High Aedes spp. larval indices in Kinshasa, Democratic Republic of Congo

Abstract Background Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. In the Democratic Republic of Congo (DRC), increases in cases of dengue and outbreaks of yellow fever and chikungunya have been reported since 2010. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, have been reported in DRC, but there is a lack of detailed information on their presence and spread to guide disease control efforts. Methods In 2018, two cross-sectional surveys were conducted in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Within the peri-domestic area of each household, searches were conducted for larval habitats, which were then surveyed for the presence of Aedes larvae and pupae. A subset of the immature specimens were reared to adults for morphological identification followed by DNA barcoding of the specimens to validate identifications. Results The most rural commune (Mont Ngafula) had the highest pupal index (number of Aedes spp. pupae per 100 inspected houses) at 246 (20) pupae/100 houses, and Breteau index (BI; number of containers positive for immature stages of Aedes spp. per 100 households) at 82.2 (19.5) positive containers/100 houses for the rainy (and dry) season, respectively. The BI was 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in Kalamu, Lingwala and N’Djili in the rainy (and dry) season, respectively. The house index (number of houses positive for at least one container with immature stages of Aedes spp. per 100 inspected houses) was, on average, across all communes, 27.5% (7.6%); and the container index (number of containers positive for immature stages of Aedes spp. per 100 inspected containers) was 15.0% (10.0%) for the rainy (and dry) season, respectively. The vast majority of Aedes-positive containers were found outside the houses [adjusted odds ratio 27.4 (95% confidence interval 14.9–50.1)]. During the dry season, the most productive containers were the ones used for water storage, whereas in the rainy season rubbish and tires constituted key habitats. Both Ae. aegypti and Ae. albopictus were found. Anopheles larvae were found in different types of Aedes larval habitats, especially during the rainy season. Conclusions In both surveys and in all communes, the larval indices (BI) were higher than the arbovirus transmission threshold values established by the World Health Organization. Management strategies for controlling Aedes in Kinshasa need to target the key types of containers for Aedes larvae, which are mainly located in outdoor spaces, for larval habitat destruction or reduction.

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High Aedes spp. larval indices in Kinshasa, Democratic Republic of Congo

10.21203/rs.3.rs-37427/v4 ◽

2021 ◽

Author(s):

Wat’senga Tezzo Francis ◽

Fasine Sylvie ◽

Manzambi Emile Zola ◽

Marquetti Maria del Carmen ◽

Binene Mbuka Guillaume ◽

...

Keyword(s):

Yellow Fever ◽

Rainy Season ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Dry Season ◽

World Health ◽

Morphological Identification ◽

Cross Sectional ◽

Republic Of Congo ◽

Larval Habitats

Abstract BACKGROUND: Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. In the Democratic Republic of Congo (DRC), increases in cases of dengue and outbreaks of yellow fever and chikungunya have been reported since 2010. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, have been reported in DRC, but there is a lack of detailed information on their presence and spread to guide disease control efforts.METHODS: In 2018, two cross-sectional surveys were conducted in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Within the peri-domestic area of each household, searches were conducted for larval habitats which were then surveyed for the presence of Aedes larvae and pupae. A subset of the immature specimens were reared to adults for morphological identification followed by DNA-barcoding of the specimens to validate identifications.RESULTS: The most rural commune (Mont Ngafula) had the highest pupal index of 246 (20) pupae/100 houses and a Breteau Index of 82.2 (19.5)/100 houses, while this latter was 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in Kalamu, Lingwala and N’Djili in the rainy (and dry) season, respectively. The House Index was on average across all communes 27.5% (7.6%); and the Container Index 15.0% (10.0%) in rainy (and dry) season, respectively. The vast majority of Aedes positive containers were found outside the houses (adjusted OR 27.4 (95%CI 14.9-50.1)). During the dry season, the most productive containers were the ones used for water storage, whereas in the rainy season rubbish and tires constituted key habitats. Both Ae. aegypti and Ae. albopictus were found. Anopheles larvae were found in different types of Aedes larval habitats, especially during the rainy season. CONCLUSIONS: In both surveys and in all communes, the larval indices (BI) were higher than the arbovirus transmission threshold values established by the World Health Organization. Management strategies for controlling Aedes in Kinshasa need to target the key containers, mainly located in outdoor spaces, for larval habitats destruction or reduction.

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High Aedes spp. larval indices in Kinshasa, Democratic Republic of Congo

10.21203/rs.3.rs-37427/v3 ◽

2020 ◽

Author(s):

Wat’senga Tezzo Francis ◽

Fasine Sylvie ◽

Manzambi Emile Zola ◽

Marquetti Maria del Carmen ◽

Binene Mbuka Guillaume ◽

...

