Date: Tue 28 Aug 2018
Source: Reuters [edited]
<https://www.reuters.com/article/us-health-yellowfever-congorepublic/congo-republic-confirms-yellow-fever-near-angolan-enclave-idUSKCN1LD1KN>

Congo Republic has confirmed a case of yellow fever near the border with an Angolan enclave, the health ministry said on Tuesday [28 Aug 2018], and has warned of "an emerging event of epidemic proportions."

In all, 186 suspected cases have been detected this year [2018], many of which were in the western commercial hub of Pointe Noire, the head of the government's epidemics unit, Lambert Kitembo told Reuters.

He said 8 blood samples were sent to Democratic Republic of Congo (DRC) for testing last month [July 2018], one of which came back positive. It was then officially confirmed last week at a laboratory in Senegal.

The sometimes deadly mosquito-borne virus causes fever, body aches and nausea and can quickly spread in areas with large unvaccinated populations.

A major outbreak in 2016 in Angola and the DRC killed more than 400 people and was believed to have infected thousands more before it was brought under control through an extensive vaccination campaign.

The confirmed victim in the case of yellow fever in Congo Republic had traveled in Tchiamba Nzassi district, which lies along the border with the Angolan enclave of Cabinda, 2 weeks prior to the onset of his symptoms, the World Health Organization (WHO) said in a weekly report.

No deaths have been reported, but the situation is being taken seriously by health officials, Kitembo said. He did not say whether authorities had plans to test other blood samples.

"Congo, in general, and the departments of Pointe Noire and Koulou in particular are experiencing since the start of 2018 an emerging event of epidemic proportions," the health ministry said in a statement dated last week.

The WHO said that the confirmed case was detected early last month [July 2018] at a health centre in Pointe Noire, where the patient with fever and jaundice was admitted for treatment.
======================
[The number of suspected cases has gone up from 70 yesterday [27 Aug 2018] to 186 mentioned above. There is now one laboratory confirmation. As noted in the previous post, this outbreak is fairly widely distributed geographically across 5 health districts. The dates on which these suspected cases were diagnosed are not given, so we do not have a picture of the time frame of this outbreak. None of these cases resulted in deaths.

It is difficult to assess the risk of an ongoing outbreak without knowing the proportion of the unvaccinated population in the areas where the cases occurred. One hopes that a vigorous vaccination campaign will be initiated as soon as possible. Yellow fever outbreaks can quickly get out of hand, as occurred in Angola and the Democratic Republic of the Congo in 2016-2017. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Republic of Congo: <http://healthmap.org/promed/p/166>]
Date: Mon 27 Aug 2018
Source: APA News [edited]
<http://apanews.net/en/news/yellow-fever-outbreak-reported-in-southern-congo>

As many as 70 suspected cases of yellow fever have been reported in southern Congo, the Congolese Ministry of Health and Population announced Monday [27 Aug 2018] in a statement. Among the prevention measures is vaccination against yellow fever for all travellers entering or leaving the country, the statement added.

"These 70 cases of yellow fever were reported in the health districts of Mongo-Pokou, Lumumba, Mvou-Mvou, Ngoyo and Tsama-Dzassi, a border district with the Republic of Angola in the departments of Kouilou and Pointe-Noire," according to the statement signed by the Minister of Health and Population, Jacqueline Lydia Mikolo. "We invite the Congolese population and our development partners to get involved in the fight against yellow fever, which is a deadly disease," the Minister said. [Byline: Leon Charles Moukouri]
=======================
[This outbreak is fairly widely distributed geographically across 5 health districts. The dates on which these cases were diagnosed are not given, so we do not have a picture of the timeframe of this outbreak. There no an indication of whether any of these 70 cases resulted in deaths. It is difficult to assess the risk of an ongoing outbreak without knowing the proportion of the unvaccinated population in the areas where the cases occurred.

