‘Our problem here is the #pig #Ebola’: local accounts of #epizootics preceding Ebola #outbreaks in north-eastern #DRC

 

Abstract

Introduction 

Despite their potential relevance for outbreak understanding, epizootic reports associated with Ebola scarcely appear in biomedical literature. This study examines local accounts of animal deaths preceding the 2012 and the 2017 Ebola outbreaks in the north-eastern Democratic Republic of the Congo (DRC).

Methods 

The analysis is based on retrospective interviews conducted with scientists deployed during these two Ebola outbreaks, as well as testimonies collected in 2022 and 2023 from local residents, clinicians and veterinarians. It also draws on local archives to examine how reports of animal deaths were framed and understood in light of a new epidemic situation.

Results 

Selective pressures that favour certain wild animal species, along with social practices such as bushmeat hunting, contribute to a narrowing of focus during outbreak investigations. This has contributed to overlooking some testimonies from marginalised local actors, which remain unpublished to this day. Animal death reports, however, need to be read in their social context. During the 2017 Ebola outbreak, local breeders framed their concerns about pig mortality into a question to be addressed by global health researchers—even though the deaths were not linked to Ebola but were likely caused by an unrelated pathogen, the African swine fever virus.

Conclusion 

Beyond their biological relevance, epizootics can offer insight into the social contexts in which epidemics are identified. These epizootics can shed light on local experiences of diseases, illustrating local priorities and sense-making processes.

Data availability statement

Data sharing is not applicable as no data sets were generated and/or analysed for this study.

DOI: https://doi.org/10.1136/medhum-2025-013586

Footnotes

Contributors: JV conceptualised the study, conducted the research and wrote the manuscript. JV is the guarantor.

Funding: The author received support from Sciences Po Medialab and IFAS (Institut Français d'Afrique du Sud) for fieldwork in the DRC in 2022 and 2023.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

Provenance and peer review: Not commissioned; externally peer reviewed.

Source: 

Link: https://mh.bmj.com/content/early/2026/04/01/medhum-2025-013586

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Case presentation of #patients hospitalised with #mpox (subclade Ib/2023sh) including #children, #adolescents, and #adults in South Kivu, #DRC: an observational cohort study

 

Summary

Background

Mpox is a public health concern in eastern DR Congo. It continues to cause substantial numbers of hospital admissions, with changing demographics including children and adolescents, requiring comprehensive clinical and epidemiological investigation. In this study, we aim to describe the clinical characteristics of hospitalised participants infected with monkeypox virus (MPXV) subclade Ib/2023sh in the Kabare Territory in South Kivu, DR Congo.

Methods

This observational cohort study included patients admitted with suspected mpox to the reference centre of mpox treatment at Lwiro Hospital, South Kivu, DR Congo. Eligible participants must have had, at the time of inclusion, skin lesions compatible with the infection. Individuals who did not present lesions compatible with MPXV infection were also eligible if they had at least one of the following symptoms: fever, cervical lymphadenopathy, or pharyngitis, provided they had been in contact with someone with suspected mpox within the last 21 days. Data from hospital records and standardised clinical forms captured demographics, presenting symptoms and signs, outcomes, and general clinical characteristics. Descriptive analyses and statistics summarised the clinical and epidemiological profiles of participants with molecular confirmation of MPXV subclade Ib/2023sh.

Findings

Between Aug 3, 2024, and Feb 8, 2025, MPXV subclade Ib/2023sh was detected in 494 (77%) of 643 participants with a median age of 9 years (IQR 2–24). Participants who were positive for MPXV subclade Ib/2023sh infection were more often female (290 [59%]) and were generally older (median 16 years [4–25]) than male participants (204 [41%]; median age 4 years [1–14]). 300 (61%) of 494 participants were aged 15 years or younger. Fever (444 [90%]), skin lesions or rash (391 [79%]), and dysphagia (279 [56%]) were the most prevalent symptoms. Children aged 0–5 years had a higher frequency of lesions on the head (84 [41%] of 203), face (67 [33%]), neck (23 [11%]), back (27 [13%]), arm (35 [17%]), palm of hand (35 [17%]), chest (46 [23%]), posterior aspect of thighs (40 [20%]), legs (25 [12%]), dorsal foot (45 [22%]), and oral cavity (37 [18%]). 117 (24%) participants had lesions in the oral cavity. Oral cavity and oropharynx swabs were able to detect MPXV subclade Ib/2023sh in the absence of assayable skin lesions.

Interpretation

The high proportion of children and adolescents (aged ≤15 years) differentiates our cohort from other clinical descriptions of the novel MPXV subclade Ib/2023sh. Given that, we hypothesise a demographic shift in the target population that contributes to the community spread of mpox in the South Kivu region of DR Congo. Targeted public health measures should consider ways to reduce transmission among children and adolescents.

Funding

Canadian Institutes of Health Research (CIHR), Canadian Foundation for Innovation, Research Nova Scotia, Dalhousie Medical Foundation, Moderna, Li-Ka Shing Foundation, European & Developing Countries Clinical Trials Partnership (EDCTP).

Translations

For the French, Swahili and Mashi translations of the abstract see Supplementary Materials section.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00051-4/fulltext?rss=yes

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#Ebola virus disease - #DRC: End of the Outbreak Declared (#WHO D.O.N., Dec. 1 '25)

 

{Summary}

Situation at a glance

On 1 December 2025, the Ministry of Health (MoH) of the Democratic Republic of the Congo (DRC) declared the end of the Ebola virus disease (EVD) outbreak which had been declared on 4 September 2025. 

The end was declared after two consecutive incubation periods (a total of 42 days) since the last person confirmed with EVD tested negative for the virus and was discharged on 19 October 2025. 

A total of 64 cases (53 confirmed, 11 probable), including 45 deaths (CFR 70.3%), were reported from six health areas in Bulape Health Zone, Kasai Province. 

WHO and partners provided technical, operational and financial support to the government to contain the outbreak. 

This is the country’s 16th outbreak of Ebola. 

Although the outbreak has been declared over, health authorities are maintaining surveillance to rapidly identify and respond to any re-emergence. 

Risk communication and community engagement activities will continue to provide accurate information, monitor and address community feedback and rumours, and support efforts to reduce stigma toward individuals affected by the outbreak.

(...)

