BASANKUSU, Congo (AP) — Hundreds of people have tested positive for malaria in northwest Congo as health officials try to understand what may be behind a surge of illnesses that has surpassed 1,000 cases and killed at least 60 people.
The World Health Organization said that while malaria — a mosquito-borne disease — is prevalent in Congo's Equateur province, it has not yet ruled out other causes. It is unclear if the outbreaks are related, the U.N. health agency said in an update Thursday.
“Detailed epidemiological and clinical investigations, as well as further laboratory testing, are (still) needed,” WHO's Africa office said.
It said nearly 1,100 cases have been reported since the first outbreaks were discovered in two villages more than 100 miles apart in late January.
Africa’s top public health agency said infections have been detected in at five villages and that the agency is investigating whether water or food could be the cause of the infections, along with flu and typhoid.
However, tests are “pointing toward malaria,” Dr. Ngashi Ngongo of the Africa Centers for Disease Control and Prevention said in an online briefing Thursday.
The first outbreak was detected in the village of Boloko after three children ate a bat and died within 48 hours. WHO has recorded 12 cases and eight deaths in Boloko. Nearly half of the people who died did so within hours of the onset of symptoms, health officials said this week.
The village of Bomate, which is around 200 kilometers (125 miles) from Boloko, has been hardest hit: 98% of the cases and 86% of deaths have been recorded in Bomate in the Basankusu health zone, WHO said. Of 571 patients in Basankusu who were tested for malaria, 309 — 54.1% — tested positive, it said.
Patients have shown common malaria symptoms such as fever and body aches. Other symptoms include chills, sweating, stiff neck, runny or bleeding nose, cough, vomiting and diarrhea.
Eddy Djoboke said he and his family fled Bomate because they were afraid of falling sick. After they left, one of his children complained his neck and stomach hurt, suggesting he may have been infected before they fled.
“We were asked to have tests done and we are waiting for what happens next," Djoboke said.
Marthe Biyombe, said her child became infected in Bomate and was suffering from body aches and fever. She said the hospital struggled to treat her child because of a lack of medication, but that she was able to buy drugs privately and WHO doctors eventually arrived with more supplies.
“When we arrived at the hospital, we went two weeks without medicine. There were no medicines and we bought the medicines elsewhere (before) the WHO doctors came and started giving us the medicines,” Biyombe said. She did not describe the drugs given to her child.
Experts say access to the sick has been hindered by the remote locations of the affected villages and that several people died before medical teams were able to reach them.
Asadu reported from Abuja. Associated Press journalist Rodney Muhumuza in Kampala, Uganda contributed.
For more on Africa and development: https://apnews.com/hub/africa-pulse
The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.
Men sit outside the general hospital in Basankusu, Democratic Republic of the Congo, where some victims of unidentified illnesses are being treated, Thursday, Feb. 27, 2025. (AP Photo/Guy Masele Sanganga)
A hemorrhagic fever outbreak in the Democratic Republic of Congo has left more than 50 people dead. (AP Graphic)
WASHINGTON (AP) — Senior officials in the Food and Drug Administration’s tobacco center were blindsided by a recent decision that opens the door to allowing more unauthorized electronic cigarettes and nicotine pouches onto the U.S. market, The Associated Press has learned.
The guidelines, posted days before former FDA Commissioner Marty Makary resigned, will allow companies to launch certain nicotine-based products before they've been fully vetted by regulators.
Some FDA officials tasked with enforcing vaping regulations were not consulted on the changes and only learned of them the night before the document was published earlier this month, according to two staffers who spoke to the AP on condition of anonymity to discuss confidential agency matters. The document's sudden appearance sparked internal confusion about how the policy came about and who authorized it, the staffers said.
In recent days, agency officials have convened hourslong meetings grappling with how to implement the six-page memo, which breaks with longstanding FDA policy requiring scientific verification of health benefits for smokers before any new products are introduced.
It’s highly unusual for the FDA to draft new policies without input from the staffers who oversee them.
“It begs the question of whether the true subject matter experts may have actually opposed this policy and were ordered to do it anyway,” said Mitch Zeller, who retired as the FDA’s tobacco director in 2022. “And that goes to the ability of the public to have trust and faith in institutions like FDA.”
The vaping guidelines bypassed a federally required period that allows for public comment and revisions. Instead, the FDA published them as a finalized policy hours after media reports surfaced that President Donald Trump had approved a plan to fire Makary. He resigned from the FDA last week following months of complaints from industry lobbyists close to the White House.
A Health and Human Services spokesperson did not address the origins of the guidance in a written statement.
