Environmental, socioeconomic, and sociocultural drivers of monkeypox transmission in the Democratic Republic of the Congo: a One Health perspective.

Monkeypox (mpox) is an emerging zoonotic disease that has persistently impacted public health in endemic regions of West and Central Africa for over half a century. The Democratic Republic of the Congo (DRC) remains one of the countries most affected. Understanding the risk factors for disease transmission from a One Health perspective is of great importance in the risk assessment, prevention, and control of zoonotic diseases. Therefore, this study aimed to investigate the risk factors for human mpox transmission at the human-animal-environment interface in the DRC. Epidemiological, environmental, socioeconomic, and sociocultural data from the DRC from 2000 to 2015 were obtained from publicly available dataset. Using these data, we applied negative binomial regression model, least absolute shrinkage and selection operator regression model, and principal component analysis (PCA) to identify key environmental, socioeconomic, and sociocultural factors contributing to mpox transmission. Moreover, a grey prediction model GM (1, n) was constructed to predict the epidemic trend of mpox post-2015 and validated using suspected mpox case data in the DRC from 2016 to 2021, sourced from the United States Centers for Disease Control and Prevention. Between 2000 and 2021, a total of 43,628 suspected mpox cases were reported in the DRC, with a peak of 6216 cases in 2020. From 2016 to 2021, suspected cases accounted for over half (24,379/43,628, 55.9%) of the total reported during the 2000-2021 period. The proportion of primary forest [incidence rate ratio (IRR): 1.023, 95% confidence interval (CI): 1.018-1.027], index of economic well-being (IRR: 1.046, 95% CI: 1.039-1.052), and mean annual precipitation (IRR 1.040, 95% CI: 1.031-1.049) were positively associated with mpox incidence. PCA identified five principal components, explaining 69% of the variance in the environmental, socioeconomic, and sociocultural variables. The first component was characterized by socioeconomic factors. The GM (1, n) model, based on the proportion of primary forest, index of economic well-being, and mean annual precipitation, predicted the epidemic trend (revealed relative error: 2.69). Both socioeconomic and environmental factors play important roles in mpox transmission. Our study further highlighted the importance of considering the interconnectedness among humans, animals, and the environment, and treating these factors as a whole to explain the transmission and emergence of mpox outbreaks in the DRC according to the One Health concept.

Lu G ，Chong Z ，Xu E ，Na C ，Liu K ，Chai L ，Xia P ，Yang K ，Zhu G ，Zhao J ，Müller O ... -  《-》

Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo.

Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30 years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail.

Mandja BA ，Handschumacher P ，Bompangue D ，Gonzalez JP ，Muyembe JJ ，Sauleau EA ，Mauny F ... -  《-》

Monkeypox Outbreak in the Democratic Republic of Congo: A Comprehensive Review of Clinical Outcomes, Public Health Implications, and Security Measures.

The Monkeypox virus (MPXV), a member of the Orthopoxvirus genus, is responsible for the zoonotic disease known as MPX. Primarily found in western and central Africa, emerging studies indicate a shift in transmission dynamics. Ongoing MPX outbreaks in the Democratic Republic of Congo (DRC) have escalated into significant public health concerns. This review endeavors to provide a comprehensive analysis of the public health implications, clinical consequences, and preventive measures related to the current MPX outbreak in the DRC. It focuses on the epidemiology, clinical manifestations, and public health responses to this global health challenge. The research synthesizes data regarding MPX outbreaks in the DRC, drawing from academic journals, public health reports, and case studies through a narrative review approach. The recent outbreak in the DRC has identified approximately 12,569 suspected MPX cases, resulting in 581 fatalities, which corresponds to a case fatality rate (CFR) of 4.6%. These cases have been documented across 156 health sectors in 22 out of 26 provinces, representing the highest case count recorded to date. The epidemic has also encroached upon previously unaffected regions. Hospitalization rates have varied between 4% and 10%, with a significant percentage of cases attributed to sexual transmission. Analysis of demographic and geographic data revealed distinct patterns in viral spread. Clinical outcomes have varied, with an average CFR close to 10%, influenced by factors such as timely diagnosis and access to healthcare services. Rural areas have accounted for over 70% of the cases, highlighting the necessity for targeted public health interventions. Control measures have focused on community awareness campaigns and immunization programs, reaching approximately 50% of the at-risk population; however, challenges related to resource limitations and political instability have impeded effective response strategies. The ongoing MPX outbreak in the DRC poses a substantial public health challenge. While progress has been made in managing the epidemic, it remains imperative to address resource deficiencies and enhance public health systems. Strengthening international collaboration, expanding healthcare access, and improving surveillance capabilities are critical to mitigating the risk of future outbreaks.

