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An exponential increase in the number of mpox cases has been reported in the Democratic Republic of the Congo (DRC), warned the DRC government, with a vaguely-known variant and potential spillover in neighboring countries lurking.

Exceptional increase, new variant

Since the beginning of 2024, a total of 11,166 suspected mpox cases, including about 450 deaths, have been reported, said Patrick Muyaya, DRC government spokesperson on Saturday, noting that the western province of Equateur has been the worst hit.

Thus far, 23 of the country’s 26 provinces have reported mpox cases since 2022.

In December 2022, the DRC declared a national outbreak of mpox, and an incident management system has been in place since February 2023, based on the increasing number of reported cases.

Since 2022, more than 21,000 cases have been reported with more than 1,000 deaths in DRC, according to the World Health Organisation (WHO). In 2023, a total of 14,626 cases and 654 deaths were recorded.

In a report published in May 2024, WHO warned that the current situation of the mpox outbreak in the DRC is of “grave concern” due to the sustained increase in suspected cases compared to previous years, with a significant burden in younger populations, particularly children under 15 years of age, who constitute the majority of both suspected cases and deaths.

According to WHO, a new variant of the clade I mpox virus has been described in the eastern province of South Kivu, and it was estimated to have emerged around mid-September 2023.

However, “It is not known if this variant is more transmissible or leads to more severe disease than other clade I mpox virus strains,” said WHO. To date, only clade I MPXV has been detected in the country, which in the WHO African region, reports the highest number of cases.

In 2022, a worldwide outbreak, notably in Europe and the U.S., which prompted the WHO to declare a public health emergency, was caused by clade II of the mpox virus which has a relatively low death rate.

Health system dragged down

In the eastern province of North Kivu, where conflicts have been raging between DRC military and rebel groups, the health system, which already struggles with overflowing, is hanging on by a thread with the mpox outbreak.

In the Mudja camp for war-displaced people, located in the territory of Nyiragongo, mpox had no mercy, as a three-year-old child Rebecca was struggling to get back on her feet.

“It’s a very contagious disease. The virus doesn’t discriminate when it comes to age. Everyone could catch it,” said Francine Mbawerimana, Rebecca’s mother, complaining about the lack of clean water to clean her daughter.

Healthcare workers are on alert and trying to raise awareness among residents to be vigilant in the war-hit North Kivu province, which announced in late June 2024 the first eight confirmed cases. According to local health experts, the number has risen to over 30 in a few weeks, with diagnostic testing remaining inaccessible.

“To date, we have 31 confirmed cases spread across three health zones of Goma, Karisimbi, and Nyiragongo,” Dr. Dan Kapuku, the Nyiragongo Health Zone director, told Xinhua in mid-July 2024.

“This disease is perilous and extremely contagious. The presence of cases in the city of Goma and surrounding areas constitutes a great threat and a high risk of contamination for the entire population of the city of Goma and its surrounding areas in particular, and for the population of North Kivu province in general,” said Prisca Lunda Kamala, senior health advisor to the military governor of North Kivu.

The newly documented occurrence of mpox in North Kivu is very concerning, said WHO.

Regional spillover lurking

According to WHO, the new features of human-to-human transmission observed in South Kivu and North Kivu raise additional concern about a further rapid expansion of the outbreak in the eastern mining provinces, as well as the rest of the country and other countries that share national borders.

“We fear because of this mpox outbreak that the DRC will be declared a country at public health risk of international concern,” said on Friday Jean-Jacques Mbungani Mbanda, former health minister of DRC, on X, formerly known as Twitter.

The DRC shares borders with numerous countries, including Rwanda, Uganda, Burundi, and Tanzania in the east, Angola and Zambia in the south, the Republic of the Congo, the Central African Republic, and South Sudan in the north.

South Africa is on high alert following the outbreak of mpox in May, with 20 confirmed cases between May 8 and July 2, 2024, according to WHO.

In April 2024, a high-level emergency regional meeting on monkeypox in Africa was convened in the DRC capital Kinshasa, gathering 12 health ministers of regional countries, aiming to develop common strategies to prevent and intervene effectively in the face of mpox in Africa.

“We must prevent the DRC from becoming the source of cross-border transmission, and our partnership must prioritize the health of those affected,” said Jean Kaseya, the director general of the African Centers for Disease Control and Prevention (Africa CDC) at the meeting.

“Over the years, monkeypox has become a real public health problem for our communities in the DRC, a regional threat and ultimately a global problem. We must now mobilize to resolve this crisis,” said Roger Kamba, DRC minister of public health, hygiene and prevention, at the meeting.

Mpox, first detected in laboratory monkeys in 1958, is assumed to be transmitted from wild animals such as rodents to people, or from human to human.