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Review of "Epidemiological and Clinical Features of Mpox during the Clade Ib outbreak in South-Kivu, Democratic Republic of the Congo: A Prospective Cohort Study"

Reviewers: S I V Ferrer (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán) | 📗📗📗📗◻️

Published onJan 30, 2025
Review of "Epidemiological and Clinical Features of Mpox during the Clade Ib outbreak in South-Kivu, Democratic Republic of the Congo: A Prospective Cohort Study"
key-enterThis Pub is a Review of
Epidemiological and Clinical Features of Mpox during the Clade Ib Outbreak in South-Kivu, Democratic Republic of the Congo: a Prospective Cohort Study
Epidemiological and Clinical Features of Mpox during the Clade Ib Outbreak in South-Kivu, Democratic Republic of the Congo: a Prospective Cohort Study
Description

Abstract Background Clade Ib, a new strain of the Clade I monkeypox virus, emerged in Eastern Democratic Republic of the Congo, sparking an international outbreak. Comprehensive studies are needed to assess its transmission dynamics and clinical presentation.Methods We conducted a prospective observational cohort study at Kamituga General Hospital in South Kivu, DRC, between May 2 and October 9, 2024. Sociodemographic, exposure and clinical data were collected from mpox suspected cases. Cases confirmed by Xpert® Mpox PCR were presumed Clade Ib infections (awaiting Clade confirmation) and followed through hospitalization and on days 29 and 59 post-diagnosis to assess clinical progression and outcomes.Findings Of 511 included suspected cases, 431 (84%) tested PCR positive; with 205 being women (47%). Age distribution was bimodal, with 279 (65%) individuals aged 15-34 years, and 63 (15%) children under five. Most cases (59%) reported contact with a suspected or confirmed mpox case; among adults, this was primarily a spouse, colleague or sexual partner, while for children, the primary contacts were parents or siblings. Comorbidities were rare (4%), including six (1%) HIV infections. Prodromal symptoms were present in 346 (88%) patients, active skin lesions in 414 (96%), mucosal lesions in 338 (82%), and lymphadenopathy in 295 (71%). In adults, lesions were more concentrated in the genital area, with 90% of adults presenting lesions in this region. In contrast, only 39% of children had genital lesions, with lesions more frequently found elsewhere on the body. Among 427 hospitalized patients, two deaths (0·5%) occurred. Among 315 patients with detailed hospital follow-up, complications were primarily genito-urinary (55%) or cutaneous (40%). Four of six pregnant women with recorded outcome (67%) had adverse pregnancy outcomes. Significant sequelae at days 29 and 59 were rare.Interpretation Clade Ib MPXV infections presented differently from previously reported Clade Ia and Clade IIb infections. In adults, the disease primarily affected the genito-urinary system, compatible with sexual transmission, while children mostly manifested extragenital lesions.Funding European & Developing Countries Clinical Trials Partnership (EDCTP2 and EDCTP3); Belgian Directorate-General Development Cooperation and Humanitarian Aid; Research Foundation – Flanders

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Summary of Review: This preprint highlights the significance of a prospective cohort study on Clade Ib Mpox infections, emphasizing its role in providing much-needed data on clinical outcomes during an ongoing outbreak. The reviewer acknowledges the study's robust methodology but points out that its focus on severe cases (hospitalized patients) may limit generalizability to milder forms of the disease. The review underscores critical findings, such as the high rate of adverse outcomes in pregnancy and the concerning mortality among children under five, while calling for further research to explore less severe cases and vaccination impacts.

Reviewer 1 (Sergio Iván Valdés F…) | 📗📗📗📗◻️

RR\ID Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

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Comments
1
Ovais Mirza:

This review highlights the importance of studying Clade Ib Mpox infections, especially given the severe outcomes in pregnant patients and young children. While the study’s methodology is strong, its focus on hospitalized cases limits generalizability. More research on milder cases and vaccination effects is crucial for a comprehensive understanding of Mpox’s clinical spectrum and public health strategies.

Regards,

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