Epidemiological profile and transmission of mpox in the Kamituga health zone of South Kivu, Democratic Republic of Congo: a cross-sectional prospective study

Monkeypox (mpox) remains a major global public health problem due to its rapid transmission, clinical severity and high case-fatality rate, especially for the clade I virus. Since August 2024, the disease was declared an public health emergency of international concern, with the resurgence of the disease cases and morbidity and mortality. Few studies exist in low-income countries. The Kamituga health zone (HZ) in South Kivu is the epicenter of the epidemic in the Democratic Republic of Congo (DRC). The aim of this study is to describe the transmission dynamics, epidemiological and clinical characteristics of mpox in this region. This was a prospective cross-sectional study conducted over 9 months (October 2023 to June 2024) in the Kamituga HZ involving 160 confirmed patients. Data included seroprevalence, sociodemographic, epidemiological, clinical and behavioral characteristics. Variables were described by means, medians or proportions as appropriate; to compare proportions, Pearson’s chi-square, Z and Fisher’s exact tests were used. A margin of error of 5% was taken as threshold of statistical significance. Seroprevalence of mpox in Kamituga was 0.3%, well above the provincial average of 0,01% (p < 0,001). Over 80% of villages reported at least one case. The average age of patients was 23.5 years, with 58.7% women. Female sex workers accounted for 36.2% of cases. Around 26.3% had been in contact with an animal, mainly primate. mpox affected 52.2% of women with an sexual infected partner and 25.7% of men (p = 0.001). Overall, 70% of patients had more than one sexual partner in the last six months with more men (81.8%) than women (61.7%) (p = 0.003). Clinically, 86.3% presented with fever, and 91.9% with extensive pustular eruptions, predominantly genital (90%). Lymphadenopathy affected 98.7% of cases. Only 5.6% of patients had recovered fully. mpox in Kamituga is alarmingly prevalent, affecting young adults and female sex workers with severe symptoms such as rashes and lymphandenopathy. Risky sexual behavior and late recourse to healthcare contribute to the spread of the disease. Urgent measures such as raising awareness, vaccine research and strengthening health infrastructures are essential. Collaboration between authorities, researchers and communities is important.