Mpox continues to menace Burundi

On the outskirts of Bujumbura, in a suburb called Kinama, 41-year-old mechanic Nyabuyoya Balthazar is tinkering with damaged cars while he recounts his recent brush with mpox, the viral illness still being considered a public health emergency of international concern (PHEIC) by the World Health Organization (WHO).

Nyabuyoya, a father of four children, started experiencing symptoms in September.

“I started feeling headache and I was always weak and I had a pimple on my private part and I thought that it was normal,” he recalls. “I took some paracetamol but I wasn’t getting relieved from the headache.”

“I decided to go the hospital… at the hospital I was received by health workers who started educating us about the signs and symptoms of the mpox. And all the signs they mentioned, I realised I had them, so they tested me and the result came out positive,” he says.

Nyabuyoya recalls the stress of being hospitalised in an isolation centre for one month, on oral treatment, before finally making his recovery.

Mpox hits Burundi

Nyabuyoya numbers among thousands of new survivors. The first case of mpox in Burundi was confirmed on 25 July 2024, as the viral disease flared regionally and spread globally, with the accelerated spread spurred dominantly by a new strain, known as Clade Ib.

By 9 December, Burundi had recorded 2,334 cases of the virus and a single fatality. In Burundi, the epidemic has been largely concentrated in and around Bujumbura, while central Gitega city is a second hotspot. In both Burundi and the Democratic Republic of the Congo (DRC), children have been disproportionately affected. 

Caused by a simian orthopox virus and spread by close contact, including via sex, mpox has affected more than 120 countries since 2022. All six WHO regions have registered spread, with more than 115,000 cases and more than 255 deaths recorded between 2022 and October 2024.

Africa is the epicentre of the current surge, with 13,171 mpox cases and 57 confirmed fatalities recorded between the start of the year and early December.

“Health workers who started educating us about the signs and symptoms of the mpox. And all the signs they mentioned, I realised I had them, so they tested me and the result came out positive.”

– Nyabuyoya Balthazar

Unfamiliar territory

Dealing with a relatively rare disease comes with specific challenges. “There is need of more sensitisation programmes for health workers and those in laboratories because most of us are yet to get enough and necessary knowledge to deal with this epidemic,” said Marie Niyonkuru, a health worker at one of the hospitals in Kabezi in the outskirts of Bujumbura. Health workers including Niyonkuru have also called for better supplies of personal protective equipment to protect themselves and other health workers who are treating patients.

By early November, however, Niyonkuru was hopeful the outbreak was ebbing: “Last month we had more than ten patients but this week we have around four people, so we hope there will be a decline in cases,” she said. A 9 December WHO situation report echoed her observations, reporting “indications of a plateau in recent weeks”.

Burundi joins hands with EAC to combat outbreaks

With Burundi recording the second-highest mpox rates of any African country after the DRC, the country is now cooperating with regional experts in response to the epidemic in the country.

On 1 November 2024 the East African Community (EAC) announced that it would operationalise its Rapidly Deployable Expert (RDE) Pool in response to the mpox international public health emergency.

“EAC Partner States such as the Democratic Republic of the Congo (DRC) and the Republic of Burundi are particularly affected, with the DRC reporting over 7,000 confirmed cases by October 2024; around 40% of them are children under 15,” said Veronica Nduva, the EAC Secretary General.

“Some neighbours don’t even want to greet me, knowing that I recovered from the disease.”

– Nyabuyoya Balthazar

According to Nduva, to support health efforts in the DRC and Burundi, the EAC Secretariat is deploying skilled regional emergency experts through three joint deployments with the German Epidemic Preparedness Team (SEEG) over the next six months. 

“During the upcoming deployments, experts will deliver critical training on [infection prevention and control] measures, as well as risk communication strategies and laboratory diagnosis, to enhance the capacities of health workers’ and local communities’ response to pox outbreaks,” part of the EAC’s November statement read.

The deployment is expected to also have a ‘train the trainers’ approach, to further amplify the knowledge within local health facilities, which has already been one of the major challenges the Burundi government has faced.

“In addition, these efforts will address shortages in critical medical supplies and personal protective equipment (PPE), ensuring communities and healthcare providers are better prepared to manage the outbreak,” the statement from EAC reads.

Not over until it’s over

For survivors, recovery may not be the end of the road. Social stigmatisation has been reported in many communities, including in Kinama suburb. “Some neighbours don’t even want to greet me despite knowing that I recovered from the disease,” said Nyabuyoya Balthazar.

Meanwhile, Burundi’s government is launching a communications initiative to try and hit back against the kind of ignorance that can spur social isolation. Radio adverts on preventive measures against mpox are playing, awareness stands have sprung up at the Kamenge District Hospital.  Surveillance teams are investigating alerts and conducting contact tracing. All of that will hopefully help demystify the still-novel illness for a rattled public.