Summary Background Mpox, caused by the monkeypox virus, is a serious public health threat in Africa , especially in DR Congo . Previously limited to endemic areas with clade 1a, monkeypox virus has recently spread to non-endemic regions, where clade 1b has emerged . This study provides a clinical comparison of mpox cases in DR Congo regions where clade 1a and clade 1b are prevalent. Methods We conducted a retrospective observational study , analysing PCR-confirmed mpox cases reported from sentinel health zones in seven provinces between Oct 1, 2023, and Sept 31, 2024. Cases from the newly affected provinces (South-Kivu and Kinshasa) were described along with those from four endemic provinces (Mai-Ndombe, Tshuapa, Tshopo, South-Ubangi, and Équateur). Surveillance data, including type of exposure, demographic details, clinical presentation, complications, and outcomes were collected from national surveillance systems and local health facilities, with laboratory confirmation using quantit...