Life sciences · Journal article
Ijid Regions · September 4, 2026
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Uganda experienced a substantial increase in mpox cases in early 2025, with notable clustering in central regions. The country reported approximately 4800 confirmed monkeypox (mpox) cases and 37 deaths, with the Masaka district contributing approximately 3% of the national burden. We investigated an outbreak in Masaka District to describe its epidemiology and identify associated risk factors. We conducted an outbreak investigation with a descriptive epidemiological analysis and an unmatched case-control study. A suspected case was defined as onset of rash with fever and at least one additional symptom (lymphadenopathy, headache, myalgia, back pain, or fatigue) in a Masaka District resident during February-April 2025. Confirmed cases were positive by polymerase chain reaction (PCR). We enrolled 86 patients with confirmed mpox and 172 neighborhood controls (1:2 ratio). Data on sociodemographic characteristics, care-seeking behavior, and potential exposures were collected using structured questionnaires. Multivariable logistic regression identified independent risk factors. Of the 86 confirmed cases, 45 (52.3%) were male and 41 (47.7%) were female. The most affected age group was 25-34 years (24 per 10,000 population), and residents of Bukakata Subcounty, a fisherfolk community, had the highest attack rate (5 per 10,000). Over half (56%) were human immunodeficiency virus (HIV) positive. Independent risk factors included HIV infection (adjusted odds ratio [aOR]: 5.4; 95% confidence interval [CI] = 2.34-12.49), having multiple sexual partners (aOR: 7.3; 95% CI = 3.5-15.3), and close contact with an individual with a rash (aOR: 3.2; 95% CI = 1.4-6.9). The mpox outbreak affected young adults, driven by high-risk sexual networks and underlying HIV infection. Strengthening integration of mpox screening, prevention, and care within HIV programs targeting sexual networks could interrupt transmission and mitigate future outbreaks.