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
LocationDemocratic Republic of the Congo

Mpox is endemic in western and central Africa, with the majority of cases occurring in the Democratic Republic of the Congo (DRC), where the disease is reportable. [1] [2] There, the more virulent clade I has been affecting some of the world's poorest and socially excluded communities. [3]

Contents

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

Early cases

Mpox in Liberia (1971) Monkeypox.jpg
Mpox in Liberia (1971)

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), [4] [5] two years after it reported its last case of smallpox. [6] The onset of their rash was on 24 August. [7] That year, the disease was identified in another four children, including three in Liberia who were playmates. [8] At the time, evidence of the virus was found in non-human primates in Liberia and Sierre Leone. [8]

Active surveillance by the World Health Organization (WHO) between 1981 and 1986, identified 338 cases with a human-to-human transmission rate of 28%. [9] [10] Until 1986, 95% of cases worldwide were identified in the DRC. [11] 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. [12] Initially it was uncommon for a family member to contract the infection unless they did not have a smallpox scar. [12]

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. [10] [13] Some likely had both mpox and chickenpox at the same time. [6] The DRC's Kasaï-Oriental region saw the largest number of cases during 1996–1997. [6]

Between 1996 and 2005, mpox cases appeared increasingly in gradually older people, with less than a quarter of cases being traced to rainforest animal contact, and with greater close contact infections. [12] Between January 2001 and December 2004, 2,734 cases of suspected human mpox were reported from the DRC. [10] However, civil war limited surveillance and only 171 clinical specimens were obtained from 136 suspected cases; less than 5% of all reported cases. [10]

2005 onwards

After 2005, the DRC was reporting more than 1000 suspected cases per year. [14] 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. [15]

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. [6] 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. [11] In the first nine-months of 2020, it reported over 4,500 suspected cases of mpox, including 171 deaths. [11]

Mpox is reportable in the DRC, where the disease is endemic, and disease burden remains high. [2] [16] There, the more virulent clade I has been affecting some of the world's poorest and socially excluded communities. [3] A regional surveillance system collects reports of all suspected mpox cases, and where possible, they may be investigated. [2]

2023-2024 outbreak

During 2023, a Clade I outbreak of mpox disease in the DRC resulted in 14,626 suspected cases being reported, with 654 associated deaths, making for a case-fatality rate (CFR) of 4.5%. The outbreak continued into 2024 with an additional 3,576 suspected mpox cases and 265 deaths being reported in the DRC through the first 9 weeks of the year, making for an estimated CFR of 7.4%. [17]

The outbreak appears to be of a primarily sexually transmitted nature and cases are occurring in areas without a history of mpox, such as South Kivu and Kinshasa. The outbreak seems to consist 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]

The outbreak spread to the neighbouring country of the Republic of Congo, with 43 mpox cases being reported in March 2024. [17]

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 those infected will recover within a few weeks without treatment. The time from exposure to onset of symptoms ranges from five to twenty-one days and symptoms typically last from two to four weeks. Cases may be severe, especially in children, pregnant women or people with suppressed immune systems.

<i>Monkeypox virus</i> 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. The monkeypox virus is a zoonotic virus belonging to the orthopoxvirus genus, making it closely related to the variola, cowpox, and vaccinia viruses. MPV is oval-shaped with a lipoprotein outer membrane. The genome is approximately 190 kb.

<span class="mw-page-title-main">2014 Democratic Republic of the Congo Ebola virus outbreak</span> Disease outbreak in central Africa

In 2014, an outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) occurred. Genome sequencing has shown that this outbreak was not related to the 2014–15 West Africa Ebola virus epidemic, but was of the same EBOV species. It began in August 2014 and was declared over in November of that year, after 42 days without any new cases. This is the 7th outbreak there, three of which occurred during the period of Zaire.

<span class="mw-page-title-main">2017 Democratic Republic of the Congo Ebola virus outbreak</span> Disease outbreak in the Democratic Republic of the Congo

The Democratic Republic of the Congo (DRC) was identified by the World Health Organization (WHO) on 11 May 2017 as having one Ebola-related death.

<span class="mw-page-title-main">2018 Équateur province Ebola outbreak</span> Disease outbreak in the Democratic Republic of the Congo

The 2018 Équateur province Ebola outbreak occurred in the north-west of the Democratic Republic of the Congo (DRC) from May to July 2018. It was contained entirely within Équateur province, and was the first time that vaccination with the rVSV-ZEBOV Ebola vaccine had been attempted in the early stages of an Ebola outbreak, with a total of 3,481 people vaccinated. It was the ninth recorded Ebola outbreak in the DRC.

<span class="mw-page-title-main">Jean-Jacques Muyembe-Tamfum</span> Virologist known for working with Ebola

Jean-Jacques Muyembe is a Congolese microbiologist. He is the general director of the Democratic Republic of the Congo Institut National pour la Recherche Biomedicale (INRB). He was part of team at the Yambuku Catholic Mission Hospital that investigated the first Ebola outbreak, and was part of the effort that discovered Ebola as a new disease, although his exact role is still subject to controversy. In 2016, he led the research that designed, along with other researchers at the INRB and the National Institute of Health Vaccine Research Center in the US, one of the most promising treatment for Ebola, mAb114. The treatment was successfully experimented during recent outbreaks in the DRC, on the express decision of the then DRC Minister of Health, Dr Oly Ilunga, despite a prior negative advice from the World Health Organization.

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

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 a number of years prior to 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 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 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 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 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 Mexico</span> Ongoing viral outbreak

The 2022–2023 mpox outbreak in Mexico is part of the larger outbreak of human mpox caused by the West African clade of the monkeypox virus. Mexico is the twenty-fourth country outside of Africa to experience an endemic mpox outbreak. The first case was reported in Mexico City, Mexico, on May 28, 2022. As of December 8th 2022, Mexico had confirmed a total of 3455 cases in all 32 states and 4 deaths.

<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.

In 2017, mpox reemerged in humans in Nigeria after 39 years. By the end of 2017, there were at least 115 confirmed cases.

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

The 2022 mpox outbreak in Asia is a part of the ongoing outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak was reported in Asia on 20 May 2022 when Israel reported a suspected case of mpox, which was confirmed on 21 May. As of 10 August 2022, seven West Asian, three Southeast Asian, three East Asian and one South Asian country, along with Russia, have reported confirmed cases.

The 2022–2023 mpox outbreak in Europe is a part of the outbreak of human mpox caused by the West African clade of the monkeypox virus. The outbreak reached Europe on 6 May 2022 when the United Kingdom reported their first case of mpox. As of 13 July 2022, 35 European countries and territories have confirmed cases.

References

  1. ↑ "Multi-country monkeypox outbreak: situation update". www.who.int. World Health Organization. 4 June 2022. Retrieved 11 June 2022.
  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. 1 2 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.
  4. ↑ Fenner F, Wittek R, Dumbell KR (1988). "8. Monkeypox virus". The Orthopoxviruses. Elsevier. pp. 227–267. ISBN   978-0-323-15022-4.
  5. ↑ 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.
  6. 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.
  7. ↑ 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.
  8. 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.
  9. ↑ 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.
  10. 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.
  11. 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.
  12. 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  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. Retrieved 19 March 2024.
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