Improving mpox diagnosis in DRC amidst the outbreak

Wivine M'puranyi, a 30-year-old mother of six, lives in the village of Karanda in South Kivu's Miti-Murhesa health zone. On this October morning, she reflects on the distressing days when her two daughters, Amenipa (9) and Asifiwe (3), contracted mpox.

“When I saw the rashes appear on my daughters, I immediately thought of mpox because one of my neighbours had already been infected with the disease, and the community liaisons had explained how it spreads. I was scared, knowing how contagious it is. To protect my other children, I rushed Amenipa and Asifiwe to Kavumu hospital right away,” says Wivine.

A few kilometres away, at the mpox treatment centre in Lwiro, the laboratory technician Augustin Kaboye carefully wore his personal protective equipment before collecting biological samples from patients with mpox symptoms.

“We consider these precautions to be even more important given that 20 front-line workers in the province have already been infected with mpox since the year began. One of our colleagues even died in Misisi,” said Augustin. To prevent such tragedies, WHO has supplied 12 personal protective equipment (PPE) kits to mpox treatment centres in the province since the start of the year, including two to the Lwiro treatment centre.

Among the patients whose samples Augustin to that day was two-month-old Amina, who had arrived with her mother seven days earlier.

Before collecting samples from several parts of the little girl's body, the laboratory technician carefully explained the procedure to her mother. He then packed the samples in triple packaging to keep it safe. Like other provinces in the country, WHO has supplied medical equipment and materials to South Kivu's health zones, including 6,000 sampling kits and triple packs. These essential medical supplies have been vital in protecting health worker, particularly for laboratory technicians and biologists.

Sample transportation from all of South Kivu's health zones to the city of Bukavu is funded by the WHO. “We are assisting the provincial authorities by going into the most inaccessible areas, in order to cover the entire territory,” said Dr Constantin Makakala, WHO field coordinator for mpox response in South Kivu. “Some samples are transported as far as 450 kilometres to Bukavu,” he added.

Before June 2024, samples arriving into Bukavu still had to be sent to Goma, the capital of North Kivu. Due to ongoing armed conflict in the region, the only link between the two towns is by boat. This required transporting the samples across Lake Kivu for a three- to five-hour journey to be analyzed at the IRNB-Goma laboratory. In these circumstances, and given the number of samples to be tested , results could only be ready in seven to 10 days.

To reduce these delays, WHO provided two additional GeneXpert® machines to South Kivu laboratories and installed mpox software on four other existing machines to perform the tests. Additionally, 15 laboratory technicians were trained by the INRB-Goma team with WHO support, in handling samples and operating the new equipment.

In Bukavu, Willy Lulihoshi, a medical biologist and laboratory manager, receives 50 to 60 mpox samples daily for testing. A total of 1,785 samples have been tested since June 2024, when laboratory was fully equipped to handle such tests. The laboratory now receives samples from Lwiro, including the one taken from little Amina. It uses the GeneXpert® machine supplied by WHO for the tests. An hour later, the suspected case was confirmed and recorded in the laboratory register for swift notification to the provincial health division. “With the equipment provided by WHO, we can now produce results in 24 hours,’ says a delighted Willy Lulihoshi.

WHO routinely supplies GeneXpert® cartridges for mpox tests. On 15 October this year, an additional 6,000 GeneXpert® cartridges were received in Kinshasa and subsequently distributed to various provinces across the country.

In Karanda, community liaisons regularly visit Wivine to ensure she and her children are doing well.

“I'm absolutely delighted with the care my daughters have received and thank the healthcare staff from the bottom of my heart,” she says happily. “At the hospital, I was vaccinated against mpox and given a hygiene kit, which I use with my children to protect ourselves from the disease. I teach them to wash their hands properly and I try to follow the advice given to me.

Community liaisons visit Wivine's neighbours to assess their state of health and alert the health centre to any mpox symptoms. With WHO support, over 350 community liaisons have been trained to monitor the disease across nine health zones in South Kivu, playing vital role in controlling the outbreak.

Mpox is a viral infection caused transmitted through contact with infected animals, humans or contaminated materials. It can cause serious complications and even death may occur in people with weakened immune systems. Treating patients relieves the fever, pain and itching caused by the sores. Research is currently ongoing to develop and test new forms of treatment. Alongside vaccination, effective mpox prevention and control requires raising community awareness, monitoring people in contact with patients and training healthcare workers.

In Karanda, Amenipa and Asifiwe can once again enjoy playing with their friends in the neighbourhood, while eagerly waiting with joy the imminent birth of their little brother or sister.