DRC - Mpox (monkeypox) outbreak 2023

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Province du Kwango
-https://en.wikipedia.org/wiki/Kwango


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Kwango: a suspected case of Monkeypox and around twenty contacts identified in Panzi

Monday, August 21, 2023 - 9:19 p.m.

A suspected case of Monkeypox has been recorded in Panzi health zone, Kwango province, for a few days. This is a 10-year-old child admitted to the Panzi General Referral Hospital who presented with fever and rashes.

The health information office confirms that the samples have been taken and sent to the National Institute of Biomedical Research in Kinshasa for confirmation.

Dr. Tchotcho Tonaka, head of the office responsible for health information, also specifies that some provisional measures have been taken to avoid probable contamination.

"We have listed about 28 contacts and among the measures, there is the isolation of this patient, the sensitization of the community, the management of this case", he said.

The DRC has recorded since the beginning of the year until last July 6,914 cases of the monkey pox disease called Monkeypox, including 328 deaths (4.7%), according to the national coordination for the fight against Monkeypox.

Jonathan Mesa, in Bandundu

https://actualite.cd/2023/08/21/kwango-un-cas-suspect-de-monkeypox-et-une-vingtaine-de-contacts-recenses-panzi

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Province du Kongo Central
-https://en.wikipedia.org/wiki/Kongo_Central

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Matadi: a suspected case of Monkey pox identified in Kikanda Hospital

Posted on Fri, 25/08/2023 - 15:11 | Modified on Fri, 25/08/2023 - 15:11

A suspected case of Monkey pox was recorded on Thursday August 24 at Kikanda Hospital in Matadi (Kongo-Central).

The head doctor of the Matadi health zone, Dr. Christian Kuzoma, delivered this information on the same Thursday to Radio Okapi.

He indicates that it is a 27-year-old man who presented symptoms of monkeypox, a week after his return from Kinshasa:

“This is a 27-year-old man who had previously presented with fevers then there were rashes in the form of pustules and scabs. And the samples have been taken and sent to Kinshasa, we are awaiting confirmation from the INRB”.

Dr Christian Kuzoma affirms that this patient including all the people who were in contact with him are quarantined.

According to him, Monkey pox is not a curative disease.

To prevent its transmission, the head doctor of the Matadi health zone calls on the population to respect barrier measures once someone around them presents the rashes.

“ The message we can give is that the transmission of this disease is like that of COVID-19 but here we have transmission by droplets, saliva and sexual contamination is also possible”, he said . underlines.

https://www.radiookapi.net/2023/08/25/actualite/sante/matadi-un-cas-suspect-de-monkey-pox-recense-dans-lhopital-de-kikanda

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Monkey Pox epidemic: the EU allocates 350,000 euros in aid to fight the disease

Posted on Tue, 08/29/2023 - 16:32 | Modified on Tue, 29/08/2023 - 16:50

The European Union (EU) announced on Tuesday August 29 that it had committed additional humanitarian aid of 350,000 euros to support the fight against the Monkey Pox epidemic which is spreading in the DRC.

Congolese health authorities report nearly 9,000 cases and 500 deaths during the current year.

The situation has worsened, particularly in three health zones in the province of Maniema. Kinshasa, the capital, is also affected with two patients confirmed and treated since last week.

This situation leads “the EU to intensify its support through the strengthening of response capacities, in particular by means of surveillance, community awareness, diagnosis and treatment”, underlines this organization in a press release.

“The emergency funds allocated by the EU will help our humanitarian partner ALIMA to meet urgent and critical needs related to training and capacity building in disease surveillance, case management and infection prevention through community engagement, health promotion and outbreak response preparedness, as well as capacity building of health personnel, structures and the health system," said Johan Heffinck, Head of Office of the European Community Humanitarian Office (ECHO).

This project will have a duration of 5 months, starting in August 2023.

https://www.radiookapi.net/2023/08/29/actualite/sante/epidemie-de-monkey-pox-lue-alloue-350-000-euros-daide-pour-lutter-contre

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DRC: in the province of Mai-Ndombe, a hospital facing the influx of cases of monkeypox

In the Democratic Republic of Congo (DRC), a hospital in Inongo, capital of the province of Mai-Ndombe, is facing, like others in the country, cases of monkeypox, a disease which has killed at least 330 dead in the country since the beginning of 2023.

Published on :08/31/2023 - 06:24
Modified :08/31/2023 - 12:10

By : RFI
With our special correspondent in Inongo, Pascal Mulegwa

In the Democratic Republic of Congo (DRC), monkeypox has not yet had its last word in several provinces. From January to July, the country recorded nearly 7,000 cases including at least 330 deaths, according to the national smallpox control coordination.

Seventeen of DRC's 26 provinces have reported cases. One of them is Mai-Ndombe, in the south-west of the country. If the city of Inongo, capital of the province, has not recorded any cases in recent months, its reference hospital continues to welcome new patients.

“ Every family has lost a member ”

Patients are isolated there in an old hospital room. That day, there were nine of them, including four members of the same family. Doctor Junior Mpeti makes his rounds to inspect them. At the door of the room, agents from the National Institute for Biomedical Research in Kinshasa put on protective gowns and masks. “ Here is the new case we just received. He comes from a surrounding village, Nkondé. He has already reached stage two. We are in the process of taking care of him. There, they are taking the samples to send to the INRB in Kinshasa. »

It is from this same village, on the shores of Lake Mai-Ndombé, that Ilamba came after losing his son, his wife and his brother. " It was the child who infected us ," he says. After they died, we also got sick. After care administered locally, nothing changed, the patients became more and more numerous. We therefore left the area by canoe to arrive at Inongo. Every family has lost a member. »

The patients are in the process of stabilization, but half of them are wearing sunglasses, due to eye problems that the hospital is trying to understand.

