By Mercy Kachenge
Nairobi, Kenya: An outbreak of an undiagnosed disease has been reported in the Panzi health zone of Kwango Province, Democratic Republic of the Congo (DRC) in the period of between October and December 2024.
The 406 recorded cases and 31 associated deaths, yield a case-fatality ratio of 7.6 percent. Children under the age of five years represent the majority of affected individuals, with severe malnutrition emerging as a common factor among fatal cases.
According to the World Health Organization (WHO), the undiagnosed disease is associated with symptoms such as fever, headache, cough, runny nose, and body aches with all the severe cases reported to be severely malnourished.
The report notes that difficulty breathing, anemia, and malnutrition are key symptoms linked to fatal outcomes. The disease’s spread appears to be localized, with cases reported in nine out of 30 health areas in Panzi, with Tsakala Panzi (169), Makitapanzi (142), and Kanzangi (78) emerging as the most affected. WHO confirmed that 95.8 percent of cases were concentrated in these three areas.
The analogy revealed that in the Panzi health zone, children aged 0-14 years represent 64.3 percent of all reported cases, with the age groups 0-59 months, 5-9 years, and 10-14 years accounting for 53 percent, 7.4 percent, and 3.9 percent of cases, respectively. Females constitute 59.9 percent of the total cases. Among the deaths, 71 percent are below the age of 15, with 54.8 percent of the total in children under the age of five years. All severe cases were reported to be malnourished. There are 145 cases aged 15 and above, of which nine died (CFR: 6.2 percent) which have primarily occurred in the village communities.
According to the Ministry of Health of the Democratic Republic of the Congo, reported to WHO that there have been several additional deaths outside of health facilities (community deaths) that still need to be investigated and are characterized by age, and gender among others that need to be verified.
WHO confirmed that rapid response teams have been deployed to identify the cause of the outbreak and strengthen the response. This is through the response teams collecting samples for laboratory testing, providing a more detailed clinical characterization of the detected cases, investigating the transmission dynamics, and actively searching for additional cases, both within health facilities and at the community level.
‘’The teams are also aiding with the treatment of patients, risk communication, and community engagement. Given the clinical presentation and symptoms reported, and a number of associated deaths, acute pneumonia, influenza, COVID-19, measles, and malaria are being considered as potential causal factors with malnutrition as a contributing factor. Malaria is a common disease in this area, and it may be causing or contributing to the cases in which laboratory tests are still underway to determine the exact cause. At this stage, it is also possible that more than one disease is contributing to the cases and deaths’’.
The report revealed that the area experiences deterioration in food insecurity, has low vaccination coverage, very limited access to diagnostics and quality case management, malaria control measures are very limited, lack of supplies and transportation means, and shortage of health staff in the area.
According to WHO, the affected area Of DRC is remoteness and logistical barriers, which entails a two-day road journey from Kinshasa that takes 48 hours as a result of the rainy season that is affecting the roads. There is also limited mobile phone and internet network coverage across the health areas which has hampered the rapid deployment of response teams and resources.
Based on the analogy, there is no functional laboratory in the health zone or province that requires the collection and shipment of samples to Kinshasa for analysis. This has led to the deployment of diagnosis and response efforts. The lack of sample collection supplies has further limited diagnostic capacity, leaving significant gaps in understanding the outbreak’s etiology.
Furthermore, the issue of insecurity within the region adds another layer of complexity to the response team and communities which poses a great risk to them as a result of the attacks by the armed groups.
To mitigate the impact of the diseases, WHO urges the strengthening of coordination mechanisms at all levels, both at national, provincial, zonal, and local levels which will ensure a unified response. Also, enhancement of communication infrastructure, such as satellite phones is required to overcome the limited network coverage in affected areas. The Cross-border collaboration between DRC and Angola is also crucial in order to monitor the situation of similar cases that will prevent potential cross-border transmission.
WHO underscored the need for careful characterization of the clinical syndrome and outcomes that will improve case definition based on the information collected. This is through the data collected from the samples which will clarify the possibility of coinfection multiple pathologies, and uncertainties in outcomes among vulnerable groups. In response to this, WHO has established the Global Clinical Platform to provide rapid turnaround of structured data analysis using anonymized case records.
WHO urged the need for Infection prevention and control (IPC) measures that must be reinforced across all health facilities. This will entail healthcare workers receiving training on IPC practices, including the proper use of personal protective equipment (PPE) such as masks and gloves, as well as strict hand hygiene protocols. These measures will reduce the impact of transmission risks within health facilities and improve the safety of healthcare delivery for the communities in the affected areas.
According to the report, WHO emphasized the need for risk communication and community engagement which are essential in raising public awareness through the targeted messages that should be disseminated to educate the public on respiratory illness symptoms, preventive measures, and the importance of seeking care early. Also, community leaders must be engaged to build trust and encourage adherence to public health guidance by addressing misinformation and fears within the community.
Additionally, WHO advises on the need for further investigations that are critical in ensuring clarity of whether anemia as observed in severe cases is linked to the outbreak. This means that the main hypothesis of respiratory illness should be validated by studying its relationship with seasonal influenza and other potential factors. Also, historical outbreaks, such as that of typhoid fever which was reported in the health zone two years ago, should also be reviewed to identify recurring vulnerabilities that may inform current response efforts. Understanding general malnutrition rates and identifying cases of acute malnutrition in the affected population can inform appropriate nutritional care and prevent further deaths in the regions.
‘’Strengthening logistical support for the deployment of teams and supplies will ensure timely access to affected areas. Contingency plans should be developed to address potential insecurity posed by armed groups, safeguarding response personnel and maintaining continuity in response activities, WHO reiterated.
WHO highlighted the importance of effective case management that is required to ensure an adequate supply of essential medications to support treatment and prevent more deaths. This involves RDTs for malaria to be distributed to facilitate differential diagnosis, while laboratory testing must be expedited through the shipment of samples to INRB Kinshasa to confirm or rule out suspected causes, including COVID-19 and influenza. Also strengthening of long-term laboratory capacity and decentralization of the same is essential in the provision of diagnostic capability in the affected health zone.
The WHO report urges the global health community to address the outbreak’s immediate needs and underlying vulnerabilities through strengthening coordination efforts, improving surveillance, and addressing malnutrition which are critical steps to prevent further loss of life. The organization reiterated the importance of long-term investments in healthcare systems to enhance preparedness for future outbreaks.