“This approach strengthens protections against youth nicotine addiction while supporting evidence-based alternatives for adult smokers seeking to move away from combustible tobacco products,” Andrew Nixon said in a statement.
Messages seeking comment from Makary were not immediately returned Friday.
Most health researchers agree that e-cigarettes are significantly less harmful than traditional cigarettes, and the products have been promoted in the U.K. and other European countries as an alternative for smokers.
In the U.S., the FDA has struggled to police the market for over a decade. The agency has authorized vaping products from five companies while rejecting millions of other applications, mainly due to the presence of fruit, candy and other sweet flavors that were deemed appealing to kids. And yet, unauthorized vapes are widely available.
But recent changes in Washington and across the U.S. reflect a shifting landscape.
Underage vaping among U.S. teenagers has fallen to its lowest level in more than 10 years, following the disruptions of the pandemic and new state and federal restrictions.
Trump came to power last year after vowing to “save” the vaping industry. Major tobacco companies, such as Reynolds American and Altria, have contributed millions to political action committees supporting Trump and other administration priorities, including Trump's inauguration and his proposed White House ballroom. Both companies have invested heavily in e-cigarettes and nicotine pouches, in addition to cigarettes.
Despite the influence campaign, vaping issues took a backseat at FDA under Makary. On rare occasions when Makary addressed e-cigarettes, he voiced skepticism about the data showing declining underage use.
Even as FDA staffers were poised to shift course on flavors, Makary and other agency leaders intervened.
In February, one of Makary’s deputies blocked an FDA decision that would have authorized the first fruit-flavored vapes, according to internal memos later released by the agency. FDA reviewers had determined the products were unlikely to be used by children when combined with digital age-verification technology.
The mango- and blueberry-flavored products were finally OK’d during Makary’s last full week heading the FDA, just days before the agency posted the new guidelines allowing unauthorized nicotine products.
Under the guidance, the FDA is supposed to publish a list of e-cigarettes and pouches that are not yet authorized but will be subject to “enforcement discretion,” meaning they can be sold without regulators targeting them for removal. While there is no public list of products that might qualify, the policy is expected to allow for new flavors that had previously been blocked by regulators.
“What we’re seeing is a broader opening up and responsiveness to flavored products by the agency both in terms of a stronger appetite for authorization but also less appetite to take enforcement action against flavored products,” said Brian King, former FDA tobacco director now with the Campaign for Tobacco-Free Kids.
While FDA’s new approach breaks with precedent, it may have little impact on the flavors already available at gas stations, vape shops and convenience stores.
The U.S. market has been flooded for years by unauthorized vapes containing mango, gummy bear, strawberry and dozens of other flavors.
These disposable e-cigarettes filled the vacuum left by Juul when it pulled its high-nicotine flavored products from the market, after they became ubiquitous in U.S. schools beginning around 2017. Currently, the company only sells FDA-authorized e-cigarettes in tobacco and menthol flavors.
Juul and other companies now see the chance to directly compete with disposable Chinese vapes, which by some estimates account for 80% of U.S. sales.
“The choice we face is not whether flavored vaping products should be sold in the U.S. They already are,” said Robyn Gougelet, a Juul vice president. “The choice is whether those products should be regulated and responsibly marketed — or illegal, untested, and smuggled into the country.”
Rather than targeting flavors, the FDA said its new enforcement approach will focus on vapes with specific youth-appealing features, such as designs that resemble children’s toys.
“The reality is they’re just deluged by illegal products coming across the border,” said Jonathan Foulds, a tobacco-addiction specialist at Penn State University. “So they’re making it clear what should be common sense: ‘We’re going to focus on the worst actors.’”
It’s far from clear whether FDA’s new approach will be embraced by the vaping industry at large, which includes multinational tobacco companies alongside hundreds of smaller companies selling imported devices from China.
As written, the guidance suggests only e-cigarettes that are under “scientific review” will qualify to launch without FDA authorization. Only a small number of applications typically reach that stage, which requires detailed health data on smokers who switch to the new product, King noted.
“This is certainly going to benefit the larger tobacco companies, which have the resources to get far enough into the application review process and thus won’t be prioritized for enforcement,” King said.
Lobbyists for smaller companies say it’s too early to tell whether the policy will be help or hinder their clients, but they fear being left behind.
“The big companies would love nothing more than to see their largest swath of competitors out of the marketplace,” said Tony Abboud of the Vapor Technology Association.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
FILE - Disposable flavored electronic cigarette devices are displayed for sale at a store in Pinecrest, Fla., June 26, 2023. (AP Photo/Rebecca Blackwell, File)