“ There are attacks on the retina , explains Doctor Junior Mpeti. Then we have a case that we suspect has neurological damage. The studies are in progress, let's see how things will evolve . »

The sick benefit from free care, but their food needs are not covered. The response is also complicated because of the inaccessibility of the villages located in the heart of this young, poor and completely landlocked province.

https://www.rfi.fr/fr/afrique/20230831-rdc-dans-la-province-du-mai-ndombe-un-h%C3%B4pital-face-%C3%A0-l-afflux-de-cas-de-variole-du-singe

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Maniema: at least 205 cases of Monkey Pox and 2 deaths recorded in 8 months

Published on Sun, 09/17/2023 - 9:25 p.m. | Modified on Sun, 09/17/2023 - 9:25 p.m.

Two people died out of around 250 cases of Monkey Pox, recorded between last January and August, in Maniema.

The provincial coordinator of the NGO One Health, Dr Saïdi Akimu, delivered these figures on Friday September 15 in Kindu to the interim governor of this province.

“ We have the town of Kindu with 42 cases, the territory of Kailo with 4 cases, that of Pangi with 3 cases, that of Kibombo with 125 cases. You yourself know that Kibombo is the epicenter. The territory of Kasongo with two cases, the territory of Lubutu with 25 cases, that of Kabambare with 1 case and that of Punia with 4 cases. In all of this, there are two deaths ,” he explained.

Dr Saïdi Akimu said that Monkey Pox disease is already rampant in the corners of Maniema.

Presenting the dark picture of this disease, he said he wanted to seek the involvement of the provincial executive and seek partners to deal with this zoonosis.

The One Health platform works with three ministries, namely: Environment, Human Health and Animal Health.

Last August, the European Union announced that it had committed additional humanitarian aid of 350,000 euros to support the fight against the Monkey Pox or monkeypox epidemic which is spreading in the DRC.

The rise in cases of this pathology led the EU to intensify its support by strengthening response capacities, in particular through surveillance, community awareness, diagnostics and treatment.

...

https://www.radiookapi.net/2023/09/17/actualite/sante/maniema-au-moins-205-cas-de-monkey-pox-et-2-deces-enregistres-en-8-mois

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Presentation of research results of the new mpox vaccine in the DRC

September 27, 2023

Kinshasa, September 27, 2023 (ACP).- The results of epidemiological and laboratory research on the new “mpox” vaccine against monkeypox (Monkeypox) were presented Wednesday in Kinshasa in the Democratic Republic of Congo, noted a journalist of the ACP.

“ Monkey pox, also called Monkeypox, has seen a dangerous increase in the number of cases in several provinces of our country over the last two years. The absence of a safe vaccine and specific treatment makes it difficult to use epidemic control strategies. We would therefore like to thank the mixed teams, the INRB as well as other partners for the presentation of the results obtained from the various research. These results will allow us to decide on the use of the new vaccine for the prevention of the population at risk, ” indicated the deputy director of the school of public health, Professor Joël Konde Nkiama Numbi. “ We want to see the results of the vaccine, how it evolves and how it increases in our antibodies. This is how we will decide on the adoption of the vaccine. We also want to ensure the effectiveness of the vaccine and know if there have been any major side effects ,” declared the director of the National Program for the Fight against Monkeypox and Viral Hemorrhagic Fever (PNLMpx- FHV), Dr Robert Shongo. And to continue: “ at this moment we are going to draw conclusions and be able to adopt the vaccine and propose recommendations to the Minister of Health and also to the government so that we can finally have a vaccine to vaccinate in our different provinces at risk ”.

Dr Shongo said that the reservoir of the “mpox” virus is unknown. However, Monkeypox or monkey pox still remains a public health problem in the DRC. This pathology has a prevalence of 10,168 cases since 1996 to the present day, of which 23 provinces are endemic. “ The PNLMpx-FHV faces major challenges, namely: the invention of a safe vaccine, specific drugs, rapid field testing, reservoir research and mobilization of funds to ensure the investigations,” he said . He specifies.

Note that the workshop representing the results of research on “mpox” by the mixed team of experts from the CDC Atlanta, the Kinshasa School of Public Health, the Faculty of Sciences of the University of Kinshasa of the Ministry of Public Health, Hygiene and Prevention is held in Kinshasa from September 27 to 28, 2023.

Monkeypox is a zoonosis characterized by fever, a vesicular and pustular rash caused by an orthropoxvirus which partially affects children clinically. it resembles smallpox and may be confused with serious chickenpox and epidemiologically, it is different from smallpox, we recall. ACP/

https://acp.cd/sante/346283/

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Tshopo: more than 1000 cases of monkey pox recorded since January

Published on Fri, 09/29/2023 - 1:23 p.m. | Modified on Fri, 09/29/2023 - 1:23 p.m.

More than a thousand cases of monkey pox have been recorded since the start of this year in the Tshopo province, including around a hundred deaths, said Thursday, September 28, the head doctor of the provincial health division, Dr. Francis Baelongadi.

The latest suspected cases of this epidemic were reported at the Makiso general hospital in Kisangani. According to the same source, they are a couple with their two children aged 22 months and 5 years respectively.

Everything is being done, in particular with the support of partners for the management of proven cases, declared Dr. Francis Baelongandi.

These four suspected cases are in isolation at the Makiso general hospital treatment site. These include high fever and skin rashes.

“There are skin rashes on the palms of the hands, chest, face and thighs. For the moment, we have isolated them, they are now in our room. We are in the analyzes at the provincial laboratory…” explained nurse John Kangakea of the epidemiological surveillance team.

For the chief medical officer of the Tshopo Provincial Health Division, many cases are recorded in the health zones of his jurisdiction.

The Yauma health zone is the epicenter of this disease.

Dr Francis Baelongadi calls on the population to respect preventive measures:

“Prevention, as we say, is first of all a certain personal hygiene, avoiding contact with people, these infected people, avoiding contact also with wild animals, it is already protecting ourselves so that we not be reached…”.

Eleven health zones out of the twenty-three in Tshopo are affected by this monkeypox epidemic.

https://www.radiookapi.net/2023/09/29/actualite/sante/tshopo-plus-de-1000-cas-de-monkey-pox-enregistres-depuis-janvier

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South Kivu: A confirmed case of monkeypox recorded in Bukavu (DPS)

Thursday October 12, 2023 - 07:23

A first case of monkeypox has been confirmed in the commune of Ibanda in Bukavu in South Kivu.

