December 11, 20245 min readMysterious Disease X Outbreak Might Be Malaria. What We KnowAuthorities in the Democratic Republic of the Congo are racing to identify a deadly illness that is affecting malnourished childrenBy Paul AdepojuDemocratic Republic of Congo Health minister Samuel-Roger Kamba addressing a press conference in Kinshasa earlier this year on the ongoing mpox crisis. The country is currently also dealing with an outbreak of an unknown disease. HARDY_BOPE/AFP via Getty ImagesThe Democratic Republic of the Congo (DRC) is confronting a health crisis in the remote Panzi health zone of Kwango Province, where an undiagnosed illness has infected more than 400 people and killed at least 31, predominantly malnourished children under the age of five. The mystery Disease Xwhich may or may not be a new diseasecauses symptoms such as fever, headache, cough, runny nose and body aches. The World Health Organization said in a press briefing on Tuesday that 10 out of 12 samples have tested positive for malaria, but its possible more than one disease is involved. The outbreak has raised pressing questions about the DRCs ability to respond effectively to health emergencies in isolated areas.Accessing Panzi is a formidable challenge, with poor road infrastructure requiring a multi-day journey from Kinshasa, the nations capital. This is really the definition of remote, says Placide Mbala, a virologist and head of epidemiology at the DRCs National Institute of Biomedical Research. He explains that limited connectivity and delayed sample collection have hampered diagnosis efforts. Specimens collected initially were unsuitable for analysis, but a team from the DRCs Ministry of Public Health has now gathered higher-quality samples, says Mbala, who is part of the team.A Complex Response Hindered by UncertaintyOn supporting science journalismIf you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.The DRCs Ministry of Health, supported by the WHO and Africa CDC, has deployed a multidisciplinary team to investigate and respond to the outbreak. But the delay in confirming a pathogen has complicated efforts to implement targeted interventions. Its difficult to have a targeted response when you dont know exactly what the pathogen is, Mbala notes. Instead the response has focused on isolating sick people, communicating risks and taking general preventive measures while providing supportive care for affected individuals.While the deployment of health care workers has improved the situation, delays in action have attracted criticism. Mbala emphasizes that the issue is not related to a lack of diagnostic capacity but rather logistical challenges. He admits the outbreak also highlights systemic vulnerabilities, including vast geographical barriers, weak infrastructure and recurring violence, that make the DRC particularly susceptible to health crises.ThankGod Ebenezer, founder of the research effort African BioGenome Project, emphasizes the critical connection between animal and human health, particularly in the context of zoonotic diseases. He explains that most diseases that affect humansincluding HIV/AIDS, SARS and likely COVIDoriginated in other animals, highlighting the importance of maintaining biodiversity and understanding genetic diversity to prevent transmission.When it comes to Disease X in DRC, one thing we often forget is that most diseases come from animals. Theres a transmission from animal to human. And what that means is that we dont often make peace with nature, Ebenezer says. He further notes that human interference with biodiversity creates vulnerabilities that allow diseases in animals to spread to humans and that genomics can play a vital role in addressing this. We can use genomics and biodiversity genomics to know how to maintain genetic diversity, prevent transmission and ensure were not [encroaching on] biodiversity conservation space, he adds.Global Support and Local ResilienceInternational organizations, including the WHO and the Africa Centers for Disease Control and Prevention, are playing a crucial role in logistics and field investigations. Their support has enabled the deployment of resources to Panzi, although uncertainty over the pathogen involved has limited the scope of assistance they can provide. Grassroots communication has also been a key element of the response, with local leaders urging calm and educating communities about preventive measures. The Ministry of Health is working to understand the situation and has sent its best people to investigate, Mbala says.The DRCs response draws on its extensive experience managing outbreaks such as Ebola and mpox. Mbala expresses confidence that the countrys seasoned public health responders can leverage this expertise to contain the outbreak quickly. If we include all the experienced people who have coordinated past responses, we should be able to manage this effectively, he says.Scientific American spoke with Mbala about the outbreak and response. (The conversation took place before the WHO confirmed that many of the samples tested positive malaria.)[An edited transcript of the interview follows.]Can you provide an update on the current situation regarding Disease X in the Democratic Republic of the Congo?The outbreak began in the remote Panzi health zone in southwestern DRC, an area difficult to access because of poor roads and lack of reliable communication. The region is heavily affected by malnutrition, making the population more vulnerable. Initial media reports claimed more than 100 deaths, but our teams first investigation confirmed 27 fatalities, 17 of which were children under five.What measures are currently in place to manage the outbreak?The focus is on isolating the affected patients, conducting risk communication and implementing general preventive measures. We are providing supportive care, such as basic medication and assistance for the affected population. Once high-quality samples are analyzed, we hope to tailor the response more effectively.Despite the DRCs robust diagnostic capabilities, why has there been a delay in identifying the pathogen?The delay stems from the remote location of the outbreak and the initial lack of clear information. It wasnt until the media spotlighted the issue that action was expedited. Its not a matter of lacking diagnostic capacity but a challenge of mobilizing teams quickly to such isolated areas.Has the national and international attention improved the response?Yes, the situation has significantly improved since the Ministry of Health deployed a multidisciplinary team to investigate. Delays in response can create the perception of incapacity, however, even when the real issue lies in logistical and bureaucratic hurdles.How are international organizations, such as the WHO and the Africa CDC, contributing to the response?Their support has primarily been logistical, ensuring that investigation teams can reach the site and conduct fieldwork. But because the pathogen [has not been fully identified], its challenging to provide targeted assistance beyond general outbreak management.What role does grassroots communication play in controlling the outbreak?Communication is critical. The Ministry of Health is urging calm and reassuring the public that experts are investigating the situation. Educating local populations on preventive measures and maintaining trust are essential components of the response.From an epidemiological perspective, how does this outbreak compare with other disease outbreaks in the DRC?The DRC frequently faces outbreaks because of its vast size, challenging infrastructure and ecological conditions. While this outbreak poses unique challenges, the country has considerable experience responding to health crises. Leveraging this expertise, we are confident in our ability to contain this outbreak quickly.Why do such outbreaks repeatedly occur in the DRC?Its a combination of factorsgeography, infrastructure deficits, malnutrition and health system weaknesses. Additionally, social insecurity in certain regions complicates both outbreak response and broader health interventions.What are the next steps in containing Disease X?Once the samples are analyzed and we understand the pathogen, we will design a targeted response plan. In the meantime, our teams will continue providing supportive care and improving risk communication to manage the situation effectively.