No abstract

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.

Aedes albopictus with an Asian origin has been reported from central African countries. The establishment of this mosquito species poses a serious threat as the vector of various infectious diseases. Since information about Ae. albopictus in Democratic Republic of the Congo (DRC) is scarce, we investigated the current distribution of this mosquito species. Based on the factors affecting the distribution, we predicted future distribution. We conduced entomological surveys in Kinshasa and three neighboring cities from May 2017 to September 2019. The survey was extended to seven inland cities. A total of 19 environmental variables were examined using the maximum entropy method to identify areas suitable for Ae. albopictus to establish a population. We found Ae. albopictus at 21 of 23 sites in Kinshasa and three neighboring cities. For the first time Ae. albopictus was also found from three of seven inland cities, while it was not found in four cities located in the eastern and southeastern parts of DRC. A maximum entropy model revealed that the occurrence of Ae. albopictus was positively associated with maximum temperature of the warmest month, and negatively associated with wider mean diurnal temperature range and enhanced vegetation index. The model predicted that most parts of DRC are suitable for the establishment of the mosquito. The unsuitable areas were the eastern and southeastern highlands, which have low temperatures and long dry seasons. We confirmed that Ae. albopictus is well established in Kinshasa and its neighboring cities. The expansion of Ae. albopictus to the inland is ongoing, and in the future the mosquito may establish in most parts of DRC.

Aedes aegypti and Aedes albopictus are arbovirus vectors of public health concern. Although the Democratic Republic of the Congo (DRC) faces a long-standing risk of Aedes-borne viruses, data on insecticide resistance of Aedes populations are absent. To address this gap, we investigated insecticide susceptibility of Ae. aegypti and Ae. albopictus in areas with a high risk of arbovirus transmission. We also investigated the frequency of knock-down resistance (kdr) mutations in Ae. aegypti. Immature stages of Ae. aegypti and Ae. albopictus were collected from two sites in Kinshasa (Lingwala and Cité Verte) between April and July 2017 and reared to the adult stage. Wild-caught adult Ae. aegypti were collected in 2016 in another site (Ngaliema). Female Ae. aegypti (from Lingwala) and Ae. albopictus (from Cité Verte) were used in WHO tube insecticide susceptibility tests. The F1534C, V1016I and V410L kdr mutations were genotyped in Ae. aegypti from Lingwala and Ngaliema. We observed Ae. aegypti to be susceptible to bendiocarb, propoxur and malathion, suspected resistant to permethrin, and resistant to deltamethrin and DDT. Aedes albopictus was susceptible to bendiocarb, propoxur, malathion and permethrin, suspected resistant to deltamethrin and resistant to DDT. While F1534C and V1016I were not detected, a few Ae. aegypti from Lingwala were heterozygous for the mutation V410L. This study reports for the first time the insecticide resistance status of Aedes spp. and the detection of the kdr mutation V410L in Ae. aegypti in DRC. Given the resistance profile, carbamates and potentially malathion are recommended insecticide options against Ae. aegypti in Kinshasa. It will be important to develop Aedes control strategies based on the resistance patterns of Aedes in Kinshasa.