Illness onset occurred while the patient was in the city of Butembo, on September 1 or 2 (see map, Figure 1). Army Medical Research Institute of Infectious Diseases, unpublished protocol).Ī thorough clinical case report was available for Case 2, a 24-year-old male. 7, 8 Cases were classified as confirmed VZV cases if a specimen tested positive for VZV DNA signatures at INRB (reagents provided by the U.S. Centers for Disease Control and Prevention (CDC). ‡Suspect cases were reclassified as confirmed MPX cases if an original specimen tested positive for Orthopoxvirus (OPXV) DNA signatures at Institut National de Recherche Biomedicale (INRB) 6 and/or if a specimen tested positive for MPXV DNA signatures at U.S. This confirmed case of MPX in an infant resulted from the bite of a chimpanzee. Punia is located just west of North Kivu in what is now Maniema Province. 4 Previously, human MPX was confirmed from the “Kivu region” in Kibwe (Punia health zone) in 1982. 3 Within DRC, many cases are reported from the central and northern provinces, but very few cases are reported and investigated from the east, specifically in North and South Kivu. MPXV is endemic in areas of western and central Africa, with the overwhelming majority of reported cases from the Democratic Republic of the Congo (DRC). The average case fatality rate has been reported to be 11% among those without a prior smallpox vaccination. 1 Prior smallpox vaccination (with the OPXV, vaccinia virus) confers protection against MPX virus (MPXV) infection. Human-to-human transmission does occur and identification of individuals who have had significant contact with a MPX patient is important to limit the spread of disease. Transmission occurs via respiratory droplets or contact with infectious lesions (at all stages of the rash, including the crusts). Lymphadenopathy is seen in many MPX patients but was not a common feature of smallpox. Lesions on one area of the body are often synchronized in their development and in rash progression (macule, papule, vesicle, pustule, and crust) to desquamation, which occurs 14-24 days after rash onset. Symptoms include an initial febrile prodrome (1–4 days) followed by characteristic deep-seated, well-circumscribed lesions typically present in a centrifugal distribution, including lesions on the palms of the hands and soles of the feet. Monkeypox (MPX) is a zoonotic Orthopoxvirus (OPXV) infection. Scale bar indicates expected substitutions per site. Clade credibility values are shown at nodes. The three cases from the Kivus are included within the Congo Basin monkeypox virus (MPXV) clade. Phylogram based on the five selected genes ( A10L, A24R, D1R, E9L, and J6R). ( A) 10 days after illness onset, pustules on the face and chest ( B) 13 days after illness onset, pustules on the palms of the hands ( C) 20 days after illness onset, scarring and hypopigmentation on the back after separation of crusts and ( D) 20 days after illness onset, pustules on the left foot. Photographs of Case 2 (dated assuming illness onset occurred on September 1). Predicted suitable areas of transmission from Maxent model are shown in gray. Horizontal hatched lines represent health zones with a confirmed monkeypox (MPX) case and vertical hatched lines represent health zones with cases confirmed to not be MPX cases.
Map showing the health zones for the six investigated cases: Walikale (Case 1), Musienene/Manguredjipa (Case 2), Kayna (Case 3), Mabaka (Case 4), Butembo (Case 5), and Minova (Case 6).
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