Press Release: WHO, 23 November 2023, 08:35


The Situation at a Glance

Between January 1 and November 12, 2023, the Democratic Republic of the Congo experienced a significant outbreak of suspected monkeypox (mpox). A total of 12,569 suspected cases have been reported, with 581 suspected deaths, resulting in a case-fatality ratio of 4.6%. This marks the highest annual number of cases ever reported, and the outbreak has reached 22 out of 26 provinces (85%). Previously unaffected areas, including Kinshasa, Lualaba, and South Kivu, have reported new cases.

Testing revealed that 1106 suspected cases were tested using reverse transcriptase-polymerase chain reaction (RT-PCR), and 714 of whom tested positive for Monkeypox virus (MPXV), indicating a positivity rate of 65%. Notably, cases with travel history to endemic provinces have been identified as sources of human-to-human transmission in provinces not previously affected by the outbreak. The situation highlights the widespread impact and challenges posed by the current monkeypox outbreak in the Democratic Republic of the Congo.

WHO Risk Assessment

The risk of mpox spreading further to neighbouring countries and worldwide appears significant. 

The increase in suspected monkeypox (mpox) cases recorded between January 1 and November 12, 2023, is a significant rise compared to the highest annual number previously reported, which was 6,216 cases in 2020. The outbreak has expanded to new geographic areas, including Kinshasa, Kwango province, and South Kivu. The reasons for this expansion, affecting individuals of all ages and genders, are currently unknown.

While increased global awareness of the mpox epidemic, particularly due to clade IIb Monkeypox virus (MPXV), has contributed to improved surveillance in the country, many aspects of the current situation remain unclear.

The circumstances surrounding the surge in cases and the expansion into new regions require further investigation and understanding. Efforts to elucidate the factors contributing to this increase and the spread of mpox are crucial for effective public health responses.

In summary,  the WHO has indicated the following as particular concerns:    

• The geographic expansion of the presence of mpox is underway in the newly affected southern and eastern provinces of the country;
• Epidemiological and scientific knowledge about mpox remains limited and modes of transmission in the country are poorly understood;
• In 2023, confirmed cases of mpox have been reported in the large urban area of Kinshasa and several other previously unaffected areas for the first time;
• Sexual transmission of mpox due to clade I MPXV is being documented for the first time and chains of transmission may have been missed;
• Key populations experience a higher prevalence of HIV infection than the general population;
• Awareness of mpox and the associated risks are insufficient in the general and key populations;
• National response capacities face challenges, including limited epidemiological information on exposure and infection risk factors, limited public awareness of mpox and prevention measures, and numerous competing priorities;

WHO Recommendations
 

All countries, health authorities, and healthcare workers should be aware that the global monkeypox (mpox) outbreak is ongoing.

Given it has been confirmed that sexual transmission of the clade I virus is occurring and that there is an increased risk of severe illness associated with clade I MPXV, it is strongly recommended that countries adhere to the Standing Recommendations of the Director-General of the World Health Organization (WHO) issued in August 2023.

This includes focusing on epidemiological surveillance of mpox, enhancing laboratory diagnostic capabilities and genomic sequencing of viruses, engaging communities through effective risk communication, ensuring the availability of vaccines, implementing optimal case management, supporting research to understand transmission modes in different contexts better, and providing sustained assistance for the development of rapid diagnostic methods and patient-tailored treatments.