Date: Fri 1 Jun 2018
Source: Relief Web [edited]
The outbreak of monkeypox in Cameroon continues, with new areas being affected. Since our last report on 18 May 2018 (Weekly Bulletin 20), 9 additional cases have been reported, bringing the cumulative total to 16, including one confirmed case as of 30 May 2018. No deaths have so far been reported. The ages of the affected people range from one month to 58 years, with a median age of 13 years, and the gender distribution is proportionate.
In addition to the 2 initial health districts, 3 others from 3 different regions have been affected, namely: Njikwa (7 cases) in the North-west Region; Akwaya (6) in the South-west Region; Biyem-Assi (1) in the Central Region; Bertoua (1) in the Eastern Region; and Fotokol (1) in the Far-North Region.
The outbreak of monkeypox in Cameroon was confirmed by the Centre Pasteur du Cameroun (CPC) on 14 May 2018 when one of 2 specimens (obtained from the initial cases) tested positive for orthopoxvirus/monkeypox virus by real-time polymerase chain reaction. The confirmed case is a 20 year old male with clinical symptoms of fever, generalized vesiculo-pustular rash and enlarged lymph nodes. Samples from 11 suspected cases have been collected and tested at the CPC. The event was initially reported to the Ministry of Health by Bjikwa health authorities on 30 Apr 2018 when the 1st 2 suspected cases were detected. The Ministry of Health formally notified WHO of the event on 15 May 2018, following laboratory confirmation.
Public health actions
On 15 May 2018, the Ministry of Health activated an Incident Management System in response to the outbreak, with support from WHO.
- An action plan has been developed for the interventions, and the needs of the different pillars of the response (coordination, operations, logistics, and communication) have been articulated.
- Active surveillance has been enhanced in the whole country, including case investigation of suspected cases and alerts.
- Training of healthcare workers on using personal protective equipment and advocating proper hand hygiene have been conducted. Information related to isolation of cases, symptomatic case management, and handwashing technique have been shared.
- A communication plan has been developed, and risk communication materials have been disseminated to increase public awareness and precautionary measures to prevent monkeypox transmission.
- On 22 May 2018, the Regional Centre for Epidemics Prevention and Control (CERPLE) organised a coordination meeting attended by the Njikwa Health District team, WHO, UNICEF, and other stakeholders.
The outbreak of monkeypox continues in Cameroon, with 5 of the 10 regions in the country reporting at least one suspected case. The cases are being reported from remote rural areas where occupational activities such as farming and hunting are increasing animal-human interaction. The detection of additional cases in the other regions could be due to enhanced surveillance following confirmation of the outbreak.
The resurgence of monkeypox in Cameroon underscores the need to maintain a high level of vigilance and raise awareness of the disease among the local population. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising public awareness of the risk factors, such as close contact with wildlife including rodents, and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical. People infected with monkeypox should be isolated, and infection prevention and control measures should be observed in healthcare facilities caring for infected patients. Close physical contact with persons infected with monkeypox should be limited, and protective equipment such as gloves, face masks and gowns should be worn when taking care of ill people in any setting. Regular hand washing should be carried out after caring for or visiting sick people.
[The previous ProMED-mail post on monkeypox cases in Cameroon did not provide numbers of cases (see ProMED-mail. Monkeypox - Africa (09): Cameroon http://promedmail.org/post/20180519.5805270)
. Monkeypox virus is widespread in central and west Africa, and sporadic human cases occur there. A report earlier this year  in MMWR stated that: "Since 2016, monkeypox cases have been reported and confirmed from Central African Republic (19 cases), DRC (more than 1000 reported per year), Liberia (2), Nigeria (more than 80), Republic of the Congo (88), and Sierra Leone (1) (table); an outbreak in captive chimpanzees occurred in Cameroon. With 80 confirmed cases, Nigeria is currently experiencing the largest documented outbreak of human monkeypox in West Africa this year (2018). The emergence of cases is a concern for global health security;" (see Monkeypox - Africa (04) http://promedmail.org/post/20180327.5712702)
. This report does not mention human cases in Cameroon, but the cases in chimpanzees in that country indicate that the virus is present.
The main reservoirs of monkeypox 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 in order to halt MPX virus exposure will be culturally and economically difficult, so continued occasional occurrence of cases can be expected.
Durski KN, McCollum AM, Nakazawa Y, et al. Emergence of monkeypox -- West and Central Africa, 1970-2017. MMWR Morb Mortal Wkly Rep 2018; 67(10):306-10. - ProMED Mod.TY]
[HealthMap/ProMED-mail map of Cameroon: