Performance and challenges of Mpox surveillance systems in Africa

Background and objectives Mpox surveillance in Africa has evolved from a largely passive system that underestimated disease burden and faced diagnostic delays. While substantial investments were made in surveillance, laboratory capacity, and workforce strengthening, a systematic assessment of performance and persistent gaps across affected countries had not been conducted. We assessed the performance across all 22 African countries that were reporting mpox confirmed cases from August 2024 to February 2025. Methods We conducted a concurrent mixed methods study within mpox surveillance systems in all 22 African countries that had reported at least one confirmed case during the study period. Data from weekly epidemiologic reports and intra-action review (IAR) reports were analysed. Surveillance systems assessed included alert investigation, event-based surveillance, point-of-entry monitoring, active case finding, contact tracing, health data management, and animal surveillance. Quantitative operational and outcome indicators were processed using Python, while qualitative data from the joint continental database and IAR workshops were thematically synthesized. Results Across the countries, 92.2% of the mpox signal validation and 86.3% of 21-day contact follow-up were achieved by the mpox surveillance system, and over 10,000 community health workers were trained. A joint continental mpox surveillance database was established, improved case reporting in high-burden countries, and universal mpox notifiable disease listing was also reported. However, critical gaps persist; 77.8% of laboratory samples were submitted, 7% deceased cases were confirmed by laboratory, 20.3% of animal exposure data were examined, and a 1:3 case-to-contact ratio was traced. Conclusion While the mpox surveillance system in Africa shows progress, critical challenges in data completeness, laboratory access, one-health integration, and human resource deployment remain. Addressing these gaps through targeted, sustainable interventions is crucial for building a resilient surveillance system capable of effective and timely detection and rapid response to mpox outbreaks across the continent.