National Monkeypox Surveillance, Central African Republic, 2001-2021

We analyzed monkeypox disease surveillance in Central African Republic (CAR) during 2001-2021. Surveillance data show 95 suspected outbreaks, 40 of which were confirmed as monkeypox, comprising 99 confirmed and 61 suspected monkeypox cases. After 2018, CAR's annual rate of confirmed outbreaks increased, and 65% of outbreaks occurred in 2 forested regions bordering the Democratic Republic of the Congo. The median patient age for confirmed cases was 15.5 years. The overall case-fatality ratio was 7.5% (12/160) for confirmed and suspected cases, 9.6% (8/83) for children <16 years of age. Decreasing cross-protective immunity from smallpox vaccination and recent ecologic alterations likely contribute to increased monkeypox outbreaks in Central Africa. High fatality rates associated with monkeypox virus clade I also are a local and international concern. Ongoing investigations of zoonotic sources and environmental changes that increase human exposure could inform practices to prevent monkeypox expansion into local communities and beyond endemic areas.

Automated summary

This study analyzed monkeypox disease surveillance in the Central African Republic from 2001 to 2021. The results show an increasing trend of confirmed outbreaks since 2018, with a majority of cases occurring in forested regions bordering the Democratic Republic of the Congo. The median age of confirmed cases was 15.5 years, and the overall case-fatality ratio was 7.5%. The study suggests that decreasing cross-protective immunity from smallpox vaccination and recent ecological changes contribute to the rise in monkeypox outbreaks in Central Africa.