Mpox activity in Africa continues at a steady pace, and though responders are seeing some promising trends, some countries face new challenges, including a rise in mpox-measles co-infections in children in two Democratic Republic of the Congo (DRC) provinces, officials from the Africa Centres for Disease Control and Prevention (Africa CDC) said yesterday.
Co-infection contributors include low measles vaccination coverage
Ngashi Ngongo, MD, PhD, who leads Africa CDC's mpox incident management team, said suspected measles cases in South Kivu province began rising alongside mpox cases in early May, with a similar trend seen in North Kivu province. He said the pattern is very concerning.
Coverage of measles-containing vaccine is very low in some areas, leaving a cohort of unvaccinated children vulnerable to the highly transmissible disease, he said. He added that trends underscore the risk of co-infection in treatment centers, especially in areas with low measles vaccination rates.
Most of the cases have occurred in children younger than 15 years old.
Ngongo said other factors likely play a role, such as high rates of childhood malnutrition, which can weaken the immune system and increase vulnerability to both diseases. He said researchers are still trying to understand the interaction between measles and mpox.
He added that trends underscore the risk of co-infection in treatment centers, especially in areas with low measles vaccination rates.
Promising trends, despite steady case rise
The region last week reported 2,729 new cases, 1,001 confirmed by lab tests. Twenty-six more people died from their infections. The DRC and Burundi accounted for 96% of last week's cases. So far this year, the region has reported 45,327 cases, including 1,014 deaths.
Ngongo said Liberia, Kenya, and Uganda all reported rising cases.
He noted several promising developments, however, including that 5 of the 18 affected countries haven't reported a confirmed case in 4 weeks: Cameroon, Gabon, Guinea, Rwanda, and South Africa.
Testing rates and test positivity have also been on the rise, which shows improvement in sample management in the wake of increased training. Ngongo noted, though, that contact tracing is still a challenge.
Another positive development in the outbreak response is high acceptance of the mpox vaccine in the DRC and Rwanda, including in congested setting in the DRC such as prisons and camps of internally displaced people. Vaccination is under way in Rwanda and in three DRC provinces.
In the DRC, the vaccine campaign in Kinshasa is expected to begin on November 5. After a delay, Nigeria is slated to begin vaccinating on October 29. Ngongo said that, so far, 5.6 million doses of mpox vaccine have been confirmed, including 2.57 million doses of Bavarian Nordic's Jynneos vaccine and 3 million doses of the LC-16 vaccine from Japan.
