• In January 2023, a suspected mpox case in South Ubangi Province, DRC, was linked to cross-border travel from the Central African Republic (CAR).

• The index case, a man from Bangui, CAR, who frequently traveled between CAR and the DRC(Democratic Republic of Congo), fell ill with fever, headache, chills, and a rash after potential exposure to wildlife meat. He died in Mbaya General Reference Hospital nine days later.

• Contact tracing revealed two clusters: the first, linked to CAR, involved three symptomatic family contacts, with two testing positive for the MPXV genome.

• The second cluster, identified in the same hospital, included three suspected cases with no direct link to the first cluster but had temporal and spatial connections.

• Phylogenetic analysis of MPXV sequences from the clusters showed that all cases belonged to clade I a and were related to historical CAR cases, though direct links between CAR and DRC were inconclusive.

• The investigation also identified 109 suspected cases in the DRC from January to November 2023, with 56% confirmed positive for MPXV.

• The study underscores the complexity of managing mpox with zoonotic and human-to-human transmission dynamics, highlighting the need for improved regional surveillance, international cooperation, and addressing challenges like porous borders, disease stigma, and population displacement.

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