Mpox Clinical and Epidemiological Patterns in the Central African Republic: a Systematic Review and Meta-analysis

Abstract

This study included 40 years evidences (1984-2024) describing the Mpox epidemiology, vaccination and clinical pattern in the Central African Republic (CAR), informing targeted control strategies for this re-emerging threat. This systematic review and meta-analysis followed the PRISMA guidelines. The searches   was conducted on PubMed, Scopus, ScienceDirect, Web of science, Embase, Cochrane Library, and AJOL. The random effect model was used to pooled estimates with R version 4.5.2. A p-value <0.05 was considered statistically significant. We included a total of seven studies conducted from 1984 to 2023. Our analysis revealed a pooled severity rate of 60.92% (95% confidence interval (CI): 47.54-72.83), peaking at 77.27% (95%CI: 55.64-90.21) in Health Region 6. Before the global Mpox outbreak in 2022, the case fatality rate (CFR) for confirmed cases was 10.71% (95% CI: 4.52-23.28). Eastern Health Regions had a higher CFR of 10.81% (95% CI: 4.03-25.93), while Western Regions reported 0.00% (95% CI: 0.00-100.00). For suspected cases, the CFR was 12.13% (95% CI: 5.59-24.34), slightly declining to 9.09% (95% CI: 0.23-41.28) post-2022. This geographic disparity remained, with Eastern Regions at 10.17% (95% CI: 4.64-20.84) and Western Regions at 5.26% (95% CI: 0.74-29.39). Vaccination uptake in CAR was 20.00% (95% CI: 10.33-35.17). The clinical profile included fever (91.1% (95%CI: 42.9-99.3)), rash (85.5% (95%CI: 75.7-91.8)), and lymphadenopathy (57.0% (95%CI: 34.3-77.1)). The CAR is one of the most affected countries in Africa by Mpox. This was characterized by high severity, elevated mortality, and suboptimal vaccine coverage, particularly in eastern regions. In order to prevent future outbreak in the country, these findings point the necessity to improve vaccination distribution, give priority to high (risk populations, and improve the surveillance systems with genomic sequencing capacity. In context-specific interventions, including community education on prevention measures and healthcare worker training will help reducing the mpox-related morbidity and mortality.