As 2024 draws to a close, scientists are raising concerns about five high-risk diseases that could trigger outbreaks in Africa in 2025. Polio, Ebola, Chikungunya, Zika and Mpox remain persistent threats, while the emerging XEC COVID variant adds a new layer of global concern. These diseases highlight Africa’s vulnerability due to inadequate healthcare infrastructure and resources. Experts caution that the Continent could face severe public health challenges in the coming year. CHINYERE OKOROAFOR reports.
Scientists have stressed that having a complete range of vaccines and treatments for these high-risk diseases is still a long way off for Africa. With the current funding and research pace, they estimate it could take over 50 years for the African Continent to have widespread access to the medical tools needed to fight these diseases effectively. This is so because limited financial resources remain a major hurdle, slowing down the development and distribution of essential disease prevention and treatment tools.
To provide a deeper understanding of the origins of these infectious threats, the 2024 Emerging Infectious Diseases (EID) report from Impact Global Health categorises the deadliest pathogens into six distinct groups. These include multifiloviruses (such as Ebola), multi-arenaviruses, multiple or non-Nipah henipaviruses, multiple bunyaviruses, and an ominous, yet-to-emerge category termed “Disease X.”
This last category represents an unpredictable pathogen that could potentially trigger a major health crisis.
Disease X: “Disease X” represents unidentified pathogens believed to have pandemic potential due to their capacity to emerge and spread rapidly, posing a serious global health threat.
Multi-filovirus: The multi-filovirus group encompasses deadly viruses, primarily categorised into Ebola and Marburg sub-groups. Zaire Ebolavirus, the deadliest strain, sparked a major West African outbreak from 2014 to 2016.
Other Ebola viruses such as Sudan, Taï Forest, and Bundibugyo also pose serious risks, while two additional strains remain under study. Marburg and Ravn viruses, in the Marburg sub-group, are similarly lethal and capable of causing outbreaks.
Multi-arenaviral: The multi-arenaviral group includes five rodent-borne viruses, with humans as accidental hosts. Lassa, Junin, Machupo and Guanarito viruses, found in West Africa and parts of South America, cause hemorrhagic fevers with around a 15 per cent fatality rate among hospitalised patients, placing a heavy strain on local healthcare. The fifth, lymphocytic choriomeningitis virus generally causes milder infections but can lead to neurological issues.
Non-Nipah: Non-Nipah henipaviruses, which include Hendra and Nipah viruses, are highly dangerous and have recently emerged from fruit bats. These viruses can jump from animals to humans, often through contact with infected animals such as pigs, goats, horses, dogs, or cats, posing a significant public health risk.
Multiple bunyaviruses: Multiple bunyaviruses can cause various health issues in humans, often leading to fevers and, in some cases, rashes. The Crimean-Congo hemorrhagic fever virus causes severe bleeding, while Rift Valley fever can lead to hemorrhagic hepatitis, encephalitis, or blindness. La Crosse virus and similar strains are associated with brain swelling, and Hantaan virus can cause severe bleeding, kidney failure, or Hantavirus pulmonary syndrome, affecting the lungs.
Why Africa needs to be cautious of these six diseases
Poliomyelitis, or polio, is a viral infection affecting motor neurons in the central nervous system but is preventable through vaccination. There are three wild poliovirus (WPV) types, namely1, 2 and 3; each requiring specific immunity. Global transmission of WPV2 and WPV3 ended in 1999 and 2012, respectively.
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The oral polio vaccine (OPV) contains a weakened virus, but in rare cases, it can mutate into circulating vaccine-derived polioviruses (cVDPV) if a community lacks sufficient immunity.
Thanks to immunisation efforts, polio cases have dropped over 99 per cent since 1988, sparing over 16 million people from paralysis. However, recent cases have surfaced in parts of Africa, including Kenya, Somalia, DRC and Nigeria. In 2014, the WHO declared the international spread of polio a Public Health Emergency of International Concern, underlining its persistent threat.
Nigeria’s polio situation remains serious, despite some positive changes over the years. Since the Global Polio Eradication Initiative (GPEI) began in 1988, the number of polio cases has decreased by more than 99 per cent. However, challenges persist, especially in certain regions of the country.
Recently, Nigeria has seen a rise in outbreaks of vaccine-derived poliovirus, specifically circulating vaccine-derived poliovirus type 2 (cVDPV2). Although the country was declared free of wild poliovirus in 2020, the number of cVDPV2 cases has increased. This type of virus comes from the oral polio vaccine and is more likely to occur in areas where immunisation rates are low.
In 2023, Nigeria reported 51 cases of cVDPV2 in six states that included Kebbi, Sokoto and Zamfara. This figure shows a significant improvement, with a 70 per cent reduction in cVDPV2 cases compared to 2022.
To combat these outbreaks, Nigeria launched mass vaccination campaigns. One notable campaign in August 2023 aimed at vaccinating over 2.5 million children, marking the first use of fractional inactivated poliovirus vaccines (fIPV) in the country.
The Federal Government, along with the World Health Organisation and other partners, is focusing on reaching at-risk populations, especially in areas facing security challenges. They are using innovative strategies, including working with local leaders and security forces, to ensure that vaccinations can reach those who need them the most.
Mpox in Africa
As of October 11, 2024, Africa CDC reported 38,300 Mpox cases (7,339 confirmed) and 979 deaths across Africa. Initially identified in monkeys in 1958, Mpox spread from wild animals such as rodents to humans and through human contact with body fluids and respiratory droplets.
