Mpox - Democratic Republic of the Congo

14 June 2024

Situation at a glance

In December 2022, the Democratic Republic of the Congo declared a national outbreak of mpox and an incident management system has been in place since February 2023, based on the increasing number of reported cases. Since September 2023, an outbreak of mpox in South Kivu province has continued to spread within the province and recently to neighbouring North Kivu, driven by sexual contact transmission. A new variant of clade I MPXV has been described in South Kivu. It carries predominantly APOBEC3-type mutations, indicating adaptation of the virus due to circulation among humans. It was estimated to have emerged around mid-September 2023, and its human-to-human transmission has been ongoing since then. This is the first documented sustained community transmission of the virus in the country. It is not known if this variant is more transmissible or leads to more severe disease than other clade I MPXV strains. Additionally, it carries gene deletions that affect diagnostics in the Democratic Republic of the Congo. To date, only clade I MPXV has been detected in the country, which in the WHO African region, reports the highest number of cases. In 2024, as of 26 May, a total of 7 851 mpox cases were reported in the Democratic Republic of the Congo, including 384 deaths (Case Fatality Rate (CFR) 4.9%). These cases were reported in 177 of the 519 (34%) health zones across 22 out of the 26 provinces (85%). The continuing development of the mpox outbreak in the Democratic Republic of the Congo remains concerning due to the continuing high incidence of mpox reported in endemic areas of the country in recent years with high case fatality, the geographic expansion to previously unaffected areas, the appearance of a novel strain of clade I MPXV, the observed sustained community transmission driven by sexual transmission and other forms of close physical contact in the eastern part of the country, resource constraints to respond over such a wide geographic area, limited public awareness of mpox, the insufficient availability of treatment kits and lack of vaccines to date, multiple competing public health priorities, and insecurity. Based on the situation, WHO assesses that the risk associated with mpox in the Democratic Republic of the Congo remains high.