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Mpox in the Democratic Republic of the Congo

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Mpox in the Democratic Republic of the Congo
Mpox (large lymph node in neck), DRC 1996/1997
DiseaseMpox
Virus strainMonkeypox virus
SourceInitially mainly animal contact in rainforest, later greater human-to-human transmission
LocationDemocratic Republic of the Congo

Mpox is endemic in western and central Africa, with the overwhelming majority of cases occurring in the Democratic Republic of the Congo (DRC), [1][2]where the more virulent clade Ib has seen a rapid rise in infections since September 2023.

Many cases occur sporadically or in small clusters, but large outbreaks also occur.[2]

Early cases

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The world's first case of human mpox was detected in a nine-month old child in 1970 in the Democratic Republic of the Congo (then Zaire),[3][4] two years after it reported its last case of smallpox.[5] The onset of their rash was on 24 August.[6] That year, the disease was identified in another four children, including three in Liberia who were playmates.[7] At the time, evidence of the virus was found in non-human primates in Liberia and Sierre Leone.[7]

Active surveillance by the World Health Organization (WHO) between 1981 and 1986, identified 338 cases with a human-to-human transmission rate of 28%.[8][9] Until 1986, 95% of cases worldwide were identified in the DRC.[10] Cases were rare in people over the age of 15-years, and over two-thirds of infections could be traced to animal contact within the rainforests.[11] Initially it was uncommon for a family member to contract the infection if they had a smallpox scar, evidence of prior vaccination.[11]

1996 reemergence

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A reemergence of the disease in the DRC in 1996 also saw a large number of reported but not all laboratory confirmed cases, with a high transmission rate and lower fatality rate; leading experts to believe a significant number may have actually been chicken pox.[9][12] Some likely had both mpox and chickenpox at the same time.[5] The DRC's Kasaï-Oriental region saw the largest number of cases during 1996–1997.[5]

Between 1996 and 2005, mpox cases appeared to be gradually increasingly in older people, with less than a quarter of cases being traced to rainforest animal contact, and with greater close contact infections.[11] Between January 2001 and December 2004, 2,734 cases of suspected human mpox were reported from the DRC.[9] However, civil war limited surveillance and only 171 clinical specimens were obtained from 136 suspected cases; less than 5% of all reported cases.[9]

  • Mpox outbreak in DRC (1997)
    Mpox outbreak in DRC (1997)
  • The US epidemiologic team after having landed at Lodja Airport - DRC 1997
    The US epidemiologic team after having landed at Lodja Airport - DRC 1997
  • Testing of Gambian rats (1997)
    Testing of Gambian rats (1997)
  • Educational meeting DRC (1997)
    Educational meeting DRC (1997)

2005 onwards

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After 2005, the DRC was reporting more than 1,000 suspected cases per year.[13] Between November 2005 and November 2007, 760 laboratory-confirmed human mpox cases were detected; particularly in people living in forested areas, males, age less than 15-years, and no previous smallpox vaccination.[14]

Many cases occur sporadically or in small clusters, but large outbreaks also occur.[2] The risk of human-to-human transmission within households in the DRC was noted to range from 50% to 100% during the 2013 outbreak.[5] The DRC's Bokungu Health Zone saw an increase in cases of 600-fold that year.[2] In 2019 the DRC reported 3,794 suspected cases and 73 deaths.[10] In the first nine-months of 2020, it reported over 4,500 suspected cases of mpox, including 171 deaths.[10]

Mpox is reportable in the DRC, where the disease is endemic, and disease burden remains high.[2][15] There, the more virulent clade I has been affecting some of the world's poorest and socially excluded communities.[16] A regional surveillance system collects reports of all suspected mpox cases, and where possible, they may be investigated.[2]

2023-2024 outbreak

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This section is an excerpt from Mpox § 2023–2024 Central Africa outbreak.[edit]

During 2023, a clade I outbreak of mpox disease in the Democratic Republic of the Congo resulted in 14,626 suspected cases being reported, with 654 associated deaths, making for a case-fatality rate of 4.5%. The outbreak continued into 2024, with 3,576 suspected mpox cases and 265 deaths reported in the Democratic Republic of the Congo through the first nine weeks of the year, making for an estimated CFR of 7.4%.[17]

Transmission of the virus in the outbreak appears to be primarily through sexual and close familial contact, with cases occurring in areas without a history of mpox, such as South Kivu and Kinshasa. An estimated 64% of the cases and 85% of fatalities have occurred in children. The outbreak consists of two separate sub-variants of clade I, with one of the sub-variants having a novel mutation, making detection with standard assays unreliable.[17][18]

The outbreak spread to the neighbouring country of the Republic of the Congo, with 43 cases reported in March 2024.[17] By early August the outbreak spread further into central and southern Africa with cases of clade I and clade II strains reported in Burundi, Rwanda, Uganda, Kenya, Cote d'Ivoire and South Africa.[19][20]

The WHO declared this a Global Health Emergency on 14 August 2024.[21] The following day, Sweden became the first non-African country to report a case of clade I mpox.[22]

On 19 August 2024, the DRC's Ministry of Public Health, Samuel-Roger Kamba Mulamba [fr], said in a press conference that all of the country's provinces, including the capital city of Kinshasa, had been affected by the outbreak,[23] while announcing that the national government would launch a €45 million response plan including awareness campaigns, medical team deployment and patient care, but not vaccines.[23][24] Kamba also said that the DRC needed about 3.5 million doses of mpox vaccines, with roughly 215.000 doses set to be donated by Belgium and up to three million doses being donated by Japan, and further donations being expected by the United States.[25][26] Germany donated 100,000 mpox vaccine doses from its military stocks to help contain the outbreak.[27]

References

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  1. ^ "Mpox - Democratic Republic of the Congo". www.who.int. World Health Organization. 14 June 2024. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  2. ^ a b c d e f Nolen LD, Osadebe L, Katomba J, Likofata J, Mukadi D, Monroe B, Doty J, Hughes CM, Kabamba J, Malekani J, Bomponda PL, Lokota JI, Balilo MP, Likafi T, Lushima RS, Ilunga BK, Nkawa F, Pukuta E, Karhemere S, Tamfum JJ, Nguete B, Wemakoy EO, McCollum AM, Reynolds MG (June 2016). "Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo". Emerging Infectious Diseases. 22 (6): 1014–21. doi:10.3201/eid2206.150579. PMC 4880088. PMID 27191380.
  3. ^ Fenner F, Wittek R, Dumbell KR (1988). "8. Monkeypox virus". The Orthopoxviruses. Elsevier. pp. 227–267. ISBN 978-0-323-15022-4.
  4. ^ Fenner F, santé Om, Organization WH, Henderson DA, Arita I, Jezek Z, Ladnyi ID (1988). "29. Human monkeypox and other poxvirus infections of man". Smallpox and Its Eradication (PDF). World Health Organization. pp. 1287–1319. ISBN 978-92-4-156110-5.
  5. ^ a b c d Sutcliffe CG, Rimone AW, Moss WJ (2020). "32.2. Poxviruses". In Ryan ET, Hill DR, Solomon T, Aronson N, Endy TP (eds.). Hunter's Tropical Medicine and Emerging Infectious Diseases E-Book (Tenth ed.). Edinburgh: Elsevier. pp. 272–277. ISBN 978-0-323-55512-8.
  6. ^ Arita I, Henderson DA (1976). "Monkeypox and whitepox viruses in West and Central Africa". Bulletin of the World Health Organization. 53 (4): 347–53. PMC 2366520. PMID 186209.
  7. ^ a b Cho CT, Wenner HA (March 1973). "Monkeypox virus". Bacteriological Reviews. 37 (1): 1–18. doi:10.1128/br.37.1.1-18.1973. ISSN 0005-3678. PMC 413801. PMID 4349404.
  8. ^ Essbauer S, Meyer H (2007). "Genus Orthopoxvirus: Monkeypox virus". In Mercer A, Schmidt A, Weber O (eds.). Poxviruses. Springer. p. 66. ISBN 978-3-7643-7556-0.
  9. ^ a b c d Rimoin AW, Kisalu N, Kebela-Ilunga B, Mukaba T, Wright LL, Formenty P, Wolfe ND, Shongo RL, Tshioko F, Okitolonda E, Muyembe JJ, Ryder R, Meyer H (June 2007). "Endemic human monkeypox, Democratic Republic of Congo, 2001-2004". Emerging Infectious Diseases. 13 (6): 934–7. doi:10.3201/eid1306.061540. PMC 2792850. PMID 17553242.
  10. ^ a b c "Monkeypox – Democratic Republic of the Congo". www.who.int. World Health Organization. Archived from the original on 5 June 2022. Retrieved 5 June 2022.
  11. ^ a b c Hobson G, Adamson J, Adler H, Firth R, Gould S, Houlihan C, Johnson C, Porter D, Rampling T, Ratcliffe L, Russell K, Shankar AG, Wingfield T (August 2021). "Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021". Euro Surveillance. 26 (32). doi:10.2807/1560-7917.ES.2021.26.32.2100745. ISSN 1560-7917. PMC 8365177. PMID 34387184.
  12. ^ Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I (1980). "Human monkeypox, 1970-79". Bull World Health Organ. 58 (2): 165–182. PMC 2395797. PMID 6249508.
  13. ^ Sklenovská N (2020). "2. Monkeypox". In Malik YS, Singh RK, Dhama K (eds.). Animal-Origin Viral Zoonoses. Singapore: Springer. pp. 39–68. ISBN 978-981-15-2650-3.
  14. ^ Rimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL, Blumberg S, Thomassen HA, Pike BL, Fair JN, Wolfe ND, Shongo RL, Graham BS, Formenty P, Okitolonda E, Hensley LE, Meyer H, Wright LL, Muyembe JJ (14 September 2010). "Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo". Proceedings of the National Academy of Sciences of the United States of America. 107 (37): 16262–16267. Bibcode:2010PNAS..10716262R. doi:10.1073/pnas.1005769107. ISSN 1091-6490. PMC 2941342. PMID 20805472.
  15. ^ Brown K, Leggat PA (20 December 2016). "Human Monkeypox: Current State of Knowledge and Implications for the Future". Tropical Medicine and Infectious Disease. 1 (1): 8. doi:10.3390/tropicalmed1010008. PMC 6082047. PMID 30270859.
  16. ^ Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM (24 May 2022). "Clinical features and management of human monkeypox: a retrospective observational study in the UK". The Lancet. Infectious Diseases. 22 (8): S1473–3099(22)00228–6. doi:10.1016/S1473-3099(22)00228-6. ISSN 1474-4457. PMC 9300470. PMID 35623380. S2CID 249057804.
  17. ^ a b c Van Beusekom M (16 March 2024). "More than 600 dead in spreading DR Congo mpox outbreak as Republic of Congo reports its first cases". University of Minnesota. CIDRAP. Archived from the original on 19 March 2024. Retrieved 19 March 2024.
  18. ^ Stawiska Z (13 March 2024). "Deadly Mpox Transmission in DR Congo Happening Under Radar; Most Victims are Children". Health Policy Watch. Archived from the original on 15 August 2024. Retrieved 6 August 2024.
  19. ^ Cohen J (3 August 2024). "Deadlier strain of mpox spreads to multiple African countries". Science. Archived from the original on 15 August 2024. Retrieved 5 August 2024.
  20. ^ "WHO considers public health emergency as mpox cases mount in Africa". University of Minnesota | CIDRAP. 5 August 2024. Archived from the original on 6 August 2024. Retrieved 6 August 2024.
  21. ^ Mandavilli A. "W.H.O. Declares Global Emergency over New Mpox Outbreak". The New York Times. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  22. ^ "Sweden confirms first case of mpox strain outside Africa". Al Jazeera. 15 August 2024. Retrieved 16 August 2024.
  23. ^ a b "Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues". RFI (in French). 19 August 2024. Retrieved 21 August 2024.
  24. ^ "DR Congo on standby for first vaccines to fight mpox outbreak". RFI. 20 August 2024. Retrieved 21 August 2024.
  25. ^ "Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues". RFI (in French). 19 August 2024. Retrieved 21 August 2024.
  26. ^ "DR Congo on standby for first vaccines to fight mpox outbreak". RFI. 20 August 2024. Retrieved 21 August 2024.
  27. ^ "Mpox: Germany to give Africa 100,000 doses of vaccine – DW – 08/26/2024". dw.com. Retrieved 2024-08-27.
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