Mpox in the Democratic Republic of the Congo

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Mpox in the Democratic Republic of the Congo
Monkeypox 12778.jpg
Mpox (large lymph node in neck), DRC 1996/1997
Disease Mpox
Virus strain Monkeypox virus
SourceInitially mainly animal contact in rainforest, later greater human-to-human transmission
Location Democratic Republic of the Congo

Mpox is endemic in western and central Africa, with the overwhelming majority of cases occurring in the Democratic Republic of the Congo (DRC), [1] [2] where the more virulent clade Ib has seen a rapid rise in infections since September 2023.

Contents

Many cases occur sporadically or in small clusters, but large outbreaks also occur. [2]

Early cases

The world's first case of human mpox was detected in a nine-month old child in 1970 in the Democratic Republic of the Congo (then Zaire), [3] [4] two years after it reported its last case of smallpox. [5] The onset of their rash was on 24 August. [6] That year, the disease was identified in another four children, including three in Liberia who were playmates. [7] At the time, evidence of the virus was found in non-human primates in Liberia and Sierre Leone. [7]

Active surveillance by the World Health Organization (WHO) between 1981 and 1986, identified 338 cases with a human-to-human transmission rate of 28%. [8] [9] Until 1986, 95% of cases worldwide were identified in the DRC. [10] Cases were rare in people over the age of 15-years, and over two-thirds of infections could be traced to animal contact within the rainforests. [11] Initially it was uncommon for a family member to contract the infection if they had a smallpox scar, evidence of prior vaccination. [11]

1996 reemergence

A reemergence of the disease in the DRC in 1996 also saw a large number of reported but not all laboratory confirmed cases, with a high transmission rate and lower fatality rate; leading experts to believe a significant number may have actually been chicken pox. [9] [12] Some likely had both mpox and chickenpox at the same time. [5] The DRC's Kasaï-Oriental region saw the largest number of cases during 1996–1997. [5]

Between 1996 and 2005, mpox cases appeared to be gradually increasingly in older people, with less than a quarter of cases being traced to rainforest animal contact, and with greater close contact infections. [11] Between January 2001 and December 2004, 2,734 cases of suspected human mpox were reported from the DRC. [9] However, civil war limited surveillance and only 171 clinical specimens were obtained from 136 suspected cases; less than 5% of all reported cases. [9]

2005 onwards

After 2005, the DRC was reporting more than 1,000 suspected cases per year. [13] Between November 2005 and November 2007, 760 laboratory-confirmed human mpox cases were detected; particularly in people living in forested areas, males, age less than 15-years, and no previous smallpox vaccination. [14]

Many cases occur sporadically or in small clusters, but large outbreaks also occur. [2] The risk of human-to-human transmission within households in the DRC was noted to range from 50% to 100% during the 2013 outbreak. [5] The DRC's Bokungu Health Zone saw an increase in cases of 600-fold that year. [2] In 2019 the DRC reported 3,794 suspected cases and 73 deaths. [10] In the first nine-months of 2020, it reported over 4,500 suspected cases of mpox, including 171 deaths. [10]

Mpox is reportable in the DRC, where the disease is endemic, and disease burden remains high. [2] [15] There, the more virulent clade I has been affecting some of the world's poorest and socially excluded communities. [16] A regional surveillance system collects reports of all suspected mpox cases, and where possible, they may be investigated. [2]

2023-2024 outbreak

This section is an excerpt from Mpox § 2023–2024 Central Africa outbreak.[ edit ]

During 2023, a clade I outbreak of mpox disease in the Democratic Republic of the Congo resulted in 14,626 suspected cases being reported, with 654 associated deaths, making for a case-fatality rate of 4.5%. The outbreak continued into 2024, with 3,576 suspected mpox cases and 265 deaths reported in the Democratic Republic of the Congo through the first nine weeks of the year, making for an estimated CFR of 7.4%. [17]

