Where and why is mpox disease spreading in DRC? | Health News

The Democratic Republic of Congo (DRC) is facing the largest outbreak of the viral MPOX disease ever recorded, with tens of thousands infected in June. In December 2022, the government declared it an epidemic.

The disease mpox, formerly known as monkeypox, is caused by the monkeypox virus and is usually zoonotic, meaning that the disease can be transmitted from animals to humans.

The virus is endemic in the densely forested areas of Central and West Africa and is related to the virus that caused the now eradicated smallpox. Mpox can be fatal in severe cases, with primary symptoms being an itchy rash over the entire body and fever. Vaccines can limit infection.

While outbreaks are common in the DRC, health experts report that a new strain has been discovered in part of the country this time.

Here’s what we know about the outbreak:

When did the mpox outbreak start?

The epidemic began in May 2022 in the country’s eastern province of Kwango. However, the disease has since spread to 22 of the DRC’s 26 provinces, including the capital Kinshasa.

However, transmission is still concentrated in the east, with high levels in Kamituga, a mining town in the eastern province of South Kivu. Doctors have found a new strain of the virus in the town.

Since 2022, more than 21,000 cases have been reported with more than 1,000 deaths, according to the World Health Organization (WHO). In 2023, a total of 14,626 cases and 654 deaths were recorded.

This year alone, 7,851 cases have been reported by the end of May, with 384 deaths. Many of those infected are children under five (39 percent). Nearly two-thirds (62 percent) of those who die from the disease are also children.

The provinces of Equateur, Sud Ubangi, Sankuru and South Kivu have been hit hardest.

How many variants of mpox are there and how deadly are they?

There have always been two types of mpox, also called clades.

Clade 2 is less deadly. It’s the type that spread in a 2022 outbreak first recorded in London that reached 111 countries in Europe, South and North America, Africa, the Middle East, Asia and Oceania. More than 99 percent of people infected in that outbreak survived because that clade of the virus is less deadly. Wealthy countries hit by the outbreak were also able to stockpile vaccines and antivirals for treatment.

Mpox Outbreak 2022
A sign announcing monkeypox vaccinations is placed at Tropical Park by Miami-Dade County and Nomi Health in Miami, Florida on August 15, 2022 [Joe Raedle/Getty Images via AFP]

However, the clade 1 classification is much more severe and can kill up to a tenth of infected people. It is clade 1 that commonly emerges in the DRC and is causing the current outbreak.

This clade of the virus is typically spread through normal physical contact. However, infections in this outbreak are primarily spread through sexual contact, experts have said.

This is especially true in the popular town of Kamituga, where many sex workers live, said Dr. Jean Bisimwa Nachega, a professor of medicine at the University of Pittsburgh.

Kamituga is the same location where the new strain of the Clade 1 classification was discovered in September 2023.

It is an “important development,” said Dr. Nachega, referring to the vulnerability of sex workers, who, in addition to being economically disadvantaged and lacking access to health care, are also more likely than the rest of the population to have reduced immunity to diseases such as HIV.

“In contrast to historical animal-to-human transmission, human-to-human sexual transmission, especially among high-risk groups such as sex workers, poses a new challenge to controlling the virus,” he said.

According to the WHO, it is unclear whether this variant is more contagious or leads to more severe illness.

Doctors who spoke to The Associated Press said the new variant presents differently. Typically, mpox lesions appear on the face, arms, chest and legs and are clearly visible in an infected person. In this case, however, the reported lesions are largely on the genitals, experts said, making it much harder to track and diagnose cases.

According to the WHO, there have been no documented cases of sexual transmission of the clade I virus in previous outbreaks in the DRC. Cases reported in the country since the 1970s are believed to have been caused primarily by direct contact with infected individuals or animals.

What are the biggest obstacles facing authorities?

The eastern region of the DRC is also hard hit by the ongoing conflict and has limited resources, making it harder for authorities to adequately track, treat and monitor infected people, experts said. There are only two testing laboratories in Kinshasa and Goma, and only 18 percent of reported cases have been tested in laboratories.

The WHO has said there are also insufficient treatment kits in the country, and virtually no vaccines. Tecovirimat, an antiviral drug approved for smallpox, is being tested on more vulnerable patients in the DRC, the WHO said.

Vaccines can help minimize the spread and were key to containing the 2022 outbreak that hit wealthier countries such as the United Kingdom and the United States. But there are not enough vaccines to cover the DRC’s 100 million people. The country’s health minister has authorized doctors to administer the vaccines available in the highest-risk areas. Officials said the DRC is in talks with countries including Japan in an effort to purchase more vaccines.

Public awareness of mpox is also low, making self-reporting and containment difficult. Some patients have left isolation to buy food or continue their professional activities, experts said.

The fact that the disease is now sexually transmitted adds an extra layer of stigma, a problem that plagued health workers during the first spread of HIV/AIDS, experts pointed out. Experts said there is a risk of “silent transmission” if people do not come forward.

What are the risks for other African countries?

The eastern region of DRC, which shares borders with Rwanda, Burundi, Uganda and Tanzania, is also a highly transient place, with people moving in and out regularly, increasing the risk of transmission to other countries. To the south, DRC borders Zambia and Angola, while the western and northern regions share borders with the Republic of Congo, the Central African Republic and South Sudan.

Like the DRC, many other African countries also have limited testing, treatment and surveillance capacity, making this a regional and global problem, Dr. Nachega said.

“Infectious diseases do not respect borders. Outbreaks in one region can quickly spread to other parts of the world, as seen with COVID-19. Even though the current MPOX outbreak appears to be limited to one part of the DRC, people across the continent must remain vigilant,” he added.

So far, 19 cases have been detected in neighboring Republic of Congo, believed to have spread from the DRC – although this has not been confirmed. Authorities there declared a public emergency in April.

Further afield, in Cameroon, 23 cases of the clade 2 virus were reported between January and April this year. South Africa also recorded five clade 2 cases in an outbreak between January and May, although the WHO says there may be more undocumented cases.

These cases are unlikely to be directly related to the DRC outbreak. There is frequent travel between South Africa and the DRC for trade, but some experts believe the cases are linked to the global clade 2 outbreak of 2022.

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