CDC issues travel notice for the Democratic Republic of the Congo and Neighboring Countries due to Clade I Mpox
The Centers for Disease Control and Prevention (CDC) issued a travel notice (Level 2 - Practice Enhanced Precautions) for the Democratic Republic of the Congo (DRC) and surrounding countries because of an outbreak of clade I mpox.
Federal health officials say cases have also been reported in Burundi, Central African Republic, the Republic of the Congo, Rwanda and Uganda.
This comes at the same time the CDC issued a Health Alert Network (HAN) Health Update earlier this week and report:
Clade I MPXV is endemic in DRC and several other Central African countries, and cases are reported annually. More than 22,000 suspect cases, with more than 1,200 suspected deaths, have been reported in DRC since January 1, 2023, a substantial increase from the median 3,767 suspect clade I mpox cases reported annually in DRC during 2016–2021. Clade I mpox cases have been reported from every DRC province, including areas where clade I mpox does not normally occur, such as the capital city Kinshasa. Outbreaks of clade I MPXV associated with sexual contact among men who have sex with men and female sex workers and their contacts have been reported in some provinces. In other provinces, patients have acquired infection through contact with infected dead or live wild animals, household transmission, or patient care (transmitted in the absence of appropriate personal protective equipment); a high proportion of cases have been reported in children younger than 15 years of age.
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While clade I MPXV is endemic, or naturally occurring, in DRC, the current outbreak is more widespread than any previous DRC outbreak and has resulted in clade I mpox transmission to some neighboring countries. The Republic of the Congo (ROC), which borders DRC to the west, declared a clade I mpox outbreak in April 2024, and there have been confirmed cases in the Central African Republic (CAR). While clade I mpox is endemic in ROC and CAR, the epidemiologic pattern of recent cases suggests a possible link to DRC.
In late July 2024, Burundi, Rwanda, and Uganda, which sit on the eastern border of DRC, reported confirmed cases of mpox, with some cases having linkages to DRC. Rwanda and Uganda have confirmed these cases are due to clade I MPXV; in Burundi, clade-specific testing is underway, but cases are presumed to be clade I due to DRC’s proximity. Mpox is not known to be endemic in these countries.
No cases of clade I mpox have been reported outside central and eastern Africa at this time. Because there is a risk of additional spread, CDC recommends clinicians and jurisdictions in the United States maintain a heightened index of suspicion for mpox in patients who have recently been in DRC or to any country sharing a border with DRC (ROC, Angola, Zambia, Rwanda, Burundi, Uganda, South Sudan, CAR) and present with signs and symptoms consistent with mpox. These can include: rash that may be located on the hands, feet, chest, face, mouth, or near the genitals; fever; chills; swollen lymph nodes; fatigue; myalgia (muscle aches and backache); headache; and respiratory symptoms like sore throat, nasal congestion, and cough.
MPXV has two distinct genetic clades (subtypes of MPXV), I and II, which are endemic to central and west Africa, respectively. Clade I MPXV has previously been observed to be more transmissible and to cause a higher proportion of severe infections than clade II MPXV. The ongoing global mpox outbreak that began in 2022 is caused by clade II MPXV, and cases continue to be reported worldwide.
CDC reports person-to-person transmission has occurred during the clade I outbreak, including through sexual contact, household contact, and within the healthcare setting (in the absence of appropriate personal protective equipment). There has also been transmission from contact with live or dead wild animals.
Mpox vaccination is recommended for people with certain risk factors.
People with risk factors for infection, who are not able to be vaccinated, and/or who are at risk for severe disease (e.g., pregnant people, infants younger than 1 year, people with eczema or active skin conditions, and people who are immunocompromised) should avoid situations that might increase their risk for mpox.
If you travel to DRC or neighboring countries:
For those eligible for mpox vaccination, get two doses of the JYNNEOS vaccine at least 28 days apart.
If you are at risk for mpox and have only received one dose, get a second dose as soon as possible.
Avoid close contact with people who are sick with signs and symptoms of mpox, including those with skin or genital lesions.
Avoid contact with wild animals (alive or dead), such as small mammals, including rodents (rats, squirrels), and non-human primates (monkeys, apes).
Avoid contact with contaminated materials used by people who are sick (such as clothing, bedding, or materials used in healthcare settings) or that came into contact with wild animals.
Avoid eating or preparing meat from wild animals (bushmeat) or using products (creams, lotions, powders) derived from wild animals.
Seek medical care immediately if you develop new, unexplained skin rash (lesions on any part of the body), with or without fever and chills, and avoid contact with others.
Tell your doctor or healthcare provider where you traveled during the last 21 days before developing symptoms.
If you are sick and could have mpox, follow isolation and infection control measures at home and during travel.
Mpox is a disease caused by infection with Monkeypox virus. Mpox is endemic in forested areas of Central and West Africa.
There are two types of Monkeypox virus. Historically, clade I has been associated with a higher percentage of people with mpox developing severe illness or dying, compared to clade II.Â
People usually get mpox through contact with the skin lesions or bodily fluids of infected wild animals in Africa (alive or dead) or humans, including respiratory secretions, or through contact with materials contaminated with the virus such as bedding clothing, and sex toys. Transmission also occurs through intimate or close contact, including sex, with an infected person.
Symptoms often include fever (≥100.4°F), rash, headache, muscle aches, and swollen lymph nodes. Fever is not always present.Â
There is a vaccine available for mpox in the U.S. for those with certain risk factors.