Human Monkeypox in the Kivus, a Conflict Region of the Democratic Republic of the Congo

Abstract

Monkeypox (MPX) is a zoonotic Orthopoxvirus infection endemic in central and western Africa. Human MPX cases occur in the central and northern regions of the Democratic Republic of the Congo (DRC), and this is the first report of confirmed MPX cases in the forested areas of North and South Kivu Provinces, with a detailed epidemiological investigation for one case. The location of each case is within areas predicted to be suitable for MPX virus transmission based on an ecological niche model. Phylogenetic analysis places these viruses in the Congo Basin clade.

Figure 1.

Map showing the health zones for the six investigated cases: Walikale (Case 1), Musienene/Manguredjipa (Case 2), Kayna (Case 3), Mabaka (Case 4), Butembo (Case 5), and Minova (Case 6). Horizontal hatched lines represent health zones with a confirmed monkeypox (MPX) case and vertical hatched lines represent health zones with cases confirmed to not be MPX cases. Predicted suitable areas of transmission from Maxent model are shown in gray.

Figure 2.

Photographs of Case 2 (dated assuming illness onset occurred on September 1). (A) 10 days after illness onset, pustules on the face and chest; (B) 13 days after illness onset, pustules on the palms of the hands; (C) 20 days after illness onset, scarring and hypopigmentation on the back after separation of crusts; and (D) 20 days after illness onset, pustules on the left foot.

Figure 3.

Phylogram based on the five selected genes (A10L, A24R, D1R, E9L, and J6R). The three cases from the Kivus are included within the Congo Basin monkeypox virus (MPXV) clade. Clade credibility values are shown at nodes. Scale bar indicates expected substitutions per site. (GenBank accession numbers: I37_A10L KP739434, I37_A24R KP739435, I37_D1R KP739436, I37_E9L KP739437, I37_J6R KP739438, I38_A10L KP739439, I38_A24R KP739440, I38_D1R KP739441, I38_E9L KP739442, I38_J6R KP739443, I14_A10L KP739444, I14_A24R KP739445, I14_D1R KP739446, I14_E9L KP739447, I14_J6R KP739448.)