Keyword(s):

Yellow Fever ◽

Rainy Season ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Dry Season ◽

World Health ◽

Morphological Identification ◽

Cross Sectional ◽

Republic Of Congo ◽

Larval Habitats

Abstract BACKGROUND: Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. In the Democratic Republic of Congo (DRC), increases in cases of dengue and outbreaks of yellow fever and chikungunya have been reported since 2010. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, have been reported in DRC, but there is a lack of detailed information on their presence and spread to guide disease control efforts.METHODS: In 2018, two cross-sectional surveys were conducted in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Within the peri-domestic area of each household, searches were conducted for larval habitats which were then surveyed for the presence of Aedes larvae and pupae. A subset of the immature specimens were reared to adults for morphological identification followed by DNA-barcoding of the specimens to validate identifications.RESULTS: The most rural commune (Mont Ngafula) had the highest pupal index of 246 (20) pupae/100 houses and a Breteau Index of 82.2 (19.5)/100 houses, while this latter was 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in Kalamu, Lingwala and N’Djili in the rainy (and dry) season, respectively. The House Index was on average across all communes 27.5% (7.6%); and the Container Index 15.0% (10.0%) in rainy (and dry) season, respectively. The vast majority of Aedes positive containers were found outside the houses (adjusted OR 27.4 (95%CI 14.9-50.1)). During the dry season, the most productive containers were the ones used for water storage, whereas in the rainy season trash and tires constituted key habitats. Both Ae. aegypti and Ae. albopictus were found. Anopheles larvae were found in different types of Aedes larval habitats, especially during the rainy season. CONCLUSIONS: . In both surveys and in all communes, the larval indices (BI) were higher than the arbovirus transmission threshold values established by the World Health Organization. Management strategies for controlling Aedes in Kinshasa need to target outdoor spaces for larval habitats destruction or reduction.

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Important Aedes Spp. Infestation Levels In Kinshasa, Democratic Republic Of Congo

10.21203/rs.3.rs-37427/v1 ◽

2020 ◽

Author(s):

Wat’senga Tezzo Francis ◽

Fasine Sylvie ◽

Manzambi Emile Zola ◽

Marquetti Maria del Carmen ◽

Binene Mbuka Guillaume ◽

...

Keyword(s):

Yellow Fever ◽

Rainy Season ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Water Storage ◽

Dry Season ◽

Transmission Risk ◽

Republic Of Congo ◽

Breeding Sites ◽

Storage Containers

Abstract BACKGROUND Arboviruses such as dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious diseases worldwide. Yellow fever and chikungunya outbreaks, and few dengue cases have been reported in Democratic Republic of Congo (DRC) in recent years. Although the main vectors of these arboviruses, Aedes aegypti and Aedes albopictus , were reported in DRC, the lack of detailed information on their presence and spread hampers transmission risk assessments in this region. METHODS In 2018, two cross-sectional surveys were realized in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Breedings sites were recorded, larvae and pupae collected and reared to obtain adults for genus and species identification. A subset of specimen was DNA-barcoded for species validation. RESULTS The most rural commune (Mont Ngafula) had the highest infestation levels, with a Breteau Index of 82.2 and 19.5/100 houses in rainy and dry season, respectively. The Breteau Index in the other communes Kalamu, Lingwala and N’Djili elevated to 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in the rainy (and dry) season respectively. The House index was on average 27.5% and 7.6%; and the Cotainer Index 15.0% and 10.0% in rainy and dry season, respectively. The vast majority of Aedes positive containers were found outside the houses (aOR 27.3 (95%CI 14.9-50.0)). The main breeding sites were used tires, water storage containers and trash. Anopheles larvae were also found in Aedes breeding sites in all four communes in the rainy season. CONCLUSIONS These results show that Kinshasa is highly infested with Aedes spp. which indicates a high potential for arbovirus transmission in the area. The present study evidences that Aedes breeding sites are mainly located outdoors. The most productive containers (for Aedes pupae production) during the dry season are the water storage containers, while over the rainy season these are the artificial containers, especially tires. This will have an impact on the design of control strategies for these vectors in Kinshasa.

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Important Aedes Spp. Density Levels in Kinshasa, Democratic Republic of Congo

10.21203/rs.3.rs-37427/v2 ◽

2020 ◽

Author(s):

Wat’senga Tezzo Francis ◽

Fasine Sylvie ◽

Manzambi Emile Zola ◽

Marquetti Maria del Carmen ◽

Binene Mbuka Guillaume ◽

...