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/ebola-virus-disease---democratic-republic-of-the-congo

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Assessing #Ebola virus circulation in the Tshuapa province (#DRC): A #OneHealth #investigation of wildlife and #human interactions

 

Abstract

The wildlife reservoir and spillover mechanisms of Ebola virus remain elusive despite extensive research efforts in endemic areas. This study employed a One Health approach to examine the virus’ circulation in wildlife and the associated human exposure risks in the Tshuapa province of the Democratic Republic of the Congo. We screened 1049 samples from 919 animals, predominantly small mammals, collected in 2021, and 380 samples from inhabitants of Inkanamongo village, the site of an Ebola virus disease outbreak in 2014. These samples were screened for evidence of current (RNA) or past (IgG antibodies) Ebola virus infections. We also conducted interviews with 167 individuals in the surrounding districts to assess their interactions with wildlife. While no Ebola virus RNA was detected in the wildlife samples, anti-orthoebolavirus IgG antibodies were found in 13 bats and 38 rodents. Among the human participants, 120 individuals had IgG antibodies against at least 1 orthoebolavirus antigen, with 12 showing seropositivity for 2 antigens of the same orthoebolavirus, despite not having a prior Ebola disease diagnosis. Furthermore, the majority of respondents reported frequent visits to the forest to hunt a variety of wild animals, particularly ungulates and rodents, which could account for occasional viral spillovers. The absence of active Ebola virus circulation in wildlife may reflect seasonal patterns in reservoir ecology, as those observed in bats. Similarly, seasonal human activities, such as hunting and foraging, may result in periodic exposure risks. These findings highlight the importance of continuous, multidisciplinary surveillance to monitor changes in seasonal spillover risks.

Author summary

Since its discovery in 1976 in the Democratic Republic of Congo (DRC), Ebola virus (EBOV) has caused more than 20 outbreaks in humans, with fatality rates as high as 90%. While the virus is believed to have an animal origin, naturalist reservoir and the mechanisms of transmission to humans remain poorly understood. Gaining insight into which species may harbour the virus and how transmission occurs is essential to predict and prevent future outbreaks. In this study, we investigate EBOV exposure in wildlife and humans in a region of the DRC with a documented history of outbreaks. Although we did not detect active infection in animals, we found serological evidence of prior exposure in several bat and rodent species, as well as among local residents. Interviews with community members revealed frequent contact with wildlife through hunting and handling, practices that could elevate the risk of animal-to-human transmission. These findings offer new clues about possible EBOV reservoirs and highlight the role of human behaviours in facilitating facilitate spillover events. Our results underscore the need for continued, integrated surveillance to improve understanding of Ebola virus ecology and to help reduce the risk of future Ebola outbreaks in endemic regions.

Source: 

Link: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1013628

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Simultaneous #outbreaks of #Ebola, #cholera, #mpox, and #measles in #DRC in 2025

 

{Excerpt}

On Sept 4, 2025, the DR Congo Government and Ministry of Health announced a new Ebola virus disease outbreak in the Bulape health zone (Kasai province), marking the end of over 15 years without any reported cases of Ebola virus disease in this region. As of Sept 14, 2025, there were 35 confirmed Ebola virus disease cases and 16 deaths, representing a case fatality rate of 45·7%.1,2 This unexpected resurgence in a region with insufficient preparedness capacity raises serious concerns about potential regional spread, including towards neighbouring Angola.

At the same time, DR Congo is experiencing one of the most severe cholera outbreaks of the past decade, with a total of 48 139 cases and 1443 deaths reported between Jan 1 and Aug 24, 2025, resulting in a case fatality rate of 3%.3 By epidemiological week 33, high case fatality rates were reported in the provinces of Kwilu (76 cases, 26 deaths; 44%), Sankuru (42 cases, 6 deaths; 14%), and Equateur (224 cases, 19 deaths; 8%).3

DR Congo also continues to be the global epicentre of mpox. Between Jan 1 and Sept 14, 2025, DR Congo has reported 16 879 confirmed mpox cases and 43 deaths.4 Response efforts have been challenged by factors such as persistent endemic conditions, gaps in surveillance, and poor access to vaccines.

(...)

Source: The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02100-2/fulltext?rss=yes

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#Ebola Virus Disease in the #DRC - External #Situation #Report 03 - September 28 '25 (#WHO, summary)

 

Date of issue: 30 September 2025

Data as reported by: 28 September 2025

{Summary}

The Ebola virus disease outbreak in the Democratic Republic of the Congo continues, with signs of a notable decline in transmission. 

Since our last update (Situation Report #2), a total of seven new cases have been reported, comprising six confirmed and one probable cases (retrospectively validated). 

The new cases were detected across three health areas within Bulape Health Zone, namely, Bulape (n=4), Mpianga (n=2), and Dikolo (n=1). 

During the same reporting period, seven deaths occurred among newly identified and previously hospitalized cases. The reported deaths were distributed across Dikolo (n=3), Bulape (n=2), Mpianga (n=1), and Bulape Communitaire (n=1) health areas.

As of 28 September 2025, a total of 64 cases (53 confirmed and 11 probable), including 42 deaths (31 confirmed, 11 probable), have been reported from Bulape Health Zone, Kasai Province, Democratic Republic of the Congo. 

The overall case fatality ratio (CFR) is 65.6%. 

Cumulatively, five confirmed cases have been reported among healthcare workers, including three deaths. 

The outbreak remains confined to six affected health areas out of the 21 that make up Bulape Health Zone.

Cases to date range in age from 0 (newborn) to 65 years. 

Since the onset of the outbreak, the majority of cases have been reported among females (57.8%, n=37), children aged 0–9 years (25.0%, n=16), and individuals aged 20–29 years (23.4%, n=15). 

Mortality has also been concentrated among these groups, with females accounting for over half of the reported deaths (57.1%, n=24) and children under 10 years representing 31.0% of deaths (n=13). 

The CFR is slightly higher among males (66.7%) compared to females (64.9%). 

In the past two weeks, fewer cases (n = 2) have been reported among children (0-9 years old). 

A decreasing CFR trend has been observed over time with improvement in surveillance (early case detection and isolation) and the quality of case management (prompt and high-quality treatment).

As of 28 September 2025, a total of 1 787 contacts were under follow-up, with 1 735 (97.1%) seen in the last 24 hours. 

Nine (9) cases were successfully treated and discharged following recovery while 13 are currently in treatment as of 28 September 2025.

(...)

Source: ReliefWeb, https://reliefweb.int/attachments/de19e29d-1f89-4ad2-a086-e9afcdce91cc/DRC_EVD_External_Sitrep_28Sept2025.pdf

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RAPID #RISK #ASSESSMENT: #EBOLA VIRUS DISEASE, DRC (#WHO, September 19 '25)

 

{Summary}

Overall risk and confidence

Overall risk

-- National: High 

-- Regional: Moderate   

-- Global: Low   

Confidence in available information 

-- National: Moderate

-- Regional: Moderate

-- Global: Moderate

Risk statement

On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of Ebola virus disease (EVD) in the Bulape Health Zone, Kasai Province, DRC. 

The first currently known suspected EVD case was admitted to the Bulape General Reference Hospital on 20 August 2025 and reported to have died five days later (25 August 2025).

This is a 34-year-old female patient with a 34-week gestational age who presented with fever, bloody diarrhoea, followed by anal, oral, and nasal haemorrhage, vomiting, and asthenia. 

She reportedly died on 25 August 2025, with a clinical picture of multiple organ failure. 

