Mpox in the Democratic Republic of the Congo

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),{{cite book |last1=Fenner |first1=Frank |last2=Wittek |first2=Riccardo |last3=Dumbell |first3=Keith R. |title=The Orthopoxviruses |date=1988 |publisher=Elsevier |isbn=978-0-323-15022-4 |pages=227–267 |chapter-url=https://books.google.com/books?id=rR_YfBN0rakC&dq=monkeypox&pg=PA227 |language=en |chapter=8. Monkeypox virus}}{{cite book |last1=Fenner |first1=Frank |last2=santé |first2=Organisation mondiale de la |last3=Organization |first3=World Health |last4=Henderson |first4=D. A. |last5=Arita |first5=I. |last6=Jezek |first6=Z. |last7=Ladnyi |first7=I. D. |title=Smallpox and Its Eradication |date=1988 |publisher=World Health Organization |isbn=978-92-4-156110-5 |pages=1287–1319 |url=https://biotech.law.lsu.edu/blaw/bt/smallpox/who/red-book/Chp%2029.pdf |language=en |chapter=29. Human monkeypox and other poxvirus infections of man}} two years after it reported its last case of smallpox.{{cite book |last1=Sutcliffe |first1=Catherine G. |last2=Rimone |first2=Anne W. |last3=Moss |first3=William J. |editor1-last=Ryan |editor1-first=Edward T. |editor2-last=Hill |editor2-first=David R. |editor3-last=Solomon |editor3-first=Tom |editor4-last=Aronson |editor4-first=Naomi |editor5-last=Endy |editor5-first=Timothy P. |title=Hunter's Tropical Medicine and Emerging Infectious Diseases E-Book |date=2020 |publisher=Elsevier |location=Edinburgh |isbn=978-0-323-55512-8 |pages=272–277 |edition=Tenth |chapter-url=https://books.google.com/books?id=y8SODwAAQBAJ&dq=monkeypox+nigeria&pg=PA272 |language=en |chapter=32.2. Poxviruses}} The onset of their rash was on 24 August.{{cite journal |last1=Arita |first1=I |last2=Henderson |first2=DA |title=Monkeypox and whitepox viruses in West and Central Africa. |journal=Bulletin of the World Health Organization |date=1976 |volume=53 |issue=4 |pages=347–53 |pmid=186209 |pmc=2366520 }} That year, the disease was identified in another four children, including three in Liberia who were playmates.{{cite journal |last1=Cho |first1=C. T. |last2=Wenner |first2=H. A. |title=Monkeypox virus |journal=Bacteriological Reviews |date=March 1973 |volume=37 |issue=1 |pages=1–18 |doi=10.1128/br.37.1.1-18.1973 |pmid=4349404 |pmc=413801 |issn=0005-3678 }} At the time, evidence of the virus was found in non-human primates in Liberia and Sierre Leone.

Active surveillance by the World Health Organization (WHO) between 1981 and 1986, identified 338 cases with a human-to-human transmission rate of 28%.{{cite book |last1=Essbauer |first1=Sandra |last2=Meyer |first2=Herman |editor1-last=Mercer |editor1-first=Andrew |editor2-last=Schmidt |editor2-first=Axel |editor3-last=Weber |editor3-first=Olaf |title=Poxviruses |date=2007 |publisher=Springer |isbn=978-3-7643-7556-0 |page=66 |chapter-url=https://books.google.com/books?id=F18FC71UH-sC&dq=Outbreak+of+monkeypox+at+Rotterdam+Zoo&pg=PA66 |language=en |chapter=Genus Orthopoxvirus: Monkeypox virus}}{{cite journal |last1=Rimoin |first1=AW |last2=Kisalu |first2=N |last3=Kebela-Ilunga |first3=B |last4=Mukaba |first4=T |last5=Wright |first5=LL |last6=Formenty |first6=P |last7=Wolfe |first7=ND |last8=Shongo |first8=RL |last9=Tshioko |first9=F |last10=Okitolonda |first10=E |last11=Muyembe |first11=JJ |last12=Ryder |first12=R |last13=Meyer |first13=H |title=Endemic human monkeypox, Democratic Republic of Congo, 2001-2004. |journal=Emerging Infectious Diseases |date=June 2007 |volume=13 |issue=6 |pages=934–7 |doi=10.3201/eid1306.061540 |pmid=17553242 |pmc=2792850 }} Until 1986, 95% of cases worldwide were identified in the DRC.{{cite web |title=Monkeypox – Democratic Republic of the Congo |url=https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox-democratic-republic-of-the-congo |website=www.who.int |publisher=World Health Organization |access-date=5 June 2022 |language=en|archive-url=https://web.archive.org/web/20220605103903/https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox-democratic-republic-of-the-congo|archive-date=5 June 2022}} 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.{{cite journal |last1=Hobson |first1=Gemma |last2=Adamson |first2=James |last3=Adler |first3=Hugh |last4=Firth |first4=Richard |last5=Gould |first5=Susan |last6=Houlihan |first6=Catherine |last7=Johnson |first7=Christopher |last8=Porter |first8=David |last9=Rampling |first9=Tommy |last10=Ratcliffe |first10=Libuse |last11=Russell |first11=Katherine |last12=Shankar |first12=Ananda Giri |last13=Wingfield |first13=Tom |title=Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021 |journal=Euro Surveillance |date=August 2021 |volume=26 |issue=32 |doi=10.2807/1560-7917.ES.2021.26.32.2100745 |pmid=34387184 |pmc=8365177 |issn=1560-7917}} Initially it was uncommon for a family member to contract the infection if they had a smallpox scar, evidence of prior vaccination.