Keyword(s):

Species Identification ◽

Yellow Fever ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Water Storage ◽

Dry Season ◽

Transmission Risk ◽

Cross Sectional ◽

Republic Of Congo ◽

Breeding Sites

Abstract BACKGROUND: Dengue, yellow fever, chikungunya and Zika are among the most important emerging infectious vector-borne diseases worldwide. Besides sporadic dengue cases, yellow fever and chikungunya outbreaks have been increasingly reported in Democratic Republic of Congo (DRC) in the last decade. The main vectors of these arboviruses, Aedes aegypti and Aedes albopictus, were reported in DRC, but there is a lack of detailed information on their presence and spread hampering transmission risk assessments in the region. METHODS: In 2018, two cross-sectional surveys were realized in Kinshasa province (DRC), one in the rainy (January/February) and one in the dry season (July). Four hundred houses were visited in each of the four selected communes (N’Djili, Mont Ngafula, Lingwala and Kalamu). Breedings sites were recorded, larvae and pupae collected and reared to obtain adults for genus and species identification. A subset of specimens was DNA-barcoded for validation of the morphological species identification. RESULTS: The most rural commune (Mont Ngafula) had the highest density levels, with a Breteau Index of 82.2 and 19.5/100 houses in rainy and dry season, respectively. The Breteau Index in the other communes Kalamu, Lingwala and N’Djili elevated to 21.5 (4.7), 36.7 (9.8) and 41.7 (7.5) in the rainy (and dry) season. The House index was on average 27.5% and 7.6%; and the Container Index 15.0% and 10.0% in rainy and dry season, respectively. The vast majority of Aedes positive containers was found outside the houses (adjusted OR 27.4 (95%CI 14.9-50.1)). The main breeding sites were used tires, water storage containers and trash. Anopheles larvae were also found in Aedes breeding sites, especially during the rainy season.CONCLUSIONS: These results show that Kinshasa is highly infested with Aedes spp. which indicates a high potential for arbovirus transmission in the area. During the dry season, the most productive containers (for Aedes pupae production) are containers used for water storage, whereas in the rainy season this is trash and tires. The present study also evidences that Aedes breeding sites are mainly located outdoors. Based on the results of this study, a contextualized Aedes control strategy can be designed for Kinshasa.

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Quantifying epidemiological drivers of gambiense human African Trypanosomiasis across the Democratic Republic of Congo

10.1101/2020.06.23.20138065 ◽

2020 ◽

Cited By ~ 4

Author(s):

Ronald E Crump ◽

Ching-I Huang ◽

Ed Knock ◽

Simon E F Spencer ◽

Paul Brown ◽

...

Keyword(s):

Human African Trypanosomiasis ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Model Fitting ◽

Case Finding ◽

World Health ◽

Model Parameters ◽

African Trypanosomiasis ◽

Republic Of Congo ◽

Case Data

AbstractGambiense human African trypanosomiasis (gHAT) is a virulent disease declining in burden but still endemic in West and Central Africa. Although it is targeted for elimination of transmission by 2030, there remain numerous questions about the drivers of infection and how these vary geographically.In this study we focus on the Democratic Republic of Congo (DRC), which accounted for 84% of the global case burden in 2016, to explore changes in transmission across the country and elucidate factors which may have contributed to the persistence of disease or success of interventions in different regions. We present a Bayesian fitting methodology, applied to 168 endemic health zones (∼ 100,000 population size), which allows for calibration of mechanistic gHAT model to case data (from the World Health Organization HAT Atlas) in an adaptive and automated framework.It was found that the model needed to capture improvements in passive detection to match observed trends in the data within former Bandundu and Bas Congo provinces indicating these regions have substantially reduced time to detection. Health zones in these provinces generally had longer burn-in periods during fitting due to additional model parameters.Posterior probability distributions were found for a range of fitted parameters in each health zone; these included the basic reproduction number estimates for pre-1998 (R0) which was inferred to be between 1 and 1.19, in line with previous gHAT estimates, with higher median values typically in health zones with more case reporting in the 2000s.Previously, it was not clear whether a fall in active case finding in the period contributed to the declining case numbers. The modelling here accounts for variable screening and suggests that underlying transmission has also reduced greatly – on average 96% in former Equateur, 93% in former Bas Congo and 89% in former Bandundu – Equateur and Bandundu having had the highest case burdens in 2000. This analysis also sets out a framework to enable future predictions for the country.Author summaryGambiense human African trypanosomiasis (gHAT; sleeping sickness) is a deadly disease targeted for elimination by 2030, however there are still several unknowns about what factors influence continued transmission and how this changes with geographic location.In this study we focus on the Democratic Republic of Congo (DRC), which reported 84% of the global cases in 2016 to try and explain why some regions of the country have had more success than others in bringing down case burden. To achieve this we used a state-of-the-art statistical framework to match a mathematical gHAT model to reported case data for 168 regions with some case reporting during 2000–2016.The analysis indicates that two former provinces, Bandundu and Bas Congo had substantial improvements to case detection in fixed health facilities in the time period. Overall, all provinces were estimated to have reductions in (unobservable) transmission including ∼ 96% in former Equateur. This is reassuring as case finding effort has decreased in that region.The model fitting presented here will allow predictions of gHAT under future strategies to be performed in the future.

