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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#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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Acute #respiratory #infections complicated by #malaria (previously undiagnosed disease) - #DRC

{Excerpts}

27 December 2024

Situation at a glance

This is an update to the Disease Outbreak News on Undiagnosed disease in the Democratic Republic of the Congo published on 8 December 2024 (now named acute respiratory infections complicated by malaria). 

It includes updated epidemiological investigation information and preliminary laboratory results. 

On 29 November, an alert was raised by local health zone authorities of Panzi health zone in Kwango province after an increase in deaths, particularly among children under five years of age, following febrile illness. 

Enhanced epidemiological surveillance was rapidly implemented, which in the absence of a clear diagnosis was based on the detection of syndromic cases of febrile illnesses with cough, body weakness, with one of a number of other symptoms compatible with acute respiratory and febrile illnesses. 

This resulted in a rapid increase in the number of cases meeting the definition, with a total of 891 cases reported as of 16 December. 

However, the weekly number of reported deaths (48 deaths reported over the period) has remained relatively stable. 

As of 16 December, laboratory results from a total of 430 samples indicated positive results for malaria, common respiratory viruses (Influenza A (H1N1, pdm09), rhinoviruses, SARS-COV-2, Human coronaviruses, parainfluenza viruses, and Human Adenovirus). 

While further laboratory tests are ongoing, together these findings suggest that a combination of common and seasonal viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths, disproportionally affecting children under five years of age. 

Multidisciplinary rapid response teams have been deployed to investigate the event and strengthen the response. 

Efforts are ongoing to address the health needs in Panzi health zone. 

Enhanced surveillance in the community and within health facilities continues. 

The teams have also been providing support for diagnosis, the treatment of patients as well as with risk communication and community engagement. 

This event highlights the severe burden from common infectious diseases (acute respiratory infections and malaria) in a context of vulnerable populations facing food insecurity. It emphasizes the need to strengthen access to health care and address underlying causes of vulnerability, particularly malnutrition, given the worsening food insecurity.

Description of the situation

Since the last Disease Outbreak News on this event was published on 8 December 2024, 485 additional suspected cases and 17 additional deaths have been reported from Panzi health zone in Kwango Province, Democratic Republic of the Congo, across 25 out of the 30 health areas in Panzi. These cases were identified as a result of enhanced surveillance put in place following the report of deaths in the context of febrile illness with acute respiratory symptoms and anaemia, first reported on 29 November. While the number of reported cases was not deemed particularly unusual in a context of high burden of pneumonia, malaria and acute respiratory infections, particularly at the start of the rainy season, it is the increase in the number of deaths that triggered the alert on 29 November.

In the absence of diagnosis, a broad surveillance case definition was used, with the resulting case numbers reflecting the detection of any febrile illness occurring in Panzi and thus representing a range of diseases and clinical syndromes. The case definition includes: any person living in the Panzi health zone from September 2024 to date, presenting with fever, cough, body weakness, runny nose, with or without one of the following symptoms and signs: chills, headache, difficulty breathing, malnutrition, body aches. This was done to better understand the epidemiology and characteristics of deaths and to collect a range of clinical samples for laboratory testing.

Between 24 October and 16 December 2024, 48 deaths and a total of 891 cases across 25/30 health areas of Panzi health zone met the case definition. Children under five years of age are disproportionally affected, representing 47% of all cases and 54% of all deaths, while they represent around 18% of the population, likely reflecting the vulnerability of young children to severe disease and death in this context. The main symptoms associated with death include difficulty in breathing, anaemia, and signs of acute malnutrition.

A total of 430 samples including blood samples, oropharyngeal and nasopharyngeal swabs, urine and breastmilk samples were collected from suspected cases in Panzi health zone and transported to the laboratory at the INRB. 

Out of 88 rapid diagnostics tests for malaria performed in the field, 55 (62%) samples tested positive. In addition, out of 26 samples analyzed by PCR BioFire Global Fever Panel test (which tests 18 different pathogens including some of the viral hemorrhagic fevers), 17 (65%) samples tested positive for Plasmodium falciparum.  In addition, a total of 89 samples were tested at INRB Respiratory Disease Surveillance Laboratory. Of the 89 samples, 64 samples were positive for common respiratory viruses including Influenza A (H1N1, pdm09) (n=25), rhinoviruses (n=18), SARS-COV-2 (n=15), Human coronaviruses (n=3), parainfluenza viruses (n=2), and Human adenovirus (n=1).