Two of the contacts of this first case (a midwife and a laboratory technician) also developed similar symptoms and died a few days later.  

As of 4 September 2025, a total of 28 suspected cases, including 15 deaths (case fatality ratio: 54 %) had been reported from the Bulape health zone (Bulape, Bulape COM and Dikolo) and Mweka health zone. 

Among deaths, four are health care workers.  

In addition, 20% of the suspected cases are aged under 15 years. 

Five blood samples and one swab were collected from six suspected cases from the three health areas and arrived today at the National Public Health Laboratory (INRB) in Kinshasa for confirmation testing.

A crisis committee has been activated at the local and provincial levels, risk communication and active surveillance activities are underway, all cases are isolated, Infection Prevention and Control (IPC) measures are being implemented, isolation and contact tracing are underway, and patients are receiving intravenous medications, including ceftriaxone and metronidazole. 

The INRB confirmed Ebola virus (EBOV), Orthoebolavirus zairense species was detected through RTPCR assays, including GeneXpert, on 3 September.    

At national level, the risk is considered high due to:  

• Information gaps on the cases, including the first case, particularly: 

-- the date of symptom onset, 

-- their therapeutic itinerary, 

-- the potential number of contacts within the community, and 

-- epidemiological links between cases does not allow an assessment as to the extent of the outbreak. Similar alerts have been reported from this location/region in the past few months.  

• Most of the cases recorded so far in this health zone live in the Health Areas with a high population density and mobility. This could accelerate disease transmission within the community.  

• The last EVD outbreak in this health zone, Bulape, was in 2007, 18 years later, the capacities required for the response to a potential EVD outbreak may not exist.  

• So far, in addition to Bulape health zone, the epicentre of the outbreak, suspected cases are being reported in the neighbouring district of Mweka showing a potential geographic extension of the outbreak.   

• Bulape has a large market every Friday, attracting people from the surrounding villages. The city of Mweka borders a health district in the province of Kasai-Central (Bena Leka). Furthermore, population movements between Bulape and Tshikapa, the capital city of Kasai province, are frequent as part of trading activities.  Tshikapa city is considered as a regional market hub receiving populations from neighbouring provinces.  

At the regional level the risk is moderate due to the proximity of Bulape to Tshikapa city, the capital city of Kasai province and the Angolan border (approximately 100 to 200 kilometres depending on the nearest border crossing point) as well as population movement between Bulape and Tshikapa then Tshikapa and Angola.  

At the global level, the risk is low. 

(...)

Source: World Health Organization, https://www.who.int/publications/m/item/who-rapid-risk-assessment---ebola-virus-disease--democratic-republic-of-the-congo-v.1

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#DRC: #Ebola #Outbreak, Kasai Province Situation #Report #2, September 15, 2025 (ReliefWeb)

 

FAST FACTS

• On September 4, the DRC Ministry of Health officially declared an outbreak of Ebola virus disease (EVD) in the Bulape and Mweka health zones in Kasai province.

• According the the World Health Organization (WHO), as of September 15 there are 81 suspected cases and 28 deaths, including four nurses. However, data reporting has been challenging, with conflicting statistics reports being circulated by various health authorities.

• Kasai is extremely isolated, sometimes requiring multiple days of driving from Kinshasa to Tshikapa, the provincial capital, during the rainy season. Very few air routes reach the province, though an airstrip in Bulape is being established.

• Significant gaps exist in the response to EVD, including adequate case management capacity, blood supplies, IPC/WASH support, and more.

OUR RESPONSE

• International Medical Corps has been responding in the DRC since 1999, and currently has offices in Goma and Kinshasa.

• Our Rapid Response Team (RRT) has deployed to Kasai, with staff on the ground assessing and planning our response.

• Through our US government-funded LEARN project, we are preparing to conduct training covering topics including case management and IPC.

• Procurement of medical supplies, including personal protective equipment, has begun and will be used both as training materials and in response to EVD.

• International Medical Corps will lead working groups on case management at the national and provincial level.

Source: ReliefWeb, https://reliefweb.int/report/democratic-republic-congo/dr-congo-ebola-outbreak-kasai-province-situation-report-2-september-15-2025

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#Ebola virus disease - #DRC (#WHO D.O.N., September 5 '25)

 

Situation at a glance

On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of Ebola virus disease (EVD) in the Bulape Health Zone, Kasai Province, DRC. 

The first known index case was a pregnant woman who presented at Bulape General Reference Hospital on 20 August 2025 with symptoms of high fever, bloody diarrhoea, haemorrhage and extreme weakness. She died on 25 August from multiple organ failure. 

On 4 September 2025, following confirmatory laboratory testing, the Ministry of Health declared an outbreak of EVD. 

Ebola virus disease is a serious, often fatal illness in humans. The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission. 

As of 4 September 2025, 28 suspected cases, including 15 deaths (case fatality ratio (CFR): 54%), have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone. 

Among the deaths, four are health-care workers. 

About 80% of the suspected cases are aged 15 years and older. Six samples were collected from five suspected cases and one probable death from Bulape health zone and arrived on 3 September at the National Public Health Laboratory (INRB) in Kinshasa for confirmation testing. All five samples tested positive for Ebola virus (EBOV) through GeneXpert and Polymerase Chain Reaction (PCR) assays on 3 September 2025. 

The Ministry of Health, with support from WHO and partners, is implementing public health response measures to contain the outbreak. WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level.

Description of the situation

On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of EVD in the Bulape Health Zone, Kasai Province, DRC. 

The first known suspected index case was admitted to the Bulape General Reference Hospital on 20 August 2025. The patient was a pregnant woman at 34-weeks of gestation who presented with symptoms of fever, bloody diarrhoea,  haemorrhage, vomiting, asthenia, followed by multiple organ failure. She died on 25 August 2025. Two of the health-care workers that had initially been in contact with this first case also developed similar symptoms and died.

As of 4 September 2025, a total of 28 suspected cases, including 15 deaths, of which four are health-care workers (case fatality ratio (CFR): 54%) have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone. 

About 80% of the suspected cases are aged 15 years and older. Five blood samples from five suspected cases and a  naso-pharyngeal swab from a probable death were collected from the three health areas and shipped to the National Public Health Laboratory (INRB) in Kinshasa for testing.

On 3 September 2025, the laboratory testing conducted at INRB confirmed Ebola virus (EBOV)[1] through GeneXpert and Polymerase Chain Reaction (PCR) assays.

The results obtained from whole genome sequencing suggest that the outbreak is a new zoonotic spillover event and is not directly linked to the 2007 Luebo or 2008/2009 Mweka EVD outbreaks.[2]

(...)

Epidemiology

Ebola virus disease is a severe disease caused by the Ebola virus (EBOV). The virus belongs to the species Orthoebolavirus Zairense. The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission by direct contact with bodily fluids, organs, or contaminated surfaces and materials.

