Case presentation of patients hospitalized with mpox (subclade Ib/2023sh) including children, adolescents, and adults in South Kivu, Democratic Republic of the Congo: an observational cohort study

Since 2022, the World Health Organization declared two Public Health Emergency of International Concern (PHEIC) events as mpox (former monkeypox) spread outside endemic regions. In late 2023, the most recent PHEIC was declared as reports of a novel virus (monkeypox virus [MPXV] subclade Ib/2023sh) configured sustained human-to-human transmission. The first studies that described the multiple MPXVs subclade Ib/2023sh outbreaks were predominantly composed by adults with sexual contact being attributed as a important mode of transmission. In this study, we describe the clinical characteristics, demographics, and epidemiology of a cohort of patients in a hospital located in the Kabare territory, Miti Murhesa Health area, South Kivu, Democratic Republic of the Congo. We identified that children aged equal to or less than 15 years old compose 300/494 PCR positive study participants. The households of study participants contain a mean number of six individuals where on average, four members are children <= 15 years old. Our clinical description of cases includes children equal to or less than 5 years of age having significantly more lesions in the head, face, neck, back of arms, palm of hand, posterior aspect of thighs, legs, dorsal foot, and oral cavity. Our results have important clinical applications that can inform clinical decision-making of relevant signs, symptoms, and lesion distribution of mpox virus subclade Ib infections especially in children. Given the high proportion of oral lesions, cough, and dysphagia, we conjecture that airborne transmission might play an important role in the spread of mpox virus subclade Ib. We also identified a high positivity rate of detecting mpox subclade Ib virus in oropharyngeal samples which might arise prior to the development of skin rash/lesions making oropharyngeal swabbing a potentially effective alternate diagnostic method of mpox in the absence of easily assayable skin lesions.