Other laboratory tests on the collected samples, including virological and bacterial analysis, are still ongoing. The ongoing investigations and preliminary laboratory findings suggest that a combination of common viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths.

Enhanced surveillance will continue, alongside response activities. The number of weekly reported suspected cases has remained steady with the exception of an increase in epidemiological week 50 (week ending 15 December 2024, Figure 1). While this may partly reflect an increase in transmission of respiratory viruses and malaria with the rainy season, it is driven by an increase in surveillance and case finding following the deployment of the rapid response teams. Notably, the increase in cases is not matched with a comparable increase in deaths.

(...)

There are proportionally more cases reported among females (58%, 514/889), particularly among adults (66% female, 173/262). While data is lacking to better understand this difference, it may stem from contact patterns of respiratory virus transmission within households, particularly a close interaction between mothers and children during acute respiratory illnesses. 

(...)

The affected area experienced deterioration in food security in recent months, with increasing levels of acute malnutrition. Between July and December 2024, which coincides with a drop in acute malnutrition, Kwango province was in Integrated Food Security Phase Classification (IPC) Acute Malnutrition (AMN) Phase 3 (Serious). Between January and June 2025, an increase in cases of malnutrition is projected in the province with a significant deterioration in the nutritional situation expected, moving to IPC AMN Phase 4 (Critical). Between July 2024 and June 2025, nearly 4.5 million children aged 6 to 59 months in the DRC are facing or expected to face acute malnutrition, including approximately 1.4 million cases of severe acute malnutrition and 3.1 million cases of moderate acute malnutrition. It is also estimated that 3.7 million pregnant and breastfeeding women are facing or expected to face acute malnutrition over the same period.[1]

Severe acute malnutrition is a life-threatening condition that requires medical treatment. In addition, disease and malnutrition combine to worsen each other. The area has low routine vaccination coverage. There is also very limited access to diagnostics and quality case management, and a lack of supplies and transportation, shortage of health staff in the area, as well as financial and geographical barriers to access to health care. Increasing malaria trends are expected with the start of the rainy season, however, malaria control measures in the area are very limited. Together, these factors may increase the severity of malaria, and common respiratory infections.

Overall, this event highlights the severe burden from common infectious diseases (acute respiratory infections and malaria) in a context of vulnerable populations facing food insecurity and emphasizes the need to strengthen access and quality of health care.

Public health response

1. Leadership and coordination:

Daily coordination meetings are being held at the national level, with provincial teams actively participating in ongoing planning and response.

National rapid response team (RRT) composed of experts from Ministry of Health (MoH), INRB and WHO deployed from Kinshasa on 7 December and arrived in Panzi on 10 December. Following the departure of the national team, a joint MoH-Africa CDC rapid response team has been deployed with support from WHO.

2. Surveillance:

A case definition has been developed based on clinical symptoms observed, guiding surveillance and reporting efforts.  

Active case search is continuing in health facilities and the community. 

Data collection is ongoing, focusing on preparing a line list and detailed epidemiological analysis.  

Community deaths are being investigated to better understand the context of deaths and vulnerability factors.

WHO is deploying a senior epidemiologist and a data manager to support the ongoing surveillance activities and improve data collection.

3. Case Management:

Provincial and national RRTs, including WHO, UNICEF and Médecins Sans Frontières, have been deployed to the affected areas and are strengthening case management in health facilities as well as providing medical supplies including medication. The teams carried medication and medical equipment to support case management and prevent more deaths.

Efforts are underway to strengthen the capacity of healthcare providers to ensure the best possible care for patients. 

Six oxygen concentrators are being installed at the Panzi General Referral Hospital and three hotspot health centers to support patient care.

4. Laboratory:

Laboratory equipment was transported to collect samples from cases and send samples for testing at the INRB in Kinshasa. Additionally, RDTs for malaria and COVID-19 have been provided to assist in diagnosis. 

Laboratory reagents have been procured to continue facilitating the ongoing testing at INRB.

