ArticleBMC medicine2026
Dynamics of Mpox epidemics by the interplay of COVID-19 pandemic in Africa.
Article in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMpox epidemics continue to spread to African borders following the outbreak that has affected over 120 countries and thus posed a threat to global health security. Dynamics of Mpox spread over time, fatality, and country-level risk were investigated intra- and post-COVID-19 pandemic to inform optimal surveillance, response, and prevention strategy.
methodsAn epidemiological (retrospective cohort) analysis of complete weekly Mpox situation report across 20 African countries was conducted intra (January 2022-May 2023) and post (June 2023-September 2024) pandemic. Mpox epidemics and mortality were assessed against endemic-related exposures, and Mpox fatality rate, distribution, and patterns were assessed via summary analysis, spatial spread, and epi-curve respectively. Mantel Haenszel statistics assessed the confounding effects of COVID-19 and seasonality, while zero-inflated negative binomial model was fitted to evaluate the epidemic and mortality risk. Analysis was performed in Excel, QGIS, and Stata at 5% level of significance.
resultsAbout 9446 confirmed Mpox cases occurred in Africa between January 2022 and September 2024, with DR-Congo accounting for over 75%. Mpox case fatality rate is 0.58% and significantly different intra (1.16%) and post (0.46%) pandemic (p < 0.001). Though fatality is more prevalent in clade Ia and Ib (58.1%), with a higher risk than clade Ia only (IRR = 4.46, 95% = 1.12-17.69), the Mpox outbreak spread more rapidly through clade Ia and II to 20 countries post pandemic. Risk of Mpox incidence is about four times higher post-COVID-19 than intra-pandemic (IRR = 3.77, 95% CI = 2.83-5.00). The epi curve reveals a mixed epidemic, with common-source and propagated patterns intra- and post -pandemic. While COVID-19 does not confound the association between Mpox mortality and endemicity (M-H = 6.821, p = 0.009), the association was confounded by seasonal variation and thus, 35% of Mpox mortality could be prevented by eliminating high-endemic spread.
conclusionsWeak surveillance capacity was evident as African countries appeared to have relaxed health security and outbreaks response strategies post-COVID-19 pandemic. Scale-up of vaccination uptake against the Mpox virus is required, particularly for clades Ia, Ib, and II, to prevent Mpox spread and mortality. A consistent multi-country surveillance will be critical to contain Mpox epidemics.
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