Treatment of mpox with tecovirimat under expanded access use in the Central African Republic

This programme primarily aimed to provide access to tecovirimat for patients with suspected mpox. Secondary objectives were to describe the clinical and virological features of Clade Ia mpox and assess the safety of tecovirimat. The programme also supported research capacity strengthening, improved case detection through surveillance engagement, and standardised case management.

An expanded access programme was implemented at Mbaiki District Hospital and Bangui General Hospital. Consenting patients with suspected mpox received oral tecovirimat for 14 days under a standardised protocol. Follow-up visits occurred at day 21 (if PCR-positive at day 14) and day 28 or later. Blood and lesion samples were collected at each visit.

Thirty-one patients were enrolled; 26 (84%) were PCR-positive and 24 (77%) had Clade Ia mpox. Symptoms were heterogeneous, most commonly lymphadenopathy, headache, myalgia, and active lesions. Most symptoms improved by day 14 and the final visit, though lymphadenopathy often persisted. PCR positivity declined over time but remained detectable in some cases. Six serious adverse events occurred in five patients.

While no clear treatment benefit was demonstrated, the programme improved understanding of disease and strengthened clinical and research capacity.