5. Risk communication and community engagement:

Key messages were developed to enhance public awareness and encourage general preventive behaviors. These messages are being disseminated through community engagement, with sensitization campaigns underway. 

6. Infection prevention and control:

Infection prevention and control measures are being reinforced. Health workers have been briefed on key practices, including the proper use of masks, hand washing, and gloves, to reduce the risk of transmission of respiratory and other pathogens. 

7. Logistics

Logistical support is being provided for effective case management, including the transportation of samples to INRB Kinshasa for laboratory testing. Health facilities and hospitals in the most affected health areas are being supplied with appropriate medications and sampling kits to support the response. 

Medical kits for malaria, IPC kits, blood transfusion kits as well as additional medical supplies to support treatment efforts have been provided.

A mobile internet kit is being deployed to address some of the telecommunication challenges in the affected health zone. 

WHO risk assessment

Symptoms such as fever, cough, headache, and body aches have been observed since 24 October, primarily through health worker reports, and an uptick in deaths was observed in epi week 47, which triggered the signal. Since the alert was reported, there has not been any significant increase in reported deaths.

The epidemiological information together with the early laboratory result indicate an event triggered by an increase in acute respiratory virus cases associated with malaria, with a background of a worsening of the nutritional situation in Panzi, disproportionally affecting young children. 

The WHO African Region accounts for about 94% of all malaria cases and 95% of deaths globally (World Malaria Report 2024). Children under five account for about 76% of all malaria deaths in the Region. Over half of these deaths occurred in four countries: Nigeria (30.9%), the Democratic Republic of the Congo (11.3%), Niger (5.9%) and United Republic of Tanzania (4.3%). Support is being provided for laboratory diagnosis and strengthening case management including the treatment of malaria cases with appropriate medication.

An increase in common respiratory viruses and malaria is expected at this time of year in Panzi with the rainy season, however it is the increase in deaths that triggered the initial signal. There has been an increase in influenza and SARS-CoV-2 activity reported from Kinshasa through sentinel sites since mid-October. WHO and UNICEF estimates of national immunization coverage for 2023 show DTP3 and PCV3 coverage at 60% and 59%, respectively, however, no data is currently available for the affected health zone, leading to uncertainties about vaccine-derived population immunity.

The Integrated Food Security Phase Classification (IPC) for acute food insecurity levels in Kwango province increased from IPC 1 (acceptable) in April 2024 to IPC 3 (Crisis Level) in September 2024. This suggests a significant phase of increase in food insecurity and risk of severe acute malnutrition. In Addition, the IPC acute malnutrition classification currently classifies Panzi health zone as IPC acute malnutrition phase 3 (serious), projected to move to phase 4 (critical) from January 2025.

While mortality from common infectious diseases is expected to increase as transmission increases, this event highlights that mortality from known and expected infectious diseases can be high in a context of vulnerability and malnutrition, emphasizing the need to strengthen malaria control, clinical management, improve access to care and reduce the prevalence of malnutrition.

Gaps in case management have also been identified. Stock-outs of medications for treating common diseases frequently occur, and care is not provided free of charge, which could limit access to treatment for vulnerable populations and increase severity and mortality of known and treatable infections.

The affected area’s remoteness and logistical barriers, including a two-day or longer road journey from Kinshasa due to the rainy season affecting the roads and limited telecommunication network coverage across the health areas, have hampered the rapid deployment of response teams and resources. Furthermore, there is no functional laboratory in the health zone or province, requiring the collection and shipment of samples to Kinshasa for analysis. This has delayed diagnosis and can continue to impact the ongoing response efforts. 

Insecurity in the region adds another layer of complexity to the response. The potential for attacks by armed groups poses a direct risk to response teams and communities, which could further disrupt the response. 

Based on the above rationale, the overall public health risk level to the affected communities is assessed as high, and requires an integrated public health approach to reduce mortality from infections, improve nutritional status and strengthen malaria control, among others.

At the national level, the risk is considered low due to the localized nature of the event and that it is caused by a range of illnesses whose severity is compounded by the vulnerability of the population in the local context. However, many other areas of DRC are seeing increasing levels of malnutrition, and what has been witnessed in Panzi could also happen elsewhere in the country.

