Submission ID 131459
| Issue/Objective | The emergence of Mpox Clade 1b in South Kivu, Democratic Republic of Congo (DRC), represents a critical shift in the epidemiology of mpox in Central and East Africa. This presentation synthesizes three years of field experience to characterize transmission dynamics, clinical patterns, and operational challenges in a conflict-affected setting, while highlighting implications for equitable outbreak response. |
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| Methodology/Approach | We conducted a mixed-methods analysis combining prospective cohort data (n=405 confirmed mpox patients), genomic surveillance, and environmental sampling (including wastewater-based surveillance). Clinical, virological, and epidemiological data were collected longitudinally across multiple sites in South Kivu between 2023-2026. Genomic sequencing was performed using both portable and centralized platforms, complemented by qualitative interviews with healthcare workers and affected communities. |
| Results | Our findings confirm the sustained circulation and expansion of Mpox Clade 1b, with evidence of heterogeneous transmission routes, including community-based spread and cross-border dynamics. Clinical presentations varied widely, with notable rates of complications linked to delayed care access and co-infections. Genomic analyses revealed intra-host and inter-host variability, suggesting viral evolution. Wastewater surveillance demonstrated early detection potential, preceding clinical case surges in selected sites. Operationally, insecurity, limited laboratory capacity, and barriers to sample transport significantly delayed diagnosis and response. |
| Discussion/Conclusion | The emergence of Mpox Clade 1b underscores the urgent need for decentralized, integrated surveillance systems that combine clinical, genomic, and environmental data. Our experience highlights how inequities-particularly in fragile and conflict-affected settings-shape outbreak trajectories and response effectiveness. Strengthening local laboratory capacity, enabling biosafe sample transport, and fostering cross-border collaboration are essential to improving preparedness. These findings contribute to global efforts to reclaim equity in outbreak response by centering locally led, context-adapted solutions that bridge the gap between evidence generation and real-world impact. |
| Presenters and Affiliations | Jean Claude Udahemuka Stansile & University of Rwanda Pacifique Ndishimye Stansile Leandre Murhula Masirika Congo Outbreaks, Research for Development Audace Mukiza Stansile Trudie Lang University of Oxford Justin BENGEHYA DPS SUD-KIVU Marion Koopmans Erasmus University Medical Center |
