What we know about the illnesses that have sickened over 400 people and killed more than 50 in Congo

In northwestern Democratic Republic of Congo, an unidentified illness has claimed the lives of over 50 people in the past five weeks, with nearly half of the patients dying within hours of feeling unwell. This situation has sparked widespread concern in the international community, urgently requiring the identification of the cause and the implementation of effective measures to control the epidemic.

The outbreak occurred in two remote villages in the Equateur Province of the Democratic Republic of Congo, beginning on January 21, and has now reported 419 cases and 53 deaths. Health officials have not yet determined the cause of the disease, nor is it clear whether the cases in the two villages, which are more than 190 kilometers apart, are related. The mode of transmission of the disease is also unclear, including whether it is transmitted between people.

The World Health Organization's Africa office stated that the first victims in one of the villages were children who died within 48 hours of eating bats. More infections were found in another village, where at least some patients had malaria. Dr. Serge Ngalibat, medical director of Bikoro Hospital, said the situation was slightly different in the two villages. "There are more deaths in the first village, and we are still investigating because the situation is very unusual. In the second village, we see a lot of malaria cases."

The Congolese Ministry of Health stated that about 80% of patients have similar symptoms, including fever, chills, body aches, and diarrhea. While these symptoms could be caused by many common infections, health officials initially worried that these symptoms, along with the rapid deaths of some victims, could also be signs of hemorrhagic fever, such as Ebola, which is also associated with infected animals. However, after collecting and testing a dozen samples in the capital Kinshasa, Ebola and similar diseases, including Marburg, have been ruled out.

The World Health Organization stated that it is investigating multiple possible causes, including malaria, viral hemorrhagic fever, food or water poisoning, typhoid, and meningitis. The Congolese government stated that it has sent experts to the villages since February 14, mainly to help investigate cases and slow the spread. Dr. Ngalibat said that patients respond well to treatment for different symptoms. The World Health Organization's Africa office stated that urgent action is needed to "accelerate laboratory investigations, improve case management and isolation capacity, and strengthen surveillance and risk communication."

The remoteness of the villages hinders contact with patients, and the weak healthcare infrastructure makes it difficult to monitor and manage patients. Such challenges are common in Congolese disease outbreaks. The United States has been the largest bilateral donor to the Congolese health sector and supports the training of hundreds of field epidemiologists to help detect and control diseases in this vast country. The discovery of these outbreaks comes as the Trump administration freezes foreign aid during a 90-day review.

There has long been concern that diseases can spread from animals to humans in places where wild animals are frequently consumed. The World Health Organization said in 2022 that the number of such outbreaks in Africa has surged by more than 60% in the past decade. Experts say this could happen in Congo, which owns about 60% of the Congo Basin forest, home to the largest tropical forest on Earth. "All these viruses are viruses that have hosts in the forest," said Gabriel Nsakala, professor of public health at the National University of Education in Congo. "So as long as we have these forests, we will always have some viral variant epidemics."