The provincial health division announced this on Wednesday October 11, 2023, following laboratory examinations.

Doctor Claude Bahizire, communications officer at the provincial health division (DPS), specifies that 3 other suspected cases have been identified, including one in the Walungu territory and two others in Kamituga in the Mwenga territory.

He informs that 15 contact cases are already in quarantine.

"There is a danger because it is a very contagious and viral disease. Suspected cases and contacts are under surveillance in quarantine. The sick person starts with fever, reddish spots or spots with fluid on the skin. The population must be careful,” he said in an address to the press.

Doctor Claude Bahizire explains that measures have been taken by the provincial health division to deal with this situation.

It should be noted that monkey pox or Monkeypox is transmitted from a sick animal to a man and from sick man to healthy man. It manifests itself as pimples filled with fluid all over the body, including the scalp. Treatment is symptomatic. To date, there is no vaccine against this disease.

Déogratias Cubaka, in Bukavu

https://7sur7.cd/2023/10/12/sud-kivu-un-cas-confirme-de-la-variole-de-singe-enregistre-bukavu-dps

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Monkey pox: South Kivu reaches 6 cases, more than 90 people under surveillance

Monday October 16, 2023 - 08:29

5 new cases of monkeypox or Monkeypox have been confirmed in the province of South Kivu. In addition to the first case confirmed in Bukavu last week, these new cases confirmed in Mwenga territory bring the bar back to 6 cases.

The Provincial Health Division (DPS) in South Kivu, confirmed this in an address to the local press, on Saturday October 14, 2023. Its communications manager, Doctor Claude Bahizire reports that 94 people listed as contacts of the cases confirmed are under surveillance. He calls on the population to respect barrier measures to protect themselves against this contagious disease.

"These cases are all monitored. Monkeypox is a very contagious disease. If it is neglected, it can lead to mortality. If the population manages to follow the advice of health professionals, they can survive." did he declare

It should be noted that monkey pox or Monkeypox is transmitted from a sick animal to a man and from sick man to healthy man. It appears as fluid-filled pimples all over the body, including the scalp. Its treatment is symptomatic.

Déogratias Cubaka, in Bukavu

https://7sur7.cd/2023/10/16/variole-de-singe-le-sud-kivu-atteint-la-barre-de-6-cas-plus-de-90-personnes-sous

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Monkey pox: In South Kivu, hunting activities suspended to limit the spread

Wednesday October 25, 2023 - 8:26 p.m.
7sur7

Animal hunting activities are suspended throughout the South Kivu province, to prevent and limit the spread of monkeypox or monkeypox, confirmed cases of which have been reported in the province.

The provincial coordination of the environment and sustainable development, which announced this decision on Tuesday October 24, 2023, indicates the objective is to avoid any contact between humans and infected animals.

In an address to the press, John Yohana, provincial environment coordinator, informs that this decision protects wildlife which is the main reservoir of the virus.

He emphasizes that the sale, consumption, storage, transport and trade of bush meat are prohibited in the 8 territories of the South Kivu province.

It should be noted that the province of South Kivu has already reported 6 confirmed cases of monkeypox, including 1 in Bukavu and 5 in Kamituga in less than 2 weeks. For the moment, dozens of contact cases are in quarantine for observation.

This contagious disease is transmitted from a sick animal to a man and from a sick man to a healthy man. It manifests itself as pimples filled with fluid all over the body, including the scalp.

Déogratias Cubaka, in Bukavu

https://7sur7.cd/2023/10/25/variole-de-singe-au-sud-kivu-des-activites-de-chasse-suspendues-pour-limiter-la

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Kwilu: three deaths reported following Monkeypox-like illness in Bagata

Monday October 30, 2023 - 10:47

An unknown disease, presenting symptoms similar to those of Monkeypox, caused three deaths at the Kindongo health center, in the Bagata health zone, Kwilu province.

The provincial health minister confirmed that of the seven cases, three deaths were reported last week. In addition, four people managed to recover through symptomatic treatment. Samples were taken from the patients and sent to the National Institute of Biomedical Research for further analysis.

Minister Bena Mutuyi said a first case, similar to Monkeypox, had been admitted to Bagata General Hospital and placed in quarantine. Unfortunately, this person managed to escape and was found in a health center in the same area, where he eventually died. Unfortunately, hygiene measures were not respected during the burial, leading to two other cases and two additional deaths.

The Minister of Health insisted on the importance of respecting barrier measures, particularly in the current context of the Covid-19 pandemic. He reminded the population of the importance of prevention, even if the exact nature of this disease is still unknown, despite the symptoms being similar to Monkeypox.

Kwilu province is facing several epidemics, including polio, measles and yellow fever. Vaccination activities are experiencing delays, mainly due to the nurses' strike and the limited availability of inputs needed for vaccination.

Jonathan Mesa

https://actualite.cd/2023/10/30/kwilu-trois-deces-signales-suite-une-maladie-similaire-au-monkeypox-bagata

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Kwilu: 3 deaths from a disease similar to Monkey pox in Bagata

Published on Tue, 10/31/2023 - 3:41 p.m. | Modified on Tue, 10/31/2023 - 3:41 p.m.


Three people have died from an unknown illness, presenting symptoms similar to those of Monkey pox, since last week in the Bagata health zone, precisely in the Kindongo health area (Kwilu).

This information is given by the provincial Minister of Health, Bena Mutuy.

The latter also confirms that in total, seven suspected cases of this disease have been recorded, of which four people have recovered thanks to symptomatic treatment.

He said that samples were taken from the patients and sent to the National Institute of Biomedical Research (INRB) in Kinshasa for in-depth analyses.

Dr Bena Mutuy insists on observing the hygiene measures enacted in the fight against the coronavirus, to fight against this unknown disease, even if its nature is not yet specified:

“It’s three deaths. So, it all started with a case similar to Monkey pox, which was received at the Bagata general hospital. We had isolated this lady. Unfortunately, the lady escaped, she went to a health center in the same health zone of Bagata. Eventually she died."

