Date: Mon 3 Apr 2017
Source: Outbreak News Today [edited]
The monkeypox outbreak declared by the government of the Republic of the Congo on 13 Mar 2017 remains active. During reporting week 13 (week ending 31 Mar 2017), 6 new cases were reported from 3 districts, distributed equally (2 cases each) among Betou, Dongou and Impfondo. As of 28 Mar 2017, a cumulative total of 26 suspected cases including 4 deaths (case fatality rate of 15 percent) has been reported since onset of the outbreak on 21 Jan 2017. The outbreak has so far been localized to Likouala province, where 4 districts have been affected: Betou (6 cases, no death), Dongou (13 cases, 2 deaths), Enyelle (4 cases and 1 death) and Impfondo (3 cases, 1 death).
The index case in this outbreak was found to have originated from ManfouÃ©tÃ© town, Dongou district. ManfouÃ©tÃ© is an isolated town with a limited communication network (telephones and internet access), road transport, lack of electricity, inadequate numbers of trained health workers, and low health service coverage. In addition, the high population movement between Congo, the Democratic Republic of Congo and Central African Republic, including influx of refugees from these countries and others like Chad, poses a high risk of propagation of the outbreak to other provinces of Congo and the neighbouring countries.
According to the CDC, the symptoms of monkeypox are as follows: About 12 days after people are infected with the virus, they will get a fever, headache, muscle aches, and backache; their lymph nodes will swell; and they will feel tired. One to 3 days (or longer) after the fever starts, they will get a rash. This rash develops into raised bumps filled with fluid and often starts on the face and spreads, but it can start on other parts of the body too. The bumps go through several stages before they get crusty, scab over, and fall off. The illness usually lasts for 2-4 weeks. Rodents such as rope squirrels, door mice and pouched rats are the suspected reservoir hosts, with monkeys and humans as secondary, spill-over hosts.
People at risk for monkeypox are those who get bitten by an infected animal or who have contact with the animal's rash, blood or body fluids. It can also be transmitted person to person through respiratory or direct contact and contact with contaminated bedding or clothing. There is no specific treatment for monkeypox.
[Although described as a single outbreak, the cases are occurring in 4 districts in Likouala province, located in the far northeast part of the country. The above report provides no evidence of human-to-human transmission, which is rare and cannot be sustained. The risk of infected people spreading the virus to neighbouring countries does not seem high.
This situation makes one wonder whether there is an increased incidence of monkeypox virus infection in rodent reservoirs with spill-over to humans. Occurrence of sporadic cases is not surprising because monkeypox virus is endemic in the Republic of the Congo, the DR Congo, and human cases occur sporadically there as well in the Central African Republic.
As noted in previous ProMED-mail posts, the monkeypox virus clade in the Congo Basin causes more severe disease in humans, with a case fatality rate of 11-17 percent, than the clade in Ghana, which causes few fatalities. The virus is seldom transmitted directly from one person to another, but there is a documented instance of that in the Republic of the Congo.
Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Although not determined, the main reservoirs of monkeypox are suspected to be rodents, including rope squirrels (_Funisciurus_ sp; an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. - ProMED Mod.TY]
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