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.{{cite journal |vauthors=Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I | year = 1980 | title = Human monkeypox, 1970-79 | journal = Bull World Health Organ | volume = 58 | issue = 2 | pages = 165–182 | pmid = 6249508 | pmc = 2395797 }} Some likely had both mpox and chickenpox at the same time. The DRC's Kasaï-Oriental region saw the largest number of cases during 1996–1997.

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

File:MonkeyPoxCDC3.png|Mpox outbreak in DRC (1997)

The US epidemiologic team after having landed at Lodja Airport - Zaire 1997.jpg|The US epidemiologic team after having landed at Lodja Airport - DRC 1997

File:12747 lores.jpg|Testing of Gambian rats (1997)

File:12781 lores.jpg|Educational meeting DRC (1997)

After 2005, the DRC was reporting more than 1,000 suspected cases per year.{{cite book |last1=Sklenovská |first1=Nikola |editor1-last=Malik |editor1-first=Yashpal Singh |editor2-last=Singh |editor2-first=Raj Kumar |editor3-last=Dhama |editor3-first=Kuldeep |title=Animal-Origin Viral Zoonoses |date=2020 |publisher=Springer |location=Singapore |isbn=978-981-15-2650-3 |pages=39–68 |chapter-url=https://books.google.com/books?id=1dX-DwAAQBAJ&dq=monkeypox&pg=PA46 |language=en |chapter=2. Monkeypox}} 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.{{cite journal |last1=Rimoin |first1=Anne W. |last2=Mulembakani |first2=Prime M. |last3=Johnston |first3=Sara C. |last4=Lloyd Smith |first4=James O. |last5=Kisalu |first5=Neville K. |last6=Kinkela |first6=Timothee L. |last7=Blumberg |first7=Seth |last8=Thomassen |first8=Henri A. |last9=Pike |first9=Brian L. |last10=Fair |first10=Joseph N. |last11=Wolfe |first11=Nathan D. |last12=Shongo |first12=Robert L. |last13=Graham |first13=Barney S. |last14=Formenty |first14=Pierre |last15=Okitolonda |first15=Emile |last16=Hensley |first16=Lisa E. |last17=Meyer |first17=Hermann |last18=Wright |first18=Linda L. |last19=Muyembe |first19=Jean-Jacques |title=Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo |journal=Proceedings of the National Academy of Sciences of the United States of America |date=14 September 2010 |volume=107 |issue=37 |pages=16262–16267 |doi=10.1073/pnas.1005769107 |pmid=20805472 |pmc=2941342 |bibcode=2010PNAS..10716262R |issn=1091-6490|doi-access=free }}

Many cases occur sporadically or in small clusters, but large outbreaks also occur. The risk of human-to-human transmission within households in the DRC was noted to range from 50% to 100% during the 2013 outbreak. The DRC's Bokungu Health Zone saw an increase in cases of 600-fold that year.{{cite journal |last1=Nolen |first1=LD |last2=Osadebe |first2=L |last3=Katomba |first3=J |last4=Likofata |first4=J |last5=Mukadi |first5=D |last6=Monroe |first6=B |last7=Doty |first7=J |last8=Hughes |first8=CM |last9=Kabamba |first9=J |last10=Malekani |first10=J |last11=Bomponda |first11=PL |last12=Lokota |first12=JI |last13=Balilo |first13=MP |last14=Likafi |first14=T |last15=Lushima |first15=RS |last16=Ilunga |first16=BK |last17=Nkawa |first17=F |last18=Pukuta |first18=E |last19=Karhemere |first19=S |last20=Tamfum |first20=JJ |last21=Nguete |first21=B |last22=Wemakoy |first22=EO |last23=McCollum |first23=AM |last24=Reynolds |first24=MG |title=Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. |journal=Emerging Infectious Diseases |date=June 2016 |volume=22 |issue=6 |pages=1014–21 |doi=10.3201/eid2206.150579 |pmid=27191380 |pmc=4880088 }} In 2019 the DRC reported 3,794 suspected cases and 73 deaths. In the first nine-months of 2020, it reported over 4,500 suspected cases of mpox, including 171 deaths.

