Maria Aubrey B.

Villamor

PSC42

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

The Central African Republic MoH in collaboration with WHO Country Office is
currently conducting response measures including:

 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.

MONKEYPOX VIRUS

Monkeypox virus (MPXV) is an orthopoxvirus that causes human monkeypox

(MPX), a viral disease with symptoms in humans similar to that seen in smallpox
patients. Smallpox no longer occurs, following its worldwide eradication in 1980,
whereas human monkeypox is regularly reported in villages of Central and West
Africa close to tropical rainforest where there is frequent contact with infected
animals.

Monkeypox is usually transmitted to humans from non-human primates,

squirrels or other rodents (e.g. Gambian rats) through contact with the infected
animal’s blood or through a bite. Humans also acquire the disease through direct
contact with infected patients but there is no evidence to date that person-to-
person transmission alone can sustain MPX in the human population.

Latest update

In May-June 2003, MPXV was identified for the first time in the Western Hemisphere
and was the cause of a cluster of cases of MPX in the US Midwest. The primary source
of the US outbreak was thought to be native prairie dogs (Cynomys sp.) housed with
rodents imported from Ghana in West Africa.

In November 2005, several MPX cases were reported in Bentiu, Unity State, Sudan. This
was the first time MPX has been reported in a dry savannah environment in Africa.

SIGNS AND SYMPTOMS

In humans, the symptoms of monkeypox are similar to but milder than the symptoms
of smallpox. Monkeypox begins with fever, headache, muscle aches, and exhaustion.
The main difference between symptoms of smallpox and monkeypox is that
monkeypox causes lymph nodes to swell (lymphadenopathy) while smallpox does not.
The incubation period (time from infection to symptoms) for monkeypox is usually
7−14 days but can range from 5−21 days.

The illness begins with:

 Fever

 Headache

 Muscle aches

 Backache

 Swollen lymph nodes

 Chills

 Exhaustion

Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient
develops a rash, often beginning on the face then spreading to other parts of the body.

Lesions progress through the following stages before falling off:

 Macules

 Papules

 Vesicles

 Pustules

 Scabs

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.