Multidisciplinary investigations of mpox outbreaks in Cameroon

Cameroon is the only known country that has notified both clades of the monkeypox virus co-circulating. We therefore aim to estimate the clade-specific disease burden, characterize the clinical manifestations as well as employ genomic sequencing approaches to investigate the transmission dynamics and identify potentially co-circulating pathogens of public health relevance. This flexible modular research protocol will pool together experiences from studying mpox outbreaks in the DRC, as well as lessons learned. Following the modular design intended, my dissertation will take the following anticipated outline and expected outputs: Module A: Retrospective analysis of existing surveillance data (epidemiological and laboratory testing data) 2017 – 2024 Expected output/manuscript: The burden, clade diversity and spatial distribution of mpox in Cameroon 2017 - 2024: a retrospective analysis of existing surveillance data Module B: Investigation of suspect mpox cases and risk factors for transmission Expected output/manuscript: Clinical manifestation and risk factors of mpox during the 2023/2024 outbreak of mpox in Cameroon Module C: Prospective follow up of high-risk contacts Expected output/manuscript: Transmission dynamics associated with mpox in Cameroon: a longitudinal study of high-risk contacts Module D: Sero-survey of mpox in affected and unaffected communities

Expected output/manuscript Serosurvey to estimate the magnitude of an outbreak of mpox in Kumba, Cameroon, 2022 – (end of outbreak) Module E: Environmental and ecological studies to investigate animal-to-human transmission of mpox Expected output/manuscript: Investigating mpox transmission in Cameroon through animal and environmental studies