The same source estimates that the local population had not put in place the “hygiene measures to be able to bury her. This is how two other cases were recorded, and the two cases there too had died”.

The head doctor of the zone then went to the site, “he carried out investigations, he took samples which were sent to the INRB in Kinshasa. Now, we are waiting for the results”.

Dr Bena says he has raised awareness among the local population regarding hygiene measures, as usual.

The same hygiene rules are observed in particular among health personnel, “who must wear gloves before handling these cases. And as soon as there are deaths, this should not be made available to the population, that the case should not be manipulated by the population. People must wear gloves, we must avoid hand greetings, all these hygiene measures that we used against COVID-19…”

https://www.radiookapi.net/2023/10/31/actualite/sante/kwilu-3-deces-dune-maladie-similaire-au-monkey-pox-bagata

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Kwilu: 37 cases of monkeypox reported and some deaths reported

02.11.2023

The Kwilu province (south-west of the DRC) is currently facing a monkeypox epidemic. According to the head of the provincial health division, Jean-Pierre Basake, 37 cases have been reported in eight health zones in the province, with a few deaths reported.

"We have recorded 37 suspected cases across the entire provincial health division. There are eight health zones. The seven cases reported in Bagata are the most worrying," he said.

“Monkeypox viral disease does not have a specific treatment, mainly awareness is crucial first,” he told us.

In order to assess the situation and confirm the evolution of the epidemic, samples were sent to the National Institute of Biomedical Research (INRB). However, Dr. Basake deplores the delay in obtaining results.

The head of the health division concluded that three deaths were recorded among the seven cases identified in Bagata.

It should be noted that monkeypox is a viral disease similar to smallpox, transmitted mainly by wild animals, particularly rodents. It can also spread from person to person through direct contact with bodily fluids or skin lesions. Although less serious than smallpox, monkeypox can cause a variety of symptoms in humans, such as fever, headache, rash, muscle pain, and swollen glands.

Guylity Mutombo
congo-press.com / MCP, via mediacongo.net

https://www.mediacongo.net/article-actualite-129038_kwilu_37_cas_de_monkeypox_notifies_et_quelques_deces_signales.html

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Source: https://www.who.int/emergencies/dise...em/2023-DON493

Mpox (monkeypox)- Democratic Republic of the Congo

23 November 2023

Situation at a Glance

Mpox is an infectious disease caused by monkeypox virus (MPXV), which is endemic in densely forested regions of West, Central and East Africa, particularly in the northern and central regions of the Democratic Republic of the Congo. Eleven of the 26 provinces of the Democratic Republic of the Congo are identified as endemic for mpox, but in more recent years the total number of mpox cases and the number of provinces reporting mpox has been expanding, to 22 provinces as of November 2023. There are two known clades of MPXV: clade I, previously known as the Congo Basin clade; and clade II, previously called the West African clade; clade II further has two subclades: clade IIa and clade IIb. Before 2018, very few cases were reported outside of the African continent: eight international travellers returning from endemic countries and one outbreak related to imported animals. Since 2022, an epidemic of clade IIb MPXV has been ongoing globally, affecting many countries outside the African continent that had never reported mpox previously. The spread of this epidemic was mainly driven by transmission via sexual contact among men who have sex with men. The Democratic Republic of the Congo has not reported cases of mpox linked to clade IIb MPXV during the global outbreak to date; only MPXV clade I has been detected in the country. Before April 2023, no formally documented cases of sexual transmission of clade I MPXV were registered globally. The first known cases were reported when a man, resident in Belgium and with connections to the Democratic Republic of the Congo, tested positive for clade I in Kenge, Kwango province, during a visit to the Democratic Republic of the Congo. Thereafter, sexual contacts of this case in the Democratic Republic of the Congo also tested positive for clade I MPXV, with closely related viral sequences. This is the first time that reported clade I MPXV infection is linked to sexual transmission within a cluster. Another outbreak in the country is also being reported with multiple cases of mpox among sex workers. In the Democratic Republic of the Congo, human-to-human transmission of mpox through close contact has been reported since the 1970s, mostly in small household or community outbreaks, presumed to be primarily due to zoonotic transmission. Due to a lack of timely access to diagnostics, difficulties with linking cases to any contact with infectious animals, and incomplete epidemiological and contact tracing investigations over the years, the dynamics of MPXV clade I transmission in the Democratic Republic of the Congo are not well understood. These new features of sexual and unknown modes of transmission now raise additional concerns over the continuing rapid expansion of the outbreak in the country. In the global outbreak of mpox which began in 2022, clade IIb MPXV transmission between humans continues in most WHO regions. In addition, clade I MPXV community outbreaks occur regularly in three countries (Cameroon, Central African Republic, and the Democratic Republic of the Congo) and sporadically in others (e.g., Sudan, South Sudan). In some of these geographic areas in East, West and Central Africa, transmission from animals to humans is also presumed to occur. The natural reservoir of the virus is unknown; while various small mammals such as squirrels and monkeys are known to be susceptible, they have rarely been linked to outbreaks.

Description of the Situation

From 1 January through 12 November 2023, a total of 12 569 suspected mpox cases, including 581 suspected mpox deaths (case fatality ratio: 4.6%), have been reported in 156 health zones from 22 out of 26 (85%) provinces in the Democratic Republic of the Congo. This is the highest number of annual cases ever reported, with new cases in geographic areas that had previously not reported mpox, including Kinshasa, Lualaba, and South Kivu. Among suspected cases, 1106 were tested by reverse transcriptase-polymerase chain reaction (RT-PCR), and 714 were positive for MPXV (positivity rate of 65%).
Cases with travel history to endemic provinces have been driving chains of human-to-human transmission in non-affected provinces (Figure 1 & 2).
Figure 1: Geographic distribution of suspected mpox cases by province, Democratic Republic of the Congo, 1 January – 4 November 2023 (Epi weeks 1 to 44)

Figure 2: Geographic distribution of confirmed mpox cases by province, Democratic Republic of the Congo, 1 January – 7 October 2023 (epi weeks 1 to 40)