The incubation period, the time between infection with the virus and the onset of symptoms, ranges from 2 to 21 days, but typically is 7–11 days. People are not infectious during the incubation period; they become contagious with early symptoms, therefore, transmission risk begins at the onset of clinical signs and increases with disease severity.

The average case fatality ratio is 50%; case fatality ratios ranging from 25% to 90% have been reported in previous outbreaks. 

The disease is characterised by an acute onset of fever with non-specific symptoms/signs (e.g., abdominal pain, anorexia, fatigue, malaise, myalgia, sore throat) usually followed several days later by nausea, vomiting, diarrhoea, and occasionally a variable rash. 

Severe illness may include haemorrhagic manifestations (e.g., bleeding), encephalopathy, shock/hypotension, multi-organ failure, and spontaneous abortion in infected pregnant women. 

Individuals who recover may experience prolonged sequelae (e.g., arthralgia, neurocognitive dysfunction, uveitis, sometimes followed by cataract formation), and clinical and subclinical persistent infection may occur in immune-privileged compartments (e.g., central nervous system, eyes, testes). 

Family members, health and care providers, and participants in burial ceremonies with direct contact with the deceased are at particular risk. 

Public health response

Health authorities are implementing public health measures, including but not limited to the following:

-- A crisis committee was activated at both the local and provincial levels.

-- Risk communication and active surveillance activities are ongoing.

-- All cases are isolated, and Infection Prevention and Control (IPC) measures have been implemented.

-- Patients are receiving intravenous medication.

-- Contact isolation and tracing are continuing.

-- Investigations are ongoing. 

WHO is supporting the national authorities, including through:

-- Risk assessment and investigation.

-- Providing operational, financial and technical support to the Ministry of Health to ensure swift response.

-- Provision of essential supplies (Personal Protective Equipment (PPE), medical supplies and infrastructures support)

-- The approved Ervebo vaccine is available with a stock of 2000 doses located in Kinshasa expected to be shipped shortly to the affected area, to vaccinate contacts of confirmed or suspected cases,  frontline and health workers.

WHO risk assessment

This is the 16th EVD outbreak in the DRC since 1976. The current outbreak occurs after almost three years without a confirmed EVD outbreak in the country. The last EVD outbreak in the country was declared on 15 August 2022 in Beni city, North Kivu province, with one single case reported who later died, and the MoH declared the end of the outbreak on 27 September 2022. In the Bulape district, the epicentre of the current outbreak, the last EVD outbreak was recorded in 2007.  

This outbreak is occurring in a complex epidemiological and humanitarian context. The country is facing several outbreaks, including mpox, cholera, and measles. In addition, the country is experiencing a long-term economic and political crisis. The country's resources and capacity to effectively respond to the current outbreak are therefore limited. 

The epicentre of this outbreak is in the proximity of the Tshikapa city, the capital city of the Kasai province, and the Angolan border (approximately 100 to 200 kilometres, depending on the nearest border crossing point). 

Although the affected district is a hard-to-reach rural area relatively far from the two main urban centres of Mbuji Mayi and Kananga, population movements between different parts of the province are frequent, especially between Bulape and Tshikapa.

In addition, epidemiological investigations are ongoing with transmission chains, and the source of the outbreak has not yet been identified; therefore, additional infected people cannot be ruled out.  

The date of symptom onset for the first case is not yet known, as well as the therapeutic itinerary prior to health facility consultation, which further increases the likelihood of an ongoing community transmission with further risk of spread to other health districts.

WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level. 

WHO advice

Effective outbreak control relies on the application of a set of interventions, namely clinical management, IPC & Water, sanitation and hygiene (WASH), surveillance and contact tracing, good laboratory service, safe and dignified burials, community engagement, and social mobilization. 

The Ebola virus can persist in some body fluids of people who have recovered from EVD. 

In a limited number of cases, secondary transmissions resulting from exposure to the body fluids of people who have recovered from EVD have been documented. Therefore, maintaining collaborative relationships with survivor associations while monitoring survivors is a priority to mitigate any potential risks.

Early diagnosis and initiation of optimized supportive clinical care can reduce mortality from EVD. 

In addition, monoclonal antibodies active against a 3-antibody combination of atoltivimab, maftivimab and odesivimab [Inmazeb®] or a single antibody ansuvimab [Ebanga®].  

Ebola treatment centres should be designed and managed to ensure safe care is provided with appropriate biosecurity and infection prevention and control intervention, and allow optimized care, allowing direct visualization of patients in the red zone as much as possible. WHO and partners have worked to develop these innovative solutions. 

There is a need to strengthen surveillance and other response activities, including at relevant points of entry and borders, to contain the possibility of exponential spread. 

Cases, contacts and individuals in affected areas who present signs and symptoms compatible with case definitions should be considered suspects and cared for and treated in designated treatment facilities with appropriate biosecurity, infection prevention and control and be offered testing in a timely fashion and advised not to travel. 

Collaboration with neighbouring countries should be enhanced to harmonize reporting mechanisms, conduct joint investigations, and share critical data in real time. 

Surrounding countries should enhance readiness activities to enable early case detection, isolation and treatment. 

Critical infection prevention and control measures should be implemented and/or strengthened in all health care facilities, per WHO's Infection prevention and control guideline for Ebola and Marburg disease.   

Health workers caring for patients with confirmed or suspected Ebola should apply transmission-based precautions in addition to standard precautions, including appropriate use of PPE and hand hygiene according to the WHO 5 moments to avoid contact with patients’ blood and other body fluids, and with contaminated surfaces and objects. 

Waste generated in health-care facilities must be safely segregated, safely collected, transported, stored, treated and finally disposed. National guidelines should be followed on rules and regulations for safe waste disposal or WHO’s guidelines on safe waste management.

Patient-care activities should be undertaken in a clean and hygienic environment that facilitates practices related to the prevention and control of health-care-associated infections, as outlined in Essential environmental health standards in health care. Safe water, adequate sanitation and hygiene infrastructure and services should be provided in healthcare facilities. For details on recommendations and improvement, follow the WASH FIT implementation Package.

In accordance with the recommendations of the Strategic Advisory Group of Experts on immunization, the Ervebo vaccine is recommended during an EVD outbreak due to EBOV for ring vaccination, for contacts and potential contacts of confirmed/suspected EVD cases, as well as for frontline workers. A global stockpile has been established and is being coordinated by the International Coordination Group for vaccine procurement.

WHO advises against any restrictions on travel and/or trade to the Democratic Republic of the Congo based on available information for the current outbreak.

(...)

Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON580

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#DRC declares #Ebola virus disease #outbreak in #Kasai Province (#WHO AFRO, September 4 '25)

 

Kinshasa – Health authorities in the Democratic Republic of the Congo have declared an outbreak of Ebola virus disease in Kasai Province where 28 suspected cases and 15 deaths, including four health workers, have been reported as of 4 September 2025.