Transmission of the virus in the outbreak appears to be primarily through sexual and close familial contact, with cases occurring in areas without a history of mpox, such as South Kivu and Kinshasa. An estimated 64% of the cases and 85% of fatalities have occurred in children. The outbreak consists of two separate sub-variants of clade I, with one of the sub-variants having a novel mutation, making detection with standard assays unreliable. [17] [18]

The outbreak spread to the neighbouring country of the Republic of the Congo, with 43 cases reported in March 2024. [17] By early August the outbreak spread further into central and southern Africa with cases of clade I and clade II strains reported in Burundi, Rwanda, Uganda, Kenya, Cote d'Ivoire and South Africa. [19] [20]

The WHO declared this a Global Health Emergency on 14 August 2024. [21] The following day, Sweden became the first non-African country to report a case of clade I mpox. [22]

On 19 August 2024, the DRC's Ministry of Public Health, Samuel-Roger Kamba Mulamba  [ fr ], said in a press conference that all of the country's provinces, including the capital city of Kinshasa, had been affected by the outbreak, [23] while announcing that the national government would launch a €45 million response plan including awareness campaigns, medical team deployment and patient care, but not vaccines. [23] [24] Kamba also said that the DRC needed about 3.5 million doses of mpox vaccines, with roughly 215.000 doses set to be donated by Belgium and up to three million doses being donated by Japan, and further donations being expected by the United States. [25] [26] On 26 August, Germany's federal government publicly announced that it would donate 100,000 vaccines to the DRC and other neighbouring African countries. [27] [28]

Related Research Articles

<span class="mw-page-title-main">Mpox</span> Viral disease of humans and animals

Mpox is an infectious viral disease that can occur in humans and other animals. Symptoms include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The illness is usually mild, and most of infected individuals recover within a few weeks without treatment. The time from exposure to the onset of symptoms ranges from three to seventeen days, and symptoms typically last from two to four weeks. However, cases may be severe, especially in children, pregnant women, or people with suppressed immune systems.

<span class="mw-page-title-main">Monkeypox virus</span> Species of double-stranded DNA virus

The monkeypox virus is a species of double-stranded DNA virus that causes mpox disease in humans and other mammals. It is a zoonotic virus belonging to the Orthopoxvirus genus, making it closely related to the variola, cowpox, and vaccinia viruses. MPV is oval, with a lipoprotein outer membrane. The genome is approximately 190 kb. Smallpox and monkeypox viruses are both orthopoxviruses, and the smallpox vaccine is effective against mpox if given within 3–5 years before the disease is contracted. Symptoms of mpox in humans include a rash that forms blisters and then crusts over, fever, and swollen lymph nodes. The virus is transmissible between animals and humans by direct contact to the lesions or bodily fluids. The virus was given the name monkeypox virus after being isolated from monkeys, but most of the carriers of this virus are smaller mammals.

<span class="mw-page-title-main">2022–2023 mpox outbreak</span> World public health emergency (May 2022 – May 2023)

In May 2022, the World Health Organization (WHO) made an emergency announcement of the existence of a multi-country outbreak of mpox, a viral disease then commonly known as "monkeypox". The initial cluster of cases was found in the United Kingdom, where the first case was detected in London on 6 May 2022 in a patient with a recent travel history from Nigeria where the disease has been endemic. On 16 May, the UK Health Security Agency (UKHSA) confirmed four new cases with no link to travel to a country where mpox is endemic. Subsequently, cases have been reported from many countries and regions. The outbreak marked the first time mpox had spread widely outside Central and West Africa. The disease had been circulating and evolving in human hosts over several years before the outbreak and was caused by the clade IIb variant of the virus.

<span class="mw-page-title-main">2022–2023 mpox outbreak in the United Kingdom</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in the United Kingdom is part of the larger outbreak of human mpox caused by the West African clade (type) of the monkeypox virus. The United Kingdom was the first country, outside of the endemic African areas, to experience an outbreak. As of 22 July 2022, there were 2,208 confirmed cases in the United Kingdom, with 2,115 in England, 54 in Scotland, 24 in Wales, and 15 in Northern Ireland.

