CDC TEAM RESPONDS TO MONKEYPOX OUTBREAK IN DRC

UNCLAS SECTION 01 OF 02 KINSHASA 000436

SIPDIS

E.O. 12958: N/A
TAGS: CDC ECON EAGR EAID SENV TBIO PGOV CG
SUBJECT: CDC TEAM RESPONDS TO MONKEYPOX OUTBREAK IN DRC

REF: KINSHASA


1. (U) Summary. The Center for Disease Control and
Prevention (CDC) sent a team of three doctors to investigate
a recent monkeypox outbreak in the Equateur Province of the
Democratic Republic of the Congo (DRC). The CDC
epidemiologists joined representatives from the GDRC Ministry
of Health (MOH) and the DRC,s National Public Health
Laboratory (INRB) in Equateur from May 5 - May 14 to educate
local medical workers, collect and share specimen data, and
study the source of the virus. While the CDC could not find
answers to all of their questions, the team was able to train
DRC health workers in monkeypox virus recognition, patient
care, infection control, and specimen collection. In the
interest of maintaining U.S. defenses against all potential
bioterrorist threats, the CDC plans to test drugs already
developed to combat smallpox on the monkeypox strain. End
Summary.


2. (U) The first documented monkeypox outbreak in humans
dates back to 1970, though an outbreak among primates was
first recorded in 1958. The monkeypox virus is endemic to
the heavily forested regions of West and Central Africa, but
a shipment of animals from Ghana caused a small outbreak (47
cases) in the U.S. in 2003. The World Health Organization,s
(WHO) Monkeypox Steering Committee was established in
February 2008, five months after the WHO issued a monkeypox
alert for Equateur. The CDC negotiated with the MOH in March
and April 2008 for an invitation to assist in investigating a
possible epidemic in Equateur, culminating in a CDC-sponsored
study in Boende, Equateur Province.


3. (U) The CDC responded to the invitation by sending three
doctors to Boende, along with two doctors from the UCLA
School of Public Health, two from the MOH, one from INRB, and
one zoology expert from the University of Kinshasa. The CDC
team arrived in Kinshasa on April 26 and undertook field
operations in Equateur province from May 5 until May 14. The
first objective of the CDC mission was to educate 37 local
healthcare workers from several health zones in Equateur.
The team trained local practitioners to be able to recognize
the monkeypox strain, care for patients that contracted the
virus, control the spread of infection, and collect specimens
for analysis. The CDC is going to release a ten-minute
educational video on monkeypox in both French and Lingala to
be distributed to local health centers. The CDC team also
traced the source of the recent outbreak to a 17-year-old
hunter near Boende that came into contact with an infected
animal. Finally, the team carried out an ecological
investigation, primarily through questionnaires for the local
population, to determine dietary habits, levels of contact
with animals, and land-use in the region.


4. (SBU) The CDC mission collected two full specimens from
patients, including blood samples, plasma samples, and lesion
swabs. The USG has already dedicated substantial funds to
develop drugs in the event of a possible bioterrorist attack
using smallpox. The subsequent analysis of the current
monkeypox strain will help determine whether drugs used to
treat smallpox will also be effective in combating monkeypox.


5. (U) This close relative of smallpox comes from animals
that live near and are habituated to humans. It can be
transferred by physical contact with lesions or through
ingestion of droplets expelled by infected humans or animals.
Children seem to be more susceptible because of their
less-developed immune systems. It is unknown whether the
disease can be passed from an expecting mother to her fetus,
but it can be passed to babies through nursing. The symptoms
include a fever and lesions similar to those common with
smallpox, but that often contain fluid and concentrate around
the limbs and head of infected patients. The recent outbreak
also caused viral conjunctivitis in some patients that can
lead to permanent blindness. The CDC trained local
healthcare workers to isolate patients, and taught them basic
prevention that includes avoiding contact with or consumption
of monkeys and rodents.


6. (SBU) Comment: The CDC team noted a significant level of
malnutrition in the Equateur Province, with many people
eating one meal or less per day. A CDC doctor said
malnutrition drives up the morbidity and mortality rates
during outbreaks, but deterring local Congolese from coming
into contact with the animals will prove difficult. With low
levels of food sources and a significant lack of

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infrastructure to import food, the local population will
likely continue to hunt and consume monkeys, despite the risk
of contact with infected animals.


7. (SBU) Comment continued: The CDC has been unable to find
the principal source or host of monkeypox in nature, nor can
they determine why it is more prevalent in some countries
than in others with similar ecologies. Though mortality
rates of monkeypox are comparatively low at an estimated ten
percent, the potential for another weapon of bioterrorism
warrants continued monitoring of outbreaks and further
studies of monkeypox prevention and treatment. End Comment.
BROCK