Mpox Outbreak in Côte d'Ivoire during 2024: Epidemiological, Clinical, Virological and Outcome Features of Hospitalised Cases in Abidjan

Abstract

Aims: To describe the epidemiological, clinical, virological and outcome features of Mpox patients hospitalised at the referral centre in Abidjan during the 2024 outbreak in Côte d'Ivoire, which totalled 89 confirmed cases nationwide. Study Design:  Descriptive observational study. Place and Duration of Study: Department of Infectious and Tropical Diseases (SMIT), Treichville University Hospital, Abidjan, Côte d'Ivoire, between June and October 2024. Methodology: We included all patients hospitalised at the SMIT with Mpox confirmed by real-time polymerase chain reaction (PCR) on skin lesion samples. Sociodemographic, clinical, virological (subclade typing by genomic sequencing at the Institut Pasteur de Côte d'Ivoire) and outcome data were collected using a standardised questionnaire. Qualitative variables were described as counts and percentages, and quantitative variables as medians with interquartile range (IQR). The in-hospital case fatality rate was estimated with its exact 95% confidence interval (CI). Results: Twenty-three patients were included (median age: 20 years [IQR: 11–40]; 18 males, sex ratio: 3.6), originating from four geographical clusters: Dianra in the north (n = 11), Abidjan in the south (n = 6), Sakassou in the centre (n = 4) and Iboké in the south-west (n = 2). No patient had been vaccinated against smallpox. The main features were skin rash (100%), fever (95.7%), headache (91.3%) and arthralgia (82.6%). Lesions were of moderate grade (10–99 lesions) in 19 patients (82.6%). Subclade IIa was identified in 22 patients (95.7%) and subclade IIb in one patient (4.3%). The median hospital stay was 13 days (IQR: 7–15). Bacterial superinfection was the main complication (21.7%). The in-hospital case fatality rate was 4.3% (95% CI: 0.1–21.9). Conclusion: In one of the first descriptions from Côte d'Ivoire, the outbreak was both rural and urban, affected young unvaccinated patients, was dominated by subclade IIa and had a generally favourable outcome. Surveillance, decentralised diagnosis and access to vaccination all need strengthening.