<span class="mw-page-title-main">2022–2023 mpox outbreak in the United States</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in the United States was part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. The United States was the fourth country outside of the African countries with endemic mpox to experience an outbreak in 2022. The first case was documented in Boston, Massachusetts, on May 17, 2022. As of August 2022, mpox had spread to all 50 states in the United States, as well as Washington, D.C., and Puerto Rico. The United States had the highest number of mpox cases in the world during the outbreak. California had the highest number of mpox cases in the United States.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Canada</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in Canada is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak started in Canada on May 19, 2022, with the country since then becoming one of the most affected in the Americas.

The 2022–2023 mpox outbreak in Portugal is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Portugal was the third country, outside of the African countries with endemic mpox, to experience an outbreak in 2022.

The 2022–2023 mpox outbreak in Italy is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Italy was the sixth country, outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Rome, Italy, on May 19, 2022. As of August 5th, Italy has 505 cases.

The 2022 – 2023 mpox outbreak in France is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. France had its first case on 20 May 2022.

The 2022–2023 mpox outbreak in Belgium is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Belgium was the fifth country, outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case was documented in Antwerp, Belgium, on 19 May 2022. As of 10 August, Belgium has 546 cases and 1 suspected case.

The 2022–2023 mpox outbreak in Israel is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Israel on 20 May 2022 when the Health Ministry announced a suspected case which was confirmed on 21 May 2022. One month later, on 21 June, the first locally transmitted case was reported.

The 2022–2023 mpox outbreak in Switzerland is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak started in Switzerland on 19 May 2022, with the country since then becoming one of the most affected in Europe.

The 2022–2023 mpox outbreak in Austria is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Austria is the fifteenth country outside of Africa to experience an endemic mpox outbreak. The first case was reported in Vienna, Austria, on 22 May 2022. As of 2 December, Austria has confirmed a total of 327 cases.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Brazil</span> Ongoing outbreak of mpox in Brazil

The 2022–2023 mpox outbreak in Brazil is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in Brazil on 9 June 2022 when a man in São Paulo was registered as the country's index case.

<span class="mw-page-title-main">2022–2023 mpox outbreak in India</span> Ongoing outbreak of mpox in India

The 2022–2023 mpox outbreak in India is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was first reported in India on 14 July 2022 when Kerala's State Health Minister Veena George announced a suspected imported case which was confirmed hours later by the NIV. India was the tenth country to report a mpox case in Asia and the first in South Asia. Currently, India has reported 23 cases of mpox.

<span class="mw-page-title-main">2022–2023 mpox outbreak in Spain</span> 2022–2023 outbreak of viral disease in Spain

The 2022–2023 mpox outbreak in Spain is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. Spain was the second country outside the African countries with endemic mpox, to experience an outbreak in 2022. The outbreak was first reported in Spain on 18 May 2022.

The 2022–2023 mpox outbreak in the Netherlands is an ongoing global outbreak which has also spread in the Netherlands. The RIVM declared the disease an A-disease which makes it mandatory to report suspected cases to the GGD. The first human case of mpox in the Netherlands has been identified at the 21 May 2022. The outbreak does have a noticeable impact at the society, especially with people spreading misinformation related to the virus. The ongoing COVID-19 pandemic in the Netherlands has increased the fear among the community for a new pandemic like mpox.

The 2022–2023 mpox outbreak in South Africa is a part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. South Africa was the forty-seventh country, outside of the African countries with endemic mpox, to experience an outbreak in 2022. The first case of mpox in South Africa was on June 23, 2022.

<span class="mw-page-title-main">2023–2024 mpox epidemic</span> Global disease outbreak since September 2023

An epidemic of a new variant of clade I mpox, known as clade 1b, began in Central Africa at least as early as September 2023. As of August 2024, more than 21,000 cases have been reported, with over 500 fatalities, nearly all in the Democratic Republic of the Congo. According to the European CDC: "The size of these outbreaks could be larger than reported due to under-ascertainment and under-reporting."