First cases of sexually transmitted clade I MPXV:
The first cluster of suspected cases of sexually transmitted mpox was identified in Kenge, Kwango province of the Democratic Republic of the Congo. It included six confirmed cases, five men and one woman, with no deaths among the confirmed cases. The first known case is a man, resident of Belgium with connections to the Democratic Republic of the Congo, who arrived in Kinshasa, on 15 March 2023 and started experiencing anal itching and discomfort the same day. On 16 March 2023, one day after arrival from Belgium, he travelled to the town of Kenge (260 km from Kinshasa). On 17 March, his anal lesion and genitals became painful blisters, and he developed further skin lesions on the trunk and buttocks. On 23 March, he consulted a doctor who suspected mpox, and a blood sample, oropharyngeal, rectal and vesicle swabs were performed on 24 March. The patient tested positive by RT-PCR of biological samples at the National Institute of Biomedical Research (INRB) in Kinshasa and the result was shared with the Ministry of Health on 10 April. Genomic sequencing of the sample confirmed that it was clade I MPXV.
The individual identified himself as a man who has sexual relations with other men. During his travel in the Democratic Republic of the Congo, he visited discretely operating known clubs of men who have sex with men and had several sexual contacts. He showed symptoms on the day of his arrival in the country, and with the mpox incubation period most often being more than one day, available information suggests that exposure took place outside the Democratic Republic of the Congo. Nonetheless, genetic analysis of the virus confirmed infection with a clade I strain, similar to other strains circulating in the Democratic Republic of the Congo. Although the patient had no reported exposure to another person with confirmed mpox, based on the epidemiological investigation exposure to mpox likely occurred in Belgium.
Epidemiological investigation following this first case identified several sexual and non-sexual contacts who were monitored over time for mpox signs and symptoms. Among 27 contacts identified and six tested, five sexual contacts tested positive for mpox: two were confirmed on 10 April and three on 18 April. Of these five contacts, three developed symptoms during their 21-day follow-up period. Two contacts who did not develop symptoms also tested positive by a mucous membrane sample. Of the five confirmed contact cases, four were men aged between 24 and 35 years old and one was a woman. The initial case confirmed having sexual contact with each of them. After his recovery from mpox he returned to Belgium on 5 May 2023.
This cluster of mpox cases represents the first documented sexual transmission of MPXV Clade I. It is also the first described transmission of MPXV Clade I among men who have sex with men. Notably, there are clubs in Kenge for men who have sex with men, some of whose members travel to visit other clubs within the country and outside the country, particularly in Europe and within Central Africa. In the city of Kinshasa, there are more than 50 such clubs. Some members of these clubs also reside outside the Democratic Republic of the Congo.

This event is unusual and highlights the risk that MPXV clade I could also widely spread among sexual networks, as seen for clade II during the 2022-23 global outbreak.

On 28 July 2023, another confirmed case of mpox was recorded in another man who had sex with men in Kenge town in the Democratic Republic of the Congo. The patient was a man residing in Kenge, with onset of the disease on 11 June 2023. He was not listed among the contacts of the first group of cases and the limited epidemiological investigation did not directly link him to the March-April cluster. Genome sequencing for this case has not been performed. Further epidemiological investigations are being conducted to verify reports of new cases in this province.
First mpox outbreak in Kinshasa
In August 2023, for the first time, mpox cases were confirmed in Kinshasa, the capital of the Democratic Republic of the Congo. Four separate events were identified where persons exposed in other provinces (Equateur, Maindombe) travelled to Kinshasa, each leading to local transmission with small clusters in the capital. Between 18 August and 12 November 2023, a total of 102 suspected cases were reported in eight health zones in Kinshasa, including 18 confirmed cases with one confirmed mpox death (case fatality ratio of 5.6% among confirmed cases).
The first confirmed case was in a person who arrived from the Maindombe province, where mpox is endemic, to Kinshasa by river boat. He was confirmed on August 18 and subsequently several of his close contacts developed symptoms and tested positive for MPXV. Additional imported confirmed cases were reported in Limete, Makala and Nsele health zones. The sex ratio among confirmed cases in Kinshasa is men 2: women 1, with a median age of 24 (95% CI 11-27) years. For the moment, 13 of the confirmed cases have recovered (including a health worker), one died and four are isolated and under treatment. The person who died also had tuberculosis and acquired mpox during hospitalization, indicating nosocomial transmission.
These new reports of human-to-human transmission of mpox in a large urban area such as Kinshasa clearly illustrate that the epidemiology of mpox in the Democratic Republic of the Congo is changing.
First mpox outbreak in South Kivu
Before 2023, South Kivu province had not reported mpox. The first confirmed case was a young trader who travelled from Kisangani, in Tshopo province, one of the mpox endemic provinces, a few days before the onset of symptoms on 26 September 2023. The first skin lesions were located on his genitals and later extended to the whole body. During the initial epidemiological investigation, 113 contacts were registered in Bukavu and Kamituga health zones. As of 22 November 2023, a total of 80 suspected and 34 confirmed cases (including 20 sex workers) of mpox have been reported in South Kivu mainly from the Kamituga health zone, with no deaths. Currently South Kivu province is grappling with conflict, displacement, food insecurity, and challenges in providing adequate humanitarian assistance, all of which have a profound impact on the local population, especially vulnerable groups, and might represent fertile ground for further spread of mpox.
Animal studies
The natural reservoir of the monkeypox virus is unknown – various small mammals such as squirrels and monkeys can be infected, and non-human primates are known to be clinically susceptible. Over the decades, the Democratic Republic of the Congo and partners have carried out animal studies to better characterize the ecology of the virus and potential animal reservoirs or incidental hosts. Such studies have been carried out in the provinces of Equateur, Haut Uélé, Kwango, Kwilu, Maïndombe, Maniema, Sankuru, Sud Ubangi, Tshopo, and Tshuapa. Eco-epidemiolocal studies are ongoing with national and international research partners collaborating to determine reservoir and incidental hosts.

