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

C. Besombes (1, 2) , F. Mbrenga (3) , C. Malaka (3) , E. Gonofio (3) , Laura Schaeffer (1) , X. Konamna (3) , B. Selekon (3) , J. Namsenei-Dankpea (3) , C. Gildas Lemon (3) , J. Landier (4) , C. von Platen (5) , Antoine Gessain (1, 6) , Jean-Claude Manuguerra (7) , A. Fontanet (1, 8) , E. Nakouné (3)

1 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
2 SU - Sorbonne Université
3 Institut Pasteur de Bangui
4 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
5 CRT - Centre de Recherche Translationnelle - Center for Translational Science
6 EPVO (UMR_3569 / U-Pasteur_3) - Epidémiologie et Physiopathologie des Virus Oncogènes / Oncogenic Virus Epidemiology and Pathophysiology
7 CIBU - Cellule d'Intervention Biologique d'Urgence (Centre National de Référence) - Laboratory for Urgent Response to Biological Threats (National Reference Center)
8 CNAM - Conservatoire National des Arts et Métiers [CNAM]

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.

Mots clés: Central African Republic; Emerging infectious diseases; Monkeypox virus; Outbreak investigation; Surveillance; Zoonosis; mpox

Domaines: Sciences du Vivant [q-bio]

C. Besombes, F. Mbrenga, C. Malaka, E. Gonofio, Laura Schaeffer, et al.. Investigation of a mpox outbreak in Central African Republic, 2021-2022. One Health, 2023, 16 (1), pp.100523. ⟨10.1016/j.onehlt.2023.100523⟩. ⟨pasteur-04079299⟩