According to the Ministry of Public Health, Sanitation and Social Security of the Democratic Republic of the Congo (hereinafter referred to as Congo), an unidentified disease (called disease X) has caused nearly 100 deaths and more than 400 infections. There are even sources that the death toll may exceed that number. The cases were detected in the Panzi area, Kwango province, Congo. Emergency public health officials (YTCC) were dispatched to the area. The first recorded symptoms were [fever, headache, nasal congestion, cough, difficulty breathing and anemia].
Most of these cases are over 15 years old and they are living in areas where malnutrition and food shortages have occurred in recent months, so we need to consider the coverage of expanded immunization as well as other infectious diseases at the same time to assess in the most comprehensive way, and not to single out a single disease that has caused the number of cases and deaths in such a short period of time. Meanwhile, the Africa CDC recorded 376 cases of the mysterious disease, including 79 deaths. Previously, information said there were more than 140 deaths. Explaining this, the head of the Africa CDC, Jean Kaseya, said the difference in data comes from the problem of monitoring and recording cases because the symptoms of this mysterious disease are quite similar to common respiratory diseases such as fever, headache, muscle fatigue, cough and anemia.
The Congolese Ministry of Health warned that the bodies of any victims with similar symptoms should be handled with the help of health authorities. Authorities also advised local residents to avoid large gatherings and follow basic hygiene rules, including washing hands with soap. The World Health Organization (WHO) told NBC News that the disease is unknown and is working with local authorities, and that WHO has sent a team to the outbreak area to collect samples for laboratory investigation.
Figure 1. Location of mysterious outbreak in the Democratic Republic of Congo
WHO Director‐General Tedros Adhanom Ghebreyesus confirmed that of the initial 12 samples collected, 10 tested positive for malaria, so they think the mysterious disease spreading in Congo could be malaria.although it is possible that more than one disease is involved.
I think the WHO’s caution is correct and completely justified, because disease X occurs in an area where many infectious diseases are circulating, including malaria, with the highest number of malaria cases in African countries and territories.
In addition, this is an area with high malnutrition, so infectious diseases, especially if they are new pathogens on the background of malnutrition and many intermingled pathogens, will have more serious consequences than areas without them. Therefore, the epidemic in Congo could be an old disease that is very familiar to humans (originating from known sources and causes because of the familiar symptoms such as fever, headache, cough and anemia, like the flu), or it could be a new disease.
Therefore, it is still too early to conclude that deaths due to only one cause (mono‐cause/agent) of malaria are not appropriate, malaria may aggravate acute underlying diseases/infections, and most of the patients are still alive. In areas where malaria has been endemic for a long time, they have more or less accumulated immunity based on age and life span (people over 15 years old) and unfortunately, the majority of deaths here are children, so there is no need to give a convincing explanation right away. Therefore, the provisional conclusion, if any, should be that these deaths are related to malaria (malaria‐related deaths) is the safest term at this stage while the laboratories are still analyzing the cause.
In addition, perhaps we are currently overusing and abusing the term “Disease X” which can cause confusion and panic among the world community. Dr. Jake Dunning, an infectious disease expert at the University of Oxford (UK), said that the media calling this mysterious disease “Disease X outbreak” can be misleading because the term “Disease X” should only be used when there is an infectious disease that has the potential to cause an outbreak or pandemic, or when the causative agent has been identified or is close to being identified, it would be more appropriate to call this an outbreak of an undiagnosed disease. (undiagnosed disease).
Based on the above symptoms, scientists and medical experts of WHO are considering this mysterious disease as acute pneumonia, influenza, COVID‐19, measles, malaria, dengue fever or Chikungunya alone aggravated by changes in virulence or a combination of the above agents in an area with multiple infectious diseases. In addition, it is necessary to synthesize these opinions: The area where the outbreak is occurring is a rural area, in a remote province, far from the capital Kinshasa, Congo, which has experienced food shortages in recent months. Medical conditions are poor, vaccination rates are low, and access to diagnosis and case management is very limited. WHO said that in Congo, there are currently about 25.6 million people living in food shortages, of which nearly 4.5 million children are severely malnourished. The problem of food scarcity in Kwango has been alarming since April this year. Malnourished children will suffer very serious complications and death when infected with diseases such as measles and other infections.
Hinh4. Is the emergence of disease X with a high mortality rate a sign that a new agent is emerging?
According to WHO, the risk level in the Panzi area of Kwango province is high, but at the national level in the Democratic Republic of Congo, the risk is medium, due to the local nature of the current outbreak in the Panzi area of Kwango province. At the regional and global levels, WHO assesses the risk level as low and only notes surveillance at the border with the neighboring country near the outbreak area, Angola. However, the investigation is facing many difficulties because this strange disease broke out mainly in the Panzi area, in Kwango province, southern Congo, about 700km from the capital Kinshasa. According to AP, Health Minister Kamba said that it took epidemiologists two days to reach the area with many cases. Even because the medical station in Panzi was not qualified, the test samples had to be transferred to the Kikwit area, more than 500km from Panzi. In addition, because Congo is experiencing the rainy season, the experts’ travel is also quite difficult. Medical experts believe that because the disease broke out in a remote area, there are not enough conditions for testing and tracing the source of the disease, making the disease so mysterious.
International health quarantine is a necessary and important step.