One hopes that a vigorous vaccination campaign will be initiated as soon as possible. Yellow fever outbreaks can quickly get out of hand, as occurred in Angola and the Democratic Republic of the Congo in 2016-2017. - ProMED Mod.TY]
 
[HealthMap/ProMED map available at: Republic of Congo:
<http://healthmap.org/promed/p/166>]
Date: Mon 3 Apr 2017
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/congo-monkeypox-continues-6-additional-cases-reported-56109/>

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 Manfouété town, Dongou district. Manfouété 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]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/166>.]
Date: Wed 15 Mar 2017
Source: NAN [edited]
<http://www.nan.ng/news/monkey-smallpox-hits-congo/>

Three people have died out of 20 cases of monkey smallpox in northern Congo, a statement by the Congolese Ministry of Health and Population in Brazzaville warned.

According to the statement, the epidemic had already surfaced in the same area back in 2003.

Monkey pox is characterized by button-like boils filled with liquid spread all over the body, including the scalp.

It is transmitted through contact with a sick animal but also from a sick human to a healthy person.

There is currently no vaccine against the disease, APA said.

Faced with this epidemic, the government has officially declared monkey pox as an epidemic in Congo to avoid any risk of it spreading and calls on its financial partners to help tackle the disease.
====================
[Monkeypox virus is endemic in the Republic of the Congo, and human cases occur sporadically there as well in DR Congo and the Central African Republic.

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]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/166>.]
Date: Wed 12 Nov 2014
Source: VOA (Voice of America) News [edited]
<http://www.voanews.com/content/vaccine-resistant-polio-strain-identifed/2517894.html>

Researchers identify vaccine-resistant polio strain
---------------------------------------------------
As the world enters the final phase of a global polio eradication effort, French researchers have identified a mutant strain of the virus that is resistant to the polio vaccine. Despite this, an American expert said the war on polio can be won with continued vaccination.

Despite progress toward the goal of wiping polio off the face of the Earth with an aggressive child vaccination campaign, transmission of the paralytic illness continues in Nigeria, Pakistan and Afghanistan. Now, a mutant strain of the virus responsible for a deadly outbreak in the Republic of the Congo in 2010 has been discovered, rendering the polio vaccine less effective.

Scientists at the French organization Institute of Research for Development, or IRD, found the mutant strain. They tested it on 60 blood samples from vaccinated volunteers in Congo and neighbouring Gabon. Antibodies raised by the vaccine were found to be ineffective in neutralizing the virus in 15 to 30 per cent of the samples. The findings were published recently in the journal Proceedings of the National Academy of Sciences.

Walter Orenstein, associate director of the Emory Vaccine Center at Emory University in Atlanta, Georgia [USA], is considered a world renowned expert in the field of infectious diseases and vaccination. He said there is concern the virus may become more virulent. "And there is the theoretical potential of evading the immune system. But I think the bottom line right now is what's said in basically the last sentence of the paper, which said ... mass campaigns using oral polio vaccines stopped the outbreak," he said.

But in some countries, there is violent opposition to those campaigns. Since January [2014], attacks by the Taliban on vaccination teams in Pakistan and Afghanistan have resulted in 235 polio cases, a 15-year high. [The attacks on polio vaccination workers has resulted in geographic areas where vaccination activities are not routinely conducted due to the security concerns for the welfare of the vaccinators. - Mod.MPP] The militants charge the healthcare workers are spies for Washington and the oral polio vaccine makes boys sterile.

