Representational photo
Geneva: The undiagnosed disease in the Democratic Republic of the Congo (DRC) is now named acute respiratory infections complicated by malaria, the World Health Organization (WHO) said, today.
Since the last Disease Outbreak News on this event was published on December 8, 2024, 485 additional suspected cases and 17 additional deaths have been reported from the Panzi health zone in Kwango Province, Democratic Republic of the Congo, across 25 out of the 30 health areas in Panzi.
These cases were identified as a result of enhanced surveillance put in place following the report of deaths in the context of febrile illness with acute respiratory symptoms and anaemia, first reported on November 29, 2024. While the number of reported cases was not deemed particularly unusual in the context of a high burden of pneumonia, malaria and acute respiratory infections, particularly at the start of the rainy season, it is the increase in the number of deaths that triggered the alert on November 29.
The number of weekly reported suspected cases has remained steady except an increase in the week ending December 15, 2024.
In the absence of diagnosis, a broad surveillance case definition was used, with the resulting case numbers reflecting the detection of any febrile illness occurring in Panzi and thus representing a range of diseases and clinical syndromes. The case definition includes: any person living in the Panzi health zone from September 2024 to date, presenting with fever, cough, body weakness, runny nose, with or without one of the following symptoms and signs: chills, headache, difficulty breathing, malnutrition, body aches.
This was done for a better understanding of the epidemiology and characteristics of deaths, and to collect a range of clinical samples for laboratory testing.
Between October 24 and December 16, 2024, 48 deaths and a total of 891 cases across 25/30 health areas of the Panzi health zone met the case definition. Children under five years of age are disproportionally affected, representing 47% of all cases and 54% of all deaths, while they represent around 18% of the population, likely reflecting the vulnerability of young children to severe disease and death in this context. The main symptoms associated with death include difficulty in breathing, anaemia, and signs of acute malnutrition.
A total of 430 samples including blood samples, oropharyngeal and nasopharyngeal swabs, urine and breastmilk samples were collected from suspected cases in the Panzi health zone and transported to the laboratory at the Institut National de la Recherche Biomédicale (INRB), which is the national medical research organization of the Democratic Republic of the Congo. Out of 88 rapid diagnostics tests for malaria performed in the field, 55 (62%) samples tested positive.
In addition, out of 26 samples analyzed by PCR BioFire Global Fever Panel test (which tests 18 different pathogens including some of the viral hemorrhagic fevers), 17 (65%) samples tested positive for Plasmodium falciparum. In addition, a total of 89 samples were tested at INRB Respiratory Disease Surveillance Laboratory. Of the 89 samples, 64 samples were positive for common respiratory viruses including Influenza A (H1N1, pdm09) (n=25), rhinoviruses (n=18), SARS-COV-2 (n=15), Human coronaviruses (n=3), parainfluenza viruses (n=2), and Human adenovirus (n=1).
Other laboratory tests on the collected samples, including virological and bacterial analysis, are still ongoing. The ongoing investigations and preliminary laboratory findings suggest that a combination of common viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths.
It may be recalled that on November 29, 2024, an alert was raised by local health zone authorities of Panzi health zone in Kwango province after an increase in deaths, particularly among children under five years of age, following febrile illness.
Also read: An undiagnosed disease causes 31 deaths in DRC
Enhanced epidemiological surveillance was rapidly implemented, which in the absence of a clear diagnosis was based on the detection of syndromic cases of febrile illnesses with cough, body weakness, with one of a number of other symptoms compatible with acute respiratory and febrile illnesses. This resulted in a rapid increase in the number of cases meeting the definition, with a total of 891 cases reported as of December 16, 2024. However, the weekly number of reported deaths (48 deaths reported over the period) has remained relatively stable.
As of December 16, laboratory results from a total of 430 samples indicated positive results for malaria, common respiratory viruses (Influenza A (H1N1, pdm09), rhinoviruses, SARS-COV-2, Human coronaviruses, parainfluenza viruses, and Human Adenovirus). While further laboratory tests are ongoing, together these findings suggest that a combination of common and seasonal viral respiratory infections and falciparum malaria, compounded by acute malnutrition led to an increase in severe infections and deaths, disproportionally affecting children under five years of age.
Multidisciplinary rapid response teams have been deployed to investigate the event and strengthen the response. Efforts are ongoing to address the health needs in the Panzi health zone. Enhanced surveillance in the community and within health facilities continues. The teams have also been providing support for diagnosis, patient treatment, risk communication, and community engagement.
The WHO stated that this event highlights the severe burden of common infectious diseases (acute respiratory infections and malaria) in the context of vulnerable populations facing food insecurity. It emphasizes the need to strengthen access to health care and address underlying causes of vulnerability, particularly malnutrition, given the worsening food insecurity.
– global bihari bureau