Epidemiology

Mpox (monkeypox) is an infectious disease caused by the monkeypox virus (MPXV). There are two known clades of MPXV: clade I, previously called the Congo Basin clade; and clade II, previously called the West Africa clade; clade II further has two subclades: clade IIa and clade IIb. The disease is caused by one of the two clades of MPXV transmitted between humans through close contact with lesions, body fluids, respiratory droplets or contaminated materials, or from animals to humans through contact with live animals or consumption of contaminated bushmeat.
The incubation period ranges from two to 21 days, although some people can acquire infection without developing symptoms. Typically for mpox, fever, muscle aches and sore throat appear first, followed by skin and mucosal rash. Typically, the rash evolves over 2-4 weeks in stages – macules, papules, vesicles, pustules. Lesions dip in the centre before crusting over. Scabs then fall off. Lymphadenopathy (swollen lymph nodes) is also a typical feature of mpox, present in most cases. Children, pregnant people and people with weak immune systems are at risk for complications and death from mpox.
Identifying mpox can be difficult as other infections and conditions can look similar. It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes, syphilis, other sexually transmissible infections, and medication-associated allergies. Someone with mpox may also concurrently have another sexually transmissible infection such as herpes. Alternatively, a child or adult with suspected mpox may also have chickenpox. For these reasons, testing is key for people to get treatment as early as possible and to prevent further spread.
Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox. The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by vigorous swabbing. In the absence of skin lesions, testing can be done on oropharyngeal, anal or rectal swabs. However, while a positive result of oropharyngeal, anal or rectal sample is indicative of mpox, a negative result is not enough to exclude MPXV infection. Testing of blood is not recommended. Antibody detection methods may be used for retrospective case classification, but not diagnosis. It needs to be restricted to reference laboratories and it may not be useful as often it does not distinguish between different orthopoxviruses.
Treatment is based on taking care of the rash, managing pain, and preventing complications. In addition, specific antiviral medications such as tecovirimat can also be used in the treatment of mpox, particularly for severe cases or individuals at higher risk of complications. In the context of the global outbreak of mpox which began in 2022 (caused mostly by Clade IIb virus), the presentation of mpox varied, with some cases showing a rash appearing before or simultaneously with other symptoms, and the initial lesions were often localized on genitals and mucosae such as the mouth. For the first time the spread of MPXV has been driven and sustained by sexual contact among men who have sex with men who are members of large sexual networks.

Public Health Response

Emergency coordination:

• The Ministry of Public Health, Hygiene and Prevention prepared a budgeted national mpox preparedness and response plan.
• Further to this plan, an mpox Emergency Operations Centre and Incident Management Team were inaugurated in February 2023 to implement the following actions:

Monitoring and detection:

• Strengthening surveillance of mpox throughout the country and particularly in Kinshasa, Kenge and Kamituga.
• Distribution of sample collection and transport kits to reference hospitals and logistical support for collecting, transporting, and examining samples from suspected cases in Kenge, Kinshasa and other affected areas.
• Capacity building of health care providers and professionals in mpox surveillance, including detection of sexual transmission and other possible modes of transmission.
• Monitoring of contacts of clinical and laboratory-confirmed cases for a period of 21 days.
• Genetic sequencing of MPXV samples to better understand the circulating viral strain(s).

Communication and awareness:

• Information campaign on the risks of mpox and other sexually transmitted infections to groups potentially at risk, specifically targeting members of sex-clubs in Kenge and elsewhere.
• Identification and engagement of other clubs and populations potentially at risk.
• Establishment of a call center to facilitate alerts reporting and promote communication between health authorities and the communities concerned.

Case management and infection prevention and control:

• Supply of personal protective equipment to health professionals in Kenge, Kinshasa, Kamituga Maindombe and Tshopo.
• Isolation of confirmed cases in hospital or at home to prevent further transmission.
• Adapted clinical care, including psychological support, for persons with mpox.

Training and capacity:

• Training of laboratory workers from Kamituga, Kenge, Kinshasa and any other affected city or province on the collection, conservation, and appropriate delivery of mpox samples.
• Raising awareness among health authorities and health care providers across the country about mpox and its management.

WHO Risk Assessment


From 1 January to 12 November 2023, there has been a two-fold increase in the number of suspected mpox cases with 12 569 suspected cases reported, compared to 6216 in 2020, the highest annual number previously reported. Mpox has also been reported in new geographic areas such as Kinshasa, Kwango province and South Kivu. The reasons for this expansion, affecting men, women and children, remain unknown. Although increased awareness of the global mpox epidemic due to clade IIb MPXV has helped improve surveillance in the country, many aspects of the current situation remain to be elucidated.
Transmission of mpox through sexual contact enables faster spread from one person to another due to direct contact of mucous membranes, possibly leading to a shorter average incubation period. Immunocompromised individuals, either due to uncontrolled HIV or other immunocompromising conditions, are at higher risk for severe mpox complications and mpox-related death. While national HIV prevalence in the Democratic Republic of the Congo is estimated to be <1%, it is estimated to be 7.1% among men who have sex with men. Overall, an estimated 17% of people living with HIV in the country do not know their status, putting them at risk of developing advanced HIV infection, compromised immunity, and severe mpox disease.
The detection of clade I MPXV among visitors to a club of men who have sex with men in Kenge, some of whose members travel to visit other clubs within and outside the country, particularly in central Africa and in Europe, represents a risk for men who have sex with men in the Democratic Republic of the Congo and internationally. In the city of Kinshasa, it is estimated that there are over 50 similar clubs, and some of their members reside outside the Democratic Republic of the Congo.
It is still unclear what proportion of mpox cases in the Democratic Republic of the Congo may be exposed through sexual contact; however, with outbreaks linked to sexual transmission documented in 2023 in three previously unaffected provinces, the potential additional public health impact of this new observation could be significant, particularly in under-resourced urban areas. The rapid evolution of the new outbreak in South Kivu, including among sex workers, is also concerning.
Additionally, the first case identified in Kinshasa had traveled to the city by boat on the Congo river. These boats constitute a potentially high exposure environment since people are often in proximity, transporting animals, selling and consuming wild game on board, and often traveling on the boats for weeks while sharing beds and sometimes engaging in sexual activities. Moreover, the human-to-human spread potential is amplified in urban settings such as Kinshasa and the implementation of containment measures is more challenging.
Response capacities for mpox remain limited in the country. Surveillance and laboratory capacities remain suboptimal: only 9% (1106 / 12 569, as of week 44) of suspected cases this year have been tested by PCR. There are no immunization programmes for populations at risk of mpox in the Democratic Republic of the Congo outside of research projects, and access to the antiviral medication tecovirimat also remains limited to a few clinical research studies in the country.
Risk communication and community engagement are therefore of critical importance to address the risk posed by modes of transmission traditionally reported as bushmeat consumption and community outbreaks, as well as for the newly described risk of sexual transmission, particularly among men who have sex with men. According to a recent WHO study, awareness of the risks associated with mpox is low in the Democratic Republic of the Congo. Additionally, anyone suffering from disfiguring skin conditions, including due to mpox, may face stigma, and the lack of health messages to date for men who have sex with men in the country exposes this population to a particular risk.
In summary, the reasons for concern about further spread of mpox in the Democratic Republic of the Congo are as follows:

