To the Editor,
The epidemiological situation in the Democratic Republic of the Congo (DR Congo) is marked by an increase in diseases with epidemic potential. These diseases have destabilized and paralyzed the DR Congo’s health system1. Since the discovery of the Monkey pox virus (MPXV) in 1970 in DR Congo, outbreaks of the MPXV have been reported spontaneously in Africa in recent days, with a low case fatality rate2. The World Health Organization (WHO) confirmed more than 750 cases of MPXV worldwide between May 13, 2022 and June 2, 2022. Despite established surveillance methods for disease control and combat, a number of new cases in DR Congo continue to rise. The current MPXV disease situation has become critical in recent days due to the high number of new outbreaks compared with previous ones3.
Since the beginning of 2022, suspected cases of MPXV have been reported from 87 health zones across 18 provinces in DR Congo. The majority of suspected cases are children over the age of 5, but the case fatality rate in children under 5 is higher4. Between January and September 2020, there were 4594 suspected cases of MPXV in 127 health zones from 17 of 26 territories, with the highest incidence in forested areas and lower age groups who were not vaccinated as part of the smallpox eradication program4. As of August 1, 2022, the total number of cases of MPXV in DR Congo was 2159 suspected cases and 107 confirmed cases5.
Exposure to the MPXV in DR Congo may be related to the presence of forest, where possible animal reservoirs are plentiful, as well as the precarious security situation, which disrupts efforts to control the disease3. Based on previous research, we were able to identify some of the risk factors or risk behaviors for contracting MPXV in DR Congo. These include sleeping in the same room or bed, particularly between people of the same sex, for example, men sleeping with men, living in the same household, and drinking or eating from the same dish were all risk factors for human-to-human transmission2,3. Sleeping outside or on the ground, living near or visiting the forest, and ineffective smallpox vaccination have also been identified as risk factors for exposure to animals and subsequent risk for animal-to-human transmission of MPXV5 (Fig. 1).
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Figure 1: Specific risk factors identified in the transmission cycle of monkey pox in the Democratic Republic of Congo that increase the risk of community-wide transmission. MPXV indicates Monkey pox virus. Original image created by H.H. with biorender.com.
Management of MPXV is essentially symptomatic as there is no specific treatment for sign pox. It is imperative that the patient be placed in contact and respiratory isolation. However, if large numbers of patients are to be treated, the Congolese government should mobilize expanded centers for isolation. People residing or traveling in areas of DR Congo where there are peak cases of MPXV should avoid contact with sick animals (rodents, marsupials, and primates), dead or alive. One of the main challenges of the current emergency is the lack of funding to respond to the multiple outbreaks of Monkeypox occurring in DR Congo. Omissions in surveillance and insufficient laboratory capacity could jointly contribute to the spread of the epidemic. Technical support should be provided by the Ministry of Health to develop and implement an urgent response plan aimed at strengthening surveillance at the national level and providing for new outbreak investigation and response activities. We recommend the implementation of specific actions in secondary health facilities as well as tertiary health centers in DR Congo, such as; increased vigilance and the prompt clinical recognition of disease symptoms which is essential to ensure the early detection and diagnoses of cases, along with the notification and isolation of patients. The health care human resources departments in the federal and state ministry of health in DR Congo should be trained and equipped with all the diagnostic tools needed to make a timely diagnosis and isolate the suspected or confirmed cases in places with adequate ventilation, that is; a dedicated bathroom.
Support from partners such as the Centers for Disease Control and Prevention, the Office of the United Nations High Commissioner for Refugees, and nongovernmental organizations will be essential to combat future outbreaks. The national government of DR Congo in collaboration with the WHO must make efforts to obtain more information on new cases and to strengthen virological and biomedical laboratory capacity. Investigation and confirmation of suspected cases will help to better understand the extent of the spread of the virus, and there is a need to strengthen cross-border collaboration with neighboring countries and the sharing of data and information on human monkeypox disease. In addition, to stop the infection’s chains of transmission in DR Congo, the Congolese government should intensify surveillance in specific population groups in the country, such as men sleeping with men communities, along with case and cluster investigation and contact-tracing activities. Finally, strategies should be adopted in DR Congo to strengthen a “one health” approach in endemic countries, as environmental factors increase the frequency of contact with potential hosts, raising the risk of animal-to-human transmission. The importance of hygiene and hand washing with soap and water or alcohol-based disinfectant should be emphasized. Handwashing stations and infection control initiatives, including the use of disinfectants, should be implemented in hospital settings.
Due to the potential impact of monkeypox disease on the DR Congo and other parts of Africa, there is an urgent need for the WHO and other international health organizations to assist in revitalizing their health care system to manage this outbreak. Furthermore, the country’s health care leaders must continue to work tirelessly to stop the spread of the disease before it causes the same devastation that other infectious outbreaks have.
Ethical approval
Not applicable.
Sources of funding
No funding received for this work.
Author contribution
A.A.: conceptualization of ideas and manuscript preparation. A.A., M.F.A., W.A.A., M.O.O., H.H.: writing of draft. M.O.O.: review with comments and data curation.
Conflicts of interest disclosure
The authors declare that they have no financial conflict of interest with regard to the content of this report.
Research registration unique identifying number (UIN)
Not applicable.
Guarantor
Aymar Akilimali
Acknowledgments
We will like to acknowledged the efforts of our colleagues; Hugues CAKWIRA, Chrispin BIAMBA, Michel K. MIRINDI, Styves BANGA and Leonard SIRONGE for making this study a successful one.
References
1. Bisimwa P, Biamba C, Aborode AT, et al. Ebola virus disease outbreak in the Democratic Republic of the Congo: a mini-review. Ann Med Surg (Lond) 2022;80:104213.
2. Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis 2022;16:e0010141.
3. Eltvedt AK, Christiansen M, Poulsen A. A case report of monkeypox in a 4-year-old boy from the DR Congo: challenges of diagnosis and management. Case Rep Pediatr 2020;2020:8572596.
