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Undetectable illness and death in African monkeypox epidemic

 


  • Africa’s infection and death rates higher than official data
  • Lack of Resources Hinders Containment
  • Wealthy countries rush for available cures
  • Africa gets left behind, repeated COVID response failures

YAROLIA, Democratic Republic of the Congo (Reuters) – At a clinic in a village in central Congo, cut off from the rest of the world by a tangle of waterways and forests, 6-year-old Angelika Riffahu is approached by a nurse in a protective suit. I’m screaming, clutching my dress. Pick her one of the hundreds of boils plaguing her delicate skin.

Her uncle, 12-year-old Lisungi Lifafu, sits at the foot of her bed, facing away from the sunlight streaming in through the doorway, straining his swollen weeping eyes. When the nurse approaches, he raises his chin but is unable to look up.

Children have monkeypox, which was first discovered in Congo 50 years ago, but cases have surged in West and Central Africa since 2019. The disease received little attention until it spread around the world this year. 77,000 infected.

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Global health organizations have counted far fewer cases in Africa during the current outbreak than in Europe and the United States. pounced A limited number of vaccines this year the disease has reached their shores.

However, Reuters reports that the outbreak and death toll in Congo may be much higher than recorded in official statistics, largely due to testing in ill-equipped rural areas. are very limited and effective medicines are not available.

A Reuters reporter found about 20 monkeypox cases, including two who died, during a six-day trip to remote Tupo this month. None had access to vaccines or antivirals, including Angelica and Lisunghi.

A lack of testing facilities and poor transport links have made tracking the virus nearly impossible, more than a dozen health workers said.

When asked about the underestimation, the African Centers for Disease Control and Prevention (CDC) acknowledged that its data did not capture the full extent of the outbreak.

Only about 10 people have died from monkeypox in the West this year, according to US CDC figures. In Europe and the US, we were able to vaccinate at-risk communities. Experts say suspected cases are routinely screened, isolated and treated early, thus improving survival.The number of cases in Europe and America is It stabilized and started to fall.

But according to the Africa CDC, more than 130 people have died in poor African countries, where many people do not have quick access to medical facilities or are unaware of the dangers, most of them in the Congo. increase.

Monkeypox vaccine is not publicly available in Africa.

Without treatment, Angelica and Lisunghi will have no choice but to wait for the disease to heal. Those are preceded by a myriad of possible outcomes, including recovery, blindness, or, as in August’s family’s case, death.

“These children are sick and suffering a lot,” said Lisunghi’s father, Litumbe Lifafu, at a clinic in Yaloria, a village dotted with mud huts, 1,200 kilometers (750 miles) from the capital, Kinshasa. .

“We demand that the government provide us poor farmers with medicines and vaccines to combat this disease.”

history repeats itself

The World Health Organization last year “moral failure” On responding to the COVID-19 pandemic as African countries find themselves at the back of the line for vaccines, tests and treatments.

But a health worker consulted by Reuters said such failures have been repeated in monkeypox for a year. This risks future flare-ups of the disease in Africa and the world, experts said.

While a sudden demand from the West has siphoned off available vaccines, poorer countries such as Congo, where the disease has been around long enough to become endemic, have been slow to seek supplies from WHO and partners. I got

Congo’s Health Minister Jean-Jacques Mbungani told Reuters that the country was in negotiations with the WHO to purchase the vaccine, but no formal request had been made. A spokeswoman for Gavi, the Vaccine Alliance, said it had not received requests from African countries where the virus is endemic.

A WHO spokeswoman said that in the absence of a vaccine available, countries should instead focus on surveillance and contact tracing.

Professor Dimi Ogoina, president of the independent Nigerian Communicable Diseases Association, said: “History repeats itself. Time and time again, the funds needed to contain disease in Africa are not available until rich countries are at risk. Yes, he said.

“It’s happening again with HIV, Ebola, COVID-19, and monkeypox.”

Without adequate resources, we will never know the true spread of the virus, he and other experts said.

“In Africa, we work blindly,” said Ogoina. “The number of cases is greatly underestimated.”

Monkeypox is spread by close contact with skin lesions. In most cases, it will resolve within a few weeks. Young children and people with weakened immune systems particularly vulnerableto serious complications.

Congo has more than 4,000 suspected and confirmed cases this year, with 154 deaths, according to the Africa CDC, based in part on data from health authorities. This is far less than his 27,000 odd cases recorded in the United States and his 7,000 recorded in Spain. African countries with outbreaks include Ghana, which has about 600 suspected and confirmed cases, and Nigeria, which has about 2,000 cases.

