A multidisciplinary investigation of the first Chikungunya virus outbreak in Matadi in the Democratic Republic of the Congo

Anja De Weggheleire, Antoine Nkuba-Ndaye, Placide Mbala-Kingebeni, Joachim Mariën, Esaie Kindombe-Luzolo, Gillon Ilombe, Donatien Mangala-Sonzi, Guillaume Binene-Mbuka, Birgit De Smet, Florian Vogt, Philippe Selhorst, Mathy Matungala-Pafubel, Frida Nkawa, Fabien Vulu, Mathias Mossoko, Elisabeth Pukuta-Simbu, Eddy Kinganda-Lusamaki, Wim Van Bortel, Francis Wat'senga-Tezzo, Sheila Makiala-MandandaSteve Ahuka-Mundeke

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Early March 2019, health authorities of Matadi in the Democratic Republic of the Congo alerted a sudden increase in acute fever/arthralgia cases, prompting an outbreak investigation. We collected surveillance data, clinical data, and laboratory specimens from clinical suspects (for CHIKV-PCR/ELISA, malaria RDT), semi-structured interviews with patients/caregivers about perceptions and health seeking behavior, and mosquito sampling (adult/larvae) for CHIKV-PCR and estimation of infestation levels. The investigations confirmed a large CHIKV outbreak that lasted February-June 2019. The total caseload remained unknown due to a lack of systematic surveillance, but one of the two health zones of Matadi notified 2686 suspects. Of the clinical suspects we investigated ( n = 220), 83.2% were CHIKV-PCR or IgM positive (acute infection). One patient had an isolated IgG-positive result (while PCR/IgM negative), suggestive of past infection. In total, 15% had acute CHIKV and malaria. Most adult mosquitoes and larvae (>95%) were Aedes albopictus. High infestation levels were noted. CHIKV was detected in 6/11 adult mosquito pools, and in 2/15 of the larvae pools. This latter and the fact that 2/6 of the CHIKV-positive adult pools contained only males suggests transovarial transmission. Interviews revealed that healthcare seeking shifted quickly toward the informal sector and self-medication. Caregivers reported difficulties to differentiate CHIKV, malaria, and other infectious diseases resulting in polypharmacy and high out-of-pocket expenditure. We confirmed a first major CHIKV outbreak in Matadi, with main vector Aedes albopictus. The health sector was ill-prepared for the information, surveillance, and treatment needs for such an explosive outbreak in a CHIKV-naïve population. Better surveillance systems (national level/sentinel sites) and point-of-care diagnostics for arboviruses are needed.

Original languageEnglish
Article number1988
Issue number10
Number of pages16
Publication statusPublished - 2021


  • chikungunya
  • outbreak investigation
  • multidisciplinary
  • Democratic Republic of the Congo
  • Aedes albopictus
  • BO


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