The outbreak has affected Bulape and Mweka health zones in Kasai Province where health officials have been carrying out investigations after the cases and the deaths reported presented with symptoms including fever, vomiting, diarrhoea and haemorrhage. Samples tested on 3 September at the country’s National Institute of Biomedical Research in the capital Kinshasa confirmed the cause of the outbreak as Ebola Zaire caused by Ebola virus disease.   

A national Rapid Response Team joined by World Health Organization (WHO) experts in epidemiology, infection prevention and control, laboratory and case management has been deployed to Kasai Province to rapidly strengthen disease surveillance, treatment and infection prevention and control in health facilities. Provincial risk communication experts have also been deployed to reach communities and help them understand how to protect themselves.

Additionally, WHO is delivering two tonnes of supplies including personal protective equipment, mobile laboratory equipment and medical supplies. The area is difficult to reach, taking at least one day of driving from Tshikapa (the provincial capital of Kasai), with few air links.   

“We’re acting with determination to rapidly halt the spread of the virus and protect communities,” said Dr Mohamed Janabi, WHO Regional Director for Africa. “Banking on the country’s long-standing expertise in controlling viral disease outbreaks, we’re working closely with the health authorities to quickly scale up key response measures to end the outbreak as soon as possible.”   

Case numbers are likely to increase as the transmission is ongoing. Response teams and local teams will work to find the people who may be infected and need to receive care, to ensure everyone is protected as quickly as possible.    

The country has a stockpile of treatments, as well as 2000 doses of the Ervebo Ebola vaccine, effective to protect against this type of Ebola, already prepositioned in Kinshasa that will be quickly moved to Kasai to vaccinate contacts and frontline health workers.   

The Democratic Republic of the Congo’s last outbreak of Ebola virus disease affected the north-western Equateur province in April 2022. It was brought under control in under three months thanks to the robust efforts of the health authorities. In Kasai province, previous outbreaks of Ebola virus disease were reported in 2007 and 2008. In the country overall, there have been 15 outbreaks since the disease was first identified in 1976.    

Ebola virus disease is a rare but severe, often fatal illness in humans. It is transmitted to people through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit bats (thought to be the natural hosts). Human-to-human transmission is through direct contact with blood or body fluids of a person who is sick with or has died from Ebola, objects that have been contaminated with body fluids from a person sick with Ebola or the body of a person who died from Ebola.

Source: World Health Organization, Regional Office for Africa, https://www.afro.who.int/countries/democratic-republic-of-congo/news/democratic-republic-congo-declares-ebola-virus-disease-outbreak-kasai-province

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The Trans-Kingdom #Spectrum of #Mpox-like Lesion Pustules of Suspect #Patients in the Mpox Clade Ib #Outbreak in Eastern #DRC

 

Abstract

During infectious disease outbreaks, acquiring genetic data across various kingdoms offers essential information to tailor precise treatment methodologies and bolster clinical, epidemiological, and public health awareness. Metagenomics sequencing has paved the way for personalized treatment approaches and streamlined the monitoring process for both co-infections and opportunistic infections. In this study, we conducted long-read metagenomic DNA sequencing on mpox-like lesion pustules from six suspected patients who were positive and confirmed to be infected with MPXV during the MPXV subclade Ib outbreak in the Eastern Democratic Republic of the Congo. The sequenced data were taxonomically classified as bacterial, fungal, and viral in composition. Our results show a wide spectrum of microorganisms present in the lesions. Bacteria such as Corynebacterium amycolatum, Gardnerella vaginalis, Enterococcus faecium, Enterobacter clocae, Staphylococcus epidermidis, and Stenotrophomonas maltophilia were found in the lesions. The viral classification of the reads pointed out the absolute predominance of the monkeypox virus. Taken together, the outcomes of this investigation underscore the potential involvement of microorganisms in mpox lesions and the possible role that co-infections played in exacerbating disease severity and transmission during the MPXV subclade Ib outbreak.

Source: Microorganisms, https://www.mdpi.com/2076-2607/13/9/2025

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Leveraging #risk #communication and community engagement and lessons from previous #outbreaks to strengthen a Public Health response: A case study of #DiseaseX in the Panzi region, #DRC

Abstract

On 08 December 2024, the World Health Organization (WHO) reported an outbreak of Disease X in the Panzi Health Zone, Kwango province, Democratic Republic of the Congo (DRC). This unknown pathogen, with 406 cases and 31 deaths at the time of its declaration, predominantly affects children under 5 years. Disease X, hypothesised to be a zoonotic ribonucleic acid (RNA) virus, poses significant challenges because of limited healthcare infrastructure, gaps in risk communication and ineffective community engagement. This opinion article aims to explore these challenges and advocate for the urgent need for culturally tailored, inclusive communication strategies that foster trust and empower local communities in responding to outbreaks. Key approaches highlighted include mobilising local leaders, utilising mobile laboratories for decentralised diagnostics and improving sample collection techniques. Drawing on lessons from previous epidemics, such as COVID-19 and Ebola, this article emphasises the importance of robust surveillance systems, community engagement and effective risk communication, skilled health workforce and collaborative management frameworks. Strengthening early warning systems and ensuring equitable access to diagnostic and treatment resources are essential for mitigating future outbreaks of unknown diseases in resource-limited settings.

Source: Journal of Public Health Africa, https://publichealthinafrica.org/index.php/jphia/article/view/1322

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#Epidemiology and phylogenomic characterisation of two distinct #mpox #outbreaks in #Kinshasa, #DRC, involving a new #subclade Ia lineage: a retrospective, observational study

Summary

Background

Clade I monkeypox virus is endemic in DR Congo. We aim to describe the epidemiological trends of the cocirculating subclades Ia and Ib mpox outbreaks in Kinshasa, DR Congo.

Methods

This retrospective observational study included suspected and laboratory-confirmed mpox cases reported between Jan 1, 2023, and Oct 31, 2024, in Kinshasa. Skin lesion swabs or blood samples were collected as part of a routine countrywide mpox surveillance programme. To confirm the diagnosis of mpox, all samples were tested at the Institut National de Recherche Biomédicale (INRB) using real-time PCR. Whole-genome sequencing was conducted for phylogenomic analysis and assessment of APOBEC3 type mutations. Samples that remained unassigned to subclade Ia or Ib after whole-genome sequencing and real-time PCR were labelled as an unknown subclade.

