Mysterious illness, dubbed "disease X," has killed dozens of people in Congo, WHO says

Situation at a glance

Description of the situation

On 29 November 2024, the Ministry of Public Health of the DRC alerted WHO to increased deaths from an undiagnosed cause in the Panzi health zone, Kwango Province. Between 24 October and 5 December 2024, 406 cases of an undiagnosed illness with fever, cough, headache, runny nose, and body aches were reported, including 31 deaths (CFR: 7.6%). The outbreak peaked in early November and remains ongoing, with additional unverified community deaths.

Cases were reported from nine out of 30 health areas, with Tsakala Panzi, Makitapanzi, and Kanzangi accounting for 95.8% of cases. Children aged 0-14 years make up 64.3% of cases, with the highest concentration (53%) among those under five years old. Females represent 59.9% of cases, and 71% of deaths occurred in those under 15, primarily malnourished individuals.

The region faces severe challenges, including food insecurity, low vaccination coverage, limited diagnostics, and shortages of medical supplies, transportation, and staff. Symptoms like fever (96.5%), cough (87.9%), and fatigue (60.9%) dominate. Fatalities are linked to difficulty breathing, anemia, and acute malnutrition.

Suspected causes under investigation include measles, influenza, acute pneumonia, malaria, COVID-19, and hemolytic uremic syndrome, with laboratory testing ongoing to confirm the cause.

WHO advice

To address the ongoing outbreak in the Panzi health zone and prevent further spread, WHO recommends the following measures:

1. Strengthen Coordination and Communication:

   • Enhance coordination at national, provincial, zonal, and local levels for a unified response.
   • Establish satellite communication infrastructure to overcome limited network coverage.
   • Collaborate with Angola to monitor cross-border cases and transmission.

2. Enhance Surveillance:

   • Continue active case searches in health facilities and communities, focusing on high-risk areas.
   • Strengthen community-based surveillance for early case detection and response.

3. Improve Data Collection and Analysis:

   • Collect detailed clinical data, particularly on coinfections, vulnerable groups, and case outcomes.
   • Utilize WHO's Global Clinical Platform for structured data analysis.

4. Ensure Effective Case Management:

   • Provide essential medications and distribute rapid diagnostic tests (RDTs) for malaria.
   • Expedite laboratory testing through sample shipment to Kinshasa and invest in local diagnostic capacity.

5. Reinforce Infection Prevention and Control (IPC):

   • Train healthcare workers in IPC practices, including proper use of PPE and hand hygiene.
   • Strengthen IPC measures across health facilities to prevent transmission.

6. Promote Risk Communication and Community Engagement:

   • Disseminate targeted messages to educate communities on symptoms, preventive measures, and early care-seeking.
   • Engage community leaders to build trust and combat misinformation.

7. Address Logistical and Security Challenges:

   • Improve logistical support for response teams and supplies.
   • Develop contingency plans to address security risks from armed groups.

8. Investigate and Address Contributing Factors:

   • Examine the relationship between anemia and the outbreak, as well as possible links to respiratory illnesses.
   • Review past outbreaks and assess malnutrition rates to guide nutritional care and identify vulnerabilities.

These measures aim to contain the outbreak, improve patient outcomes, and address systemic challenges in the affected region.

 Source

World Health Organization (8 December 2024). Disease Outbreak News; Undiagnosed disease – Democratic Republic of the Congo. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON546