Concern Over Mpox Outbreak in Congo Among Doctors

The epidemiologist Dr. Jean Nachega from the University of Pittsburgh has warned about an impending global health emergency as a significant outbreak of mumps disease spreads in the Democratic Republic of the Congo (DRC). He warns that it is only a matter of time before this transmission crosses African borders and becomes a worldwide concern if nothing is done to contain it.

Mpox, formerly known as monkeypox, is causing alarm among public health experts due to three specific reasons. Firstly, there has been an unprecedented increase in cases in the DRC, with around 400 suspected cases reported weekly, with the majority of victims being children. Secondly, the strain of virus currently circulating is particularly lethal; around one in every ten people infected succumbs to the disease. Finally, scientists have observed that this virus behaves differently than before, surfacing not just in new areas or populations but also spreading through new methods, including sexual contact and evading diagnostic tests.

Dr. Rosamund Lewis from the World Health Organization (WHO) expresses her concerns regarding our preparedness for such outbreaks: "For measles, cholera, or polio, we know what measures need to be taken because these diseases have been around for quite some time now; however, for mumps, many aspects are still unknown."

In 2023 alone, the DRC recorded more than 14,500 suspected cases, resulting in over 650 deaths from mpox, which far exceeds figures from previous years. These numbers continue to rise unabatedly, with more than 3500 suspected cases and over 250 deaths within the first two months of the current year.

Most commonly, these outbreaks occur within remote villages located amidst dense forests across the northern and central regions of the DRC, where initial infections occur when humans come into contact with infected animals like rodents or bushmeat during hunting or cooking activities, thereby allowing virus spread within households or communities via skin-to-skin contacts or shared surfaces, e.g., bedsheets, towels, etc.

Not everyone who contracts mpox experiences severe symptoms, but for some, it can be deadly, causing high fever, malaise, and painful lesions all over the body. This disease is particularly lethal to children under 15 years old, who make up two-thirds of total cases in the DRC.

The strain of virus currently prevalent in the DRC, known as Clade I, is ten times deadlier than its counterpart, Clade II, which caused a global outbreak previously. Furthermore, this strain has started spreading sexually among high-mobility populations like miners and sex workers in the mining region of Kamituga, where such cases were unheard before.

Dr. Nachega stresses the need for urgent intervention from both the local government and the international community to contain this spread by ramping up surveillance, case management, testing, and vaccination efforts.

Unfortunately, confirming mpox infection remains a challenge due to limited lab facilities capable of conducting required PCR tests; hence, most diagnoses are made solely based on symptoms, which can often lead to misdiagnosis since mild mpox resembles other diseases like chickenpox or measles, while sexually transmitted mpox needs to be distinguished from herpes, syphilis, etc.

Vaccination against mumps also faces multiple hurdles, including a lack of authorization for usage within African nations despite having three available vaccines that have proven effective during previous outbreaks elsewhere globally, although their effectiveness among malnourished adults and children still remains uncertain due to a lack sufficient data regarding the same, thus requiring further research into the matter.

Despite these challenges, WHO's Health Emergency Programme's executive director, Dr. Michael Ryan, emphasizes the urgency controlling the current outbreak given its increased virulence compared to past strains, thereby necessitating close monitoring moving forward even amidst ongoing political instability within affected regions, making implementation of health operations a difficult task at hand yet crucial nonetheless considering potential global implications if left unchecked.