Investigation of a mpox outbreak in Central African Republic, 2021-2022

• Published in: One health Vol. 16; no. 1; p. 100523
• Main Authors: Besombes, C., Mbrenga, F., Malaka, C., Gonofio, E., Schaeffer, L., Konamna, X., Selekon, B., Namsenei-Dankpea, J., Gildas Lemon, C., Landier, J., von Platen, C., Gessain, A., Manuguerra, J.C., Fontanet, A., Nakouné, E.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2023; Elsevier
• Subjects: Central African Republic; Emerging infectious diseases; Life Sciences; Monkeypox virus; mpox; Outbreak investigation; Surveillance; Zoonosis; Monkeypox virus; Surveillance; Outbreak investigation; Emerging infectious diseases; Central African Republic; Zoonosis; mpox
• ISSN: 2352-7714; 2352-7714
• DOI: 10.1016/j.onehlt.2023.100523

Human monkeypox virus is spreading globally, and more information is required about its epidemiological and clinical disease characteristics in endemic countries. We report the investigation of an outbreak in November 2021 in Central African Republic (CAR). The primary case, a hunter, fell ill after contact with a non-human primate at the frontier between forest and savannah. The ensuing investigation in a small nearby town concerned two families and four waves of inter-human transmission, with 14 confirmed cases, 11 suspected cases and 17 non-infected contacts, and a secondary attack rate of 59.5% (25/42). Complications were observed in 12 of the 19 (63.2%) confirmed and suspected cases with available clinical follow-up data: eight cases of bronchopneumonia, two of severe dehydration, one corneal ulcer, one abscess, two cutaneous superinfections, and six cutaneous sequelae (cheloid scars, or depigmentation). There was one death, giving a case fatality ratio of 1/25 (4.0%) for confirmed and suspected cases. This outbreak, with the largest number of confirmed cases ever described in CAR, confirms the potential severity of the disease associated with clade I monkeypox viruses, and highlights the need for rapid control over virus circulation to prevent the further national and international spread of infection. •Importance of epidemiological description of mpox outbreak in endemic settings•Extension of mpox outbreak size in Central Africa with 4 waves of secondary interhuman transmission•Extension of mpox epidemic towards urban and connected areas highlighting the risk of dissemination of the clade I•Persistence of a high morbidity and mortality with the clade I in Central Africa