Mpox surveillance in endemic regions: a scoping review of trends, challenges, and recommendations

Abstract

Mpox continues to pose a significant public health threat in endemic regions of Africa, particularly with the emergence of new viral clades and continuous human-to-human transmission. This scoping review assesses existing Mpox surveillance systems in endemic parts of Africa, highlighting key trends, challenges, and opportunities for improvement. A scoping review was conducted following the PRISMA-ScR guidelines. Five electronic databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched in September 2025. Studies conducted in the WHO African Region that described, evaluated, or implemented Mpox laboratory surveillance systems were included. Eligible articles underwent screening and data extraction using the Covidence software. Data extracted from the reviewed studies were charted according to surveillance structures, diagnostic methods, reporting strategies, and implementation challenges. 24 studies were included for review, predominantly from Central and West Africa, particularly the Democratic Republic of Congo (DRC), Nigeria, Cameroon, and the Central African Republic (CAR). Surveillance systems varied in scope and design, ranging from passive and active national frameworks to cross-border monitoring. Diagnostic approaches commonly relied on polymerase chain reaction (PCR) testing, though limitations in laboratory infrastructure and delayed specimen transport hindered timely case confirmation. Key challenges identified include deficits in diagnostic capacity, misclassification of disease based on symptoms, and limited follow-up investigations. Structural barriers such as poor infrastructure, healthcare worker shortages, and conflict-related disruptions further weakened Mpox surveillance. Stigma and lack of community awareness contributed to underreporting. Additionally, the circulation of multiple Mpox viral clades and frequent cross-border transmission complicated outbreak detection and containment. While Mpox surveillance capacity has improved modestly, major structural and systemic challenges persist. Strengthening Mpox surveillance in endemic regions requires a multi-level strategy to ensure timely detection and containment of future outbreaks. Not applicable