The Democratic Republic of Congo (DRC) is experiencing its largest ever outbreak of viral MPOX, with tens of thousands of people infected as of June, and in December 2022 the government declared it an epidemic.
Formerly called monkeypox, monkeypox is caused by the monkeypox virus and is typically a zoonotic disease, meaning it can be transmitted from animals to humans.
The virus is endemic to densely forested areas of Central and West Africa and is related to the now-eradicated virus that causes smallpox, which is characterized by an itchy full-body rash and fever and can be fatal in severe cases. Vaccination can control infection.
While outbreaks are common in the Democratic Republic of Congo, health experts said this time a new variant had been found in parts of the country.
Here’s what we know about the outbreak.
When did the MPOX outbreak begin?
The outbreak began in May 2022 in Kwango province in the country’s eastern region, but has since spread to 22 of the DRC’s 26 provinces, including the capital, Kinshasa.
But infections remain concentrated in the east, with high infection rates recorded in the mining town of Kamituga in eastern South Kivu province, where doctors have discovered a new strain of the virus.
According to the World Health Organization (WHO), more than 21,000 cases and over 1,000 deaths have been reported since 2022. 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. Most of those infected are children under the age of five (39%). Nearly two-thirds (62%) of those who have died from the disease are also children.
The worst-hit provinces in the country include Equateur, South Ubangi, Sankuru and South Kivu.
How many variants of mpox are there and how deadly are they?
There have always been two types (also called clades) of mpox.
Lineage 2 is less lethal. This is the type that spread in the first recorded epidemic in London in 2022, which spread to 111 countries in Europe, North and South America, Africa, the Middle East, Asia and Oceania. More than 99% of people infected in this epidemic survived because this lineage of the virus is less lethal. Rich countries affected by the epidemic were also able to stockpile vaccines and antiviral drugs for treatment.
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However, lineage 1 is much more severe and can kill up to one in ten people who are infected. Lineage 1 is the one that usually occurs in the Democratic Republic of Congo and is causing the current outbreak.
This strain of the virus is usually spread through casual physical contact, but in this outbreak, experts say the infection is mainly being spread through sexual contact.
Dr. Jean Bisimwa Ngatsega, a professor of medicine at the University of Pittsburgh, said this is especially true in the hotspot town of Kamitsuga, which has a large population of sex workers.
Kamitsuga is the same location where a new strain of the clade 1 classification was discovered in September 2023.
Dr Nachega called this an “important development”, noting the vulnerability of sex workers, who are not only more economically disadvantaged and lacking access to healthcare, but are also more likely to have weakened immunity to diseases such as HIV than the rest of the population.
“Unlike previous animal-to-human transmission, human-to-human sexual transmission, especially among high-risk populations such as sex workers, poses new challenges for controlling the virus,” he said.
The WHO says it is unclear whether the variant is more contagious or causes 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 on the face of infected people. But in this case, the reported lesions are mainly on the genitals, making it much harder to track and diagnose cases, experts said.
According to the WHO, no sexual transmission of lineage I viruses has been recorded in previous outbreaks in the DRC, and cases reported in the country since the 1970s are understood to be primarily due to everyday direct contact with infected people or animals.
What are the main obstacles facing authorities?
The eastern region of the country has also been hard hit by the ongoing conflict, and experts say limited resources are making it difficult for authorities to adequately trace, treat and monitor cases: Kinshasa and Goma each have only two testing laboratories, and only 18 percent of reported cases are being tested in laboratories.
The WHO says there is also a shortage of treatment kits in the country and the vaccine is virtually nonexistent. The WHO says an antiviral drug approved for smallpox, Tecovirimat, is being tested in more vulnerable patients in the Democratic Republic of Congo.
Vaccines help minimize the spread of infection and were crucial to containing the 2022 outbreak that hit wealthy countries such as Britain and the United States. But there aren’t enough vaccines to cover the Democratic Republic of Congo’s population of 100 million. The country’s health minister has given doctors permission to administer any available vaccine in the highest-risk areas. Officials said the country is in talks with countries including Japan to procure more vaccines.
Public awareness of mpox is also limited, making self-reporting and containment difficult, and experts say some patients are leaving isolation to buy food or continue their work duties.
The fact that the disease can be transmitted sexually introduces additional stigma, an issue that plagued health workers when HIV/AIDS first spread, experts said. There is a risk of “silent infections” if people do not come forward.
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What are the risks for other African countries?
The eastern region of the Democratic Republic of the Congo, which borders Rwanda, Burundi, Uganda and Tanzania, is also a highly mobile area with high population movement, increasing the risk of transmission to other countries. The Democratic Republic of the Congo borders Zambia and Angola to the south, and the Republic of the Congo, the Central African Republic and South Sudan to the west and north.
Dr. Nachega said the Democratic Republic of the Congo, like many other African countries, has limited testing, treatment and surveillance capacities, which is a regional and global concern.
“Infectious diseases cross borders. As we have seen with COVID-19, an outbreak in one area can quickly spread to other parts of the world. Although the current MPOX outbreak appears to be under control in parts of the Democratic Republic of Congo, people across the continent need to remain vigilant,” he added.
There have been 19 confirmed cases in neighbouring Republic of Congo, which is thought but has not confirmed to have spread from the Democratic Republic of Congo. Authorities there declared a public health emergency in April.
Further afield, Cameroon reported 23 lineage 2 virus cases between January and April this year, and South Africa recorded five lineage 2 cases during an outbreak between January and May, although the WHO says there may be more unrecorded cases.
These cases are likely not directly related to the outbreak in the Democratic Republic of the Congo (there is a lot of trade between South Africa and the Democratic Republic of the Congo), but some experts believe the cases are linked to the outbreak of lineage 2, a pandemic that has been spreading since 2022.