A new study published in the lacent has revealed a shift in the spread of mpox in eastern Democratic Republic of the Congo, with children and adolescents accounting for the majority of infections.
The observational study, conducted at Lwiro Hospital in South Kivu, analysed hundreds of patients admitted with suspected mpox between August 2024 and February 2025. Out of 643 individuals tested, 494 were confirmed to have the virus. Notably, 61 percent of those infected were aged 15 years or younger, signalling a major change in the demographics of the disease.
Researchers say this trend marks a departure from earlier outbreaks, which were largely concentrated among adults. “Children and adolescents (≤15 years) comprised 300 (61%) of the 494 study participants,” the study notes.
Mpox, a viral disease historically linked to contact with infected animals, has increasingly spread through human-to-human transmission in recent years. While earlier outbreaks were associated with sexual contact, particularly among adults, the South Kivu study points to a different pattern.
The findings indicate that the virus was spreading widely within households, driven by close physical contact and shared living conditions. Many families in the study area live in crowded homes, often with multiple children sharing beds, clothing, and sanitation facilities. This environment creates ideal conditions for transmission.
“Transmission extended well beyond sexual networks, resulting in intrafamily and interfamily spread,” the researchers observed, highlighting the shift towards community-based infections.
Clinically, the disease continues to present with familiar symptoms, including fever, skin rashes, and sore throat. Fever was the most common symptom, affecting 90 percent of patients, followed by skin lesions in 79 percent. Children, particularly those under five years, were more likely to develop widespread lesions across the body, including the face, arms, legs, and even the oral cavity.
In contrast, adults showed a higher concentration of lesions in the genital area, reflecting earlier patterns linked to sexual transmission.
The study also identified an important diagnostic development. Researchers found that mpox could be detected through oral swabs even before visible skin lesions appeared. This could improve early diagnosis, especially in cases where traditional symptoms are not yet evident.
Despite the high number of infections, the overall fatality rate remained low at 0.8 percent. However, all recorded deaths occurred in patients who were also suffering from severe malaria, suggesting that co-infections significantly increase the risk of complications.
Public health experts warn that the findings call for urgent intervention strategies tailored to children and family settings. “We identified children and adolescents as important targets… who might therefore drive transmission,” the study concludes.
Photo from El Pais