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Neonatal COVID-19: a clinical case report from the Democratic Republic of Congo (DRC)

10.21203/rs.3.rs-51061/v1 ◽

2020 ◽

Author(s):

Serge ZIGABE ◽

Etienne Kajibwami ◽

Guy-Quesney Mateso ◽

Benjamin Ntaligeza

Keyword(s):

Case Report ◽

World Health Organization ◽

Clinical Case ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

World Health ◽

Wuhan City ◽

Republic Of Congo ◽

The World ◽

Health Organization

Abstract COVID-19 started as a cluster of pneumonia cases in Wuhan City, the Province of Hubei, China, in December 2019. It spread to many regions of China, outside of China and was declared a pandemic by the World Health Organization (WHO) on March 11th, 2020. Initially Africa had no case and now the continent is reporting an increasing number of confirmed cases in an exponential manner (1,2).

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Evaluation of the Influenza Sentinel Surveillance System in the Democratic Republic of Congo, 2012-2015

10.21203/rs.2.10330/v1 ◽

2019 ◽

Author(s):

Pélagie Diambalula Babakazo ◽

Joelle Kabamba-Tshilobo ◽

Emile Okitolonda Wemakoy ◽

Léopold Lubula ◽

Léonie Kitoko Manya ◽

...

Keyword(s):

Data Quality ◽

Surveillance System ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Sentinel Surveillance ◽

World Health ◽

Influenza Surveillance ◽

Surveillance Systems ◽

Republic Of Congo ◽

Sentinel Surveillance System

Abstract Background The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012-2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: <60% weak performance; 60-79% moderate performance; ≥80% good performance. Results During 2012-2015, we enrolled and tested 4,339 patients with influenza-like illness (ILI) and 2,869 patients with severe acute respiratory illness (SARI) from 11 sentinel sites situated in 5 of 11 provinces. Influenza viruses were detected in 446 (10.3%) samples from patients with ILI and in 151 (5.5%) samples from patients with SARI with higher detection during December-May. Data quality and completeness was >90% for all evaluated indicators. Other strengths of the system were timeliness, representativeness, simplicity, stability and utility that scored >70% each. Flexibility and acceptability had moderate to week performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. Conclusions The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.

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Identification of Dengue and Chikungunya viruses among suspected cases of Yellow fever in the Democratic Republic of Congo

Journal of Virus Eradication ◽

10.1016/s2055-6640(20)31218-8 ◽

2016 ◽

Vol 2 ◽

pp. 48-49

Author(s):

Sheila Makiala Mandanda ◽

Nadine Ngwaka ◽

Pierre Becquart ◽

Steve Ahuka ◽

Nicolas Berthet ◽

...

Keyword(s):

Yellow Fever ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Republic Of Congo

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Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen

Conflict and Health ◽

10.1186/s13031-020-00326-5 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Nguyen Toan Tran ◽

Alison Greer ◽

Brigitte Kini ◽

Hassan Abdi ◽

Kariman Rajeh ◽

...

Keyword(s):

Reproductive Health ◽

Health System ◽

Collaborative Design ◽

Sexual And Reproductive Health ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Health System Strengthening ◽

World Health ◽

Republic Of Congo ◽

Humanitarian Settings

Abstract Background Planning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product. Methods Anchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates. Results Results suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations. Conclusion Collaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.

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Evaluation of the Influenza Sentinel Surveillance System in the Democratic Republic of Congo, 2012-2015

10.21203/rs.2.12209/v3 ◽

2019 ◽

Author(s):

Pelagie Diambalula Babakazo ◽

Joelle Kabamba-Tshilobo ◽

Emile Okitolonda Wemakoy ◽

Léopold Lubula ◽

Léonie Kitoko Manya ◽

...

Keyword(s):

Data Quality ◽

Surveillance System ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Sentinel Surveillance ◽

World Health ◽

Influenza Surveillance ◽

Surveillance Systems ◽

Republic Of Congo ◽

Sentinel Surveillance System

Abstract Background The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012-2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: <60% weak performance; 60-79% moderate performance; ≥80% good performance. Results During 2012-2015, we enrolled and tested 4,339 patients with influenza-like illness (ILI) and 2,869 patients with severe acute respiratory illness (SARI) from 11 sentinel sites situated in 5 of 11 provinces. Influenza viruses were detected in 446 (10.3%) samples from patients with ILI and in 151 (5.5%) samples from patients with SARI with higher detection during December-May. Data quality and completeness was >90% for all evaluated indicators. Other strengths of the system were timeliness, simplicity, stability and utility that scored >70% each. Representativeness, flexibility and acceptability had moderate performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. Conclusions The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.

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