德国特里亚斯普约尔大学Prof Oriol Mitjà研究团队发现，刚果民主共和国猴痘确诊病例的临床表现和流行病学评估：一项基于监测的观察性研究。这一研究成果发表在2025年4月10日出版的国际学术期刊《柳叶刀》上。

背景：由猴痘病毒引起的Mpox是非洲特别是刚果民主共和国的严重公共卫生威胁。猴痘病毒以前仅限于具有1a分支流行地区，但最近已传播到已出现1b分支。本研究对刚果民主共和国1a和1b分支流行地区的麻疹病例进行了临床比较。

方法：该团队进行了一项回顾性观察研究，分析了2023年10月1日至2024年9月31日期间在7个省哨点卫生区报告的PCR确诊的猴痘病例。对来自新受影响省份（南基伍省和金沙萨省）的病例以及来自四个流行省份（迈恩多姆贝省、措帕省、措波省、南乌班吉省和萨基塔省）的病例进行了描述。从国家监测系统和地方卫生设施收集监测数据，包括接触类型、人口统计细节、临床表现、并发症和结果，并使用定量PCR进行实验室确认。所有分析均局限于描述性统计。

发现：在17,927例疑似病例中，10,986例接受调查，5,948例PCR阳性，最终4,895例符合纳入标准（新发区4,436例 vs 流行区459例）。新发病例省份中位年龄为20岁（IQR 8 ~ 28岁），女性2119人（47.8%），男性2310人（52.1%）。流行省份中位年龄为15岁（7-26岁），女性179例（39.0%），男性277例（60.3%）。新发病省有1951人（44.0%）与流行省有25人（5.4%）有直接或密切的人接触，人畜共患暴露分别为11人（0.2%）和99人（21.6%）。出现全身症状（新发感染省份3828例[83.3%]，流行省份427例[93.3%]）和呼吸道症状（2450例[55.2%]和219例[47.7%]）以及中位皮肤病变计数（91例[IQR 37-200]和163例[95-345]）的参与者比例在新发感染地区和流行地区之间相似。并发症包括皮肤感染（新发省2041例[46.0%]，流行省201例[43.8%]）、呼吸窘迫（82例[1.8%]和29例[6.3%]）、视力损害（7例[0.2%]和28例[6.1%]）和前列腺衰竭（695例[15.7%]和51例[11.1%]）。新感染地区的儿童病死率为0.7% (95% CI 0.4 - 1；1924年的14例)，成人病死率为0.6%(0.3-1.0；2483例中有14例)，而流行地区的儿童和成人病死率分别为5.9% (3.4 ~ 10.0；236人中有14人）和2.7% (1.1 ~ 6.1；222人中有6人）。

内容说明：本文及其附录包含影响面部和生殖器等不同部位的猴痘病变的图形图像。

研究结果表明，研究小组的研究表明，刚果民主共和国同时发生猴痘暴发，涉及年轻人，妇女和女孩的比例更高，与分支2b谱系B.1疫情相比，具有更高的病变计数和呼吸道症状的独特表现。感染并发症的高比例和病死率，特别是在流行地区，强调需要及时进行抗生素治疗和有针对性的疫苗接种，以降低发病率和死亡率。

附：英文原文

Title: Clinical presentation and epidemiological assessment of confirmed human mpox cases in DR Congo: a surveillance-based observational study