Findings

As part of routine disease surveillance, 1479 suspected mpox cases were reported in Kinshasa. Samples were collected from 1314 suspected mpox cases and tested by PCR at the INRB. 440 (34%) of 1314 suspected cases had PCR confirmed mpox, with the first confirmed mpox case detected on Aug 18, 2023. 262 (60%) of 440 cases were male, 172 (39%) were female, and six (1%) were unknown, and the median age was 26 years (IQR 19–34). The epidemiological curve suggests two distinct periods during the 2023–24 outbreaks in Kinshasa. Between Aug 18, 2023, and June 30, 2024 (period 1), 218 suspected mpox cases underwent investigation and 24 (11%) were PCR confirmed as mpox; all cases were identified as subclade Ia. After a decline in suspected and confirmed cases in early 2024, the first confirmed subclade Ib mpox case in Kinshasa was reported on July 1, 2024. Between July 1 and Oct 31, 2024 (period 2), 1096 suspected mpox cases were reported and 416 (38%) were PCR confirmed as mpox. In-depth epidemiological case investigations during period 1 identified three small, self-limiting transmission chains between August and September, 2023. Case investigation data were available for 127 cases with PCR confirmed mpox, including clinical symptom data available for 61 (64%) of 95 with subclade Ia. The most commonly reported symptoms were fever (49 [80%] of 61) and skin rash (48 [79%]). The most common lesion locations were genital or anorectal (35 [64%] of 55 cases with available data). Case investigation data were available for 32 cases with subclade Ib mpox, including clinical symptom data available for 21 (66%) with subclade Ib. The most commonly reported symptoms were skin rash (18 [86%] of 21) and fever (12 [57%]). Genital or anorectal involvement was reported in 13 (68%) of 19 cases with available lesion location data. Genomic analysis shows five separate self-limiting clusters of subclade Ia (group II sampled from August, 2023, to August, 2024) and two larger clusters (occurring from July, 2024, to October, 2024, in period 2) belonging to subclade Ia (group II) and subclade Ib. 32 (68%) of 47 mutations for subclade Ia cluster outbreak and 28 (72%) of 39 mutations for subclade Ib outbreak were consistent with APOBEC3 driven changes.

Interpretation

Sustained human-to-human transmission occurred after repeated self-limiting introductions of subclade Ia documented since 2023, which has cocirculated with subclade Ib in Kinshasa from July, 2024. Increased APOBEC3 driven changes in the new subclade Ia lineage support a shift towards human-to-human transmission. These findings reveal important changes in mpox transmission dynamics and suggests that any monkeypox virus subclade has the potential to cause sustained human outbreaks when favourable transmission conditions are met.

Source: Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00294-6/abstract?rss=yes

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#Clinical presentation and #epidemiological #assessment of confirmed #human #mpox cases in #DRC: a surveillance-based observational study

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 quantitative PCR. All analyses were restricted to descriptive statistics.

Findings

Of 17 927 suspected cases identified, 10 986 were investigated, 5948 were PCR-positive, and 4895 met the inclusion criteria based on data completeness: 4436 in newly affected and 459 in endemic regions. In newly affected provinces, median age was 20 years (IQR 8–28), 2119 (47·8%) participants were female, and 2310 (52·1%) were male. In endemic provinces, median age was 15 years (7–26), 179 (39·0%) participants were female, and 277 (60·3%) were male. Direct or intimate human contact was reported by 1951 (44·0%) individuals in newly affected provinces versus 25 (5·4%) in endemic provinces, and zoonotic exposure in 11 (0·2%) and 99 (21·6%), respectively. The proportions of partcipants with systemic symptoms (3828 [86·3%] in newly affected provinces and 427 [93·0%] in endemic provinces) and respiratory symptoms (2450 [55·2%] and 219 [47·7%]), and median skin lesion counts (91 [IQR 37–200] and 163 [95–345]) were similar between newly affected and endemic regions. Complications included skin infections (2041 [46·0%] in newly affected provinces and 201 [43·8%] in endemic provinces), respiratory distress (82 [1·8%] and 29 [6·3%]), vision impairment (7 [0·2%] and 28 [6·1%]), and prostration (695 [15·7%] and 51 [11·1%]). The case-fatality rate was 0·7% (95% CI 0·4–1·3; 14 of 1924) in children and 0·6% (0·3–1·0; 14 of 2483) in adults in newly affected areas, compared with 5·9% (3·4–10·0; 14 of 236) in children and 2·7% (1·1–6·1; six of 222) in adults in endemic regions. 

Content note: this Article and its appendix contain graphic images of mpox lesions affecting various sites including the face and genitals.

Interpretation

Our study indicates concurrent mpox outbreaks in DR Congo, involving younger individuals, a higher proportion of women and girls, and distinct presentations with higher lesion counts and respiratory symptoms compared with clade 2b lineage B.1 outbreaks. The high proportion of infectious complications and case-fatality rates, especially in endemic regions, emphasise the need for timely antibiotic therapy and targeted vaccination to reduce morbidity and mortality.

Source: Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00152-7/abstract?rss=yes

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Clade Ia #Monkeypox Virus Linked to Sexual #Transmission, #DRC, August 2024

Abstract

Several concurrent mpox outbreaks are ongoing in the Democratic Republic of the Congo. We report a case of severe clade Ia mpox in an adult woman with indeterminate HIV status who died 16 days after symptom onset. She self-identified as a sex worker and had spent time in the capital city, Kinshasa.

Source: US Centers for Disease Control and Prevention, https://wwwnc.cdc.gov/eid/article/31/5/24-1690_article

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#Cluster of #community #deaths in Basankusu, Equateur- #DRC

Situation at a glance

On 9 February 2025, officials in the Democratic Republic of the Congo reported to regional health authorities a cluster of 24 unexplained community deaths in a single village in Ekoto health area, Basankusu health zone, Equateur province. 

As of 25 February, a total of 53 deaths have been reported, with the last death occurring on 22 February. 

Deaths have occurred in all age groups, but adolescents and young adults, particularly males, appeared to be disproportionately affected in the initial cluster reported. 

Disease progression appeared to be fast, with a median time from onset of symptoms to death of one day. 

Given the rapid decline in the incidence of reported deaths, their geographic clustering, the age profile of deaths and the rapid disease progression in the initial cluster, working hypotheses include chemical poisoning or a rapid onset bacterial meningitis cluster, on a background of malaria and other infectious illnesses endemic in the region. 

The definitive cause of illness remains undetermined, with initial samples testing negative for Ebola and Marburg viruses. 

Field investigations and additional laboratory testing are ongoing including but not limited to the cerebrospinal fluid testing and the toxicological analysis of environmental samples, including water and other samples to explore chemical causes. 

Local authorities began surveillance with a broad case definition including any individual with fever and at least one other symptom, to better understand disease patterns. 

A total of 1318 patients had symptoms meeting the working suspected case definition as of 25 February 2025. Approximately 50% of malaria tests performed on these cases tested positive for malaria, the cases identified through this enhanced surveillance therefore likely reflect the various febrile illnesses in the area. 

With the available information, WHO assesses the local public health risk as moderate, and the national and global public health risk as low.

Description of the situation

On 9 February 2025, an initial cluster of 24 community deaths of unknown origin were reported from a single village in Ekoto Health Area, Basankusu Health Zone, Equateur province, in the Democratic Republic of Congo. This triggered an investigation by the Ministry of Health, supported by WHO.

