Monkeypox outbreak investigation – Aketi

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The research mission investigated an eruptive disease cluster in Aketi health zone (DRCongo) and more specifically we tried to identify the index case of the outbreak in the Bombongolo health area, in Bogbengo locality. In Aketi town before conducting the outbreak investigation in Bogbengo, human monkeypox (HMPX) was suspected in the Itimbiri neighbourhood and x skin biopsies were taken on active suspected cases. In Bogbengo seven skin biopsies (vesicles, crusts) were collected from active cases. We also gathered the epidemiological data for suspect HMPX cases notified for the entire Aketi health zone from 2014 to 2016 as older data were not available. Biopsies were sent to the National Institute of Biomedical Research (INRB) to verify the nature of the outbreak (infection with either VZV or MKXV). On a total of 12 skin biopsies analysed, 2/5 were positive for VZV and 3/5 for MPX in Aketi town and 3/7 were positive for VZV and 4/7 for MPX in Bogbengo, illustrating once more i) the occurrence of a mixed outbreak, ii) the confusion between the eruptive skin diseases and iii) difficult diagnostic in situ and with undertrained health staff. By sampling local wildlife, we aimed also to understand the nature of this outbreak (Orthopoxvirus infection or something else), its origin (imported or locally acquired infection, and which hosts were involved) and potential risk factors. All samples were shipped to Belgium to the EVOECO laboratory (University of Antwerp) to be screened for OXP and MPX DNA presence and positive PCRs fragments have been sequenced and compared to known sequences of the virus.