• Eugene Bangwen, Ruth Diavita, Elise De Vos, Emmanuel Hasivirwe Vakaniaki, Sabin Sabiti Nundu, Annie Mutombo, Felix Mulangu, Aaron Aruna Abedi, Emile Malembi, Thierry Kalonji, Cris Kacita, Eddy Kinganda-Lusamaki, Tony Wawina-Bokalanga, Cécile Kremer, Isabel Brosius, Christophe Van Dijck, Emmanuel Bottieau, Koen Vercauteren, Adrienne Amuri-Aziza, Jean-Claude Makangara-Cigolo, Elisabeth Muyamuna, Elisabeth Pukuta, Beatrice Nguete, Didine Kaba, Joelle Kabamba, Christine M Hughes, Olivier Tshiani-Mbaya, Anne W Rimoin, Nicole A Hoff, Jason Kindrachuk, Niel Hens, Martine Peeters, Nicola Low, Andrea M McCollum, Robert Shongo, Daniel Mukadi-Bamuleka, Jean-Jacques Muyembe-Tamfum, Steve Ahuka-Mundeke, Laurens Liesenborghs, and Placide Mbala-Kingebeni.
• Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
• Lancet. 2025 Feb 1; 405 (10476): 408419408-419.

BackgroundDR Congo has the highest global burden of mpox, a disease caused by infection with the monkeypox virus. The incidence has risen since 1980, but recent analyses of epidemiological trends are lacking. We aimed to describe trends in suspected and confirmed mpox cases in DR Congo using epidemiological and laboratory mpox surveillance data collected from 2010 to 2023, and provide insights that can better inform the targeting and monitoring of control strategies.MethodsWe analysed aggregated national epidemiological surveillance data and individual-level laboratory data from 2010 to 2023. We calculated incidence based on suspected cases, case-fatality ratios, and percentage of laboratory-confirmed cases and assessed geospatial trends. Demographic and seasonal trends were investigated using generalised additive mixed models.FindingsBetween Jan 1, 2010, and Dec 31, 2023, a total of 60 967 suspected cases and 1798 suspected deaths from mpox were reported in DR Congo (case-fatality ratio 2·9%). The number of reporting provinces increased from 18 of 26 provinces in 2010 to 24 of 26 provinces in 2023. The annual incidence increased from 2·97 per 100 000 in 2010 to 11·46 per 100 000 in 2023. The highest incidence (46·38 per 100 000) and case-fatality ratio (6·0%) were observed in children younger than 5 years. Incidence was higher in rural compared with urban areas. PCR testing was performed for 7438 suspected cases (12·2%), with 4248 (57·1%) of 7438 samples testing positive. Median age of confirmed cases (13·0 years [IQR 6·0-25·0]) remained stable, although the 95th percentile of age increased over time.InterpretationThe incidence and geographical distribution of suspected mpox cases have increased substantially since 2010. Improvements in surveillance and decentralised testing are essential to monitor mpox trends and direct interventions effectively, to address the public health emergency declarations issued in August, 2024.FundingBelgian Directorate-General Development Cooperation and Humanitarian Aid; European and Developing Countries Clinical Trials Partnership; Research Foundation-Flanders; European Civil Protection and Humanitarian Aid Operations; Department of Economy, Science, and Innovation of the Flemish Government; Canadian Institutes of Health Research; and the International Development Research Centre.Copyright © 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

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