Mpox: Research after the Outbreak of 1996 in DRC

00:00 In 1996, there was a turning point with the situation in Katako-Kombe. It was a major outbreak affecting 54 villages led to renewed research interest. And there was limited global research attention at that time.

00:33 So we have to create a new partnership.

00:36 We contacted the center for Disease Control and Prevention CDC Atlanta, the United States Army Medical Research (USAMRIID) and University of California in Los Angeles. So the Institut National de Recherche Biomédicale (INRB) established a good partnership with these three institutions.

01:07 But the monkeypox challenge was from animal disease to human public health concern.

01:14 And monkeypox virus crossed the species barrier to human. Another challenge was the disease has no specific diagnostic tools, no targeted treatment and no specific vaccines.

01:34 So we are we establish a research project for diagnostics, epidemiology and clinical characterization of MPOX.

01:51 Okay. So the research activities.

01:53 First, it is a Center for Disease Control and Prevention for Biosurveillance. And this team was located in the Ecuador region.

02:07 The second was the University of North Carolina.

02:11 University of North Carolina and University of California at Los Angeles to conduct active surveillance in Sankuru District and US Army Medical Research Institute of Infectious Diseases conducted clinical st udies in Sankuru. It was initially the problem we had at the beginning was the diagnosis of the disease, laboratory diagnosis. We had to collect samples and send to CDC. And so we have to to wait for a long time to receive the results, the laboratory results.

03:06 So we try to make the transfer of of technology.

03:14 And we succeeded in a local transfer of technology by PCR and other laboratory technique. And we developed a very strong partnership with CDC.

03:36 And also when we obtain new laboratory facilities with high level of biosafety, these facilities were donated by Japanese international cooperation. We can test Ebola soil samples, Marburg samples, Crimean-congo hemorrhagic fever samples, and also MPOX samples.

04:14 And after that, we conducted active surveillance of MPOX in Sankuru Province.

04:22 We detected a major increase in human monkeypox incidents 30 years after smallpox vaccination campaigns ceased in the Democratic Republic of Congo.

04:37 So we established our, uh, our services in the health zone of Tschudi Loto, Kole, Lomela and so on. And what we discover is that, as you know, the first case of MPOX was discovered in 1970, but we don't know what happened before this date.

05:04 Maybe monkeypox was there, but under the umbrella of smallpox. So this disease was not detected as a specific disease because it was confused with cases of smallpox. So after 1970, the number of cases were very sporadic, as you can see on these slides. And during the active surveillance established by WHO, we detect an increase of number of of cases.

05:37 But when we started our study, the surveillance study in the sankuru.

05:42 So you see a very important increase of the incidence of the disease.

05:49 The transmission of the the disease we saw is like an accident with the contact with other wild animals, mainly, uh, rodents and monkeys.

06:10 Rodents is or rodents are hunted by children. So you see here, uh, the instruments used by the children when they are in the bush or in the savanna looking for a squirrel or rodent.

06:31 A Gambian rats are also the source of contamination, and here also you see children in the village with hunting tools. This case was described by Jesek.

06:48 The child, the baby, the child was the baby was bitten by a chimpanzee and after that he developed monkeypox.

06:59 So for adults, the risk factor is also the contact with monkeys found dead in the forest or like as a source of food.

07:14 So you see here hunting monkeys is with trapping and so on is also a risk factor for catching monkeypox. So in this slide , I want to show you the average cumulative incidence of human impacts by age group in Kole health zone between 1981 versus 2006. So in yellow we give the incidence, uh, obtain uh between 2006 and 2007.

07:54 And in blue, the incidence of the disease between 1981 -1986. So in 1981, the incidence was low, very low but this incidence increased between 200 6. How can we explain that? We can't say that in 18 uh, in 1981 most of people. So you can say 80%, 94%, most of these people have been vaccinated against smallpox, so they are protected against MPOX.

08:36 But in 2006, most of the people have no antibodies against smallpox.

08:43 They are not protected against smallpox because they have no scars of vaccination.

08:52 And also after 1980, WHO stopped the vaccinations against smallpox. So these people are not protected against MPOX. It is clear.

09:06 So, so the question is, did the end of smallpox vaccination remove the cross protection that is provided against other orthopox like MPOX? We will say yes.

09:22 Smallpox vaccination provided protections against MPOX. The question is, did the loss of herd immunity account for the increase in incidence of MPOX? We we we answer yes.

09:39 The answer is yes. So, to explain why now we have a smallpox cases are increasing, uh, in the community. The answer is yes, because most of people now in the country has, uh, lost their immunity, the herd immunity against smallpox. But other reasons are the fact that are the the contact of wild animal is increasing because the population are are looking for, use bushmeat as source of animal protein.

10:38 So for two reasons, main reason, the incidence of MPOX is increasing in DRC and in African countries.

10:53 I want to show you the our colleagues who were involved in the research on MPOX in DRC. So this sister is, the director of the Coley Reference Laboratory. And, uh, the doctor, there is a director of the National MPOX control. And, these are Dr. Huggin john, uh, is American, and Doctor Mbala is the chief of the laboratory.