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National Monkeypox Surveillance, Central African Republic, 2001-2021

Camille Besombes et al. Emerg Infect Dis. 2022 Dec.

Abstract

We analyzed monkeypox disease surveillance in Central African Republic (CAR) during 2001-2021. Surveillance data show 95 suspected outbreaks, 40 of which were confirmed as monkeypox, comprising 99 confirmed and 61 suspected monkeypox cases. After 2018, CAR's annual rate of confirmed outbreaks increased, and 65% of outbreaks occurred in 2 forested regions bordering the Democratic Republic of the Congo. The median patient age for confirmed cases was 15.5 years. The overall case-fatality ratio was 7.5% (12/160) for confirmed and suspected cases, 9.6% (8/83) for children <16 years of age. Decreasing cross-protective immunity from smallpox vaccination and recent ecologic alterations likely contribute to increased monkeypox outbreaks in Central Africa. High fatality rates associated with monkeypox virus clade I also are a local and international concern. Ongoing investigations of zoonotic sources and environmental changes that increase human exposure could inform practices to prevent monkeypox expansion into local communities and beyond endemic areas.

Keywords: Central Africa; Central African Republic; emerging infectious diseases; monkeypox; monkeypox virus; national surveillance; outbreak investigation; viruses; zoonoses.

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Figures

Figure 1
Figure 1
Cases detected and investigated during national monkeypox surveillance, Central African Republic, 2001–2021.
Figure 2
Figure 2
Confirmed outbreaks detected during national monkeypox surveillance, Central African Republic, 2001–2021.
Figure 3
Figure 3
Confirmed outbreaks detected during national monkeypox surveillance, Central African Republic, 2001–2021. Source: Copernicus 2019 Global 100 m Landcover (https://doi.org/10.3390/rs12061044). Rep., Republic.
Figure 4
Figure 4
Frequency of signs and symptoms among 99 confirmed monkeypox cases detected during national surveillance, Central African Republic, 2001–2021.
Figure 5
Figure 5
Examples of rash severity detected during national monkeypox surveillance, Central African Republic, 2001–2021. A) Serious rash on a patient’s left hand. Serious rash was reported in 5.7% of cases. B) Moderate rash on a patient’s back. Moderate rash was reported in 57.1% of cases.
Figure 6
Figure 6
Example of fistulation of axillary adenopathy detected during national monkeypox surveillance, Central African Republic, 2001–2021.
See this image and copyright information in PMC

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