The mysterious “Disease X” outbreak may be malaria. what we know

The Democratic Republic of Congo (DRC) is facing a health crisis in the remote Panji health zone of Kwango province. The undiagnosed disease has infected more than 400 people and killed at least 31 people there, most of them malnourished children under the age of five. The mysterious “Disease X,” which may or may not be a new disease, causes symptoms such as fever, headache, cough, runny nose, and body aches. The World Health Organization said in a press conference on Tuesday that 10 out of 12 samples were infected. The malaria test was positive.However, multiple diseases may be involved. The outbreak raises pressing questions about whether the DRC can effectively respond to health emergencies in isolated areas.

Access to Panji is a challenge, requiring several days of travel from the capital Kinshasa due to poor road infrastructure. “This is the very definition of remote,” says Placido Mbala, a virologist and head of epidemiology at the National Institute of Biomedical Research in the Democratic Republic of the Congo. He explains that limited connectivity and delays in sample collection are hampering diagnostic efforts. Team member Mbala said the samples initially collected were not suitable for analysis, but a team from the Democratic Republic of Congo's Ministry of Public Health is now collecting higher quality samples.

Complex responses hampered by uncertainty

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The DRC Ministry of Health, with support from WHO and Africa CDC, deployed a multidisciplinary team to investigate and respond to the outbreak. However, delays in identifying the pathogen complicate efforts to implement targeted interventions. “If you don't know exactly what the pathogen is, it's difficult to have a targeted response,” Mbala said. Instead, the response is focused on isolating sick people, communicating risks, and providing supportive care to affected individuals while taking common precautions.

The situation has improved with the dispatch of medical workers, but the delayed response has drawn criticism. Mbala stresses that the problem is not a lack of diagnostic capacity, but rather a logistical issue. He acknowledged that the outbreak has also highlighted the DRC's overall vulnerabilities, including vast geographic barriers, weak infrastructure, and recurring violence, which make it particularly vulnerable to health crises.

Thank God Ebenezer, founder of the African Biogenome Project, emphasizes the important link between animal and human health, especially in the context of zoonotic diseases. He explained that most diseases that affect humans, including HIV/AIDS, SARS, and perhaps the new coronavirus, originate from other animals, and that biodiversity should be maintained and genetic diversity should be maintained to prevent infection. It emphasizes the importance of understanding.

“When it comes to disease X in the DRC, one of the things we tend to forget is that most diseases come from animals. “We don't often make peace with nature,” Ebenezer says. He further pointed out that human interference with biodiversity creates vulnerabilities that allow animal diseases to spread to humans, and that genomics could play an important role in addressing this. . “We can use genomics and biodiversity genomics to learn how to maintain genetic diversity, prevent transmission, and ensure infection prevention. [encroaching on] It is a biodiversity conservation space,” he added.

Global support and local resilience

International organizations such as the WHO and the African Centers for Disease Control and Prevention play an important role in logistics and field investigations. Their support has enabled the deployment of resources to Panji, but uncertainty regarding the pathogens involved has limited the scope of assistance they can provide. Grassroots communication is also a key component of the response, with local leaders urging calm and educating communities on precautions. “The Ministry of Health is trying to understand the situation and has sent qualified personnel to investigate,” Mbala said.

The DRC's response is based on extensive experience managing outbreaks such as Ebola and mpox. Mbala expressed confidence that the country's skilled public health responders can use this expertise to quickly contain the outbreak. “We should be able to manage this effectively if we bring in all the experienced people who have coordinated past responses,” he says.

scientific american We spoke to Mr. Mbala about the outbreak and response. (This conversation took place before WHO confirmed that many of the samples tested positive for malaria.)

[An edited transcript of the interview follows.]

Can you give us an update on the situation regarding Disease X in the Democratic Republic of the Congo?

The outbreak began in the remote Panji health zone in southwestern Democratic Republic of the Congo, which is difficult to access due to poor roads and a lack of reliable communications. The region is highly affected by malnutrition and its people are more vulnerable. Initial media reports reported more than 100 deaths, but our team's initial investigation confirmed 27 deaths, 17 of which were children under the age of five.

What measures are currently being taken to manage the outbreak?

The focus is on isolating affected patients, conducting risk communication, and implementing general precautions. We provide supportive care, including basic medications and support, to those affected. Once high-quality samples are analyzed, we hope to tailor our response more effectively.

Despite the DRC's strong diagnostic capabilities, why are pathogens being identified so slowly?

The delay was due to the remote location of the outbreak and the lack of clear information initially. It was only when the media spotlighted the issue that action was quickly taken. This is not a problem of lack of diagnostic capacity, but a challenge of quickly mobilizing teams to such isolated areas.

Has the response improved due to domestic and international attention?

Yes, the situation has improved significantly since the Ministry of Health sent a multidisciplinary team to investigate. But even when the real problem is a logistical or bureaucratic hurdle, a delayed response can create a perception of incompetence.

How are international organizations such as the WHO and Africa CDC contributing to this response?

Their support is primarily logistical, allowing survey teams to arrive on site and carry out field investigations. However, due to the presence of pathogens, [has not been fully identified]it is difficult to provide targeted assistance beyond general outbreak management.

What role does grassroots communication play in outbreak control?

Communication is important. The Ministry of Health has urged the public to remain calm and reassured that experts are investigating the situation. Educating local populations about preventive measures and maintaining trust are key elements of the response.

From an epidemiological perspective, how is this outbreak different from other disease outbreaks in the Democratic Republic of the Congo?

DRC faces frequent outbreaks due to its vast size, difficult infrastructure, and ecological conditions. While this outbreak poses unique challenges, the country has extensive experience in responding to health crises. We are confident that by leveraging this expertise, we can quickly contain this outbreak.

Why do such infectious diseases occur repeatedly in the Democratic Republic of the Congo?

This is a combination of factors including geography, lack of infrastructure, malnutrition and weak health systems. Additionally, social unrest in certain regions complicates both outbreak response and broader health interventions.

What are the next steps to contain Disease X?

Once the sample is analyzed and the pathogen is understood, a targeted response plan is designed. In the meantime, our team will continue to provide supportive care and improve risk communication to effectively manage the situation.