As such, efforts need to continue to prevent similar situation in other vulnerable parts of the country.  At the regional and global levels, the risk remains low at this time.  

WHO advice

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

-- Strengthening coordination mechanisms at all levels—national, provincial, zonal, and local—is critical for a unified response. Enhanced communication infrastructure, such as satellite phones, is required to overcome the limited network coverage in affected areas.

-- Improving surveillance efforts is a priority to better understand disease trends and mortality. Active case searches should continue in both health facilities and communities, with a particular focus on areas reporting deaths and family clusters. Community-based surveillance must be strengthened to ensure early case detection and rapid response.

-- Careful characterization of the clinical syndrome and outcomes and an improved case definition based on the information collected will be necessary to understand the situation. In particular, data which clarify possibility of coinfection and multiple pathologies, and uncertainties in outcomes among vulnerable groups should be collected. The WHO has established the Global Clinical Platform to provide rapid turnaround of structured data analysis using anonymized case records; its use is recommended in the detailed capture of patient syndromes and outcomes. 

-- Effective case management requires ensuring an adequate supply of essential medications, access to oxygen therapy, and training of healthcare workers including basic emergency and critical care to support treatment and prevent more deaths. RDTs for malaria should be distributed to facilitate early diagnosis and prompt treatment. Long-term laboratory capacity strengthening, and decentralization will be important in provision of diagnostic capability in the affected health zone and detect cause of deaths early.  

-- Infection prevention and control measures must be reinforced across all health facilities. Healthcare workers should receive training on best practices, including the proper use of personal protective equipment such as masks and gloves, as well as strict hand hygiene protocols. These measures will reduce transmission risks within health facilities and improve the safety of healthcare delivery.  

-- The role and added value of the health sector during food crises is crucial to prevent, reduce and reverse the causal relationship between poor nutrition, disease and death – before, during and after the onset of severe food shortages. As needs and vulnerabilities during food crises are complex, interlinked and multidimensional, intersectoral coordination and collaboration, especially between the health, nutrition, water, sanitation and hygiene (WASH) and food security clusters, should be stepped up as part of the overall humanitarian response. Data collection and analysis should be strengthened to inform the overall response.

-- Risk communication and community engagement are essential to raising public awareness. Targeted messages should be disseminated to educate the public on respiratory illness symptoms, preventive measures, and the importance of seeking care early. Community leaders must be engaged to build trust and encourage adherence to public health guidance. Addressing misinformation and fears within the community is critical to ensuring effective collaboration in the response.  

-- Logistical and security challenges also require attention. Strengthening logistical support for the deployment of teams and supplies will ensure timely access to affected areas. Contingency plans should be developed to address potential insecurity posed by armed groups, safeguarding response personnel and maintaining continuity in response activities.  

(...)

Source: World Health Organization, https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON547

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#DRC, #Kwango province affected by #influenza {A #H1N1} virus in #Panzi health zone

The flu caused by the Influenza virus, associated with malaria on a ground of malnutrition, is the unknown disease that has been decimating the population in the health zone of Panzi, in the province of Kwango, for more than a month.

This is what the diagnosis made by the INRB reveals after in-depth analyses. 

The governor of Kwango province, Willy Bitwisila, officially declared on Wednesday night, December 5, this epidemic which has caused around thirty deaths and more than 400 cases in this part of the Kasongolunda territory.

"This is the epidemic that is causing deaths in the previously unidentified Panzi health zone. 

''After a rigorous investigation, the results from the INRB laboratory have just confirmed that it is influenza caused by the Influenza AH1N1 virus, {rhinovirus, SARS-CoV-2, edited, in the article the terms are unreadable}, associated with malaria on the ground of malnutrition. 

''An epidemic that I am now officially declaring. I would therefore like to reassure each and every one of you that all necessary measures are being taken to slow the spread of this virus," said Willy Bitwisila.  

Source: Radio Okapi, https://www.radiookapi.net/2024/12/26/actualite/sante/la-province-du-kwango-affectee-par-le-virus-influenza-dans-la-zone-de

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#Hypotheses raised over unknown #disease in #DRC as test results awaited

 {Excerpt}

KINSHASA, Dec. 21 (Xinhua) -- The Democratic Republic of the Congo (DRC) is grappling with a deadly illness of unknown origin that has claimed dozens of lives in a province, prompting investigations and heightened alertness as test results are awaited.