Pakistani government officials, saying they don't want to see children paralyzed for life, are vowing to make the country polio-free in 6 months. Orenstein said that's the only way to lessen the threat of a vaccine-resistant strain. "So it to me adds to the urgency of let's just get rid of this virus, and then we won't have to worry about this kind of issue," he said. Orenstein said it's likely polio will be eradicated in Africa by the end of this year [2014], while Pakistan remains the major reservoir. He said stepped-up commitments are needed to vanquish the disease once and for all.   [byline: Jessica Berman]
=========================
[The article referred to in the above media report is: Drexler JF, Grard G, Lukashev AN, Kozlovskaya LI, Bottcher S, Uslu G, et al. Robustness against serum neutralization of a poliovirus type 1 from a lethal epidemic of poliomyelitis in the Republic of Congo in 2010. Proc Natl Acad Sci USA. 2014 Sep 2;111(35):12889-94. doi: 10.1073/pnas.1323502111. (abstract available at <http://www.pnas.org/content/111/35/12889.abstract>).

Abstract
--------
"In 2010, a large outbreak of poliomyelitis with unusual 47 percent lethality occurred in Pointe Noire, Republic of Congo. Vaccine-mediated immunity against the outbreak virus was never investigated. A wild poliovirus 1 (WPV1) isolated from a fatal case (termed PV1-RC2010) showed a previously unknown combination of amino acid exchanges in critical antigenic site 2 (AgS2, VP1 capsid protein positions 221SAAL [-->] 221PADL). These exchanges were also detected in an additional 11 WPV1 strains from fatal cases. PV1-RC2010 escaped neutralization by 3 different mAbs relevant for AgS2. Virus neutralization was tested in sera from fatal cases, who died before supplementary immunization (n = 24), Gabonese recipients of recent oral polio vaccination (n = 12), routinely vaccinated German medical students (n = 34), and German outpatients tested for antipoliovirus immunity (n = 17) on Vero, human rhabdomyosarcoma, and human epidermoid carcinoma 2 cells. Fatal poliomyelitis cases gave laboratory evidence of previous trivalent vaccination. Neutralizing antibody titers against PV1-RC2010 were significantly lower than those against the vaccine strain Sabin-1, 2 genetically distinct WPV1s isolated in 1965 and 2010 and 2 genetically distinct vaccine-derived PV strains. Of German vaccinees tested according to World Health Organization protocols, 15-29 per cent were unprotected according to their neutralization titers (less than 1:8 serum dilution), even though all were protected against Sabin-1. Phylogenetic analysis of the WPV1 outbreak strains suggested a recent introduction of virus progenitors from Asia with formation of separate Angolan and Congolese lineages. Only the latter carried both critical AgS2 mutations. Antigenetically variant PVs may become relevant during the final phase of poliomyelitis eradication in populations with predominantly vaccine-derived immunity. Sustained vaccination coverage and clinical and environmental surveillance will be necessary."

The above mentioned outbreak was associated with a much higher case fatality rate than had been seen -- 47 per cent. At the time of the outbreak, there was speculation that perhaps the high lethality observed was related to a reporting artifact, where only the more serious cases were brought for medical attention, thereby erroneously elevating the observed case fatality rate. A Eurosurveillance report about the outbreak, which detailed studies on the outbreak associated viruses also mentioned a "putative" association with an enterovirus 109 in addition to the WPV1 identified (see Poliomyelitis - worldwide (28): Rep of Congo, Asia, Russia 20101126.4272 for the full report). This new PNAS study provides more in-depth analysis of the WPV1 involved, demonstrating there had been mutations in the virus resulting in a more virulent virus with reduced immunologic protection provided by vaccine induced antibodies.

Genetic sequencing of the WPV1 identified it as a virus known to be circulating in Angola at the time (which had originally been imported from India in 2005, then circulated in Angola and the Democratic Republic of the Congo before renewed circulation beginning in 2007 (see Poliomyelitis - Worldwide (07): Angola, Congo DR, Chad, RFI 20070731.2468).

While the documentation of such a WPV is very disconcerting, the fact that transmission of this WPV was interrupted through the accepted vaccination campaigns suggests that the challenges posed by this virus are presently not insurmountable, although the possibility this may change is of concern.

For the HealthMap/ProMED map of the Republic of Congo, see
<http://healthmap.org/promed/p/166>. - ProMed Mod.MPP]
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