On August 14, 2024, the World Health Organization declared mpox a Public Health Emergency of International Concern due to rising cases in Africa, the emergence of the sexually transmissible Clade Ib, and increased morbidity and mortality, especially among children. By September 2024, 14 African countries were facing mpox outbreaks involving both Clade I and II strains. However, critical gaps remain in understanding the epidemiology, transmission dynamics, genomic diversity, and natural history of mpox, particularly regarding the impact of different viral clades. Our study aims to investigate factors influencing MPXV transmission and outcomes in the Democratic Republic of the Congo (DRC), Cameroon, and Nigeria to inform mpox control efforts. The specific aims are: 1)To estimate mpox incidence through community-based case- finding using rapid molecular diagnostics. 2)To characterize clinical features, outcomes, and severity by socio-demographics, transmission route, and viral clade in MPXV-PCR+ patients. 3) To conduct genomic sequencing to track viral evolution and clade-specific transmission dynamics. 4) To raise awareness and disseminate information to understand factors associated with MPXV infection. These outcomes will help address key knowledge gaps and guide strategies for ongoing mpox prevention and control in Africa. "

Factor-analytic studies have reduced Obsessive Compulsive Disorder (OCD) symptoms to a few dimensions: contamination/washing, checking, hoarding, symmetry/ordering, and sexual/religious obsessions, distinguished by sociodemographic differences, comorbid chronic tics and personality disorders, and antidepressant treatment response. Previous studies have reported in OCD patients, compared with normal and other psychiatric populations: 1. cognitive and motor dysfunction, particularly, impaired motor initiation and execution, executive function, and recognition of facial expressions of disgust; 2. increased neurological soft signs, reflecting impairments in several functional systems; 3. structural brain abnormalities; and 4. dysfunctional fronto-cortico-thalamic circuitry, which improves after successful treatment. There has been little study of the specific neurobiological bases of the different OCD symptom dimensions, which remain unknown. Preliminary findings associate hoarding with more widespread cognitive and motor dysfunction, and abnormalities in related neural structures, and symmetry/ordering and checking with different types of striatal dysfunction. Contamination/washing may be associated with increased experience and recognition of disgust per se, and activation in brain regions underlying disgust perception. With the expertise in the clinical and neuropsychological assessment and treatment of OCD patients, and facilities available for structural and functional neuroimaging of psychiatric populations, at the Maudsley Hospital and IOP, we aim to expand upon these initial findings to determine whether: 1. the different OCD symptom dimensions can be distinguished by the extent of abnormality in the above cognitive and motor functions, and associated neural structures; 2. contamination/washing, but not other symptoms, is associated with increased experience and recognition of the non-symptom-related disgust of standardised disgust-provoking scenarios and facial expressions, and activation of brain regions underlying disgust perception: the anterior insula and striatum; 3. different symptoms, provoked using visual imagery and scenes depicting symptom-related material, are associated with distinct behavioural and neural correlates. We predict that whilst contamination/washing is associated with an experience of disgust of similar intensity to that experienced by all subjects to aversive scenes, and activation predominantly of the anterior insula and striatum, other OCD symptoms are associated with the experience of anxiety, but not disgust, and are distinguished by different patterns of activation within fronto-striatal regions previously associated with symptom provocation in OCD. Our findings from studies 1. and 2. will allow specific predictions to be made regarding these distinctions. Determination of the neurobiological bases of the different OCD symptom dimensions will aid future development of successful treatments for specific OCD symptoms.