Date: Mon 3 Dec 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/hepatitis-e-central-african-republic-outbreak-continues-dozens-cases-reported-29606/>

In a follow-up to the hepatitis E outbreak in Bocaranga-Koui Health District, Central African Republic, since late October 2018, 67 new cases of acute jaundice syndrome were reported, of which 51 were confirmed with hepatitis E virus infection. As of 23 Nov 2018, a total of 119 cases of acute jaundice syndrome were recorded, including 2 deaths (case fatality ratio, 1.7%). Of the 119 cases, 80 (67%) have been confirmed positive for hepatitis E virus infection by the Institut Pasteur Bangui. The outbreak has largely been localized to Bocaranga City.

The outbreak of hepatitis E was declared by the Minister of Health on 2 Oct 2018. Epidemiological investigation revealed that the 1st suspected cases emerged in July 2018. Health officials report an increasing trend being observed lately.

Hepatitis E infection is found worldwide. The virus is shed in the stools of infected persons and enters the human body through the intestine. It is transmitted mainly through contaminated drinking water. Usually the infection is self-limiting and resolves within 2 to 6 weeks. Occasionally a serious disease, known as fulminant hepatitis (acute liver failure) develops, and a proportion of people with this disease can die [especially pregnant women - ProMED Mod.LL].

According to WHO, every year, there are an estimated 20 million hepatitis E infections worldwide, leading to an estimated 3.3 million symptomatic cases of hepatitis E, and 56 600 hepatitis E-related deaths.
======================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus.

Ouham-Pende is one of the 16 prefectures of the Central African Republic (<https://en.wikipedia.org/wiki/Ouham-Pend%C3%A9>). Located in the west of the country, its capital is Bozoum. In the north it has a border with Cameroun and Chad. In the south is the prefecture Ombella-Mpoko; in the southwest, the prefecture Nana-Mambere; and in the east, the prefecture Ouham. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Central African Republic: <http://healthmap.org/promed/p/66>]
Date: Thu, 6 Dec 2018 06:36:12 +0100
By Charles BOUESSEL

Bangui, Central African Republic, Dec 6, 2018 (AFP) - The line of parents waiting to see doctors stretches back outside the hospital into the dusty courtyard. Mums and dads carrying weak, starving children. Many hanging limply in their arms like half empty sacks of rice.  The scene at the paediatric complex in Bangui, capital of Central African Republic, is not dissimilar to a war zone.

And as conflict tears through the country, people here are desperately fighting another deadly foe: hunger.   In a doorway, a young girl stands with the round shape of her belly protruding out above her skinny legs.   A few metres away another malnourished girl sits barefoot, joints protruding, with shoulder blades poking out of her skin like blades, a baggy top the only clothing to cling to her perished frame.   "Central African Republic is one of the most difficult countries to be a child," Donaig Le Dru, UNICEF spokesperson in CAR, told AFP.

The statistics underline the horrors that stalk childhood in the country.   Infant mortality in CAR is the highest in the world, according to the UN.    One in 24 children die in the first 28 days of life.   The number of children with severe or acute malnutrition rose from around 32,000 to 43,000 between 2014 and the end of 2018.   And two out of three children -- 1.5 million youngsters in total -- are in need of humanitarian assistance, according to UNICEF.   The UN's World Food Programme warned last month that CAR was facing the worst situation of food insecurity in four years, with nearly two million people in urgent need of food aid.


- 'More dangerous for children' -
Civil unrest has lacerated this impoverished but mineral-rich country for years, leaving the economy in tatters and causing misery for those caught in the violence.    In a report released last month, the UN expressed alarm over a "sharp increase in fighting" and said "life may be even harder and more dangerous for children" than it was at the height of the last outbreak of civil war five years ago.    One of the world's poorest countries, the CAR spiralled into bloodshed after longtime leader Francois Bozize was overthrown in 2013 by a predominantly Muslim rebel alliance called the Seleka.

Nominally Christian militias called the anti-Balaka emerged in response, accelerating a cycle of sectarian violence.   France intervened militarily from 2013 to 2016 to push out the Seleka, winding down the operation after Faustin-Archange Touadera was elected president.   Touadera governs today with the support of a large UN peacekeeping operation. But most of the country is controlled by ex-rebels and militias, many of them claiming to act as guardians for the Muslim or Christian communities.

- Severe malnutrition -
The Bangui hospital is just a few kilometres from the mainly Muslim PK5 district -- an area that has become a flashpoint in the troubled country.   But just five paediatricians work here, struggling with limited equipment or support eked out of the creaking healthcare system.   Inside the hospital, a group of parents and children stare at a malnourished girl crying during what has become a daily routine -- being weighed on scales in a large blue bucket.   One by one, the children are lifted onto the scales as other emaciated infants and parents look on, waiting their turn.

