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An ongoing investigation into an unexplained illness cluster in the Democratic Republic of the Congo (DRC) Equateur province suggests chemical poisoning or rapid-onset bacterial meningitis might be causing the sudden onset of deaths in a village, especially in young men, the World Health Organization (WHO) said yesterday in an outbreak notice.

There have been two unexplained illness clusters in Equateur Province, a smaller one in Bolomba Health Zone that began in January and a larger one in Basankusu Health Zone that began in early February, with a report of 24 unexplained deaths from a single village. The WHO said the epidemiological investigation doesn’t show a link between outbreaks at the two locations, which are about 100 miles apart and separated by dense forests and poor infrastructure. 

Fever was one of the symptoms in a broad case definition, and initial fears of Marburg or Ebola virus were ruled out in earlier testing.

Most deaths occurred within a day or two of illness onset

Of the now 53 deaths reported from Basankusu, most were reported from the same village. Time of symptom onset to death in the initial cluster was 1 day, with symptoms that included fever, chills, headaches, muscle aches, abdominal pains, diarrhea, sweating, dizziness, shortness of breath, agitation, and others. Adolescent and young adult males were disproportionately affected.  With a rapidly declining incidence, suggesting that the event is not spreading in time or place, the WHO said. 

Enhanced surveillance using the broad case definition identified 1,318 suspected cases, which the WHO said makes the information difficult to interpret and probably covers a range of febrile illnesses, including malaria. About 50% tested positive on rapid tests, which the WHO said isn’t usual in an area where malaria is endemic. 

More samples, including cerebrospinal fluid, have been collected, and environmental samples have been collected to test for chemical causes, such as organophosphate contamination. “The definitive cause of illness remains undetermined. Further testing and field investigations are ongoing to better characterize the cases and deaths,” the group added.