Monday, January 18, 2016

Monkeypox Outbreak Reported In Central African Republic


Monkeypox is a rare virus, endemic in monkeys and rodents in central Africa, that produces a remarkably `smallpox looking'  illness in humans, albeit with a much lower fatality rate. Human monkeypox was first identified in 1970 in the DRC, and since then has sparked mostly small, sporadic outbreaks in the Congo Basin and Western Africa.

But in 1996-97, a major outbreak occurred in the Democratic Republic of Congo (see Eurosurveillance Report), where more than 500 cases in the Katako-Kombe and Lodja zones were identified.  Mortality rates were lower for this outbreak (1.5%) than earlier ones, but this was the biggest, and longest duration outbreak on record.
The name `monkeypox’  is a bit of a misnomer. It was first detected (in 1958) in laboratory monkeys, but further research has revealed its host to be rodents or possibly squirrels.  Humans can contract it in the wild from an animal bite or direct contact with the infected animal’s blood, body fluids, or lesions.

Consumption of undercooked bushmeat is also suspected as infection risk, but human-to-human transmission is also possible.  This from the CDC’s Factsheet on Monkeypox:

The disease also can be spread from person to person, but it is much less infectious than smallpox. The virus is thought to be transmitted by large respiratory droplets during direct and prolonged face-to-face contact. In addition, monkeypox can be spread by direct contact with body fluids of an infected person or with virus-contaminated objects, such as bedding or clothing.

According to the CDC
there are two distinct genetic groups (clades) of monkeypox virus—Central African and West African. West African monkeypox is associated with milder disease, fewer deaths, and limited human-to-human transmission.

Credit CDC

On December 30th the Institut Pasteur in Bangui confirmed two cases of monkeypox virus infection in the Bangassou district of the  Central African Republic.  In a report on their website, they wrote:

A team from Doctors without Borders Belgium located in this area at the border of the Democratic Republic of the Congo, has collected samples from two children of the same family who presented with rashes (maculopapular) after consuming thryonomys meat a rodent locally known as sibissi.

One of the children, aged 9 years died. As the clinical picture was not in favor of a measles infections, highly endemic in Central African Republic, the samples were sent to the Institut Pasteur in Bangui for analysis.

The Laboratory of Arboviruses, Viral Hemorrhagic Fevers and of Emerging Zoonotic viruses led by Dr. Emmanuel Nakouné  received the samples on December 25th and immediately conducted molecular analyzes that proved positive for monkeypox virus.

Today Pathfinder on FluTrackers posted a media report that indicates this outbreak extends beyond those first two cases, although details remain scant.

Virus "Monkeypox": the epidemic confirmed in the Mbomou

Par, source Rjdh - 18/01/2016

It is the Minister of Public Health has certified that the Thursday, January 14, 2016, during a press conference. A virus epidemic "Monkeypox" plaguing the region

This is for several days as information relating to the presence of the disease in Mbomou circulate. Two deaths were deplored and several patients quarantined. This is now a reality and that the Ministry of Health has certified. Ms. Margueritte Maliévo Samba said that after tests and investigations made ​​by his department, the disease is confirmed in the Mbomou.
The government official gave details on disease patterns of contamination, saying "there are two modes of transmission of this disease. The first mode is that of the transmission of live or dead animals, contaminated with man. The second mode is sick or deceased person to another healthy person in close contact with body fluids including blood, urine, vomit, sweat, semen or by handling objects contaminated by secretions " .
The Ministry of Health says have control of the situation, however, calls for vigilance "I call all the Central African population in general and that of the Prefecture of Mbomou especially for calm and strict compliance with preventive measures which were to wash hands regularly, avoid any manipulation with sick or dead animals and secretions of infected person and objects "launched the Health Minister.

Although generally limited to small outbreaks in Africa, in 2003 the United States saw an outbreak (of the milder, West African clade) that affected 47 confirmed and probable cases in six states—Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, all of whom had contact with infected prairie dogs purchased as pets.

These pets became infected when an animal distributor imported hundreds of small animals from Ghana, which in turn infected prairie dogs that were subsequently sold to the public (see MMWR Update On Monkeypox 2003).

While still considered a geographically limited threat, in 2010 a study that appeared in PNAS warned that the incidence of human monkeypox infection was increasing, and that it posed a potential risk well beyond localized outbreaks in Africa. 

Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo 

Anne W. Rimoina,b,1,Prime M. Mulembakanic, Sara C. Johnstond,James O. Lloyd Smithb,e,Neville K. Kisaluf, Timothee L. Kinkelac,Seth Blumbergb,e,Henri A. Thomasseng,Brian L. Pikeh,Joseph N. Fairh,Nathan D. Wolfeh,Robert L. Shongoi,Barney S. Grahamj,Pierre Formentyk,Emile Okitolondac,Lisa E. Hensleyd,Hermann Meyerl,Linda L. Wrightm, andJean-Jacques Muyemben

Thirty years after mass smallpox vaccination campaigns ceased,human monkeypox incidence has dramatically increased in rural DRC. Improved surveillance and epidemiological analysis is needed to better assess the public health burden and develop strategies for reducing the risk of wider spread of infection.

Although monkeypox outbreaks tend to burn themselves out fairly quickly, and rarely spread very far, those were the same qualities we attributed to Ebola two years ago.  So we'll keep an eye on this outbreak, in the unlikely event it should spread beyond a handful of cases in Mbomou.

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