Enhanced surveillance was implemented shortly after, using a broad working case definition given the limited details on the clinical presentation, disease progression, demographic and other characteristics of the initial cluster. 

As of 25 February, a total of 53 deaths were reported. Deaths occurred across all age groups, but compared to the age and sex distribution of the population, appeared to disproportionately affect adolescents and young adult males, particularly in the initial cluster. This further pointed to an unusual event, as mortality from common causes in the area is usually highest among the elderly, and among young children (under five years) in a context of a high burden from infectious diseases, including malaria. The majority of deaths (50) occurred in the same village. Furthermore, the incidence of death rapidly declined following the initial cluster, suggesting this is not an event spreading in time or place.

The preliminary findings of the in-depth analysis revealed that the median time from symptom onset to death in the initial cluster was one day, with a mean time of two days. Symptoms reported include fever, chills, headaches, muscle aches, abdominal pains, diarrhea, sweating, dizziness, shortness of breath, agitation, and others.

(...)

Since the initiation of enhanced surveillance,1318 people reported symptoms meeting the working suspected case definition. However, given the broad nature of the case definition (fever and one other symptom from a range of general respiratory, gastrointestinal, or neurological symptoms), the trends in cases are difficult to interpret, and most likely reflect the prevalence of a range of febrile illnesses in the community. This is further suggested by the age distribution broadly mirroring that of the population, and the high malaria positivity among cases that were tested (approximately 50% positive on rapid diagnostic tests), which is not deemed unusual in an area where malaria is hyperendemic.

(...)

Although the cases were initially identified using a broad (i.e. non-specific) case definition, given the localized nature of the cluster of deaths, the steady decline in incidence of deaths, the demographic profile of deaths, and the rapid disease progression in the initial cluster, working hypotheses are that of a contamination by a chemical poisoning–be it accidental or deliberate—or possibly a rapid onset bacterial meningitis cluster.

Initial laboratory test results released on 13 February 2025 were negative for both Marburg and Ebola. Additional samples (blood, urine, oral, nasal) have been collected for further testing and investigations are ongoing. In addition, environmental samples–including water and other samples–are being collected to explore chemical causes, such as contamination by organophosphates.

The definitive cause of illness remains undetermined. Further testing and field investigations are ongoing to better characterize the cases and deaths.

Of note, this event in Basankusu follows a recent cluster of community deaths in the Bolomba Health Zone, which occurred from 10 to 27 January 2025. The epidemiological investigation documented 12 cases with eight deaths. Laboratory testing excluded Ebola and Marburg virus diseases and suggested that severe malaria could be the cause. While both Bolomba and Basankusu are located within Equateur Province, these health zones are separated by approximately 175 kilometers of difficult terrain including dense forests and poor road infrastructure; epidemiological investigation has found no evidence linking these distinct events.

Public health response

-- Coordination: A provincial rapid response team deployed to Basankusu and arrived on 16 February. The team was further supported by a WHO-MoH team from Kinshasa which arrived on 23 February.

-- Surveillance: WHO is supporting the MoH teams with field investigations, including the development of a structured epidemiological investigation protocol and the collection of additional samples for testing. As surveillance is being scaled up, the focus is on better understanding the characteristics of deaths. WHO is supporting health teams in their case investigations and active case search in the affected areas, including in communities, churches, and health facilities.

-- Laboratory: WHO is providing laboratory support to guide proper collection, storage, and transport of collected specimens to the National Institute of Biomedical Research (INRB) in Kinshasa, the biggest and most equipped laboratory in the country.

-- Logistics: WHO has provided essential medical supplies for management of usual infectious diseases and their symptoms, laboratory testing and infection prevention and control (IPC).

-- Risk communication and community engagement: Community engagement efforts are ongoing. Training sessions for community health workers are being conducted on how to identify people who meet the case definition and perform disease surveillance reporting. Awareness activities include community briefings and local radio broadcasts, as well as targeted discussion in villages on care-seeking behavior. 

-- Infection prevention and control: Systematic decontamination of isolation rooms at the General Hospital in Basankusu and Ekoto Health Center have been performed. On-site training of IPC supervisors and hygienists on chlorine solution preparation for decontamination have been conducted.

WHO risk assessment

Since the initial cluster of deaths was reported on 9 February 2025, there has been an overall downward trend in deaths. The most recent death was reported on 22 February 2025. Current epidemiological information suggests a localized event with a steady decline in incidence, not expanding in time and place. Given the clinical presentation of deaths and the speed from symptom onset to death in this unusual cluster, current differentials include a rapid onset bacterial meningitis cluster or a contamination by a chemical poisoning as key hypotheses in a context of high incidence of other common infectious diseases in the areas, particularly malaria.

Operational challenges related to this event involve the isolation of Basankusu and resulting logistical barriers, as it is located in a forested region, approximately 450 kilometers from the nearest major city of Mbandaka and has poor infrastructure. The remoteness of Basankusu has hindered the timeliness of the initial investigation and response activities and poses challenges to laboratory testing. Samples must be collected, stored, and shipped long distances to a larger city with laboratory testing capacity (either Mbandaka or Kinshasa), introducing delays in diagnosis. Access to care is another key challenge, as the region lacks robust healthcare services, and the region’s poor infrastructure makes travel to neighboring health zones difficult, leading to delays in treatment.  

The province faces a severe urban water crisis with only 5% of its urban population having access to drinking water. The water network suffers frequent leaks and has never been rehabilitated. Many households rely on unregulated private water sources such as wells, springs and streams which pose contamination risks.

With ongoing investigations and given that the causative agent of the cluster is not yet determined, there remains a level of risk attributed to the event. As such, the overall public health risk level to the affected communities is assessed as moderate.

At the national level, however, the risk is considered low due to the localized nature of the event and apparent decreasing incidence. Similarly, at the regional and global levels, the risk is low at this time. 

WHO advice

To reduce the impact of the event in the Basankusu health zone, WHO advises the following measures:  

-- Careful characterization of the clinical syndrome and outcomes as well as an improved case definition based on collected information to better understand the outbreak.

-- Enhanced surveillance focusing specifically on deaths, and severe febrile cases or severe cases of unexplained illness, with better clinical characterization to reinforce early case detection and reporting.

-- Continued laboratory testing and environmental assessments (including water sources) to evaluate the current hypotheses of meningitis and/or a toxin/poisoning event, particularly among severe cases and deaths.

-- Risk communication and community engagement to increase public awareness about the event, explaining symptoms and the importance of seeking immediate care. It is also critical to address any potential misinformation about the outbreak circulating in the community.

Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON557

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#DRC deepens #investigation on #cluster of #illness and #community #deaths in #Equateur province

Kinshasa – Health authorities in the Democratic Republic of the Congo and experts from World Health Organization (WHO) are carrying out further investigations to determine the cause of another cluster of illness and community deaths in Equateur province. 

