Thursday, October 13, 2016

WHO Update On The Monkeypox Outbreak In The Central African Republic


Roughly 3 weeks ago, in Another Monkeypox Outbreak In The Central African Republic, we looked at reports of the second outbreak of Monkeypox in the CAR this year, and also looked back at Reports Of A Large Monkeypox Outbreak In The DRC earlier in the year. 

As I noted, Monkeypox outbreaks appear to be increasing  in recent years, possibly due to the waning smallpox vaccine derived immunity in the community.

In 2013, the DRC reported a 600% increase in cases over both 2011, and 2012 (see EID Journal:Extended H-2-H Transmission during a Monkeypox Outbreak) .  The authors also cite a higher attack rate, longer chains of infection, and more pronounced community spread than have earlier reports. 

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.

It produces a remarkably `smallpox looking'  illness in humans, albeit not as deadly.  The CDC's Monkeypox website states:

The illness typically lasts for 2−4 weeks. In Africa, monkeypox has been shown to cause death in as many as 1 in 10 persons who contract the disease

Humans can contract it in the wild from an animal bite or direct contact with the infected animal’s blood, body fluids, or lesions, but consumption of under cooked bushmeat is also suspected as an infection risk.

Today the World Health Organization has published a report on this latest outbreak in the CAR.

Monkeypox in Central African Republic
On 6 September 2016, the Ministry of Health staff from Haute-Kotto health district alerted the central level of suspected monkeypox cases admitted at Ira Banda health centre. 

The index case was a hunter who fell ill on 17 August and died in his village without specimens being collected for laboratory testing. Between 4 September and 7 October, 26 cases have been admitted and of these, three have been laboratory confirmed for monkeypox. Epidemiological investigations are currently on-going to evaluate the magnitude of the outbreak.

Public Health Response

  • Strengthening public health surveillance for possible cases.
  • Training healthcare workers on using personal protective equipment, and advocating proper hand hygiene and cleaning procedures in the health care setting.
  • Installing two isolation units for case management.
  • Provision of free care for patients affected with monkeypox.
  • Increasing public awareness to take precautionary measure to prevent monkeypox transmission.
  • Engaging International Medical Corps and the Catholic Organisation for Relief and Development Aid (CORDAID) to support case management and prevention measures.

WHO Risk Assessment

Small scale monkeypox outbreaks regularly occur in tropical Africa. Monkeypox is usually transmitted to humans through contact with an infected animal or through infected animal bites. Person-to-person transmission can also occur during outbreaks through close contact with patients but there is no evidence to date that person-to-person transmission alone can sustain monkeypox transmission in humans.

Given the lack of adequately equipped isolation units in healthcare facilities in the area and the known transmission dynamics of monkeypox between humans, the WHO encourages individuals and healthcare workers to follow infection prevention and control procedures when caring for patients, to prevent transmission of disease.

Given the location of the outbreak in a relatively remote and sparsely populated area at this stage the risk of international spread seems limited.

The WHO does not recommend any restriction for travel and trade to Central African Republic based on available information at this point in time.

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