{ "abstract": "Background: Evidence on paediatric mpox during contemporary African clade IIb outbreaks remains limited. We described paediatric cases in Sierra Leone’s 2024–2025 clade IIb G.1 outbreak by person, time, and place and examined clinical care, outcomes, vaccination records, and documented exposures. Methodology/Principal findings: We conducted a retrospective descriptive study using the national District Health Information Software 2 (DHIS2) mpox database, supplemented by patient charts and outbreak-investigation forms. Among 5,466 cases with recorded age, 415 (7.6%) were children younger than 15 years; 188 (45.3%) were aged 0–4 years, 121 (29.2%) were aged 5–9 years, and 106 (25.5%) were aged 10–14 years. Of 415 paediatric cases, 411 (99.0%) were laboratory-confirmed. Outcome was recorded for 261 children (62.9%); three died (1.1%, exact 95% CI 0.2 to 3.3). Care location was recorded for 285 children; 216 (75.8%) received hospital care for isolation, clinical management, or both. Three sporadic paediatric cases of mpox-like illness were reported from 2017 through 2024; notifications then rose rapidly from April 2025 and peaked in May. Western Area Urban accounted for 195/413 cases with known district (47.2%); crude notified paediatric rates were highest in Western Area Urban, Koinadugu, and Falaba. Household or caregiving contact was the most common documented exposure among 246 classifiable investigation forms (141, 57.3%). Mpox vaccination status was recorded for 27/54 cases aged 12–14 years; six were vaccinated. Conclusions/Significance: Children were not spared during Sierra Leone’s clade IIb outbreak. Response plans should include children in case finding, contact follow-up, clinical care, and vaccination assessment. DHIS2 should capture epidemiological links, clinical outcomes, vaccine eligibility and status, and potential exposure settings through standardised fields. Author summary: The 2022 global mpox outbreak focused attention on adults, who comprised most reported cases. We analysed Sierra Leone’s national surveillance database, patient charts, and outbreak-investigation forms to describe paediatric mpox during the country’s 2024–2025 clade IIb outbreak. Children accounted for 415 of 5,466 cases with recorded age, and almost half of paediatric cases occurred in children younger than 5 years. Three children died among those with recorded outcomes. National records documented three sporadic paediatric cases of mpox-like illness from 2017 through 2024. Notifications then rose rapidly from April 2025 and peaked in May. Western Area Urban recorded the most paediatric cases, while crude notified rates were also high in Koinadugu and Falaba. Household or caregiving contact was the most common documented exposure in available investigation forms, but the records could not establish how individual children acquired infection. Mpox response should identify child contacts early, investigate local exposure patterns, and record linked cases, clinical outcomes, and vaccine eligibility consistently. Prospective contact studies can clarify transmission pathways and guide age-appropriate prevention.", "abstract_shown": true, "affiliations": [ "National Public Health Agency (NPHA), Freetown, Sierra Leone.", "School of Professional Counseling, Lindsey Wilson University, Columbia, Kentucky, United States of America." ], "article_type": "Research Article", "arxiv": null, "author_total": 5, "authors": [ { "affs": [ 0 ], "name": "Eric Nzirakaindi Ikoona", "orcid": "0000-0003-3402-1961" }, { "affs": [ 1 ], "name": "Lucy Namulemo" }, { "affs": [ 0 ], "name": "Mary Magdalene Sinnah" }, { "affs": [ 0 ], "name": "Mohamed Alex Vandi" }, { "affs": [ 0 ], "name": "Foday Sahr" } ], "bibtex": "https://research.draconitic.com/paper/c7gn1wcf47q6e.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014785", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014785", "id": "c7gn1wcf47q6e", "issns": [ "1935-2735", "1935-2727" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014785", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2406|Poxvirus research and outbreaks" ], [ "plos", "/Biology and life sciences/Immunology/Vaccination and immunization" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Microbiology/Virology/Viral vaccines/HIV vaccines" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Computer and information sciences/Data management/Data visualization/Infographics/Charts" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Disease surveillance/Infectious disease surveillance" ], [ "plos", "/Medicine and health sciences/Immunology/Vaccination and immunization" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Infectious disease surveillance" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Vaccines/Viral vaccines/HIV vaccines" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV" ], [ "plos", "/Medicine and health sciences/Pediatrics" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization" ], [ "plos", "/People and places/Population groupings/Age groups/Children" ], [ "plos", "/People and places/Population groupings/Families/Children" ] ], "openalex": "W7220853889", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014785&type=printable", "pmcid": "PMC13674859", "pmid": "42842633", "published": "2026-10-07", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/c7gn1wcf47q6e.ris", "sources": [ { "first_seen": "2026-10-30T12:17:30Z", "native_id": "10.1371/journal.pntd.0014785", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014785" }, { "first_seen": "2026-10-30T12:18:02Z", "native_id": "MED:42842633", "source": "europepmc", "url": "https://europepmc.org/article/MED/42842633" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Paediatric mpox during Sierra Leone’s 2024 to 2025 clade IIb outbreak: A national surveillance and outbreak-investigation study of 415 children", "title_text": "Paediatric mpox during Sierra Leone’s 2024 to 2025 clade IIb outbreak: A national surveillance and outbreak-investigation study of 415 children", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:02Z", "url": "https://research.draconitic.com/paper/c7gn1wcf47q6e", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }