Epidemiology, clinical features, and outcomes of Mpox in children and adolescents in Uganda, August 2024–January 2025

Objectives: Recent Mpox outbreaks in Uganda have primarily affected adults, but children and adolescents are at a higher risk of severe disease. We described the epidemiology, severity, and factors associated with severe Mpox among children and adolescents in Uganda during August 2024-January 2025. Methods: We conducted a cross-sectional study among polymerase chain reaction-confirmed Mpox cases in patients aged 0-17 years in eight high-burden districts. Medical records were reviewed, and Mpox severity was measured using the severity scoring system. Participants' variables were summarized using descriptive statistics and attack rates. Modified Poisson regression identified factors associated with severe disease. Results: Among 160 case-patients, males (attack rate [AR] = 2.2/100,000) and females (AR = 2.1/100,000) were equally affected. Children <5 years had the highest AR (3.7/100,000). Household (50%) and school (36%) exposures were most common. Overall, Mpox severity was 91% (adjusted prevalence ratio [aPR], 95% confidence interval: 87-96%). Care-seeking after 7 days from symptom onset was associated with higher severity (aPR: 1.1, 95% confidence interval: 1.03-1.3). Case fatality was 1.9%. Conclusions: Children, especially those younger than 5, experienced high Mpox infection, often linked to household and school exposure. Care-seeking beyond 7 days increased disease severity. Interventions promoting early detection and timely care in households and schools could reduce Mpox-related morbidity and mortality in children and adolescents.