Monkeypox

The Ministry of Health and Population in the Central African Republic declared a new outbreak of monkeypox in Mbaiki health district, located in the south-western part of the country at the beginning of the month.

Monkeypox Image/CDC
Monkeypox Image/CDC

The latest event was detected on 26 September 2018 when a cluster of three case-patients (from one family) in Zouméa-Kaka village, Mbaiki Health District presented to the local health facility with diffuse skin eruptions and fever. Blood specimens were collected from the case-patients and shipped to the Institut Pasteur Bangui, and the test results were positive for monkeypox virus infection by reverse transcription polymerase chain reaction (RT-PCR).

Last week, one new suspected monkeypox case was reported, bringing the total number of cases reported in the past two weeks to four, including three confirmed. There was no reported death among the cases during this latest event.

Mbaiki is situated in a dense forest region inhabited by an indigenous Bayaka population. This indigenous tribe is nomadic and circulates freely between the borders of Democratic Republic of the Congo and the Republic of Congo, where monkeypox outbreaks have been reported. The Bayaka hunter-gatherer lifestyle frequently exposes them to the blood of wild animals found in the jungle fauna.

This is the fourth monkeypox public health event in the Central African Republic in 2018, and it is the second time this year that Mbaiki District has been affected by the disease.

Since notification of the first event in Bangassou on 17 March 2018, a total of 33 cases and one death have been reported nationally as of 5 October 2018. Of these, 14 cases were confirmed in three districts: Bangassou (6 cases), Bambari (3 cases) and Mbaïki (5 cases).

To date, no epidemiological linkage has been established between the four clusters. Investigations are ongoing to identify key risk factors for disease transmission.

Hepatitis E

IMage/CIA
IMage/CIA

On 2 October 2018, the Ministry of Health and Population in the Central African Republic declared an outbreak of hepatitis E virus (HEV) infection in Bocaranga-Koui Health District, located in the north-western part of the country.

Outbreak investigation conducted by health authorities identified 31 cases of acute jaundice syndrome that occurred between weeks 37 and 39, and blood specimens were accordingly obtained. Test results from the Institut Pasteur Bangui laboratory showed that 29 of the 31 specimens were IgM positive for HEV by serology, confirming the outbreak. One of the 31 cases died, translating into a case fatality ratio of 3%. The death occurred in a pregnant woman in her third trimester.

Bocaranga-Koui Health District, one of the most insecure places in the country, with high levels of crime and incessant displacement of people, who either live in the bush or in host communities. Data from the United Nations Office for Coordination of Humanitarian Affairs (UN OCHA) estimates that 146,251 inhabitants live the health district (in 2018), of which more than 25 000 are in humanitarian distress. The affected population live in precarious conditions characterized by poor sanitation and hygiene. The main sources of drinking water are wells or rivers and most health infrastructures are non-functional with insufficient qualified health personnel.

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