As of December 12, 2024, a total of 527 cases have been recorded, including 32 deaths in medical facilities (6% mortality rate). Symptoms include fever, headache, cough, runny nose and muscle pain. Cases are mainly children (53% of cases and 54.8% of deaths are under 5 years old) and all severe cases have severe malnutrition. As of December 27, 2024, the most complete updated information has not been collected and is being loaded.
Africa and Congo are also working with WHO, the US Centers for Disease Control and Prevention (US.CDC) and relevant agencies to assess the risk and propose appropriate responses, including strengthening health quarantine. WHO assesses the risk level for affected communities in the outbreak area as high. This is based on information on limited provision and access to health services; low vaccination rates; difficult living conditions, food, and transportation in the area. However, at the national level in Congo, the risk is considered moderate because the current outbreak is localized in the Panzi area, Kwango province, although there is still the potential for spread to neighboring areas. At the regional and global levels, WHO assesses the risk level as low; only noting surveillance at the border with the neighboring country near the outbreak area, Angola.
Given the situation pandemic With a flu‐like outbreak in southern Congo, some countries have begun tightening airport checks as a precaution. “Initiate procedures to increase vigilance at ports and airports immediately. Do not underestimate the situation, but do not panic,” said Francesco Vaia, an official at the Italian Ministry of Health.
Hong Kong (China) has stepped up health checks on passengers on flights from Africa since the outbreak began. So far, no symptoms of the disease have been reported in Hong Kong. Passengers from Congo often travel to Hong Kong via flights that transit through South Africa and Ethiopia before arriving in the country. Local authorities have advised residents and visitors to report any unwell symptoms. Those planning to travel to Congo should also maintain personal hygiene, avoid crowded places, and avoid contact with patients.
In Japan, the country’s Ministry of Foreign Affairs also recommends that people should not travel unnecessarily to areas affected by the epidemic.
The Thai Ministry of Public Health has issued a warning to all units under the ministry and asked health checkpoints at border gates and airports to be vigilant about the outbreak in Congo. Mr. Opas Kankawinpong, permanent secretary of the Thai Ministry of Public Health, said all local health agencies have been asked to closely monitor people’s travel routes and regularly update the situation of the disease, although Thailand is considered a country with a low risk of transmission of the “strange disease”.
The Department of Preventive Medicine (Ministry of Health) is closely monitoring the development of the epidemic situation, proactively conducting event‐based surveillance and information on the epidemic in Congo and coordinating with WHO as well as the International Health Regulations (IHR) focal points of countries to update and share information on the epidemic. In case of new developments, the Department of Preventive Medicine will coordinate with WHO, US.CDC and related units to assess the risk to propose appropriate responses, including strengthening medical quarantine work. The Department of Preventive Medicine (Ministry of Health) said that the unit is always monitoring and closely following the developments of the new epidemic situation in Congo.
In Ho Chi Minh City, Tan Son Nhat International Airport does not have direct flights from Congo, passengers from the Democratic Republic of Congo will have to transit through countries in Europe, the Middle East, and Asia before being able to arrive at Tan Son Nhat. Furthermore, the country’s four international airports (Ndjili International Airport ‐ Kinshasa City, Lubumbashi in Lubumbashi City, Goma in Goma City, and Bangoka in Kisangani City) are not in the epidemic area according to the WHO report. Regarding the sea route, Congo has 1 seaport Boma in Kinshasa City. This city is also not in the epidemic area according to the WHO report and normally the time to travel from here to Ho Chi Minh City Seaport takes about 30‐40 days, enough time to detect the disease if any. To be proactive and ready to respond when an epidemic breaks out, the Department of Health directs the City Center for Disease Control to closely monitor the epidemic situation, continuously contact and connect units to update information, and at the same time prepare response plans according to each level of epidemic risk.
Hình5. Strict International Health Quarantine are important actions taken by the Ministry of Health.
The City Center for Disease Control has an International Health Quarantine unit on duty 24/7 at Tan Son Nhat International Airport and Ho Chi Minh City Maritime Port to control the risk of infectious diseases entering Ho Chi Minh City from abroad. At Tan Son Nhat, health quarantine officers continuously monitor incoming passengers through a remote body temperature measurement system and observe abnormal health symptoms while passengers continue to move normally, without any restrictions. Depending on the epidemic situation, the City Center for Disease Control will activate the early warning monitoring system at medical facilities and in the community through a network of community health collaborators that currently covers all 22 districts, towns, and Thu Duc City; organize training for rapid response teams and related units in monitoring, investigation and handling of epidemics; deploy a network of collection and treatment routes as soon as suspected cases are detected so that the epidemic does not spread in the community. To proactively prevent the epidemic, people should not go to epidemic areas if not necessary. For those who have traveled to epidemic areas, if they detect suspicious symptoms, they should immediately go to a health facility and provide medical staff with full information about their travel history for timely diagnosis and treatment as well as to limit infection in the community.
Some countries in the region also believe that the risk of disease entering from Congo is low, because the number of visitors from this area is very small and there are no direct flights from Congo. The area where the “mysterious” epidemic is occurring in Congo is a rural area, in a province far from the capital Kinshasa (48 hours by road). Currently, the Department of Preventive Medicine (Ministry of Health) of Vietnam is continuing to monitor the situation. pandemic; coordinate with WHO and countries to update and share information about the epidemic. In case of new developments, the Department of Preventive Medicine will coordinate with WHO, the US CDC and related units to assess the risk to propose appropriate responses. Most recently, the World Health Organization announced that the mysterious Disease X could be a combination of viral infections causing seasonal respiratory infections, malaria and malnutrition.
REFERENCES
