CDC in the Democratic Republic of the Congo
A surveillance team from the Ministry of Health works with local community healthcare workers to list and monitor contacts of people diagnosed with Ebola in Chowe during the 2018-2020 Ebola outbreak in Eastern DRC. Photo by Mary Claire Worrell/CDC
The Centers for Disease Control and Prevention (CDC) began working in the Democratic Republic of the Congo (DRC) in 2002 with an initial focus on health systems strengthening. CDC’s support expanded with the launches of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2004 and U.S. President’s Malaria Initiative (PMI) in 2005. Since 2015, CDC works with the Government of DRC through the Global Health Security Agenda (GHSA) to address other infectious diseases and strengthen laboratory systems, preparedness and disease outbreak response, surveillance, and workforce capacity to respond to disease outbreaks.
Global Health Security
The DRC has a large population, covers a wide geographic area, and shares borders with nine other countries. CDC works with the DRC Ministry of Health (MOH) and other partners to prevent, detect, respond, and control infectious disease outbreaks. Strong rapid response capacity in DRC is critical to addressing public health threats within the country and preventing the spread of disease regionally and globally. CDC supports a working group that provides technical expertise in outbreak preparedness and response. CDC also helped develop standardized training materials for rapid response teams and public health emergency management.
In November 2021, CDC supported a high-level visit to Cameroon by a DRC MOH delegation to discuss implementation of national PHEOCs
Field Epidemiology Training Program (FETP)
Through FETP, CDC strengthens the DRC’s workforce capacity to investigate and respond to disease outbreaks before they become epidemics. Participants strengthen their skills in data collection and translation of data into evidence-based action. FETP graduates primarily include national and district public health staff whose expertise have been critical to DRC’s Ebola and COVID-19 responses.
Since the first FETP cohort graduated in 2015, graduates have supported Ebola outbreak responses in 2014, 2017, 2018, 2021, and 2022
The first case of COVID-19 in the DRC was confirmed on March 10, 2020. The Kinshasa province accounts for the majority of cases but all 26 provinces in the country have reported cases. Since the pandemic was declared, CDC has supported the DRC with disease surveillance and data management, laboratory systems, and vaccination. CDC’s community-based surveillance support was critical to the country’s COVID-19 response. FETP graduates are also crucial to the country’s COVID-19 response as they lead risk assessments, case investigations, contact tracing, and risk communication in Haut Katanga, Kinshasa, and North Kivu.
During the COVID-19 pandemic response, a community animator facilitates a village-level assembly in Mont Ngafula Health Zone and counts votes during the Community Animation Cell election in 2022. Photo by Eric Ahassa/Bizzell
CDC and the MOH expanded regional laboratory capacities to provide rapid diagnostic and conventional testing for COVID-19 and other emerging infectious diseases in Equateur and Haute Katanga
HIV and Tuberculosis (TB)
HIV is a leading cause of death and a health threat to millions worldwide. As a key implementer of PEPFAR, CDC partners with the DRC government to continue strengthening health systems and provide patient-centered, integrated HIV and TB services. CDC works with the MOH to sustain epidemic control by providing services in Kinshasa and Haut-Katanga, including:
- Scale-up of HIV prevention and treatment programs through case-finding, treatment initiation and continued treatment for people with HIV, elimination of mother-to-child transmission, increased viral load coverage, and increased access and uptake of pre-exposure prophylaxis (PrEP)
- Integration of HIV and TB care and treatment programs
- Strengthening of disease surveillance, health information systems, laboratory capacity, and health workforce development
Participants of a "Training of Trainers" session discuss recency testing for HIV surveillance in November 2021. Recency testing is critical to informing public health responses that are tailored to the geographies and subpopulations with increasing HIV cases. Photo by Yves Banze/ICAP DRC
CDC strengthened HIV surveillance in three provinces (Kinshasa, Haut Katanga & Lualaba) by establishing recency testing capacity
Laboratory Capacity Building
CDC helps strengthen laboratory functions, such as diagnostics, network optimization, and quality management systems. CDC helps enhance laboratory infrastructure to meet the increasing need for early diagnosis of HIV in infants, viral load testing, TB, and emerging infectious diseases. CDC also helped develop the national laboratory strategic plan that guides laboratory systems strengthening in the DRC. In Lubumbashi, CDC donated a high-temperature incinerator to the provincial public health laboratory to enhance waste management. CDC also assessed a sample system to optimize the diagnostic network in Lubumbashi. During the COVID-19 pandemic, CDC donated equipment and safety materials to laboratories to promote safe sample processing.
