Understanding Disease X: Concerns grow as mysterious outbreak claims lives in DRC

THE WORLD Health Organization (WHO) has recently released a detailed update on the mysterious Disease X outbreak in the Democratic Republic of the Congo (DRC).

Since its identification in late October, Disease X has sparked global concern due to its unknown origin and growing case numbers.

With 406 cases and 31 deaths reported thus far, this outbreak raises important questions about global health preparedness, particularly in areas already burdened by poverty, malnutrition and inadequate healthcare infrastructure.

Disease outbreak news on undiagnosed disease in #DRCongo https://t.co/iZgKKFIhU3 pic.twitter.com/JFR8vZUHke

— World Health Organization (WHO) (@WHO) December 8, 2024

The WHO coined the term "Disease X" in 2018 as a place holder for any unknown pathogen that could cause a serious international epidemic.

It represents a hypothetical disease with pandemic potential, underscoring the need for constant vigilance in global health.

In this case, Disease X has materialised in the Kwango Province of the DRC, with symptoms such as fever and cough — hallmarks of a respiratory illness.

The WHO report indicates a case fatality ratio (CFR) of 7.6%, meaning that out of the 406 cases reported, 31 have resulted in death.

Disease outbreak news on undiagnosed disease in #DRCongo https://t.co/iZgKKFIhU3 pic.twitter.com/JFR8vZUHke

— World Health Organization (WHO) (@WHO) December 8, 2024

While Disease X appears less deadly than SARS, its severity is still cause for concern — particularly given its disproportionate impact on children. Over 64% of cases are in individuals under the age of 14, with half of all deaths occurring in children under five.

Why are children the most affected?

Several factors may explain why Disease X overwhelmingly affects children:

Malnutrition: Many patients in the affected region show signs of extreme malnutrition, which weakens the immune system and makes individuals more vulnerable to severe illness.

Other diseases: Malaria is endemic in the Kwango Province, further compromising the health of the population. These coexisting conditions likely worsen the clinical outcomes of Disease X.

Healthcare access: Limited access to healthcare facilities means children are less likely to receive timely treatment, increasing the likelihood of severe outcomes.

In contrast to the Ebola virus, which is transmitted through direct contact with bodily fluids, Disease X appears to have the hallmarks of a respiratory pathogen.

The clustering of cases within families and the symptoms of fever and cough suggest person-to-person transmission, which could accelerate its spread if not contained.

However, according to the WHO, the current risk level remains low globally. This is a crucial distinction from the early days of Covid-19 when global travel facilitated the rapid spread of the virus.

For now, Disease X remains confined to the Kwango Province, but experts emphasise that the situation is fluid and could change as more is learned about the illness.

Challenges in identifying the cause

Despite weeks of investigation, the precise cause of Disease X remains unknown. Preliminary evidence suggests a respiratory virus could be the culprit but other possibilities, including bacterial or non-communicable causes, have not been ruled out.

The lack of critical background information complicates the investigation. For instance:

Vaccine histories: Little is known about the vaccination status of affected individuals, which could provide clues about potential vulnerabilities.

Limited testing infrastructure: Samples from patients are still being analysed, and results may take time due to limited laboratory resources.

As of now, scientists are working to identify the pathogen responsible for Disease X. Once the cause is determined, public health officials will have a clearer path forward in terms of treatment and prevention.