Cameroon - Outbreak of monkeypox in Njikwa District in the north-west region of the country

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Outbreaks and Emergencies Bulletin, Week 20 : 12 May - 18 May 2018

Monkeypox Cameroon
7
Cases
0
Deaths
0%
CFR

EVENT DESCRIPTION

On 15 May 2018, the Ministry of Public Health of Cameroon notified WHO
of an outbreak of monkeypox in Njikwa District in the north-west region
of the country. The event was initially reported on 30 April 2018 when
a cluster of two case-patients presented to a local health facility with
fever, headache and lymphadenopathy, later followed by skin rashes.
Biological specimens, including swabbing of the skin lesions and blood
serum, were collected from the initial case-patients and shipped to the
Centre Pasteur du Cameroun (CPC). Test results released by the CPC on
14 May 2018 showed that one of the two specimens was positive for
orthopoxvirus by real-time polymerase chain reaction. Accordingly, the
Ministry of Public Health formally declared an outbreak of monkeypox
on 15 May 2018.

Active case search conducted by the rapid response team identified five
additional suspected cases of monkeypox. As of 15 May 2018, a total
of seven suspected cases have been reported, one of which has been
confirmed. No deaths have so far been reported. Two districts have so
far been affected, namely Njikwa (5 cases) in North-West Region and
Akwaya (2 cases) in the South-east Region. A preliminary investigation
(reportedly) established that the index case, a guard in a game park,
handled a gorilla three weeks preceding his illness. Further epidemiologic
investigations are being conducted.

PUBLIC HEALTH ACTIONS

The Ministry of Health convened an emergency coordination
meeting to assess the outbreak situation and plan for response
interventions. An incident management system has been activated at the sub-national level.
An outbreak response plan is under development, articulating the control strategies and activities and detailing the required resources.
Active epidemiological surveillance is being strengthened in the affected regions, including investigtions to identify the source of infection, active search for
additional cases, follow up of contacts, and collection of laboratory specimens to facilitate confirmation.
Infection prevention and control measures are being enhanced at the health facilities as well as capacity for case management.
Health emergency information products, including situation reports and a press release have been prepared and disseminated to key stakeholders and the general
public, respectively.

SITUATION INTERPRETATION

An outbreak of monkeypox has occurred in Cameroon, coming after about three decades since the last human case was reported in the country in 1989. Only three
human cases of monkeypox had previously been reported in the country: the first case occurred in 1979 in the forest zone of South-East Region, the second case in
1980 in the East Region and the third case in the Central Region (in 1989). However, a monkeypox outbreak occurred among captive chimpanzees in 2014.
Since 2016, there has been an apparent increase in human monkeypox cases across the African Region, with outbreaks occurring in Central African Republic, Congo,
Democratic Republic of the Congo, Liberia, Nigeria, and Sierra Leone. The cases are mostly being reported from rural areas where occupational activities such as
farming and hunting are increasing the risk of animal-to-human transmission.
The potential for further spread and the lack of reliable surveillance remain a concern for this emerging zoonosis. The confirmation of monkeypox in Cameroon,
therefore, underscores the need to maintain high level of vigilance and raise awareness of the disease among the local population. Communication and education for
people on how to prevent the disease by avoiding contact with wild animals, particularly rodents and primates, are important. Healthcare workers also need to observe
standard precautions when taking care of symptomatic patients and isolate them from others. Furthermore, gaps in knowledge about the epidemiology and ecology of
the virus need to be addressed as a priority research agenda to design, recommend and implement needed prevention and control measures.

http://apps.who.int/iris/bitstream/h...1218052018.pdf
http://www.afro.who.int/publications...ay-18-may-2018

 

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Outbreaks and Emergencies Bulletin, Week 22 : 26 May - 01 June 2018

Monkeypox Cameroon
16
Cases
0
Deaths
0%
CFR

EVENT DESCRIPTION
The outbreak of monkeypox in Cameroon continues, with new areas
being affected. Since our last report on 18 May 2018 (Weekly Bulletin
20), nine additional cases have been reported, bringing the cumulative
total to 16, including one confirmed case, as of 30 May 2018. No deaths
have so far been reported. The ages of the affected people range from
one month to 58 years, with a median age of 13 years, and the gender
distribution is proportionate.
In addition to the two initial health districts, three others from three
different regions have been affected, namely: Njikwa (7 cases) in the
North-west Region, Akwaya (6) in the South-west Region, Biyem-Assi
(1) in the Central Region, Bertoua (1) in the Eastern Region, and Fotokol
(1) in the Far-North Region.
The outbreak of monkeypox in Cameroon was confirmed by the
Centre Pasteur du Cameroun (CPC) on 14 May 2018 when one of
two specimens (obtained from the initial cases) tested positive for
orthopoxvirus/monkeypox virus by real-time polymerase chain reaction.
The confirmed case is a 20-year-old male with clinical symptoms of
fever, generalized vesiculo-pustular rash and enlarged lymph nodes.
Samples from 11 suspected cases have been collected and tested at the
CPC. The event was initially reported to the Ministry of Health by Bjikwa
health authorities on 30 April 2018 when the first two suspected cases
were detected. The Ministry of Health formally notified WHO of the event
on 15 May 2018, following laboratory confirmation.

PUBLIC HEALTH ACTIONS
On 15 May 2018, the Ministry of Health activated an Incident Management System in response to the outbreak, with support from WHO.
An action plan has been developed for the interventions and the needs of the different pillars of the response (coordination, operations, logistics, and
communication) have been articulated.
Active surveillance has been enhanced in the whole country, including case investigation of suspected cases and alerts.
Training of healthcare workers on using personal protective equipment and advocating proper hand hygiene has been conducted. Information related to isolation
of cases, symptomatic case management and handwashing technique have been shared.
A communication plan has been developed and risk communication materials have been disseminated to increase public awareness and take precautionary
measure to prevent monkeypox transmission.
On 22 May 2018, the Regional Centre for Epidemics Prevention and Control (CERPLE) organised a coordination meeting, attended by the Njikwa Health District
team, WHO, UNICEF and other stakeholders.

SITUATION INTERPRETATION
The outbreak of monkeypox continues in Cameroon, with five of the 10 regions in the country reporting at least one suspected case. The cases are being reported from remote rural areas where occupational activities such as farming and hunting are increasing animal-human interaction. The detection of additional cases in the other regions could be due to enhanced surveillance following confirmation of the outbreak.
The resurgence of monkeypox in Cameroon underscores the need to maintain a high level of vigilance and raise awareness of the disease among the local population.
In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising public awareness of the risk factors, such as close contact with wildlife including rodents, and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical. People infected with monkeypox should be isolated and infection prevention and control measures should be observed in healthcare facilities caring for infected patients. Close physical contact with persons infected with monkeypox should be limited and protective equipment such as gloves, face masks and gowns should be worn when taking care of ill people in any setting. Regular hand washing should be carried out after caring for or visiting sick people.

http://apps.who.int/iris/bitstream/h...0501062018.pdf

http://www.afro.who.int/health-topic...encies-updates