As part of the HIV rapid test CQI, 23 quality mentors (or auditors) were trained to facilitate program implementation
As of July 2022, the DRC has experienced 14 Ebola outbreaks since the first case was reported in 1976. In the last four years, six outbreaks occurred in two provinces (North Kivu and Equateur). On August 1, 2018, the DRC MOH reported an outbreak of Ebola virus disease (EVD) in the North Kivu province that was the second largest Ebola outbreak after the 2014-2016 West Africa Ebola outbreak. CDC supported the MOH’s outbreak responses through disease surveillance, laboratory support, border health, data management, IPC, vaccination, risk communication, and community engagement.
CDC supported validation of the Orasure Ebola rapid diagnostic test (RDT) during the 10th Ebola outbreak in 2018-2020. These RDTs are used for postmortem surveillance of Ebola in the bodies of patients who die from the disease
The northern part of the DRC forms the southern border of the meningitis belt. In 2021, the DRC MOH reported an outbreak of bacterial meningitis in the Banalia health zone, Tshopo province. The first suspected cases were reported in June 2021 and the outbreak was confirmed in September 2021. At the end of the outbreak, the country reported more than 2,660 suspected cases, 40 confirmed cases, and 200 deaths. CDC partnered with the World Health Organization (WHO) to train MOH staff and establish the latest testing technology for bacterial meningitis to increase in-country laboratory diagnostic capacity. CDC is supporting decentralization of meningitis bacterial testing in the Tshopo provincial laboratory.
CDC and WHO’s capacity-strengthening efforts shortened the turnaround time of laboratory-confirmed diagnosis of meningitis from two months to one week
CDC supports the DRC MOH’s responses to recurrent typhoid fever outbreaks. In 2021, the DRC national laboratory (INRB) confirmed two distinct salmonella outbreaks in the Popokabaka and Mushie health zones. In 2022, the Popokabaka health zone experienced an increase in the number of suspected typhoid fever cases and intestinal holes that required surgery. CDC supported MOH staff to conduct an outbreak investigation and pilot new rapid diagnostic tests. CDC also works with national authorities and other partners to support water, sanitation and hygiene (WASH) activities to permanently establish a safe water supply in the Popokabaka health zone.
While investigating the 2022 typhoid fever outbreak, the MOH team also engaged with the local population to raise awareness of effective hygiene practices
Malaria, a disease transmitted by mosquitoes, is a leading cause of preventable illness and deaths around the world. The DRC accounts for 11% of global malaria deaths, with 60% of all hospital visits in the country attributed to malaria. Through PMI, CDC supports implementation and scale-up of malaria prevention and control activities and research in DRC. CDC-supported activities include:
- Monitoring mosquito behavior and resistance to insecticides
- Providing long-lasting insecticide-treated bed nets (LLINs)
- Preventing malaria during pregnancy
- Enhancing diagnostics, case management, surveillance, and monitoring and evaluation of malaria-related activities
- Researching social and behavioral changes that impacting malaria prevention and case management.
In 2021, CDC and the NMCP updated the national treatment guidelines to include use of injectable artesunate for treatment of severe malaria cases
Monkeypox is a disease that causes symptoms similar to smallpox. However, monkeypox is associated with milder symptoms than smallpox and is rarely fatal. Historically, monkeypox is endemic to West and Central Africa, with the majority of annual cases reported in the Congo Basin. CDC has supported laboratory-based monkeypox surveillance in DRC’s Tshuapa province since 2010. This robust surveillance system is a platform for clinical research and enhanced understanding of monkeypox transmission.
CDC continues to partner with KSPH to research human behavior related to wild animals in DRC’s Tshuapa province. CDC also supports research to understand monkeypox transmission
With financial and technical support from CDC, the DRC began influenza surveillance in 2006. Currently, there are four sentinel sites conducting influenza surveillance in Kinshasa, DRC’s capital. Influenza surveillance is focused among outpatients with influenza-like illness and inpatients with severe acute respiratory illness. These surveillance activities served as the backbone for conducting COVID-19 surveillance in DRC.
With CDC support, the MOH participates in the WHO Global Influenza Surveillance Network and contributes virus strains to the WHO Collaborating Center to inform annual seasonal vaccine development
- 12 U.S. Assignees
- 32 Locally Employed
- Population: >92.3 million
- Per capita income: $580
- Life expectancy: F 63 / M 59 years
- Infant mortality rate: 64/1,000 live births
Sources: World Bank 2021, Democratic Republic of the Congo
- Lower respiratory infections
- Neonatal disorders
- Diarrheal diseases
- Ischemic heart disease
- Road injuries
- Hypertensive heart disease
- Cirrhosis and other chronic liver diseases
Source: GBD Compare 2019, Democratic Republic of the Congo
Photos: DRC | CDC Global Flickr
- DRC Articles All Issues | Emerging Infectious Diseases journal | CDC
- Ebola Virus Disease Outbreak in DRC, August 2018–November 2019 | MMWR
- Population Movement Patterns Among the Democratic Republic of the Congo, Rwanda, and Uganda During an Outbreak of Ebola Virus Disease: Results from Community Engagement in Two Districts | MMWR