Q&A: Cause of DRC outbreak identified as combination of malaria, flu and malnutrition
Click Here to Manage Email Alerts
Key takeaways:
- In December, the DRC Ministry of Health announced the emergence of an unknown disease causing influenza-like symptoms.
- The disease outbreak was identified as a combination of malaria, respiratory infection and malnutrition.
In early December, health officials in the Democratic Republic of the Congo, or DRC, announced that an unknown illness had emerged and had already killed dozens of patients, with hundreds more sick.
At the time, the Ministry of Public Health said that the unknown illness, which was being referred to at the time as “Disease X,” was causing influenza-like symptoms and was primarily affecting children aged 15 years and older.
Since its emergence, though, health officials have determined that the mystery illness was actually an outbreak of malaria associated with influenza exacerbated by severe malnutrition.
We spoke with Richard Fotsing, MPH, infectious hazard management officer for WHO in the DRC, about what happens next in terms of tracking and outbreak response.
Healio: What are the latest totals — cases, deaths, etc.? Will this situation continue to be followed as a distinct epidemic, or will it be integrated into the case counts of identified diseases?
Fotsing: The disease in the Panzi health zone has been identified as an outbreak of malaria associated with influenza in an area with severe malnutrition. The latest situation report (published on Jan. 10, 2025), covering the period from Dec. 31, 2024, to Jan. 9, 2025, reports 649 new cases, bringing the total to 3,512 cases, with 80 deaths recorded, giving a case fatality rate of 2.2%, particularly among children aged younger than 5 years old.
How this situation will be tracked will depend on the decisions of local health authorities and the evolution of the epidemic. If the situation continues to show specific characteristics, such as worsening because of malnutrition and geographical spread, it may be monitored as a distinct epidemic for 3 to 6 months, following the Emergency Response Framework, before being integrated into the global disease counts at the national level once the situation is deemed under control. As of now, all 30 health zones are affected. This is why a national incident management system has been set up, and a response plan will be validated in the coming days.
Healio: Is the cause of death in these children considered to be severe malaria or a combination of all the diseases?
Fotsing: The deaths of these children are primarily due to a combination of several factors. Laboratory results from 430 samples tested on Dec. 16, 2024, show acute respiratory infections caused by common viruses (influenza A, rhinovirus, SARS-CoV-2, etc.) associated with Plasmodium falciparum malaria and exacerbated by severe acute malnutrition. This suggests a complex coinfection where the different diseases combine and worsen the situation, particularly in a context of increased vulnerability. This combination of viral infections and malaria led to severe infections and deaths, particularly in children aged younger than 5 years old, with a case fatality rate of 2.2%.
Healio: For years, WHO has used the term "Disease X" as a substitute for an unknown pathogen that could cause human diseases. COVID-19 was a "Disease X." Many stories have attributed these deaths in DRC to "Disease X" after the Africa CDC used this term. Is WHO concerned that the term "Disease X" has been misused here or that it might be associated with these diseases in the future?
Fotsing: The term "Disease X" is used by WHO to refer to an infectious disease currently unknown, which could cause an epidemic or pandemic if it spreads beyond borders. It is not a disease that has already been identified. In the case of DRC, the deaths are linked to respiratory infections and malaria, as revealed by laboratory test results. This term is mainly used in the context of preparedness for unforeseen threats. WHO has a list of nine potentially dangerous diseases, including "Disease X," but this list is not exhaustive and does not specifically predict the next epidemic.
Q: Is one of the malaria vaccines being used in these regions?
According to the World Malaria Report 2024, nearly 263 million cases of malaria were reported globally in 2023 compared with 204 million in 2000. Five countries in the African Region accounted for more than half of the global cases, including the Democratic Republic of the Congo, which contributed 12.6% of the cases and 11.3% of nearly 569,000 deaths reported in the same year.
The malaria vaccine R21 has been integrated into the DRC's expanded vaccination program and launched in the Kongo Central province, one of the hardest hit areas, targeting 173,375 children in 31 health zones in October 2024. DRC became the 15th African country to introduce this vaccine, offering a new measure of prevention against this deadly disease.
In this first phase, 300,000 children will receive four doses of the vaccine over the period from 2024 to 2025. The extension plan includes three vaccination phases aiming to cover all 26 provinces of DRC by the end of 2025. The first phase covers 10 provinces, including the Kwango province where the Panzi health zone is located. It is important to note that the vaccine is an additional measure to the existing prevention methods already in place, such as the distribution of insecticide-treated nets, preventive treatments and insecticide spraying.
Q: What other measures are being taken to respond to this situation?
Fotsing: Efforts continue to address the health needs in the Panzi health zone. WHO has deployed multidisciplinary rapid response teams to investigate the event and strengthen the response in the Panzi health zone alongside local health authorities.
An epidemiologist and a data manager have also been deployed to Panzi to support surveillance, data management and coordination of the response for a period of three months.
Additionally, oxygen concentrators, all-terrain motorcycles, laboratory supplies, rapid malaria diagnostic tests and essential medicines have been delivered to health facilities in the area. These efforts have helped treat and save more than 3,400 lives.
References:
- WHO. Acute respiratory infections complicated by malaria (previously undiagnosed disease) - Democratic Republic of the Congo. https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON547. Published Dec. 27, 2024. Accessed Jan. 15, 2024.
Collapse
Healio interview
Read more about
Click Here to Manage Email Alerts