In recent months, disease surveillance has identified increases in illness and deaths three times in different areas of the country, and triggered follow-up investigations to confirm the cause and provide needed support.  

Since the beginning of 2025, a series of illnesses and community deaths have affected Equateur province. The most recent cluster occurred in the Basankusu health zone, where last week 141 additional people fell ill, with no deaths reported. In the same health zone, 158 cases and 58 deaths were reported in the same health zone earlier in February. In January, Bolamba health zone reported 12 people who fell ill including 8 deaths. 

Increased disease surveillance has identified in total of 1096 sick people and 60 deaths in Basankusu and Bolomba fitting a broad case definition that includes fever, headache, chills, sweating, stiff neck, muscle aches, multiple joint pain and body aches, a runny or bleeding from nose, cough, vomiting and diarrhoea.  

The Democratic Republic of the Congo is facing many concurrent crises and outbreaks, putting a further strain on the health sector and the population. 

In response to the latest cluster of illness, a national rapid response team from Kinshasa and Equateur including WHO health emergency experts was deployed to Basankusu and Bolomba health zones to investigate the situation and determine if there is an unusual pattern. The experts are stepping up disease surveillance, conducting interviews with community members to understand the background, and providing treatment for diseases such as malaria, typhoid fever and meningitis.  

WHO has delivered emergency medical supplies, including testing kits, and developed detailed protocols to enhance disease investigation. 

Initial laboratory analysis has turned out negative for Ebola virus disease and Marburg virus disease. 

Around half of the samples tested positive for malaria, which is common in the region. Further tests are to be carried out for meningitis. Food, water and environmental samples will also be analysed, to determine if there might be contamination. The various samples will be sent for further testing at the national reference laboratory in Kinshasa. Earlier samples turned out not to be viable and re-testing was undertaken.  

Basankusu and Bolomba are about 180 kilometres apart and more than 300 kilometres from the provincial capital Mbandaka. The two localities are reachable by road or via the Congo River from Mbandaka. This remoteness limits access to health care, including testing and treatment. Poor road and telecommunication infrastructure are also major challenges. 

WHO is supporting the local health authorities reinforce investigation and response measures, with more than 80 community health workers trained to detect and report cases and deaths.   

Further efforts are needed to reinforce testing, early case detection and reporting, for the current event but also for future incidents. WHO remains on the ground supporting health worker, collaborating closely with zonal, provincial and national health authorities to provide lifesaving medical supplies and to coordinate response to curb the spread of the illness and other outbreaks in the region. 

Source: World Health Organization, Regional Office for Africa, https://www.afro.who.int/countries/democratic-republic-of-congo/news/democratic-republic-congo-deepens-investigation-cluster-illness-and-community-deaths-equateur

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Evolving #Epidemiology of #Mpox in #Africa in 2024

Abstract

Background

For decades after the identification of mpox in humans in the Democratic Republic of Congo (DRC) in 1970, the disease was largely confined to the rural areas of Central and West Africa and thus did not garner broad attention. On August 13, 2024, mpox was declared a Public Health Emergency of Continental Security (PHECS) by the Africa Centers for Disease Control and Prevention (Africa CDC), a notice that was followed the next day by a declaration of a Public Health Emergency of International Concern (PHEIC) by the World Health Organization.

Methods

In this study we analyzed all mpox cases and deaths, based on clinical or laboratory diagnosis, that were reported to the Africa CDC from January 1, 2022, to October 30, 2024, to identify temporal variations, geographic distributions, and epidemiologic trends.

Results

From January 1, 2022, to August 18, 2024, a total of 45,652 mpox cases were clinically diagnosed and laboratory-confirmed in 12 African countries. These cases resulted in 1492 deaths (case fatality rate, 3.3%). From 2022 to 2024, weekly laboratory-confirmed mpox cases increased by a factor of 2.8 (from 176 to 489 cases), whereas all weekly reported cases (including those with a clinical diagnosis) increased by a factor of 4.3 (from 669 to 2900 cases). The DRC, which had reported approximately 88% of mpox cases in Africa in 2024, had 19,513 cases before the emergency declaration, with a case fatality rate of 3.1% — a weekly average of 591 cases as compared with 281 in 2023. In 2024, six African countries reported their first imported mpox infections, with Burundi also reporting local transmission.

Conclusions

The high mpox disease burden in Africa, especially in the DRC — with a rising number of cases, high case fatality rate, and high degree of spread to other previously mpox-free African countries — is cause for increased international concern. Case detection, contact tracing, public health measures, and affordable vaccines are needed to implement interventions in the DRC to reduce the risk of global spread of the virus.

Source: New England Journal of Medicine, https://www.nejm.org/doi/full/10.1056/NEJMoa2411368?query=TOC

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Suspected and confirmed #mpox cases in #DRC: a retrospective #analysis of national epidemiological and laboratory #surveillance data, 2010–23

Summary

Background

DR Congo has the highest global burden of mpox, a disease caused by infection with the monkeypox virus. The incidence has risen since 1980, but recent analyses of epidemiological trends are lacking. We aimed to describe trends in suspected and confirmed mpox cases in DR Congo using epidemiological and laboratory mpox surveillance data collected from 2010 to 2023, and provide insights that can better inform the targeting and monitoring of control strategies.

Methods

We analysed aggregated national epidemiological surveillance data and individual-level laboratory data from 2010 to 2023. We calculated incidence based on suspected cases, case-fatality ratios, and percentage of laboratory-confirmed cases and assessed geospatial trends. Demographic and seasonal trends were investigated using generalised additive mixed models.

Findings

Between Jan 1, 2010, and Dec 31, 2023, a total of 60 967 suspected cases and 1798 suspected deaths from mpox were reported in DR Congo (case-fatality ratio 2·9%). The number of reporting provinces increased from 18 of 26 provinces in 2010 to 24 of 26 provinces in 2023. The annual incidence increased from 2·97 per 100 000 in 2010 to 11·46 per 100 000 in 2023. The highest incidence (46·38 per 100 000) and case-fatality ratio (6·0%) were observed in children younger than 5 years. Incidence was higher in rural compared with urban areas. PCR testing was performed for 7438 suspected cases (12·2%), with 4248 (57·1%) of 7438 samples testing positive. Median age of confirmed cases (13·0 years [IQR 6·0–25·0]) remained stable, although the 95th percentile of age increased over time.

Interpretation

The incidence and geographical distribution of suspected mpox cases have increased substantially since 2010. Improvements in surveillance and decentralised testing are essential to monitor mpox trends and direct interventions effectively, to address the public health emergency declarations issued in August, 2024.

Funding

Belgian Directorate-General Development Cooperation and Humanitarian Aid; European and Developing Countries Clinical Trials Partnership; Research Foundation–Flanders; European Civil Protection and Humanitarian Aid Operations; Department of Economy, Science, and Innovation of the Flemish Government; Canadian Institutes of Health Research; and the International Development Research Centre.

Source: Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02669-2/abstract?rss=yes

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