Category: KB

Source: The Conversation – Africa – By Yap Boum, Professor in the faculty of Medicine, Mbarara University of Science and Technology

Walking through the crowded streets of the Pakadjuma neighbourhood in Kinshasa, capital of the Democratic Republic of Congo, I am struck by the vibrant atmosphere around me.

Children play happily in puddles, surrounded by piles of plastic bags and open ditches of sewage. Shacks patched together from pieces of corrugated iron crowd the settlement. Loud rumba music blasts through the air as young people enjoy themselves in open bars, waiting for grilled pork or chicken to be served. Sex workers sit outside tin shacks in narrow alleyways, calling for customers.

Nearby a Médecins Sans Frontières triage centre is the only reminder that this slum area is the epicentre of the mpox epidemic in Kinshasa. There are no posters, no pamphlets or banners warning residents of the dangers of this viral disease that was declared a continental and global emergency in August last year.

At the clinic, patients suspected to have mpox are sent to one of three dedicated mpox centres in the city. Common symptoms include fever, headache, muscle ache, chills, exhaustion, swollen lymph nodes and lesions. With symptomatic care most patients get better in 7 to 35 days, depending on the severity of the case.

As an epidemiologist co-leading the response to mpox for Africa Centres for Disease Control and Prevention, I visited Pakadjuma to get a better sense of the situation on the ground.

Mpox has historically been a rural disease in the DRC. This microcosm of Kinshasa sheds light on the complex challenges of managing the outbreak in a city.

Fighting on two fronts

With a population of more than 17 million, Kinshasa is Africa’s biggest megacity. Pakadjuma is one of the city’s many overcrowded areas where people live in extreme poverty.

Kinshasa, often called “Kin la Belle”, faces a unique crisis in the fight against mpox. Both strains of the virus, clade Ia and clade Ib, are circulating in the city simultaneously. This is first time this has happened.

Clade Ia, which is primarily transmitted from animal to human and then within households through touch, has been endemic to Africa for decades.

Clade Ib is a new strain and contracted predominantly through sexual contact. It is the strain that has spread rapidly across 21 African countries during the current epidemic in east and central Africa.

This dual transmission makes the fight against mpox even more complicated: how does one tackle a public health crisis rooted in both intimate human connections and structural inequities such as living in overcrowded areas?

Although the strains are treated similarly clinically, their spread and transmission differ.

Clade Ia is mainly associated with zoonotic transmission (from animals to humans) in rural areas. Animal surveillance and community education are required to control spillovers.

Clade Ib, with higher human-to-human transmissibility, necessitates intensified contact tracing, vaccination, and preventive measures in urban and peri-urban areas.

Tailoring strategies to these differences is key to containing the outbreak.

When condoms don’t work

Pakadjuma, in the north-east of the city, is known for poverty and high crime rates. For many girls and young women the sex trade is their only option if they want to survive.

One of the most pressing challenges to combat the virus in the area is curbing sexual transmission.

Unlike HIV, where condoms can significantly reduce the risk of spread, mpox poses a different challenge: because the virus is spread by touch there is no practical preventive measure for sexual transmission apart from complete abstinence.

Mpox lesions start in the groin, making any movement excruciating. For these sex workers, though, abstinence is not an option. It would mean losing their livelihood and the ability to feed their children.

For their clients, who come from all over the city, it would require altering a core aspect of their lives for a disease they perceive as less lethal than Ebola. There are no easy answers to this dilemma.

Tracing the spread

Contact tracing, a cornerstone of outbreak control, is another hurdle.

Identifying and tracing the contacts of sex workers is complex. As a result only a fraction of mpox cases are confirmed with laboratory analysis.

On average, each mpox case has about 20 contacts, yet tracing clients in a highly confidential sexual network is next to impossible.

Without effective contact tracing, infected individuals remain in the community, often seeking treatment only when their condition worsens. From discussions with Médecins Sans Frontières staff in the triage zone, it emerges that suspected mpox cases usually arrive in advanced stages of the disease, when symptoms are clearly visible. Many patients first attempt other remedies such as traditional healing methods, before seeking medical care.

Fortunately Kinshasa benefits from a strong laboratory network led by the Institut National de la Recherche Biomédicale and test results are available within 48 to 72 hours. This state-of-the-art institute was pioneered by Dr Jean Jacques Muyembe, the microbiologist who first discovered Ebola.

In the first week of January 2025 there were 1,155 confirmed cases and 27 deaths in the city, according to the DRC Ministry of Health.

Even for those who seek care at the dedicated mpox centres, navigating the chaotic, congested roads is a nightmare. Yellow minibuses – ominously known locally as the “Spirit of Death” – are crammed and it can take hours to get to a destination.

With increasing patient numbers, mpox centres in the city are overwhelmed.

The fight on all fronts

Addressing the mpox outbreak in Kinshasa requires a multifaceted approach which includes:

Vaccination: Blanket vaccination drives offer the strongest hope for controlling the outbreak in hotspots such as Pakadjuma where contact tracing is almost impossible. In these cases the whole community needs to be vaccinated.

This could break transmission chains while allowing individuals at risk, such as sex workers, to continue plying their trades.

Prevention and control: Home care is essential, particularly in informal settlements like Pakadjuma. Providing food and material support to patients and their families and encouraging the isolation of infected relatives will help to limit the spread of the disease.

These measures require new thinking, however, when people are trying to survive from day to day.

Talking to the community: This is difficult because of the stigma around the disease, but it must be at the heart of the response.

Amplifying the message: The media, local leaders and trusted community members need to be engaged to spread the word loud and clear.

This all needs to happen immediately or the epidemic will be almost impossible to contain in this vast, sprawling city. The consequences would be dire.

Yap Boum does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Mpox in the DRC: residents of the slum at the centre of Kinshasa’s epidemic have little chance of avoiding this major health crisis – https://theconversation.com/mpox-in-the-drc-residents-of-the-slum-at-the-centre-of-kinshasas-epidemic-have-little-chance-of-avoiding-this-major-health-crisis-247809