National Monkeypox Surveillance, Central African Republic, 2001–2021
Camille Besombes, Festus Mbrenga, Laura Schaeffer, Christian Malaka, Ella Gonofio, Jordi Landier, Ulrich Vickos, Xavier Konamna, Benjamin Sélekon, Joella Namsenei Dankpea, Cassandre Von Platen, Franck Gislain Houndjahoue, Daniel Sylver Ouaïmon, Alexandre Hassanin, Nicolás Berthet, Jean‐Claude Manuguerra, Antoine Gessain, Arnaud Fontanet, Emmanuel Nakouné-Yandoko
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.