Re-Emergence of Monkeypox in Sierra Leone, a Challenge for Clinicians in a Developing Country, 2021: A Case Report

Introduction: Monkeypox is an emerging zoonotic disease with potentially serious illness with similar symptoms as smallpox but with the distinguishing symptom of lymphadenopathy. On March 9, 2021, health authorities in the Koinadugu District in Sierra Leone reported a suspected case of monkeypox. We investigated this case to confirm the diagnosis, and to identify the source of infection and risk factors, and institute control measures. Methods: We used the Integrated Disease Surveillance Response case-based form to collect demographic information and clinical symptoms. Blood samples from the case-patient were collected for laboratory confirmation. Contacts were identified, line listed, traced, and monitored for 21 days. Active searches for people with monkeypox-like symptoms in health facilities and communities and an environmental assessment in the community was conducted. Results: Monkeypox case was confirmed in a 47-year-old male who presented with fever, headache, generalized painless vesicles, rash, itching skin, and firm pustules prominent on the face and ear. The case-patient had no travel history in the last two months and no contact with animals. However, his household’s surroundings showed poor sanitary conditions and the presence of rodents. None of the 24 contacts identified and monitored daily for 21 days showed signs or symptoms of monkeypox infection. The case-patient was isolated, treated, and recovered from the disease. No additional cases were found in health facility or in the community. Conclusions: The confirmation of human monkeypox virus infection in the Koinadugu District indicates that the virus is circulating in the environment. However, the source of infection and risk of exposure are unknown. Strengthening surveillance capacity to quickly detect and notify similar cases may be helpful to raise awareness of the disease and its manifestations and establish appropriate prevention measures, preparedness, and response activities.