The Democratic Republic of the Congo (DRC) has the highest number of cases and deaths, with Mpox largely circulating in West Africa. The DRC, Burundi, Nigeria, Côte d’Ivoire, and Uganda account for 98.7 per cent of cases. In response to the outbreak, the Africa CDC and the WHO declared it a public health emergency.
African CDC Director-General Jean Kaseya reported 3,186 new cases in the past week, including 53 deaths. Central Africa remains the most affected, with 99 per cent of Mpox-related deaths this year. The outbreak shows no sign of decline, with weekly cases averaging between 2,500 and 3,000—a 300 per cent increase over 2023.
Nigeria’s Mpox situation
As of October 2024, Nigeria has reported 94 confirmed Mpox cases this year, up from 78 in the previous year, with no deaths recorded. Nigeria’s Mpox outbreak is part of a regional challenge, with the Democratic Republic of the Congo leading in cases. The virus strain in Nigeria is primarily clade II, though underreporting remains a concern due to limited diagnostic resources.
In response, Nigeria’s health authorities have strengthened surveillance and public awareness efforts, educating citizens on transmission and symptoms. Collaborating with WHO, they aim to improve testing and vaccination, supported by the prequalified MVA-BN vaccine for ages 12–17. Nigeria is focused on enhancing diagnostic capacity to address underreporting and control the outbreak.
Chikungunya
Chikungunya is a mosquito-borne viral disease with no specific treatment, first identified in Tanzania in 1952. It can be severe, especially for newborns.
Symptoms include sudden fever, severe joint pain, muscle pain, headache, rash, and fatigue. Most patients recover within weeks, with treatment focused on symptom relief.
The current situation of Chikungunya in Nigeria is concerning, as the country has experienced an uptick in cases recently. Between January and September 2024, the Nigeria Centre for Disease Control (NCDC) reported over 900 suspected cases, primarily affecting states such as Ogun, Ekiti, Lagos and Ondo.
Ebola
Ebola virus disease (EVD) is a severe, often fatal illness originating from wild animals like fruit bats, porcupines, and primates, and spreads to humans through contact with infected animals’ blood, bodily fluids, or tissues. In humans, it spreads via contact with infected bodily fluids or contaminated materials, such as bedding and clothing, according to the Africa CDC.
Major outbreaks have impacted West and Central Africa, with the largest from 2014 to 2016 in Sierra Leone, Liberia, and Guinea, causing 28,610 cases and 11,308 deaths. In 2018, the Democratic Republic of Congo (DRC) saw another outbreak in North Kivu and Ituri Provinces, leading to nearly 2,800 cases and over 1,800 deaths.
History of Ebola
In 1976, Dr. Jean-Jacques Muyembe, a microbiologist and field epidemiologist, received an urgent call to investigate a strange disease in Yambuku, a village in the Democratic Republic of Congo. Many villagers were dying from symptoms similar to malaria, typhoid, or yellow fever, but the illness was clearly more dangerous.
Dr. Muyembe noticed that Belgian nuns working in the village—some vaccinated against yellow fever and typhoid—were also succumbing to the disease.
He collected a blood sample from one of the nuns and sent it to Belgium for testing. The results were alarming: the nun’s blood was infected with a virus that caused severe hemorrhagic fever, which researchers later described as one of the deadliest infections known.
This new virus was named Ebolavirus, after the nearby Ebola River.
Zika
The Zika virus, mainly transmitted by Aedes aegypti mosquitoes, has been detected in 16 African countries, including Nigeria, Kenya, and Angola according to the WHO.
Most infected individuals show no symptoms, but mild fever, headache, rash, and joint pain may occur. There’s no specific treatment, and symptomatic relief is recommended.
Zika can be sexually transmitted and may cause severe birth defects, such as microcephaly, if a pregnant person is infected. It is also linked to Guillain-Barré syndrome, which can cause muscle weakness and paralysis. Mosquito control remains vital, especially in tropical areas.
Nigeria has a low incidence of Zika virus but remains at risk due to the presence of Aedes aegypti mosquitoes, known carriers of the virus. Cases have been reported, and while no large outbreaks have occurred, Zika poses a serious health risk, particularly for pregnant women, as it can cause congenital conditions like microcephaly in newborns.
XEC COVID strain
First identified in Germany in June 2024, the XEC COVID strain has spread to 27 countries, including the U.S., U.K., China and Canada, with over 600 cases reported in four months.
Classified by the WHO as an Omicron sub-variant, XEC shows increased transmissibility and partial immune escape, raising reinfection risks despite vaccination or prior infection.
The UK Health Security Agency (UKHSA) attributes the strain’s enhanced spread to mutations and identifies it as a combination of the KS.1.1 and KP.3.3 variants.
Current data shows hospital admission rates for COVID-19 have risen to 4.5 per 100,000 people, with XEC accounting for 13 per cent of sequenced cases.
Symptoms mirror other COVID strains, including fever, fatigue, and sore throat, but can be severe in high-risk groups.
In Nigeria, the XEC strain has not been officially detected, but health authorities remain vigilant.
The Ministry of Health is urging precautionary measures to prevent its entry and emphasising vaccination as the best protection against severe disease. Vaccines are widely accessible across public and private facilities nationwide.
A public health expert, Dr. Adesola Adebayo, emphasised the critical need to uphold public health measures amid the emergence of the XEC strain. “This new variant is a stark reminder that the pandemic is not over. Nigerians must remain vigilant, adhere to safety protocols, and take personal responsibility to curb the spread of COVID-19,” he said.
Adebayo added, “Vaccination, coupled with strict compliance to safety guidelines and public health measures, is essential to safeguarding ourselves and our communities.”
