Congo reports biggest mpox outbreak with first sexually transmitted cases in the world: WHO

As many as 22 of country's 26 provinces reported cases, total suspected cases almost three times the previous highest recorded in 2020
Photo: iStock
Photo: iStock

The Democratic Republic of the Congo reported 12,569 suspected mpox cases, including 581 deaths, from January 1 through November 12, 2023, according to World Health Organization (WHO) situation report November 25, 2023. This is the highest number of annual cases ever reported, noted WHO.

Infections were observed in geographic areas that had previously not reported mpox, including Kinshasa, Lualaba and South Kivu, the United Nations health agency said.

The year also marked two more grim milestones for DRC:The first confirmed sexually-transmitted mpox infections and the first cases in the country’s capital. 

The cases were recorded in 22 out of 26 (85 per cent) provinces in the Democratic Republic of the Congo (DRC).

Eleven of the 26 provinces of the Democratic Republic of the Congo were identified as endemic for mpox, but in recent years, the number of provinces reporting mpox grew to 22 provinces as of November 2023. 

Before this, the largest number of mpox infections were noted in 2020.

From January 1 through September 13, 2020, 17 DRC provinces comprising 127 health zones recorded 4,594 suspected cases of mpox, including 171 deaths.

Mpox is an infectious disease caused by monkeypox virus (MPXV), which is endemic in densely forested regions of west, central and east Africa, particularly in the northern and central regions of the Democratic Republic of the Congo. Mpox was first identified in humans in 1970 in the DRC.

Sexual transmission of Clade 1

The global health body also noted a growing outbreak of mpox cases linked to sexual transmission in DRC.

There are two types of mpox virus (MPXV) — Clade I and Clade II.  MPXV Clade I was previously known as the Congo Basin Clade, and Clade II the West African Clade.

Clade II further has two sub-clades: Clade IIa and Clade IIb. "The Democratic Republic of the Congo has not reported cases of mpox linked to Clade IIb MPXV during the global outbreak to date; only Clade I MPXV has been detected in the country," according to WHO. 

Before April 2023, no formally documented cases of sexual transmission of Clade I MPXV were registered globally.

The first-ever globally confirmed case of sexual transmission of Clade 1 was reported in March 2023 in the Democratic Republic of the Congo.

The first known case of sexual transmission in this report is of a traveller from Belgium who tested positive for Clade I in Kwango province. Thereafter, sexual contacts of this case in the Democratic Republic of the Congo also tested positive for clade I MPXV, with closely related viral sequences.

First mpox outbreak in Kinshasa

In August 2023, for the first time, mpox cases were confirmed in Kinshasa, the capital of DRC.

Four separate events were identified where persons exposed in other provinces (Equateur, Maindombe) travelled to Kinshasa, each leading to local transmission with small clusters in the capital. From August 18-November 12, 2023, a total of 102 suspected cases were reported in eight health zones in Kinshasa, including 18 confirmed cases with one confirmed mpox death.

The new report of human-to-human transmission of mpox in a large urban area such as Kinshasa clearly illustrates that the epidemiology of mpox in the Democratic Republic of the Congo is changing.

A joint mission by the Ministry of Health and WHO is underway in the country to assess the situation.

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