It’s a sequence that we would like to be reserved for the past. For several weeks, a mysterious disease has continued to spread in the Democratic Republic of Congo (DRC). Soaring cases, a large number of deaths, and no information on the disease in question… It’s difficult not to draw a parallel with the emergence of Covid-19. “However, for the moment at least, the two situations do not have much in common,” reassures Brigitte Autran, president of the Health Risk Monitoring and Anticipation Committee (Covars).
The body has no international prerogatives. But it still closely monitors the situation in the DRC, in order to prevent any threat to the health of the French. The time has not come for a new pandemic, reassures the specialist, professor emeritus of immunology at the Sorbonne, but we will still have to monitor what is happening in Central Africa, she says. This is where the latest pandemic after Sars-CoV-2 comes from, Mpox, the consequences of which, although little discussed in the West, are significant.
L’Express: Congolese institutions each provide a different count of the number of deaths. So much so that half a dozen reports are circulating in the press at the same time. We are talking about 27, 79, and even 131 victims. Which estimate should we trust?
Brigitte Autran: The count varies greatly depending on the sources. I have in my hands documents from the National Institute of Public Health of the DRC. They report 27 victims and date as of today. Make no mistake: this figure is certainly underestimated. But in my opinion this is the most reliable assessment we have. The actual number of deaths is actually unknown to us. Gathering information in this country is extremely difficult, due to its weak health infrastructure. Panzi, where the majority of cases come from, is a village that is very difficult to access, located 700 kilometers from the capital Kinshasa.
How can we interpret this figure?
The number of victims is high. As of December 3, still according to the National Institute of Public Health, there were 382 cases detected. This would potentially increase the mortality rate to 7%. It’s important, abnormal. But we should not draw hasty conclusions. Remember that the epidemic occurs in one of the poorest regions of the country, itself poorly organized. There is a very high rate of malnutrition, so many people die from the slightest infection. Added to this is a great lack of screening. The actual mortality rate remains uncertain.
What do we know about the symptoms and nature of this pathogen?
According to health authorities, the pathogen mainly affects the respiratory tract, although headaches and muscle pain have also been reported. We can therefore think of a pulmonary pathology. But we know almost nothing. It is possible that it is a virus or a bacteria already known, no avenue is excluded.
We have no reliable data on the mode of transmission or contagiousness. Samples were sent to national laboratories for initial sequencing. L’World Health Organization [OMS] deployed a team of epidemiologists, clinicians, laboratory technicians and infection control experts to assist health authorities. By Sunday, we should know more.
What will we need to watch out for in the coming weeks?
It is absolutely necessary to know whether the cause is bacterial or viral. This changes everything. If it’s bacterial, maybe we already have effective antibiotics. If it’s viral, the situation could be much more complicated, because there are very few effective antiviral medications. The risk, then, would be that it would be much more difficult to fight against this pathogen. Africa CDC, WHO and many NGOs are present on site, attention is high. We should soon know more about how to respond.
Could it be Covid-19, or Mpox?
Rapid screenings were carried out, it seems, and would a priori exclude Covid, even if at this stage, it is not possible to have certainty. Mpox, or monkey orthopox by its scientific name, emerged in Congo in the 1970s, and a variant recently mutated there, but it is unlikely that this is it. This disease is very identifiable because it causes blisters and pustules. There may be pulmonary forms of Mpox but if this were the case, the doctors on site would have reported damage to the mouths and bodies of the patients. But we can’t exclude anything.
Hong Kong has just strengthened its border health control measures for flights from Africa. Should we do the same?
For the moment, there is no particular reason to apply health control measures at the borders. This is not an international decision, but the decision of Hong Kong alone. Since the Sars epidemic in 2003, the country is often the first to carry out such responses. But it is important that French doctors who are likely to receive patients from the area are aware of the situation. This is part of the surveillance implemented in France.
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