Mpox clinical and epidemiological patterns in the Central African Republic: a systematic review and meta-analysis

BackgroundMpox remains a critical public health challenge in Central Africa, where endemic circulation of the virulent Clade I virus persists through zoonotic and human-to-human transmission. This systematic review and meta-analysis synthesize 40 years of evidence (1984-2024) to characterize Mpox epidemiology, vaccination gaps and clinical pattern in the Central African Republic (CAR), informing targeted control strategies for this re-emerging threat. MethodsFollowing PRISMA guidelines, we conducted a comprehensive search of PubMed, Scopus, ScienceDirect, Web of science, Embase, Cochrane Library, and AJOL for studies reporting laboratory-confirmed Mpox cases in CAR. Pooled estimates were calculated using random/fixed-effects models with R Software version 4.4.2 with subgroup analysis conducted for period, region, participants and disease burden. Heterogeneity (I2) and publication bias (funnel plots, Eggers and Beggs tests) were rigorously assessed. The confidence intervals (CIs) were estimated at 95% level of confidence. A p-value 5% was considered statistically significant. ResultsAnalysis of seven studies (1984-2023) found a pooled severity rate of 60.9% (95%CI: 48.5-77.7), peaking at 77.3% (95%CI: 55.6-90.2) in Health Region 6. Before the global mpox outbreak, the CFR for confirmed cases was 11.54% (95% CI: 6.11-20.71). Eastern Health Regions had a higher CFR of 11.11% (95% CI: 5.08-22.60), while Western Regions reported 0.00% (95% CI: 0.00-100.00). For suspected cases, the CFR was 12.77% (95% CI: 7.39-21.15), slightly declining to 9.09% (95% CI: 0.23-41.28) post-2022. This geographic disparity remained, with Eastern Regions at 10.17% (95% CI: 4.64-20.84) and Western Regions at 5.26% (95% CI: 0.74-29.39). Vaccination uptake in CAR was only 20.00% (95% CI: 10.33-35.17). The clinical profile included fever (91.1% (95%CI: 42.9-99.3)), rash (85.5% (95%CI: 75.7-91.8)), and lymphadenopathy (57.0% (95%CI: 34.3-77.1)). ConclusionThe CAR faces a disproportionate Mpox burden characterized by high severity, elevated mortality, and suboptimal vaccine coverage, particularly in eastern regions. These findings suggest the urgent need for: (1) enhanced surveillance systems with genomic sequencing capacity; (2) prevention of disease lethality through early case detection and appropriate care provision; (3) strengthening vaccine distribution prioritizing high-risk populations; and (4) context-specific interventions, including community education and healthcare worker training, to curb future outbreaks.