Mpox is reportable in the DRC, where the disease is endemic, and disease burden remains high.{{cite journal |last1=Brown |first1=K |last2=Leggat |first2=PA |title=Human Monkeypox: Current State of Knowledge and Implications for the Future. |journal=Tropical Medicine and Infectious Disease |date=20 December 2016 |volume=1 |issue=1 |page=8 |doi=10.3390/tropicalmed1010008 |pmid=30270859 |pmc=6082047 |doi-access=free }} There, the more virulent clade I has been affecting some of the world's poorest and socially excluded communities.{{cite journal |last1=Adler |first1=Hugh |last2=Gould |first2=Susan |last3=Hine |first3=Paul |last4=Snell |first4=Luke B. |last5=Wong |first5=Waison |last6=Houlihan |first6=Catherine F. |last7=Osborne |first7=Jane C. |last8=Rampling |first8=Tommy |last9=Beadsworth |first9=Mike Bj |last10=Duncan |first10=Christopher Ja |last11=Dunning |first11=Jake |last12=Fletcher |first12=Tom E. |last13=Hunter |first13=Ewan R. |last14=Jacobs |first14=Michael |last15=Khoo |first15=Saye H. |date=24 May 2022 |title=Clinical features and management of human monkeypox: a retrospective observational study in the UK |journal=The Lancet. Infectious Diseases |volume=22 |issue=8 |pages=S1473–3099(22)00228–6 |doi=10.1016/S1473-3099(22)00228-6 |issn=1474-4457 |pmc=9300470 |pmid=35623380 |s2cid=249057804 |doi-access=free |last16=Newsholme |first16=William |last17=Porter |first17=David |last18=Porter |first18=Robert J. |last19=Ratcliffe |first19=Libuše |last20=Schmid |first20=Matthias L. |last21=Semple |first21=Malcolm G. |last22=Tunbridge |first22=Anne J. |last23=Wingfield |first23=Tom |last24=Price |first24=Nicholas M.}} A regional surveillance system collects reports of all suspected mpox cases, and where possible, they may be investigated.

{{Excerpt|Mpox|2023–2024 Central Africa outbreak}}On 19 August 2024, the DRC's Ministry of Public Health, {{Interlanguage link|Samuel-Roger Kamba Mulamba|lt=Samuel-Roger Kamba Mulamba|fr|Samuel Roger Kamba Mulamba}}, said in a press conference that all of the country's provinces, including the capital city of Kinshasa, had been affected by the outbreak,{{Cite web |date=19 August 2024 |title=Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues |url=https://www.rfi.fr/fr/afrique/20240819-mpox-en-rdc-un-plan-de-riposte-de-49-millions-de-dollars-et-des-doses-de-vaccin-attendues |access-date=21 August 2024 |website=RFI |language=fr}} 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.{{Cite web |date=20 August 2024 |title=DR Congo on standby for first vaccines to fight mpox outbreak |url=https://www.rfi.fr/en/africa/20240820-dr-congo-on-standby-for-first-vaccines-to-fight-mpox-outbreak |access-date=21 August 2024 |website=RFI}} 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.{{Cite web |date=19 August 2024 |title=Mpox en RDC: un plan de riposte de 49 millions de dollars et des doses de vaccin attendues |url=https://www.rfi.fr/fr/afrique/20240819-mpox-en-rdc-un-plan-de-riposte-de-49-millions-de-dollars-et-des-doses-de-vaccin-attendues |access-date=21 August 2024 |website=RFI |language=fr}}{{Cite web |date=20 August 2024 |title=DR Congo on standby for first vaccines to fight mpox outbreak |url=https://www.rfi.fr/en/africa/20240820-dr-congo-on-standby-for-first-vaccines-to-fight-mpox-outbreak |access-date=21 August 2024 |website=RFI}} On 26 August, Germany's federal government publicly announced that it would donate 100,000 vaccines to the DRC and other neighbouring African countries.{{Cite web |date=26 August 2024 |title=Deutschland spendet Impfstoff |url=https://www.sueddeutsche.de/politik/mpox-virus-deutschland-spendet-impfstoff-lux.XLBXAaNfvCMS2ewQKP1W2G |url-status=live |archive-url=https://web.archive.org/web/20240827091416/https://www.sueddeutsche.de/politik/mpox-virus-deutschland-spendet-impfstoff-lux.XLBXAaNfvCMS2ewQKP1W2G |archive-date=27 August 2024 |access-date=28 August 2024 |website=Süddeutsche Zeitung |language=de}}{{Cite web |date=26 August 2024 |title=Mpox: Germany to give Africa 100,000 doses of vaccine |url=https://www.dw.com/en/mpox-germany-to-give-africa-100000-doses-of-vaccine/a-70055504 |url-status=live |archive-url=https://web.archive.org/web/20240827091437/https://www.dw.com/en/mpox-germany-to-give-africa-100000-doses-of-vaccine/a-70055504 |archive-date=27 August 2024 |access-date=28 August 2024 |website=dw.com |publisher=Deutsche Welle |agency=Agence France-Presse, Reuters}}

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Category:Disease outbreaks in the Democratic Republic of the Congo

Category:Mpox