Zaire: IRIN Special Feature on Monkeypox, 3/20/97

U N I T E D N A T I O N S Department of Humanitarian Affairs Integrated Regional Information Network for the Great Lakes

Tel: +254 2 622147 Fax: +254 2 622129 e-mail: irin@dha.unon.org

Zaire: IRIN Special Feature on Monkeypox 20 Mar 1997

A rare disease related to smallpox has broken out in eastern Zaire, and threatens in particular children under 15. Monkeypox (French: Orthopoxvirose simienne), a viral infection acquired by humans from wild animals but occasionally spread through human contact, is reported from areas near Katako-Kombe, in the Sankuru region of eastern Kasai. Since the disease was identified in 1970, the vast majority of reported cases have occurred in Zaire. Between 1982-1986, 331 known cases were reported in Zaire.

A surveillance system was set up in late 1981 but had identified only small clusters of cases with little evidence of any inter-human transmission. However, missions by experts from Medecins sans Frontieres Belgium, the World Health Organization and the US Centres for Disease Control (CDC), undertaken in August 1996 and followed up in February 1997, have found evidence of a more serious outbreak with possible public health implications.

Last year's outbreak in Katako-Kombe started in February, but was only reported in July. Seventy-one cases were reported up to 30 August, of which six proved fatal. Specimens collected at the time and tested at the WHO Collaborating Centre for Smallpox and other Poxvirus Infections at the CDC, confirmed monkeypox infection.

An international mission was sent to Lodja and Katako-Kombe in the Sankuru region of Eastern Zaire from February 17 to March 1 1997 to investigate a possible further outbreak. The mission, which was led by the World Health Organization, included experts from the Centers for Disease Control in Atlanta, the European Union, Medecins Sans Frontieres-Belgium (MSF) and local health and research authorities.

Unfortunately, the second mission was interrupted because of the retreating Zairean soldiers (FAZ) who looted several of the affected villages, killing at least 30 people in Katako-Kombe following the rebel Allied Democratic Forces for the Liberation of Congo-Zaire (ADFL) advance on Kindu, some 280 kms east of Katako-Kombe. There is speculation that fleeing soldiers may become infected and spread the disease if they continue to travel beyond the area. Rapes by retreating FAZ soldiers have often been reported elsewhere in eastern Zaire, and might be a source of human to human monkeypox infection in this area.

Despite its premature end, WHO reported that the mission had identified some 98 cases. The average age of the victims was about 12. The illness has afflicted all ages from 1 month old to 62 years old, but children under 15 are the most susceptible. This is attributed to the fact that vaccinations against smallpox, which appear to provide some protection against monkeypox, were stopped some 15 years ago. Smallpox was widely considered to have been eradicated in 1980. Three-quarters of the cases examined by the team did not have the smallpox vaccination scar. Although the observed death to case ratio was 10% in the 80s, amongst 88 current cases that were traced only 3.4% had died by March 1.

Initially, the viral infection was believed to be transmitted only from wild animals (its natural hosts include chimpanzees, monkeys and squirrels) to humans. However there is a high incidence of cases amongst family members and findings suggest that two-thirds of the current cases originated with other infected people. Monkeypox is now believed to be transmitted more through human contact than once thought.

The possiblility of increased inter-human transmission coupled with the difficulty in reaching the affected areas in order to provide treatment increases the possibility that it will become a serious public health problem. However, despite the rise in the number of cases, the WHO claims that actual inter-human transmission remains poor. A WHO report in 1988 states that the longest chain of human transmission appeared to be four person-to-person infections in a row without animal contact.

According to the WHO and CDC, to prevent an escalation in the number of affected people all cases need to be isolated, and cared for by one person who is vaccinated against smallpox. Humanitarian sources claim this could be problematic given the current advancement of the war in Zaire. Moreover, aid workers are concerned that the possible arrival of the Rwandan refugees, who are for the most part in poor health and are currently fleeing towards Sankuru region, could contribute to an escalation in the number of cases and its spread. However, CDC cautions that "it is not known whether this newly identified person to person transmission potential of the disease is sufficient for monkeypox to sustain itself in human populations in an area where there is no introduction of the virus from wild animals".

WHO also recommends that scratches from animals should be avoided, and that meat from wild animals should be eaten well-cooked.

The WHO has requested that all suspected cases be reported immediately to the nearest WHO representation.

Nairobi, 20 March 1997

[ENDS]

[Via the UN DHA Integrated Regional Information Network. The material contained in this communication may not necessarily reflect the views of the United Nations or its agencies. UN DHA IRIN Tel: +254 2 622123 Fax: +254 2 622129 e-mail: irin@dha.unon.org for more information. If you re-print, copy, archive or re-post this item, please retain this credit and disclaimer. Quotations or extracts from this report should include attribution to the original sources mentioned, not simply "DHA".]

Date: Thu, 20 Mar 1997 11:16:21 +0300 From: UN DHA IRIN - Great Lakes <irin@dha.unon.org> Subject: Zaire: IRIN Special Feature on Monkeypox 20 Mar 1997 97.03.20 Message-ID: <Pine.LNX.3.95.970320110445.27623I-100000@amahoro.dha.unon.org>

Editor: Ali Dinar, aadinar@mail.sas.upenn.edu