Mpox clinical features and varicella-zoster virus coinfection in the Democratic Republic of Congo: a systematic review and meta-analysis (1970–2024)
Abstract
Background
Monkeypox (Mpox) remains endemic in the Democratic Republic of Congo (DRC), with inc. Despite five decades of outbreaks, gaps persist in understanding clinical patterns and coinfections with varicella-zoster virus (VZV) and HIV in this high-burden setting.
Methods
We conducted a systematic review and meta-analysis (1970–2024) of Mpox cases in the DRC, extracting data from PubMed, ScienceDirect, and Google Scholar. Pooled prevalence rates were calculated using fixed and random-effects models, with subgroup analyses by time period, region, setting, study design and participant characteristics.
Results
Among 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%) versus Equateur (11.10%). The VZV pooled prevalence rate among 64131 suspected Mpox cases was 16.73% (95% CI: 5.36-28.10; n = 8), withI2= 99.4% (p□ 0.001). HIV coinfection was low (0.52%, 95% CI: 0.18–0.87) but elevated in South Kivu (1.64%). Among confirmed cases, rash (99.97%), painful lesions (78.17%), and Malaise (77.14%) dominated clinical presentation and underscored their diagnostic importance in the case definition. A similar clinical pattern of Mpox was observed among suspected cases, featuring a near-universal presentation of rash (99.43%) and fever (98.91%). Heterogeneity was high (I2> 90%) for most outcomes.
Conclusion
Mpox in the DRC presents with consistent rash-centered symptomatology but high VZV coinfection rates complicate diagnosis. The low HIV coinfection suggests distinct transmission dynamics from global outbreaks. Findings underscore the need for integrated VZV/Mpox diagnostics and context-specific surveillance in endemic regions.
Related articles
Related articles are currently not available for this article.