<span class="mw-page-title-main">Timeline of the 2023–2024 mpox epidemic</span> Major events in a virus outbreak

This article documents the chronology and epidemiology of the 2023–2024 mpox epidemic, an outbreak of clade Ib of mpox.

References

  1. ↑ "Mpox - Democratic Republic of the Congo". www.who.int. World Health Organization. 14 June 2024. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  2. 1 2 3 4 5 6 Nolen LD, Osadebe L, Katomba J, Likofata J, Mukadi D, Monroe B, Doty J, Hughes CM, Kabamba J, Malekani J, Bomponda PL, Lokota JI, Balilo MP, Likafi T, Lushima RS, Ilunga BK, Nkawa F, Pukuta E, Karhemere S, Tamfum JJ, Nguete B, Wemakoy EO, McCollum AM, Reynolds MG (June 2016). "Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo". Emerging Infectious Diseases. 22 (6): 1014–21. doi:10.3201/eid2206.150579. PMC   4880088 . PMID   27191380.
  3. ↑ Fenner F, Wittek R, Dumbell KR (1988). "8. Monkeypox virus". The Orthopoxviruses. Elsevier. pp. 227–267. ISBN   978-0-323-15022-4.
  4. ↑ Fenner F, santé Om, Organization WH, Henderson DA, Arita I, Jezek Z, Ladnyi ID (1988). "29. Human monkeypox and other poxvirus infections of man". Smallpox and Its Eradication (PDF). World Health Organization. pp. 1287–1319. ISBN   978-92-4-156110-5.
  5. 1 2 3 4 Sutcliffe CG, Rimone AW, Moss WJ (2020). "32.2. Poxviruses". In Ryan ET, Hill DR, Solomon T, Aronson N, Endy TP (eds.). Hunter's Tropical Medicine and Emerging Infectious Diseases E-Book (Tenth ed.). Edinburgh: Elsevier. pp. 272–277. ISBN   978-0-323-55512-8.
  6. ↑ Arita I, Henderson DA (1976). "Monkeypox and whitepox viruses in West and Central Africa". Bulletin of the World Health Organization. 53 (4): 347–53. PMC   2366520 . PMID   186209.
  7. 1 2 Cho CT, Wenner HA (March 1973). "Monkeypox virus". Bacteriological Reviews. 37 (1): 1–18. doi:10.1128/br.37.1.1-18.1973. ISSN   0005-3678. PMC   413801 . PMID   4349404.
  8. ↑ Essbauer S, Meyer H (2007). "Genus Orthopoxvirus: Monkeypox virus". In Mercer A, Schmidt A, Weber O (eds.). Poxviruses. Springer. p. 66. ISBN   978-3-7643-7556-0.
  9. 1 2 3 4 Rimoin AW, Kisalu N, Kebela-Ilunga B, Mukaba T, Wright LL, Formenty P, Wolfe ND, Shongo RL, Tshioko F, Okitolonda E, Muyembe JJ, Ryder R, Meyer H (June 2007). "Endemic human monkeypox, Democratic Republic of Congo, 2001-2004". Emerging Infectious Diseases. 13 (6): 934–7. doi:10.3201/eid1306.061540. PMC   2792850 . PMID   17553242.
  10. 1 2 3 "Monkeypox – Democratic Republic of the Congo". www.who.int. World Health Organization. Archived from the original on 5 June 2022. Retrieved 5 June 2022.
  11. 1 2 3 Hobson G, Adamson J, Adler H, Firth R, Gould S, Houlihan C, Johnson C, Porter D, Rampling T, Ratcliffe L, Russell K, Shankar AG, Wingfield T (August 2021). "Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021". Euro Surveillance. 26 (32). doi:10.2807/1560-7917.ES.2021.26.32.2100745. ISSN   1560-7917. PMC   8365177 . PMID   34387184.
  12. ↑ Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I (1980). "Human monkeypox, 1970-79". Bull World Health Organ. 58 (2): 165–182. PMC   2395797 . PMID   6249508.
  13. ↑ Sklenovská N (2020). "2. Monkeypox". In Malik YS, Singh RK, Dhama K (eds.). Animal-Origin Viral Zoonoses. Singapore: Springer. pp. 39–68. ISBN   978-981-15-2650-3.