In the overcrowded hospital grounds, a father called Theodore hugs his young daughter who is suffering from malnutrition.   His wife is in hospital after having a nervous breakdown, he says, after the couple's first child died. He struggles to earn enough money to buy food.   In general, children are hospitalised for a little over a week until their weight recovers.   But not all survive, with some losing the fight against severe malnutrition or disease -- the lasting consequences of violence and poverty in a nation wracked by conflict.
Date: Wed 24 Oct. 2018
Source: Xinhua News Agency [in French trans. Corr.SB, edited]
<http://french.peopledaily.com.cn/Afrique/n3/2018/1024/c96852-9511220.html>

On [Tue 23 Oct 2018], the Central African Minister of Health and Population, Pierre Some, formally recognized the existence in the Central African Republic city of Bocaranga ([Ouham-Pende prefecture] in the extreme north west) of a case of yellow fever, whose signs were discovered in a woman aged 80 and confirmed by the Pasteur Institute of Bangui.

As a result, Mr Somse announced the strengthening of epidemiological surveillance in the locality and response measures that have benefited from the support of the World Health Organization (WHO), the Pasteur Institute of Bangui, and the NGO CORDAID [Catholic Organization for Relief and Development Aid].

These measures, he added, include immunization, patient care, and community outreach to improve hygiene and sanitation.

Mr Somse urged residents of so-called risk areas or forest areas to sleep under impregnated mosquito nets. He also advised people in these areas to immediately refer all people with yellow fever indications to health centres.

He described yellow fever as responsible for a mortality rate of between 25 and 50 percent of proven cases, manifested by jaundice caused by a virus. The disease, which is transmitted to humans through mosquitoes, he added, has a reservoir in primates, like monkeys.  [Byline: Gao Ke, Yishuang Liu]
======================
[The situation of yellow fever (YF) remains worrying in Africa, particularly in Central Africa. Yet, there is an effective vaccine, available, and well tolerated; a single dose of the vaccine protects against the disease for life.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The term "yellow" refers to jaundice presented by some patients.

A big epidemic of YF had broken out in the DRC in June 2016. This epidemic was the subject of much ink: it was declared over in February 2017, after more than 6 months without new cases; it occurred following cases of YF in Angola; there was a shortage of vaccines; the usual dose had been divided to cover needs.

In the face of this epidemic in CAR, an epidemiological survey must be carried out, an anti-vector control must be undertaken, as well as a response vaccination. - ProMED Mod.BM]

[It would be of interest to know which mosquito vector species were involved in YF virus transmission in this small outbreak. If mosquito species that transmit YF virus in urban/suburban settings are present there is a risk of ongoing transmission and a significant outbreak. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Central African Republic:
<http://healthmap.org/promed/p/64597>]
Date: Thu 25 Oct 2018
Source: Pulse [edited]
<https://www.pulse.ng/news/world/on-the-frontline-against-monkeypox-in-central-african-republic-id9022707.html>

In a remote southwestern pocket of the Central African Republic (CAR), doctor Patrick Karume and his small team are on the jungle frontline to quarantine a rare outbreak of monkeypox. From a makeshift base in Zomea Kaka village, they trek 30 kilometres (18 miles) across muddy tracks to Bagandou, where a dozen children appear to have developed rashes characteristic of the virus, which in rare cases can be fatal.

Monkeypox virus, 1st identified in the Democratic Republic of Congo in 1970, has symptoms similar to human smallpox, if less severe. In May [2018], the virus became a "public health threat," according to local CAR authorities. It was the latest outbreak detected in CAR since 2013, according to World Health Organisation advisor Augustin Diebert.

Medecins sans Frontieres (MSF) dispatched an emergency team to set up in Zomea Kaka after 3 cases of the virus were identified. Already they have quarantined 9 people, most of them children. "Monkeypox may be endemic to this area," Karume said, pulling off muddied boots after another trek out of their MSF base.

Before entering the "red zone" quarantine area cordoned off with a fence, everyone dons the required gear -- rubber boots, disposable overalls, masks and goggles. Nearby, a few metres away, their patients sit on benches eating breakfast. Some show traces of the virus on their faeces. For some, crusts have discoloured parts of their skin. Peeling is a sign of healing.

"It's a self-limiting virus; we just treat the symptoms and administer antibiotics and prevent infections," Karume said. "We used to think it was transmitted by monkeys, but it is more by rodents. Secondary transmission is through an infected person. If nothing is done it can lead to complications," he said, adding that one patient lost an eye because of oedema.

