Association of Preoperative Inflammatory Markers With Preoperative Anxiety and Emergence Agitation in Children.

Mpox (previously monkeypox), is a zoonotic viral disease endemic in tropical forested regions of Central and West Africa, with the Democratic Republic of the Congo (DRC) being the most affected country. Since reporting the first human case in 1970 [], the DRC has experienced substantial increases in mpox incidence, with over 10,000 laboratory-confirmed cases reported in 2024 alone [–]. Historically, human mpox incidence has been driven by zoonotic events with self-limiting transmission clusters in remote regions, where rodents were believed to play a key role as a potential reservoir []. Genomically, monkeypox virus (MPXV) has been classified as two separate clades: Clade I, endemic in regions of the Congo River Basin, and Clade II, endemic in Western African regions []. While studies have shown virulence differences between the two clades, more recent observations from mpox outbreaks have been less certain. Both virus clades have demonstrated transmission through similar zoonotic events, and increasing persistence in human populations, with seemingly context-specific divergence []. Although mpox outbreaks had previously been largely confined to endemic regions of Africa, the 2022 global outbreak marked a major epidemiological shift with rapid international spread of Clade IIb among non-endemic regions, and infections concentrated among men who have sex with men (MSM) [, ]. Unlike earlier zoonosis-driven outbreaks, transmission during this outbreak was sustained through human-to-human spread within dense sexual networks and the absence of zoonotic exposures []. Furthermore, in 2024, a novel sub-lineage of Clade I was identified – Clade Ib – with sustained human-to-human transmission clusters first detected in Kamituga, South Kivu Province, DRC []. Subsequent work delineating Clade I MPXV diversity has shown a predominance of zoonotic transmission in DRC related to Clade Ia, historically comprising Clade I, with specific sexual networks and high population density contributing to the continued propagation of mpox (Clade Ib) in urban centres []. Today, outbreaks of mpox in urban settings continue to be sporadically reported both in endemic and non-endemic settings; for instance, as of October 2025, Clade I MPXV was confirmed in Los Angeles County, California, USA, in patients with no reported travel to endemic regions, yet later linked to an importation event with evidence of local transmission [, ]. While continued mpox emergence and sustained transmission was historically unprecedented in non-endemic settings, these recurrent events highlight the need to examine transmission dynamics in urban centres in mpox-endemic countries to clarify whether similar network-driven mechanisms occur, or whether distinct social, ecological, or virological factors sustain mpox transmission in these regions.