2 and EDCTP3); Belgian Directorate-General Development Cooperation and Humanitarian Aid; Research Foundation-Flanders.
进化枝Ib是进化枝I猴痘病毒的一种新毒株，在刚果民主共和国东部出现，引发了一场国际疫情。需要进行全面研究以评估其传播动态和临床表现。
2024年5月2日至10月9日，我们在刚果民主共和国南基伍省的卡米图加综合医院进行了一项前瞻性观察队列研究。收集了猴痘疑似病例的社会人口学、暴露情况和临床数据。通过Xpert Mpox PCR确诊病例，并在住院期间以及诊断后的第29天和第59天进行随访。
在纳入的510例疑似病例中，407例（80%）通过PCR检测呈阳性。在407例确诊病例中，196例（48%）为女性。年龄分布呈双峰型，5岁以下儿童有58例（14%），15 - 34岁个体有267例（66%）。大多数病例（406例中的237例[58%]）报告与疑似或确诊的猴痘病例有接触；在成人中主要是同事、配偶或性伴侣，在儿童中是父母或兄弟姐妹。自我报告的合并症很少见（400例中的18例[5%]），包括6例（2%）感染艾滋病毒的人。375例患者中有331例（88%）出现前驱症状，407例患者中有394例（97%）出现活动性皮肤病变，394例患者中有324例（82%）出现黏膜病变，394例患者中有288例（73%）出现淋巴结病。在成人中，314例中有280例（89%）有生殖器皮肤病变，生殖器部位的平均病变密度最高。相比之下，84例儿童中只有35例（42%）有生殖器病变，皮疹分布更为均匀。在403例住院患者中，有2例（<1%）死亡。在296例有详细住院随访的患者中，并发症主要是泌尿生殖系统（169例[57%]）或皮肤方面（121例[41%]）。记录了结局的6例孕妇中有4例（67%）出现不良妊娠结局。在第29天和第59天，除了疤痕外，很少有后遗症报告。
与该国其他地区的进化枝Ia疫情以及全球进化枝IIb疫情相比，卡米图加的进化枝Ib感染表现出不同的临床模式。在成人中，该疾病主要影响泌尿生殖系统，符合性传播，而儿童大多表现为生殖器外病变。这些发现凸显了需要更新病例定义和有针对性的公共卫生干预措施，以应对不断演变的传播动态并降低包括孕妇和幼儿在内的弱势群体的风险。
欧洲与发展中国家临床试验伙伴关系（EDCTP2和EDCTP3）；比利时发展合作与人道主义援助总局；弗拉芒研究基金会。