1. The Democratic Republic of the Congo is experiencing a significant increase in the number of suspected cases reported in 2023;
2. Geographic expansion of the presence of mpox is underway in the newly affected southern and eastern provinces of the country;
3. Epidemiological and scientific knowledge about mpox remains limited and modes of transmission in the country are poorly understood;
4. In 2023, confirmed cases of mpox have been reported in the large urban area of Kinshasa and several other previously unaffected areas for the first time;
5. Sexual transmission of mpox due to clade I MPXV is being documented for the first time and chains of transmission may have been missed;
6. Key populations experience a higher prevalence of HIV infection than the general population;
7. Awareness of mpox and the associated risks are insufficient in the general and key populations;
8. National response capacities face challenges, including limited epidemiological information on exposure and infection risk factors, limited public awareness of mpox and prevention measures, and numerous competing priorities;
9. Collaboration and coordination among partners are needed to sustain essential research and support a robust response at national as well as provincial and local levels.

The risk of mpox further spreading to neighbouring countries and worldwide appears to be significant. In addition to the features outlined above, arguments supporting the assessment of a high risk of international spread of mpox include the following:

• These first reported outbreaks of mpox due to clade I MPXV linked to sexual contact include a history of international travel within and across WHO regions;
• The introduction of clade I MPXV in different and possibly intersecting sexual networks could facilitate and amplify the spread of this historically more virulent clade of the virus;
• A concurrent outbreak of mpox is occurring in the neighbouring Republic of Congo along the Congo River ecosystem, whose links, if any, with cases in the Democratic Republic of the Congo remain unknown.

These factors pose an additional risk of mpox outbreaks with potentially more severe consequences than the one which has been affecting the world since 2022.


WHO Advice

All countries, including their health authorities and clinicians/healthcare workers, should take note that the global mpox outbreak is ongoing; and, furthermore, the occurrence of sexual transmission of the clade I virus has been confirmed. Infection with clade I MPXV may lead to an increased risk of severe illness.
It is therefore strongly advised that countries continue to follow the Standing Recommendations of the Director-General of the WHO issued in August 2023, particularly concerning the epidemiological surveillance of mpox, strengthening of laboratory diagnostic capacities and genomic sequencing of viruses, community engagement and risk communication, making vaccines available, optimal case management, strengthening research to better understand modes of transmission in different contexts, and sustained support for the development of rapid diagnostic methods and treatments tailored to the needs of patients.
In all settings, it is essential to emphasize the importance of case investigation with sensitivity and absence of stigma and in-depth understanding of human-to-human transmission of mpox in communities, while strengthening the One Health approach in areas where the monkeypox virus circulates in possible mammalian hosts or reservoirs.
It is essential to deepen knowledge in different contexts about the links between mpox and HIV infection, their respective and common risk factors, to provide a population specific health service, and to integrate surveillance and case management within a strengthened and agile health service which meets patient needs.
Actions in the community
Communication on the risks of sexual transmission of mpox must be strengthened, especially among the people most at risk and individuals and households affected by this disease. Advocacy must be done at all levels to support, inform and engage community leaders in implementing the necessary measures to inform and engage their communities about mpox and how to stop its spread.
Risk communication and community engagement activities will be vital in motivating affected communities to become aware of the risks and locally relevant protective behaviours. Socio-behavioural data should be collected, and a situation analysis should be carried out to better understand transmission and risk factors. This information can then be used to improve decision-making, to ensure response efforts are aligned with community needs, priorities and capacities, and to inform the development of risk communications plans and evidence-based community engagement. Key audiences should be identified, including health professionals, men who have sex with men, people working at or attending venues and events where sexual activity takes place, sex workers, and people at risk of more serious illness (including those whose HIV is not treated or adequately controlled).
Partnerships should be established with trusted networks working with these communities to facilitate community engagement. Two-way feedback systems should be established or activated. Particular attention should be paid to measures to understand, prevent and combat stigma and discrimination – these are never acceptable and can undermine the response to the epidemic and have a serious impact on health outcomes.
Concerning the health facility, points of entry and control
Infection prevention and control measures in community venues and health centers are necessary to prevent and respond to outbreaks of mpox. It is important to train staff on the risks linked to contamination, to provide protective equipment, hand washing and hygiene devices in hospitals and at entry/control points; and ensuring appropriate patient isolation is in place. Health care professionals caring for patients with suspected or confirmed mpox infection should take “standard,” “contact,” and “droplet” precautions.
While protecting themselves with recommended measures, healthcare workers should also ensure that stigmatization of patients with mpox is avoided, and that psychological support is provided to patients and their families.
WHO advises against any travel or trade restrictions for the current outbreak.
When collecting clinical and laboratory specimens
Specimens collected from persons and animals suspected of being infected with MPXV should be handled by trained personnel working in equipped laboratories. Confirmation of monkeypox virus depends on the type and quality of the sample, and the type of laboratory test. Thus, specimens must be packaged and shipped in accordance with national and international requirements. RT-PCR is the preferred laboratory test, given its accuracy and sensitivity. For this, the optimal diagnostic samples for MPXV should be taken from skin or mucosal lesions - fluid from vesicles and pustules, and dry scabs. PCR blood tests are generally inconclusive due to the short duration of viremia compared to the time of sample collection after the onset of symptoms; they should not be systematically collected from patients. Because orthopoxviruses are serologically cross-reactive, antigen and antibody detection methods are not sufficiently specific for MPXV and do not constitute a formal confirmatory diagnosis. It is therefore essential that laboratories support health authorities in providing specimen collection kits for skin or mucosal lesions.
Preventive measures
Anyone with a clinical or laboratory-confirmed diagnosis of mpox should follow the instructions of health authorities according to the local context, including isolation during the infectious period whenever feasible. Contacts of a confirmed case should be monitored or should self-monitor for any sign or symptom, practice hand hygiene and respiratory etiquette, avoid contact with immunocompromised individuals, children, or pregnant women, and avoid sexual contact and non-essential travel for a period of 21 days from the last contact with a person with mpox.
Vaccines and antiviral treatments
Vaccines for the prevention of mpox are composed of vaccinia virus and were first developed as safer vaccines for the purpose of smallpox preparedness: third-generation vaccines causing fewer side effects than the vaccines used during smallpox eradication are available. These include MVA-BN, first approved for the prevention of mpox in 2019 and the LC16-KMB vaccine approved for mpox in 2022. These vaccines offer 66-90% protection against mpox due to the antigenic similarity of the viruses that cause smallpox and mpox. A few countries maintain stocks of vaccines against smallpox and mpox, especially since the start of the global outbreak in 2022. Vaccination against mpox is recommended for persons at risk of contracting the disease, including children, and persons who have been in close contact with someone who has mpox.
Antivirals are also being developed and a clinical trial of the antiviral agent tecovirimat is ongoing in the the Democratic Republic of the Congo in two district hospitals in the provinces of Maniema & Sankuru. In order to access tecovirimat in the country, a request can be made to national health authorities.