"This is, therefore, influenza, which has been formally identified," Patrick Muyaya, spokesperson for the DRC government, announced at a national television broadcast late Friday as he read the minutes of the Council of Ministers meeting chaired by President Felix Tshisekedi in Kinshasa, the country's capital, earlier that day.

During the meeting, Public Health Minister Roger Kamba said that since October, 592 cases of the illness have been recorded in the Panzi health zone of the southwestern Kwango province. Symptoms exhibited by patients are "similar to the flu," according to Kamba, who noted that the outbreak coincides with the seasonal flu period, which peaks in December.

Laboratory analysis revealed a 28 percent prevalence of the influenza virus, Muyaya said, noting a "significant presence" of human rhinovirus and SARS-CoV-2 in the samples, which accounted for the respiratory infections identified.

The Ministry of Public Health has not yet provided further clarification. However, the government declared a "high alert" earlier this month in response to the alarming situation.

Meanwhile, the African Centers for Disease Control and Prevention (Africa CDC) has highlighted two working hypotheses regarding the illness, which has so far caused 37 deaths in health facilities, primarily among children under five.

Investigators are also examining whether an additional 44 community-reported deaths are linked to the outbreak, which has a case-fatality rate of {62 percent - this figure is not compatible with total cases just above mentioned - GM}, according to the Africa CDC.

Ngashi Ngongo, chief of staff at Africa CDC, said during a Thursday press briefing that the first hypothesis suggests a combination of severe malaria, malnutrition, and a viral infection, while the second points to a viral infection co-occurring with malaria and malnutrition. Ngongo added that an adult patient presenting with hemorrhagic fever symptoms had died, with their sample sent to Kinshasa for further analysis.

(...)

Source: Xinhua, https://english.news.cn/20241221/06f87e5efb0e44559ef5ce528fbf43ea/c.html

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New undiagnosed #disease in #DRC: urgent action needed

 {Excerpt}

The outbreak of an undiagnosed disease in DR Congo, reported by WHO on Dec 8, 2024,1 is a pressing global health concern that demands swift and coordinated action. As of Dec 5, 406 cases and 31 deaths have been reported in the Panzi health zone in Kwango province, with influenza-like symptoms and anaemia. Most affected individuals are children aged younger than 5 years, many of whom are severely malnourished.

The remoteness of the region and poor infrastructure complicate the identification of the pathogen, with suspicions that multiple diseases could be contributing to these cases. Furthermore, the outbreak has the potential to transcend regional boundaries, particularly as DR Congo shares porous borders with Angola, where provinces such as Uige are vulnerable to cross-border transmission. Mobility between these regions could facilitate the spread of the disease to neighbouring African countries, raising the potential for a Public Health Emergency of International Concern.

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Source: Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02794-6/fulltext

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#Italy, a 55-year-old man died from suspected #hemorrhagic #fever: after returning from a trip to #DRC

 {Excerpt}

He had recently returned from a trip to Congo and died on Monday evening from a suspected case of hemorrhagic fever . The victim is a 55-year-old man from Trevignano , in the province of Treviso. The news was communicated by the Public Health Hygiene Service of the Azienda Ulss 2 Marca trevigiana and diagnostic tests are underway in collaboration with the Spallanzani Institute of Rome to trace the origins of the death.

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Source: Il Fatto Quotidiano (in Italian), https://www.ilfattoquotidiano.it/2024/12/17/treviso-55enne-morto-febbre-emorragica-rientrato-congo/7808209/

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#Vietnam, Epidemiological #surveillance reinforced at Noi Bai #airport to prevent a #disease that appeared in the #DRC

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According to the Hanoi Center for Disease Control (CDC), in close collaboration with international health authorities, it maintains enhanced epidemiological surveillance at Noi Bai airport to quickly detect any suspected cases and implement preventive measures adapted to the evolution of the global and local health situation.

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Source: Vietnam+, https://fr.vietnamplus.vn/surveillance-epidemiologique-renforcee-a-laeroport-de-noi-bai-pour-prevenir-une-maladie-apparue-en-rdc-post237120.vnp 

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