It not only helps halt the spread, but allows him to understand this little-studied disease. "This here is my champion, my miracle worker," Karume said, smiling under his mask in front of a young Bagandou boy who has developed no symptoms unlike the rest of his family. "If he tests positive for monkeypox, it means he has some sort of immunity," he said. A blood sample is to be sent to the capital for testing.

Not far from the health centre, the team's joint coordinator prepares everything for the day's return expedition to Bagandou to take samples from a dozen suspected cases detected the day before. The driver of the 4x4 vehicle steers onto what passes as a track winding through the vegetation.

When the team arrives in a village, some worried residents often think the MSF vehicles are there to respond to Ebola, the disease that ravaged parts of West Africa. Informing communities beforehand is key to allaying fears.

Arriving in Bagandou, adults welcome the MSF team. Only a few children move away, frightened by the memory of the sting of the last vaccination campaign conducted by the NGO in this area.

But back in the CAR capital Bangui, Bagandou's blood samples turn out to be negative. It seems the virus is not ready to reveal its secrets yet to Karume.
======================
[These sporadic cases of monkeypox (MPX) are not new to the Central African Republic (CAR). Since 2013, CAR has been experiencing at least one MPX outbreak every year, especially in its eastern region. Since the beginning of 2018, outbreaks have been reported in 3 health districts, namely, Bambari in the centre, Bangassou in the eastern part of the country, Mbaiki in the southwest, and now Bagandoun in the south. The case fatality rate continues to be very low.

Prevention of MPX virus infections will not be possible without knowing the source of infection. The question remains about the source of these recent infections within Nigeria, Cameroon, Liberia and more recently in CAR. One wonders whether there is an MPX virus epizootic going on in rodent hosts across a relatively wide geographic area in CAR and the other affected countries. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or in previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected. - ProMED Mod.TY]

[HealthMap/ProMED map:
Central African Republic: <http://healthmap.org/promed/p/66>]
Date: Thu, 25 Oct 2018 12:09:32 +0200
By Charles BOUESSEL

Zomea Kaka, Centrafrique, Oct 25, 2018 (AFP) - In a remote southwestern pocket of the Central African Republic, doctor Patrick Karume and his small team are on the jungle frontline to quarantine a rare outbreak of monkeypox.   From a makeshift base in Zomea Kaka village, they trek 30 kilometres (18 miles) across muddy tracks to Bagandou, where a dozen children appear to have developed rashes characteristic of the virus which in rare cases can be fatal.   Monkeypox virus, first identified in the Democratic Republic of Congo in 1970, has symptoms similar to human smallpox, if less severe.   In May, the virus became a "public health threat", according to local CAR authorities. It was the latest outbreak detected in CAR since 2013, according to World Health Organisation advisor Augustin Diebert.

Medecins sans Frontieres (MSF) dispatched an emergency team to set up in Zomea Kaka after three cases of the virus were identified. Already they have quarantined nine people, most of them children.   "Monkeypox may be endemic to this area," Karume said, pulling off muddied boots after another trek out of their MSF base.   Before entering the "red zone" quarantine area cordoned off with a fence, everyone dons the required gear - rubber boots, disposable overalls, masks and goggles.

Nearby a few metres away, their patients sit on benches eating breakfast. Some show traces of the virus on their faces.   For some, crusts have discoloured parts of their skin. Peeling is a sign of healing.   "It's a self-limiting virus, we just treat the symptoms and administer antibiotics and prevent infections," Karume said.   "We used to think it was transmitted by monkeys, but it is more by rodents. Secondary transmission is through an infected person."   "If nothing is done it can lead to complications," he said, adding that one patient lost an eye because of an oedema.

- Medical detective -
A graduate in epidemiology, the doctor does not just treat patients but attempts to trace their steps to see where they travelled and who they contacted to check on other possible cases.    It not only helps halt the spread, but allows him to understand this little-studied disease.   "This here is my champion, my miracle worker," Karume said, smiling under his mask in front of a young Bagandou boy who has developed no symptoms unlike the rest of his family.   "If he tests positive for monkeypox, it means he has some sort of immunity," he said. A blood sample is to be sent to the capital for testing.

Not far from the health centre, the team's joint coordinator prepares everything for the day's return expedition to Bagandou to take samples from a dozen suspected cases detected the day before.   The driver of the 4X4 vehicle steers onto what passes as a track winding through the vegetation.   When the team arrives in a village, some worried residents often think the MSF vehicles are there to respond to Ebola, the disease that ravaged parts of West Africa. Informing communities beforehand is key to allaying fears.   Arriving in Bagandou, adults welcome the MSF team. Only a few children move away, frightened by the memory of the sting of the last vaccination campaign conducted by the NGO in this area.    But back in the CAR capital Bangui, Bagandou's blood samples turn out to be negative. It seems the virus is not ready to reveal its secrets yet to Karume.
More ...