An Outbreak of Monkeypox in Doedain District, Rivercess County, Liberia, June, 2017

Background: Monkeypox is a zoonotic virus disease with symptoms similar to smallpox, although less severe. The last confirmed monkeypox case in Liberia was recorded in 1970 from Grand Gedeh County. On June 23, 2017, Rivercess County Health Team received information from Dodain District, Rivercess County about a suspected monkeypox that reported at the clinic on June 19. We investigated to verify the report, confirm the diagnosis, determine the source and magnitude of the disease, and recommend evidence-based control and prevention measures. Methods: We defined a suspected case as any person who presented with generalized rash with fever, headache, lymphadenopathy, back pain, myalgia, and weakness in Dodain District from June 1 to July 1, 2017. We defined the probable case as a suspected case in whom the clinician suspected monkeypox. A confirmed case was a suspected or probable case with laboratory confirmed monkeypox. We reviewed patient records, and using the case definitions, we conducted active case search and contact tracing in the affected community to identify cases. We interviewed family and community members to identify cases and contacts. We performed laboratory tests on identified cases to confirm the diagnosis. We monitored and followed up contacts for 21 days to see if any developed signs and symptoms. Results: We identified two cases, one confirmed, and one suspected. The confirmed case was an 8-year old male with onset of symptoms on 17 June 2017. He presented with rashes, fever, and headache. His mother (a suspected case/primary case) was a farmer married to a hunter. She had similar symptoms (onset date, 19th April 2017) but recovered two weeks before her son’s onset. Although the suspected case’s husband was a hunter, there was no clear information that the primary case had been exposed to bush meat. Both the mother and her child had not travelled outside their area of residence. Both cases responded well to symptomatic treatment. None of the 15 contacts developed signs and symptoms in the 21-day follow-up. Conclusion: This was a confirmed outbreak of monkeypox in Dodain District, Rivercess County whose source was not identified. The outbreak was most likely spread through person-to-person transmission. The outbreak was controlled through effective case management, awareness in the community and early reporting.