Author: Emile Malembi, Roser Escrig-Sarreta, Jackie Ntumba, Camila G Beiras, Robert Shongo, Justin Bengehya, Charles Nselaka, Elisabeth Pukuta, Daniel Mukadi-Bamuleka, Nolla Mulopo-Mukanya, Xinying Leng, Clara Pérez-Maá, Cristina Galván-Casas, Susana Muoz, Steeven Bilembo-Kitwanda, Pierre Kitha, Vivi Maketa, Patrick Mitashi, Aruna Abedi, Justus Nsio, Steve Ahuka-Mundeke, Placide Mbala-Kingebeni, Jean-Jacques Muyembe, Michael Marks, Hypolite Muhindo-Mavoko, Oriol Mitjà, Thierry Kalonji, Derrick Tshisuaka, Bob Misima, Junior Mukaba, Freddy Bikioli, Aimé Umba, Phanzu M Delphin, Olivier Makuma, Bandu Bola Rodriguez, Innocent Kanda, Sylvie Linsuke, Joules Madinga, John Kalowa, Alba Català, María Jesús Torres, Astrid Carrion, Pere Capella, Lobna Chakkour, Maruan Dermoumi, Juan Garay, Narcís Roig, Anne Rimoine, Nicole Hoff, Emile Muhindo-Milonde, Nolla Nsimire-Bahasa, Tavia Bodisa-Matamu, Zéphanie Paluku-Kalimuli, Michel Ngimba, Laetitia Nyinya wa Mupanga, Brigitte Modadra-Madakpa, Adèle Kavira-Kamaliro, Patrick Muhindo-Karungu, Jacques Daudi Cinyabuuma

Issue&Volume: 2025-04-10

Abstract: Background

Mpox, caused by the monkeypox virus, is a serious public health threat in Africa, especially in DR Congo. Previously limited to endemic areas with clade 1a, monkeypox virus has recently spread to non-endemic regions, where clade 1b has emerged. This study provides a clinical comparison of mpox cases in DR Congo regions where clade 1a and clade 1b are prevalent.

Methods

We conducted a retrospective observational study, analysing PCR-confirmed mpox cases reported from sentinel health zones in seven provinces between Oct 1, 2023, and Sept 31, 2024. Cases from the newly affected provinces (South-Kivu and Kinshasa) were described along with those from four endemic provinces (Mai-Ndombe, Tshuapa, Tshopo, South-Ubangi, and équateur). Surveillance data, including type of exposure, demographic details, clinical presentation, complications, and outcomes were collected from national surveillance systems and local health facilities, with laboratory confirmation using quantitative PCR. All analyses were restricted to descriptive statistics.

Findings

Of 17927 suspected cases identified, 10986 were investigated, 5948 were PCR-positive, and 4895 met the inclusion criteria based on data completeness: 4436 in newly affected and 459 in endemic regions. In newly affected provinces, median age was 20 years (IQR 8–28), 2119 (47·8%) participants were female, and 2310 (52·1%) were male. In endemic provinces, median age was 15 years (7–26), 179 (39·0%) participants were female, and 277 (60·3%) were male. Direct or intimate human contact was reported by 1951 (44·0%) individuals in newly affected provinces versus 25 (5·4%) in endemic provinces, and zoonotic exposure in 11 (0·2%) and 99 (21·6%), respectively. The proportions of partcipants with systemic symptoms (3828 [86·3%] in newly affected provinces and 427 [93·0%] in endemic provinces) and respiratory symptoms (2450 [55·2%] and 219 [47·7%]), and median skin lesion counts (91 [IQR 37–200] and 163 [95–345]) were similar between newly affected and endemic regions. Complications included skin infections (2041 [46·0%] in newly affected provinces and 201 [43·8%] in endemic provinces), respiratory distress (82 [1·8%] and 29 [6·3%]), vision impairment (7 [0·2%] and 28 [6·1%]), and prostration (695 [15·7%] and 51 [11·1%]). The case-fatality rate was 0·7% (95% CI 0·4–1·3; 14 of 1924) in children and 0·6% (0·3–1·0; 14 of 2483) in adults in newly affected areas, compared with 5·9% (3·4–10·0; 14 of 236) in children and 2·7% (1·1–6·1; six of 222) in adults in endemic regions. Content note: this Article and its appendix contain graphic images of mpox lesions affecting various sites including the face and genitals.

Interpretation

Our study indicates concurrent mpox outbreaks in DR Congo, involving younger individuals, a higher proportion of women and girls, and distinct presentations with higher lesion counts and respiratory symptoms compared with clade 2b lineage B.1 outbreaks. The high proportion of infectious complications and case-fatality rates, especially in endemic regions, emphasise the need for timely antibiotic therapy and targeted vaccination to reduce morbidity and mortality.

DOI: 10.1016/S0140-6736(25)00152-7

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00152-7/abstract