Further Information

WHO interim technical guidance:

• https://www.who.int/publications/i/i...oratory-2023-1
• Surveillance, case investigation and contact tracing for mpox (monkeypox): interim guidance, 22 December 2022; https://www.who.int/publications/i/i...illance-2022.4
• Vaccines and immunization for monkeypox: Interim guidance, 16 November 2022; https://www.who.int/publications/i/i...X-Immunization
• Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance, 10 June 2022; https://www.who.int/publications/i/i...and-IPC-2022.1

Surveillance and other data

• https://www.who.int/publications/m/i...ing-form-(crf)
• 2022-23 Mpox (Monkeypox) Outbreak: Global Trends; https://worldhealthorg.shinyapps.io/mpx_global/
• UNAIDS. Democratic Republic of the Congo.; https://www.unaids.org/en/regionscou...blicofthecongo

Risk communication and community engagement and Public Health Advice

• https://www.who.int/publications/i/i...PX-RCCE-2022.1
• Risk communication and community engagement public health advice on understanding, preventing and addressing stigma and discrimination related to mpox; https://www.who.int/publications/m/i...d-to-monkeypox (disponible en français ici)
• Public health advice for sex workers on mpox; https://www.who.int/publications/m/i...s-on-monkeypox (disponible en français ici)
• Public health advice on mpox and congregate settings: settings in which people live, stay or work in proximity; https://www.who.int/publications/m/i...k-in-proximity (disponible en français ici)
• Public health advice on mpox (monkeypox) and sex-on-premises venues and events; https://www.who.int/publications/m/i...ues-and-events (disponible en français ici)
• Mpox Q&A: What you need to know about mpox; https://www.who.int/europe/news-room...now-about-mpox (disponible en français ici)

Strategic Planning and global support

• https://www.who.int/publications/i/i...-Ethics-2023.1
• Smallpox vaccines, SAGE September 2023: meeting highlights; https://www.who.int/publications/m/i...ing-highlights

Citable reference: World Health Organization (23 November 2023). Disease Outbreak News; Mpox (monkeypox) in the Democratic Republic of the Congo. Available at: https://www.who.int/emergencies/dise...em/2023-DON493

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Related to the WHO report above.

Translation Google

DRC: outbreak of monkeypox cases worries WHO

The World Health Organization (WHO) is very concerned about the outbreak of monkeypox cases in the DRC. The country has already recorded 581 deaths out of nearly 13,000 cases. A high mortality rate even though the WHO raised the alert for this disease a few months ago. If the specialized UN agency justifies this outbreak by structural ills, the Congolese health authorities cite financial problems.

Published on :11/27/2023 - 02:02
By : RFI
With our correspondent in Kinshasa, Pascal Mulegwa

The epidemic is affecting 21 of the 26 Congolese provinces, but the peak in recent weeks has been recorded in the provinces of Équateur, Sankuru, Maï-Ndombe and in the capital Kinshasa. For the WHO, this rapid spread is due in particular to the lack of health infrastructure. But according to the response team, it is mainly financial resources that pose a problem.

The government is struggling to release the 4 million USD necessary for an emergency plan in these four provinces, where the virus is circulating very quickly. Cris Kasita is responsible for the response. “ This plan was never implemented and we never responded in Kinshasa. All we do is routine data that we have. But effective, active surveillance to carry out this fight against M-Pox [Monkey Pox, monkey pox, Editor's note], quite honestly, has not yet started. This is how we skate. We are approaching the festivities, if we do not know how to act upstream, it will be difficult for Kinshasa to contain this epidemic. »

Faced with the highest number of annual cases ever reported, with new contaminations in geographical areas which had not been affected such as the capital and the provinces of Lualaba and South Kivu, the WHO estimates that the risk of spread to neighboring countries and the world is “ high ”.

The investigation went back to March, with the trip of a Belgian tourist to the DRC, who allegedly had several sexual partners.

A mode of contamination sometimes poorly understood in the DRC, due to lack of awareness. The virus is also transmitted from human to human through contact with skin lesions, or from an infected animal. However, knowledge about the virus remains limited.

https://www.rfi.fr/fr/afrique/20231127-rdc-la-flamb%C3%A9e-des-cas-de-variole-du-singe-inqui%C3%A8te-l-oms