Mpox 7-1-7 diagnostic and sequencing targets in the Democratic Republic of the Congo

Background

Mpox remains a global public Health concern with the democratic Republic of Congo as Epicenter. The 7-1-7 agenda has as target detection within ≤7 days to respond to outbreaks. The Democratic republic of Congo (DRC), faces persistent transmission linked to gaps in surveillance and laboratory systems. This study assessed the diagnostic yield, timeliness to Mpox diagnosis, sequencing and operational determinants associated with timeliness.

Methods

We conducted a retrospective analysis of National surveillance and Laboratory data (2022-2025) extracted from DHIS-2. Timeliness was defined as difference from symptom onset to Mpox diagnosis or sequencing and categorized as ≤ 7 or ≥ 7 days. Logistic regression estimated crude and adjusted odds ratios (COR, AOR) and statistical significance at p < 0.05. A cascade analysis was used to evaluate attrition across response stages.

Results

A total of 30784 suspected alerts among which 11771(38.2% were validated, 9139 (77.6%) samples collected, and 2829(9.2%) tested, positivity of 951(33.61%) and 386 (40.5%) sequenced. Only 50.6 % of all samples achieved timely OPX diagnosis while 53.9% met sequencing targets. Delays in sample transport ≥3 days (AOR: 0.19, CI: 0.10-0.44, p<0.001), laboratory turnaround time >4 days (AOR: 0.15, CI: .11-0.22)) reduced the odds of timely Mpox diagnosis. Symptom to alert interval within 24-48H, alert to sample collection, Sample reception to analysis were 4.10 (C.I: 2.8-6.01), 1.73 (C.I: 0.83-4.32), 2.75 (1.85-3.5) respectively. Attrition rate between stages were 62%, 69%, 85 % and 59.41% from alerts to Sequencing.

Conclusions

Mpox diagnostic and sequencing timelines in DRC within 7-1-7 framework remains remains suboptimal with operational insufficiencies as determinants. Re-enforcing early detection, specimen transport, decentralized laboratory capacity could be essential to achieve 7-1-7 tarets and improve outbreak response.

Key messages

• Mpox diagnostic and sequencing timelines in the DRC remain suboptimal, with only 50.6% of cases meeting the 7-1-7 target, largely due to significant attrition between alerts and laboratory testing.

• Achieving 7-1-7 targets in DRC reqires addressing operational barriers by decentralizing laboratory capacity and optimizing specimen transport to reduce critical delays in detection and response.