“Yes, it is underestimated,” said Ahmed Ogwell Ouma, deputy director of the Africa CDC. “Communities that are endemic to monkeypox typically don’t have access to regular medical facilities.” He said the CDC can’t say how big the underestimation is right now.

Congo’s Health Minister Mbungani said testing capacity was lacking outside of Kinshasa, but did not respond to a request for comment on missed cases.

front line

African countries should be aware that the WHO decision in July declare monkeypox a public health emergency of international concern

WHO has dispatched about 40,000 tests to Africa, including 1,500 to Congo, said Ambrose Talisuna, WHO’s monkeypox incident manager on the African continent.

This month, the Congo National Institute of Biomedical Sciences began a clinical trial of the antiviral drug tecovirimato in patients with monkeypox. There is no vaccine for public consumption, but health minister Mubungani said trials are underway using his Imvanex vaccine from Bavaria and his Nordics against Congolese health workers.

However, little has changed in central Congo.

Yaloria, where Angelica and Lisunghi are patients, can only be reached by a bike path that tunnels through dense jungle or a canoe carved from a felled tree trunk. A few years ago, a series of wooden bridges collapsed, cutting off an old road leading to a nearby village.

In August, Lisungi’s brother developed a rash and had trouble breathing. His family thought it was smallpox. When his condition worsened, doctors put him on an IV. He died before he was empty.

A grief-stricken Lisungi cradled his brother’s infected corpse. Two weeks later in his early September, he also developed a rash and his eyes were swollen shut. After that, Angelica fell ill.

Lisumbe took the children to Yaloria, where they were diagnosed with monkeypox based on symptoms. He sold his belongings to buy fever-lowering medicine.

The nurses caring for them are baffled by the lack of treatment.

“If there is a vaccine, we should have it. If there is a treatment, we should have it,” said nurse Marcel Osekasomba.

The incident was not reported to authorities until Reuters visited Yaloria with a local health official called Theopist Maroko. He only went to the village at the suggestion of Reuters.

If there is no test result, it is recorded as a suspected case.

isolated case

Roughly the size of England, Tsopo is heavily wooded and carved by the Congo River and its many winding tributaries. Maroko’s job is to track cases in an area that spans 5,000 square kilometers. However, he cannot afford gasoline and has no transportation.

A nurse took a sample from a wound on Angelica’s leg and placed it in a polystyrene cooler attached to the back of her bike, but Maroko was skeptical.

To avoid spoilage, samples must be kept cool and arrive at the laboratory within 48 hours, but often this is not the case, he said. The nearest laboratory is in Kinshasa. Results may take weeks or months.

“We are suffering. This is really our warning cry. We are raising our voices so that someone can hear us,” he said.

In some cases, no sample is even taken.

The village of Yaranga is a day’s journey by road and boat from Yaloria. Surrounded by jungle, there is no telephone network or electricity. When the lights go out, health center patients lie on hard bamboo beds in the dark.

The clinic, a small building with a tin roof and five rooms, has had three cases in recent months. Nurses have to travel half a day to receive calls to notify authorities of new cases. When they are busy it is impossible to escape. The most recent case was recorded several weeks late, said nurse Aringo Rikaka Manase.

Lituka Wenda Dety, a 41-year-old mother, believes she got sick after eating infected bush meat. At the height of her illness in August, her throat was so sore that she had trouble swallowing her own saliva.

Detty’s body is still dotted with round scars and her bones are aching. she is sad Her six-month-old son contracted monkeypox and died when she was ill and hospitalized. He is buried in the sand by his mud-brick house.

At the end of the day, Dety and her family gather around a small rectangular grave. She whispers a prayer.

“I want to do a vaccination campaign,” she said. “Given the suffering we suffer, it would be devastating if many people got this disease.”

Reported by Jafar al-Khatanti at Tsopo and Edward McAllister at Dakar. By Edward McAllister. Additional reporting by James Macharia Chege, Johannesburg and Stanis Bujakera, Kinshasa.Edited by Frank Jack Daniel

Our criteria: Thomson Reuters Trust Principles.

Sources

1/ https://Google.com/

2/ https://www.reuters.com/business/healthcare-pharmaceuticals/africas-monkeypox-outbreak-sickness-death-go-undetected-2022-10-31/

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