  14. ↑ Rimoin AW, Mulembakani PM, Johnston SC, Lloyd Smith JO, Kisalu NK, Kinkela TL, Blumberg S, Thomassen HA, Pike BL, Fair JN, Wolfe ND, Shongo RL, Graham BS, Formenty P, Okitolonda E, Hensley LE, Meyer H, Wright LL, Muyembe JJ (14 September 2010). "Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo". Proceedings of the National Academy of Sciences of the United States of America. 107 (37): 16262–16267. Bibcode:2010PNAS..10716262R. doi: 10.1073/pnas.1005769107 . ISSN   1091-6490. PMC   2941342 . PMID   20805472.
  15. ↑ Brown K, Leggat PA (20 December 2016). "Human Monkeypox: Current State of Knowledge and Implications for the Future". Tropical Medicine and Infectious Disease. 1 (1): 8. doi: 10.3390/tropicalmed1010008 . PMC   6082047 . PMID   30270859.
  16. ↑ Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, Osborne JC, Rampling T, Beadsworth MB, Duncan CJ, Dunning J, Fletcher TE, Hunter ER, Jacobs M, Khoo SH, Newsholme W, Porter D, Porter RJ, Ratcliffe L, Schmid ML, Semple MG, Tunbridge AJ, Wingfield T, Price NM (24 May 2022). "Clinical features and management of human monkeypox: a retrospective observational study in the UK". The Lancet. Infectious Diseases. 22 (8): S1473–3099(22)00228–6. doi: 10.1016/S1473-3099(22)00228-6 . ISSN   1474-4457. PMC   9300470 . PMID   35623380. S2CID   249057804.
  17. 1 2 3 Van Beusekom M (16 March 2024). "More than 600 dead in spreading DR Congo mpox outbreak as Republic of Congo reports its first cases". University of Minnesota. CIDRAP. Archived from the original on 19 March 2024. Retrieved 19 March 2024.
  18. ↑ Stawiska Z (13 March 2024). "Deadly Mpox Transmission in DR Congo Happening Under Radar; Most Victims are Children". Health Policy Watch. Archived from the original on 15 August 2024. Retrieved 6 August 2024.
  19. ↑ Cohen J (3 August 2024). "Deadlier strain of mpox spreads to multiple African countries". Science. Archived from the original on 15 August 2024. Retrieved 5 August 2024.
  20. ↑ "WHO considers public health emergency as mpox cases mount in Africa". University of Minnesota | CIDRAP. 5 August 2024. Archived from the original on 6 August 2024. Retrieved 6 August 2024.
  21. ↑ Mandavilli A (14 August 2024). "W.H.O. Declares Global Emergency over New Mpox Outbreak". The New York Times. Archived from the original on 14 August 2024. Retrieved 14 August 2024.
  22. ↑ "Sweden confirms first case of mpox strain outside Africa". Al Jazeera. 15 August 2024. Retrieved 16 August 2024.
  23. 1 2 "Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues". RFI (in French). 19 August 2024. Retrieved 21 August 2024.
  24. ↑ "DR Congo on standby for first vaccines to fight mpox outbreak". RFI . 20 August 2024. Retrieved 21 August 2024.
  25. ↑ "Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues". RFI (in French). 19 August 2024. Retrieved 21 August 2024.
  26. ↑ "DR Congo on standby for first vaccines to fight mpox outbreak". RFI . 20 August 2024. Retrieved 21 August 2024.
  27. ↑ "Deutschland spendet Impfstoff". Süddeutsche Zeitung (in German). 26 August 2024. Archived from the original on 27 August 2024. Retrieved 28 August 2024.
  28. ↑ "Mpox: Germany to give Africa 100,000 doses of vaccine". dw.com. Deutsche Welle. Agence France-Presse, Reuters. 26 August 2024. Archived from the original on 27 August 2024. Retrieved 28 August 2024.
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