ACCESS
Systematic Review
Volume 1, Article ID: 2026.0002
Fabrice Zobel Lekeumo Cheuyem
zobelcheuyem@gmail.com
Constantine Tanywe Asahngwa
asahngwa@gmail.com
William Ndjidda Bakari
bakariwilliam@yahoo.fr
Chabeja Achangwa
chabejaacha@yahoo.com
Jessy Goupeyou-Youmsi
goupeyou.youmsi@gmail.com
Brian Ngongheh Ajong
ajong.brian@yahoo.com
Claude Axel Minkandi
minkandiclaude@gmail.com
Solange Dabou
solangedabs@gmail.com
Mohamadou Adama ,
bachiroudoc@yahoo.fr
Jude Tsafack Zefack
judetsafackz@gmail.com
Badou Guianga
guiangabadou@gmail.com
Jonathan Hangi Ndungo
ndungojonathan@gmail.com
1 Department of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaoundé, Cameroon
2 Department of anthropology, The University of Yaoundé 1, Yaoundé, Cameroon
3 Department of Periodontology, Faculty of Medicine, Pharmacy and Odontology, University Cheikh Anta Diop of Dakar, Dakar, Senegal
4 Department of Public Health, Faculty of Medical Sciences, University of West Indies, Bridgetown, Barbados
5 Institute of Healthcare Management, Strathmore University Business School, Nairobi, Kenya
6 Health Emergencies Programme, World Health Organization (WHO), Kinshasa, Democratic Republic of Congo
7 National Multisectoral Programme to Fight against Maternal and Child Mortality, Ministry of Public Health, Yaoundé, Cameroon
8 Department of Biochemistry, University of Dschang, Dschang, Cameroon
9 Department of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
10 Higher Institute of Medical Techniques, Bunia, Democratic Republic of Congo
* Author to whom correspondence should be addressed
Received: 01 Nov 2025 Accepted: 03 Feb 2026 Available Online: 05 Feb 2026
Introduction: Monkeypox (Mpox) is an endemic disease in the Democratic Republic of Congo (DRC). After five decades of outbreaks, gaps still remain in understanding clinical patterns and coinfections with varicella-zoster virus (VZV) and human immunodeficiency virus (HIV) in this high-burden setting. This systematic review and meta-analysis were conducted to synthesize data on Mpox clinical presentation and coinfection trends in the Democratic Republic of the Congo. Estimating the burden of VZV and HIV coinfections will help informing decision maker during the fight against this outbreak.
Methods: This study was conducted by systematically extracting data from online databases including PubMed, ScienceDirect, and Google Scholar. The pooled estimate VZV and HIV coinfection rates were calculated using fixed and random-effects models. Subgroup analyses were performed by time period, region, study design, setting, and participant characteristics.
Results Among a total of 1,841 confirmed Mpox cases, VZV coinfection was 9.69% (95% CI: 1.33–18.06; n = 8), with higher rates in Kivu (33.33%) compared to Equateur (11.10%). The VZV pooled prevalence rate among 64,131 suspected Mpox cases was 16.73% (95% CI: 5.36-28.10; n = 8), with I2 = 99.4% (p ˂ 0.001). The pooled estimate of HIV coinfection rate was low (0.52%, 95% CI: 0.18–0.87) at national level but elevated in South Kivu (1.64%). Among confirmed cases, rash (99.97%), painful lesions (78.17%), and Malaise (77.14%) were the main clinical presentation and this highlights their diagnostic importance in the case definition. A similar clinical pattern of Mpox was observed among suspected cases, were almost all recorded cases reported rash (99.43%) and fever (98.91%). Heterogeneity was high (I² > 90%) for most study outcomes.
Conclusion: The substantial VZV coinfection prevalence and distinct regional HIV patterns highlight critical gaps in syndromic surveillance and the urgent need for integrated diagnostic strategies. This review confirms that Mpox in the DRC presents with near-universal rash, underlining their centrality to case definitions. These findings provide essential evidence for strengthening frontline detection and tailored outbreak response in endemic zones.
Disclaimer : This is not the final version of the article. Changes may occur when the manuscript is published in its final format.