Mpox in the Democratic Republic of Congo (DRC): Early History

00:01 Good afternoon. I would like to share with you the history of human MPOX, formerly monkeypox in the Democratic Republic of Congo.

00:16 The history of this disease is linked with the global eradication of smallpox between 1960 and 1965. At that time, all the countries surrounding DRC were free of smallpox except South Sudan.

00:49 So, we had in DRC sometime 3000 cases of smallpox per year. You.

01:02 It is why DRC , together with WHO started the campaign against for variola vaccination. At that time we observed in DRC two types of variola, called also smallpox.

01:26 Both variola major and variola minor were circulating in DRC.

01:35 With case fatality rate between 5% and 15%. After independence, the reporting was irregular. Only variola major was documented, and major outbreaks occur in Kasai, Equateur and Katanga provinces.

01:59 The capital, Kinshasa, experienced a very, very important, outbreak of smallpox with more than 200 deaths.

02:14 So we we need ten months to control this outbreak.

02:21 The context in the region was that, the transmission was interrupted in neighboring countries, except South Sudan, as I said. And we can retain key dates. Uh, in 1970, this was the first human monkeypox detected in the world that was in the Basankusu, uh, District Equatorial Province, and in 1977 smallpox was eradicated in DRC. The main events of MPOX are as follows. As I said, in 1970, the first case of MPOX was identified in Basankusu District, and in 1976 it was the first Ebola outbreak in Congo in Yambuku. And in 1977 we received a certification of the eradication of smallpox in DR Congo, and in 1980 WHO/AFRO program for integrated surveillance of MPOX and viral hemorrhagic fever, global cessation of smallpox vaccination.

04:06 So the most important thing to know now is the global cessation of smallpox vaccination in 1980.

04:15 And between 1981 and 1986, the WHO and the Minister of Health introduced the intense and active surveillance of MPOX in Africa, and in 1986, this program was stopped and the surveillance activities for monkeypox were also stopped. But in 1996 1997 there was a reemergence of a large outbreak of MPOX, affecting 54 villages in the Catacomb Health Zone district of Sankuru, and the impulse was included on the national list of notifiable diseases and in 2001 INRB, the Institut National de Recherche Biomédicale established international research partnership with WHO, CDC, Institute of Tropical Medicine for MPOX studies.

05:23 So this is the the first case of MPOX in a seven year old child in Democratic Republic of Congo.

05:34 This is the photo of WHO.

05:39 And here we see the physical, the lesion caused by, uh, these, uh, these diseases. So the first human MPOX case was detected in 1970, in a rural DRC during the smallpox eradication campaign, the discovery of this new disease was considered a serious threat to the global Smallpox Eradication Program. The transmission of the disease was by contact with the infected rodent or monkeys, or with a patient. So the first mode of transmission is with the contact with a wild animals, while infected animals like rodents. And the incidence of the disease was very high among children and non-smallpox -vaccinated adult.

06:58 This I want to show you in this light, the status of MPOX in Africa in 1970 -1986. So at that time the the incidence of the disease was very low and WHO promised to pay anyone who discovers and report a case of monkeypox. That is confirmed by laboratory testing. A reward of 500 Zaire at that time is mean $1,000, because the disease was rare.

07:55 And this reward was translated in a in a in local languages and distributed everywhere in the country. So between 1970 and 1980, only 59 cases were detected by passive surveillance despite this reward given by the WHO.

08:26 Between 1981 -1986, 345 cases were detected/reported by active surveillance.

08:41 This was the program established by WHO and the Ministry of Health, and 90% of MPOX cases in Africa were reported by DRC. So as you can see, our seven African countries were affected.

09:05 We have the Cameroon, Central African Republic, Ivory Coast, Liberia, Nigeria, Sierra Leone and DRC. So between 1970 and 1979, very few cases were reported.

09:23 But between 1980 and 1986, because of the active surveillance, the number of cases detected were more than 300, but 95% of all cases were reported by DRC. Okay, so after this active surveillance that was organized between 1981 -1986.

09:56 The question was, is that a threat to global smallpox eradication program achievement? So the answer of the WHO team of MPOX intensified surveillance program, organized between 1981 -1986, in DRC, was no. Because MPOX was a sporadic disease and majority of cases resulted from animal to to human transmission.

10:36 So person to person transmission was rather difficult and the secondary attack rate was low.

10:47 We have no transmission beyond the fourth round of transmission. The WHO team conclusion was that MPOX is not a public health concern.

11:01 The WHO active surveillance program was then stopped. This is the team, and I was a member of of this team.

11:14 I was still young there at that time.