{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:17:38Z","timestamp":1763684258350,"version":"3.45.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In February 2025, a fatal outbreak of a hemorrhagic fever-like illness emerged in the Basankusu Health Zone of the Democratic Republic of Congo (DRC), a region where the burdens of poverty and infectious disease intersect. Initial field diagnostics for common filoviruses like Ebola and Marburg returned negative, creating a  critical diagnostic void and confronting local health systems with a potential \u201cDisease X.\u201d This opinion piece analyzes the outbreak\u2019s unique clinical and ecological context to advance a specific, actionable hypothesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main body<\/jats:title>\n                    <jats:p>We argue that the presenting clinical syndrome, particularly the unusual combination of hemorrhagic signs with intractable hiccups and dysphagia, is highly consistent with a fulminant zoonotic orthopoxvirus infection. We hypothesize that this spillover event is directly linked to the socio-ecological pressures of poverty, including reliance on bushmeat for protein and accelerated deforestation for subsistence agriculture and charcoal production, which increase human-wildlife contact. Framing the outbreak through this lens shifts the public health paradigm from confronting a complete unknown to managing a new variant of a known threat. This perspective underscores that the poverty-driven exploitation of ecosystems is a primary engine of novel epidemics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The definitive etiology of the Basankusu outbreak remains unresolved, but the clinical and ecological evidence points toward a potential zoonotic origin consistent with known patterns of pathogen emergence in the Congo Basin. In a setting constrained by limited diagnostic capacity, such evidence-informed approach provides a pragmatic framework for immediate public health action\u2014guiding the deployment of targeted diagnostics (pan-poxvirus PCR), therapeutics (tecovirimat), and vaccines (MVA-BN). Ultimately, preventing future outbreaks of diseases of poverty requires a global commitment to investing in local diagnostic capacity, sustainable development, and equitable health security within high-risk endemic regions like the Congo Basin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphic abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-025-01386-6","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:02:15Z","timestamp":1763683335000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A diagnostic void in the Congo Basin: proposing a zoonotic orthopoxvirus as the cause of a hemorrhagic fever outbreak and a call for equitable health security"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7319-3980","authenticated-orcid":false,"given":"Tshibambe Nathanael","family":"Tshimbombu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"1386_CR1","unstructured":"World Health Organization. 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