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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 JC, Fontanet A, Nakouné E. Investigation of a mpox outbreak in Central African Republic, 2021-2022. One Health 2023; 16:100523. [PMID: 36950196 PMCID: PMC9988319 DOI: 10.1016/j.onehlt.2023.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
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.
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Affiliation(s)
- C Besombes
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
- Sorbonne Université, Paris, France
| | - F Mbrenga
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - C Malaka
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - E Gonofio
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - L Schaeffer
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
| | - X Konamna
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - B Selekon
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - J Namsenei-Dankpea
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - C Gildas Lemon
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
| | - J Landier
- IRD, Aix Marseille Université, INSERM - SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - C von Platen
- Institut Pasteur Paris- Centre de Recherche Translationnelle- CC, France
| | - A Gessain
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
- Université Paris Cité, CNRS UMR 3569 - Unité Épidémiologie et Physiopathologie des Virus Oncogènes, France
| | - J C Manuguerra
- Environment and Infectious Risk Research Unit, Laboratory for Urgent Response to Biological Threats (ERI-CIBU), France
| | - A Fontanet
- Institut Pasteur, Université Paris Cité, Epidemiology of Emerging Diseases, 75015 Paris, France
- Conservatoire National des Arts et Métiers, PACRI Unit, Paris, France
| | - E Nakouné
- Institut Pasteur, Bangui, République Centrafricaine - Department of Arboviruses, Emerging Viruses and zoonosis, Central African Republic
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Besombes C, Mbrenga F, Schaeffer L, Malaka C, Gonofio E, Landier J, Vickos U, Konamna X, Selekon B, Dankpea JN, Von Platen C, Houndjahoue FG, Ouaïmon DS, Hassanin A, Berthet N, Manuguerra JC, Gessain A, Fontanet A, Nakouné-Yandoko E. National Monkeypox Surveillance, Central African Republic, 2001-2021. Emerg Infect Dis 2022; 28:2435-2445. [PMID: 36328951 PMCID: PMC9707566 DOI: 10.3201/eid2812.220897] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
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.
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Affiliation(s)
- Camille Besombes
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Festus Mbrenga
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Laura Schaeffer
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Christian Malaka
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Ella Gonofio
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Jordi Landier
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Ulrich Vickos
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Xavier Konamna
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Benjamin Selekon
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Joella Namsenei Dankpea
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Cassandre Von Platen
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Franck Gislain Houndjahoue
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Daniel Sylver Ouaïmon
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Alexandre Hassanin
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Nicolas Berthet
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Jean-Claude Manuguerra
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
| | - Antoine Gessain
- Sorbonne Université, Paris, France (C. Besombes)
- Institut Pasteur, Paris (C. Besombes, L. Schaeffer, C. Von Platen, N. Berthet, J.-C. Manuguerra, A. Gessain, A. Fontanet)
- Institut Pasteur, Bangui, Central African Republic (F. Mbrenga, C. Malaka, E. Gonofio, X. Konamna, B. Selekon, J. Namsenei Dankpea, E. Nakouné Yandoko)
- Aix Marseille Université, Marseille, France (J. Landier)
- Centre Hospitalier Universitaire, Bangui (F.G. Houndjahoue, D.S. Ouaïmon)
- Sorbonne Université, Paris (A. Hassanin)
- Institut Pasteur of Shanghai, Shanghai, China (N. Berthet)
- Conservatoire National des Arts et Métiers, Paris (A. Fontanet)
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