Salomon I ，Hamitoglu AE ，Hertier U ，Belise MA ，Sandrine U ，Darius B ，Abdoulkarim MY ... -  《Immunity Inflammation and Disease》

Clade I mpox virus genomic diversity in the Democratic Republic of the Congo, 2018-2024: Predominance of zoonotic transmission.

Recent reports raise concerns on the changing epidemiology of mpox in the Democratic Republic of the Congo (DRC). High-quality genomes were generated for 337 patients from 14/26 provinces to document whether the increase in number of cases is due to zoonotic spillover events or viral evolution, with enrichment of APOBEC3 mutations linked to human adaptation. Our study highlights two patterns of transmission contributing to the source of human cases. All new sequences from the eastern South Kivu province (n = 17; 4.8%) corresponded to the recently described clade Ib, associated with sexual contact and sustained human-to-human transmission. By contrast, all other genomes are clade Ia, which exhibits high genetic diversity with low numbers of APOBEC3 mutations compared with clade Ib, suggesting multiple zoonotic introductions. The presence of multiple clade I variants in urban areas highlights the need for coordinated international response efforts and more studies on the transmission and the reservoir of mpox.

Kinganda-Lusamaki E ，Amuri-Aziza A ，Fernandez-Nuñez N ，Makangara-Cigolo JC ，Pratt C ，Vakaniaki EH ，Hoff NA ，Luakanda-Ndelemo G ，Akil-Bandali P ，Nundu SS ，Mulopo-Mukanya N ，Ngimba M ，Modadra-Madakpa B ，Diavita R ，Paku-Tshambu P ，Pukuta-Simbu E ，Merritt S ，O'Toole Á ，Low N ，Nkuba-Ndaye A ，Kavunga-Membo H ，Shongo Lushima R ，Liesenborghs L ，Wawina-Bokalanga T ，Vercauteren K ，Mukadi-Bamuleka D ，Subissi L ，Muyembe-Tamfum JJ ，Kindrachuk J ，Ayouba A ，Rambaut A ，Delaporte E ，Tessema S ，D'Ortenzio E ，Rimoin AW ，Hensley LE ，Mbala-Kingebeni P ，Peeters M ，Ahuka-Mundeke S ... -  《-》

Clade Ia Monkeypox Virus Linked to Sexual Transmission, Democratic Republic of the Congo, August 2024.

Makangara-Cigolo JC ，Kenye KM ，Lunyanga L ，Jansen D ，Kinganda-Lusamaki E ，Kavira S ，Amuri-Aziza A ，Malembi E ，Anta Y ，Akil-Bandali P ，Lokilo-Lofiko E ，Vakaniaki EH ，Nundu SS ，Pukuta-Simbu E ，Paku-Tshambu P ，Ola-Mpumbe R ，Lumembe-Numbi R ，Kabamba-Lungenyi G ，Luakanda G ，Kacita C ，Shongo-Lushima R ，Mwamba D ，O'Toole Á ，Merritt S ，Halbrook M ，Mukadi-Bamuleka D ，Hoff NA ，Low N ，Bogoch I ，Cevik M ，Gonsalves G ，Shaw S ，Subissi L ，Liesenborghs L ，Ayouba A ，Peeters M ，Delaporte E ，Tessema S ，Rimoin AW ，Muyembe-Tamfum JJ ，Rambaut A ，Vercauteren K ，Ahuka-Mundeke S ，Kindrachuk J ，Wawina-Bokalanga T ，Mbala-Kingebeni P ... -  《-》