Monkeypox is a rare viral zoonotic disease; primary infections are reported from remote forest areas of Central and West Africa. We report an investigation of a monkeypox outbreak in Lobaye, southwest Central African Republic, in October 2018.

BackgroundOutbreaks of hepatitis E frequently occur in tropical developing countries during the rainy season due to overflowing drains, short-circuiting of networks of clean water and use of contaminated water from wells. Hepatitis E virus (HEV) infections are usually accompanied by general symptoms of acute liver disease. This study was conducted to define the clinical and epidemiological aspects of the HEV outbreak that occurred in May 2004 in Bangui.MethodsBlood samples were collected from 411 patients aged 1-87 years, most of whom presented with jaundice, asthenia or signs of uncomplicated malaria, for a transversal study from June 2004 to September 2005. Patients were recruited at 11 health care centres, including two referral hospitals, after they had given informed consent. The diagnosis of HEV was made with a commercial ELISA test to detect IgM and/or IgG antibodies. HEV RNA was amplified by RT-PCR to confirm the presence of the viral genome.ResultsThe most frequent clinical signs found were jaundice (93.4%), vomiting (50.7%), hepatalgia (47.4%), hepatomegaly (30.9%) and asthenia (26.8%), which are the general clinical signs of hepatic disease. Acute hepatitis E was found in 213 patients (51.8%) who were positive for HEV IgM antibodies. The IgG anti-HEV seroprevalence during this outbreak was high (79.5%). The age group 18-34 years was more frequently infected (91.2%) than those aged 1-17 (78.0%) or over 34 (64.9%) (p < 10-6). RT-PCR performed on 127 sera from the 213 IgM-HEV-positive patients was amplified, and the presence of the viral genome was found in 65 samples.ConclusionAlthough no specific clinical signs exist for hepatitis E infection, people presenting with jaundice, vomiting, hepatalgia, asthenia, hepatomegaly or distended abdomen with no signs of uncomplicated malaria in tropical developing countries should be sent to a laboratory for testing for hepatitis E.

M onkeypox, caused by monkeypox virus (MPXV), a member of the Orthopoxvirus genus, was considered a rare emerging disease before a multinational outbreak was identified in May 2022 (1).After global smallpox eradication in 1977, monkeypox became the most concerning human Orthopoxvirus infection. Clinical manifestations of monkeypox typically resemble those of smallpox, including a febrile prodrome and subsequent disseminated maculopapular rash, including vesicles and pustules, that occurs in successive stages (2). Lymphadenopathy is a prominent feature of monkeypox and usually does not occur for smallpox and chickenpox (3). Illness is less severe and death less likely among monkeypox cases than smallpox cases, but monkeypox mortality rates vary and are higher for clade I (formerly the Congo Basin clade) than for clade II (formerly the West African clade) viruses (2). Prior smallpox vaccination can confer cross-immunity for monkeypox, but smallpox vaccination programs worldwide ended in the early 1980s (4).In 1970, a human monkeypox case was reported from Basankusu, Equateur Province, Democratic Republic of the Congo (DRC) (5). Subsequent sporadic monkeypox cases were reported among human and animal populations from remote areas of Central Africa during the 1970s and 1980s (6,7). Since 1990, increases in the frequency and scale of epidemics in Africa have been reported for clade I and, to a lesser extent, since 2000 for clade II. Since 2016, confirmed monkeypox cases have been reported in DRC, Central African Republic (CAR), Republic of Congo (hereafter Congo), Nigeria, Sierra Leone, Liberia, and Cameroon (6). The true burden, circulation rates, and geographic range of this emerging disease remain unknown because many countries lack systematic routine monkeypox surveillance and affected areas often are remote (8,9).An outbreak of human monkeypox disease occurred outside Africa in 2003, after infected animals from Ghana were imported into the United States

BackgroundFebrile jaundice results clinically in generalized yellow coloration of the teguments and mucous membranes due to excess plasma bilirubin, accompanied by fever. Two types are found: conjugated and unconjugated bilirubin jaundice. Jaundice is a sign in several diseases due to viruses (viral hepatitis and arbovirus), parasites (malaria) and bacteria (leptospirosis). In the Central African Republic (CAR), only yellow fever is included on the list of diseases for surveillance. The aim of this study was to identify the other pathogens that can cause febrile jaundice, for better management of patients.MethodsBetween 2008 and 2010, 198 sera negative for yellow fever IgM were randomly selected from 2177 samples collected during yellow fever surveillance. Laboratory analyses targeted four groups of pathogens: hepatitis B, C, delta and E viruses; dengue, chikungunya, Zika, Crimean–Congo haemorrhagic fever, West Nile and Rift Valley arboviruses; malaria parasites; and bacteria (leptospirosis).ResultsOverall, 30.9% sera were positive for hepatitis B, 20.2% for hepatitis E, 12.3% for hepatitis C and 8.2% for malaria. The majority of positive sera (40.4%) were from people aged 16–30 years. Co-infection with at least two of these pathogens was also found.ConclusionThese findings suggest that a systematic investigation should be undertaken of infectious agents that cause febrile jaundice in the CAR.

Background: Infection by hepatitis E virus (HEV) can cause a high burden of morbidity and mortality in countries with poor access to clean water and sanitation. Our study aimed to investigate the situation of HEV infections in the Central African Republic (CAR). Methods: A retrospective analysis of the blood samples and notification forms collected through the national yellow fever (YF) surveillance program, but for which a diagnosis of YF was discarded, was carried out using an anti-HEV IgM ELISA and a HEV-specific RT-PCR. Results: Of 2883 YF-negative samples collected between January 2008 and December 2012, 745 (~26%) tested positive by at least either of the 2 tests used to confirm HEV cases. The results revealed that the CAR was hit by a large HEV outbreak in 2008 and 2009. The results also showed a clear seasonal pattern with correlation between HEV incidence and rainfall in Bangui. A phylogenetic analysis showed that the circulating strains belonged to genotypes 1e and 2b. Conclusions: Overall, this study provides further evidences that HEV can be a significant cause of acute febrile jaundice, particularly among adults during rainy season or flood, in a country from Sub-Saharan Africa.