Mpox in the DRC 2023-2024

Mpox Outbreak Updates:

November 2024: There has been a case of clade I in California. November 16, 2024: The California Department of Public Health confirmed the first known case of clade I mpox in the United States related to the outbreak in Central and Eastern Africa (CDC).

August 2024: The director-general of the World Health Organization (WHO) declared mpox a Public Health Emergency of International Concern (PHEIC) on August 14, 2024, in the Democratic Republic of Congo (DRC) and neighboring countries. Find out more in the WHO Disease Outbreak News, and "The Mpox Global Health Emergency — A Time for Solidarity and Equity" (NEJM).

November 2023: An outbreak of Mpox is ongoing in the Democratic Republic of the Congo (DRC). From January 1 to November 12, 2023, there had been a two-fold increase in the number of suspected Mpox cases, with 12,569 suspected cases reported, compared to 6,216 in 2020, the highest annual number previously reported.

The infections in the DRC were caused by Mpox Virus (MPXV) clade I, which is generally considered to be more virulent than MPXV clade II, which was responsible for the multi-country epidemic of Mpox in 2022-23.

The timeline below is derived from the WHO Disease Outbreak News report published on November 23, 2023.

November 2023: A total of 12,569 suspected Mpox cases, including 581 suspected Mpox deaths (case fatality ratio: 4.6%), have been reported in 156 health zones from 22 out of 26 (85%) provinces in the DRC.

Eleven of the 26 provinces of the DRC are identified as endemic for Mpox, but in more recent years the total number of Mpox cases and the number of provinces reporting Mpox has been expanding, to 22 provinces as of November 2023 (WHO).

September 2023: South Kivu province reported its first Mpox outbreak. The first confirmed case was a young trader who traveled from Kisangani, in Tshopo province, one of the Mpox endemic provinces, a few days before the onset of symptoms. As of November 22, 2023, a total of 80 suspected and 34 confirmed cases (including 20 sex workers) of Mpox have been reported in South Kivu mainly from the Kamituga health zone, with no deaths.

August 2023: For the first time, Mpox cases were confirmed in Kinshasa, the capital of the DRC. Four separate events were identified where persons exposed in other provinces (Equateur, Maindombe) traveled to Kinshasa, each leading to local transmission with small clusters in the capital. The first confirmed case was in a person who arrived from the Maindombe province, where Mpox is endemic, to Kinshasa by river boat. As of 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

July 2023: A confirmed case of Mpox was recorded in another man who had sex with men in Kenge town in the DRC. Limited epidemiological investigation did not directly link him to the March-April cluster.

April 2023: The first cluster of suspected cases of sexually transmitted clade I MPXV was identified in Kenge, Kwango province of the DRC. It included six confirmed cases, five men and one woman, with no deaths among the confirmed cases. The first known case was a man, a resident of Belgium with connections to the DRC, who confirmed having sexual contact with the five other confirmed cases. He showed symptoms on the day of his arrival in the country, and with the Mpox incubation period most often being more than one day, available information suggests that exposure took place outside the DRC.

Mpox:

Mpox disease is caused by the Mpox Virus (MPXV), of which there are two known clades: clade I, previously known as the Congo Basin clade or the Central African clade; and clade II, previously called the West African clade. Clade II is responsible for the global Mpox epidemic that began in 2022. The current outbreak in the DRC is clade I.

Clade I MPXV is known for more severe clinical manifestations compared to other clades. This variant is characterized by a higher rate of transmission, increased virulence, and a greater potential for causing serious health complications. The symptoms typically include fever, rash, and swollen lymph nodes, and can lead to more severe outcomes, especially in immunocompromised individuals.

Mpox is a rare but potentially serious viral illness that typically begins with flu-like symptoms, followed by a rash that often begins on the face and then spreads to other parts of the body. Some individuals have had genital lesions, and the rash may be hard to distinguish from syphilis, herpes simplex virus (HSV) infection, chancroid, varicella zoster, and other more common infections.

Hospital and ambulatory staff members should screen all patients regardless of travel histories, exposure, or clinical symptoms that might suggest the person could have or have been exposed to someone with Mpox.

NETEC has collected some essential resources on this page. Additionally, health care and public health professionals can submit a question to one of NETEC’s many experts via the web portal or by emailing info@netec.org.

See below for clinical care and infection control resources related to Mpox, NETEC Resources and Other Resources, and for Waste Management Resources.

The following resources were developed and shared during the multi-country Mpox outbreak of clade II in 2022-2023. The current outbreak of Mpox clade I requires different considerations for patient management as clade I is considered a select agent. If you have questions related to the isolation of patients and waste management, please reach out to us here or email us at info@netec.org.