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Brooks JT, Reynolds MG, Torrone E, McCollum A, Spicknall IH, Gigante CM, Li Y, Satheshkumar PS, Quilter LAS, Rao AK, O'Shea J, Guagliardo SAJ, Townsend M, Hutson CL. How the Orthodox Features of Orthopoxviruses Led to an Unorthodox Mpox Outbreak: What We've Learned, and What We Still Need to Understand. J Infect Dis 2024; 229:S121-S131. [PMID: 37861379 DOI: 10.1093/infdis/jiad465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
Orthopoxviruses have repeatedly confounded expectations in terms of the clinical illness they cause and their patterns of spread. Monkeypox virus (MPXV), originally characterized in the late 1950s during outbreaks among captive primates, has been recognized since the 1970s to cause human disease (mpox) in West and Central Africa, where interhuman transmission has largely been associated with nonsexual, close physical contact. In May 2022, a focus of MPXV transmission was detected, spreading among international networks of gay, bisexual, and other men who have sex with men. The outbreak grew in both size and geographic scope, testing the strength of preparedness tools and public health science alike. In this article we consider what was known about mpox before the 2022 outbreak, what we learned about mpox during the outbreak, and what continued research is needed to ensure that the global public health community can detect, and halt further spread of this disease threat.
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Affiliation(s)
- John T Brooks
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary G Reynolds
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Torrone
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea McCollum
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ian H Spicknall
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Crystal M Gigante
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Laura A S Quilter
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Agam K Rao
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse O'Shea
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Anne J Guagliardo
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Townsend
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christina L Hutson
- Mpox Multinational Response, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Beeson A, Styczynski A, Reynolds MG, McCollum AM, Guagliardo SAJ. Inevitable issues in identifying mpox respiratory transmission - Authors' reply. Lancet Microbe 2023; 4:e573. [PMID: 37236214 DOI: 10.1016/s2666-5247(23)00141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Amy Beeson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ashley Styczynski
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Mary G Reynolds
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Andrea M McCollum
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Sarah Anne J Guagliardo
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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3
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Pittman PR, Martin JW, Kingebeni PM, Tamfum JJM, Mwema G, Wan Q, Ewala P, Alonga J, Bilulu G, Reynolds MG, Quinn X, Norris S, Townsend MB, Satheshkumar PS, Wadding J, Soltis B, Honko A, Güereña FB, Korman L, Patterson K, Schwartz DA, Huggins JW. Clinical characterization and placental pathology of mpox infection in hospitalized patients in the Democratic Republic of the Congo. PLoS Negl Trop Dis 2023; 17:e0010384. [PMID: 37079637 PMCID: PMC10153724 DOI: 10.1371/journal.pntd.0010384] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/02/2023] [Accepted: 03/13/2023] [Indexed: 04/21/2023] Open
Abstract
We describe the results of a prospective observational study of the clinical natural history of human monkeypox (mpox) virus (MPXV) infections at the remote L'Hopital General de Reference de Kole (Kole hospital), the rainforest of the Congo River basin of the Democratic Republic of the Congo (DRC) from March 2007 until August 2011. The research was conducted jointly by the Institute National de Recherche Biomedical (INRB) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The Kole hospital was one of the two previous WHO Mpox study sites (1981-1986). The hospital is staffed by a Spanish Order of Catholic Nuns from La Congregation Des Seours Missionnaires Du Christ Jesus including two Spanish physicians, who were members of the Order as well, were part of the WHO study on human mpox. Of 244 patients admitted with a clinical diagnosis of MPXV infection, 216 were positive in both the Pan-Orthopox and MPXV specific PCR. The cardinal observations of these 216 patients are summarized in this report. There were three deaths (3/216) among these hospitalized patients; fetal death occurred in 3 of 4 patients who were pregnant at admission, with the placenta of one fetus demonstrating prominent MPXV infection of the chorionic villi. The most common complaints were rash (96.8%), malaise (85.2%), sore throat (78.2%), and lymphadenopathy/adenopathy (57.4%). The most common physical exam findings were mpox rash (99.5%) and lymphadenopathy (98.6%). The single patient without the classic mpox rash had been previously vaccinated against smallpox. Age group of less than 5 years had the highest lesion count. Primary household cases tended to have higher lesion counts than secondary or later same household cases. Of the 216 patients, 200 were tested for IgM & IgG antibodies (Abs) to Orthopoxviruses. All 200 patients had anti-orthopoxvirus IgG Abs; whereas 189/200 were positive for IgM. Patients with hypoalbuminemia had a high risk of severe disease. Patients with fatal disease had higher maximum geometric mean values than survivors for the following variables, respectively: viral DNA in blood (DNAemia); maximum lesion count; day of admission mean AST and ALT.
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Affiliation(s)
- Phillip R Pittman
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - James W Martin
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Placide Mbala Kingebeni
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa-Gombe B.P. 1197, Democratic Republic of the Congo (DRC)
- L'Hôpital Général de Référence de Kole, Kole, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa-Gombe B.P. 1197, Democratic Republic of the Congo (DRC)
| | - Gaston Mwema
- L'Hôpital Général de Référence de Kole, Kole, Democratic Republic of the Congo
| | - Qingwen Wan
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Pierre Ewala
- L'Hôpital Général de Référence de Kole, Kole, Democratic Republic of the Congo
| | - Jules Alonga
- L'Hôpital Général de Référence de Kole, Kole, Democratic Republic of the Congo
| | - Guy Bilulu
- L'Hôpital Général de Référence de Kole, Kole, Democratic Republic of the Congo
| | - Mary G Reynolds
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Xiaofei Quinn
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Sarah Norris
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Michael B Townsend
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Panayampalli S Satheshkumar
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - James Wadding
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Bryony Soltis
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Anna Honko
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Fernando B Güereña
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Lawrence Korman
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - Kerry Patterson
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
| | - David A Schwartz
- Perinatal Pathology Consulting, Atlanta, Georgia, United States of America
| | - John W Huggins
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland, United States of America
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Beeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, Morgan C, Ciampaglio K, Reynolds MG, McCollum AM, Guagliardo SAJ. Mpox respiratory transmission: the state of the evidence. Lancet Microbe 2023; 4:e277-e283. [PMID: 36898398 PMCID: PMC9991082 DOI: 10.1016/s2666-5247(23)00034-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/09/2023]
Abstract
The relative contribution of the respiratory route to transmission of mpox (formerly known as monkeypox) is unclear. We review the evidence for respiratory transmission of monkeypox virus (MPXV), examining key works from animal models, human outbreaks and case reports, and environmental studies. Laboratory experiments have initiated MPXV infection in animals via respiratory routes. Some animal-to-animal respiratory transmission has been shown in controlled studies, and environmental sampling studies have detected airborne MPXV. Reports from real-life outbreaks demonstrate that transmission is associated with close contact, and although it is difficult to infer the route of MPXV acquisition in individual case reports, so far respiratory transmission has not been specifically implicated. Based on the available evidence, the likelihood of human-to-human MPXV respiratory transmission appears to be low; however, studies should continue to assess this possibility.
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Affiliation(s)
- Amy Beeson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Styczynski
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Florence Whitehill
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina M Angelo
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faisal S Minhaj
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint Morgan
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kaitlyn Ciampaglio
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary G Reynolds
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea M McCollum
- Mpox Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Taha TY, Townsend MB, Pohl J, Karem KL, Damon IK, Mbala Kingebeni P, Muyembe Tamfum JJ, Martin JW, Pittman PR, Huggins JW, Satheshkumar PS, Bagarozzi DA, Reynolds MG, Hughes LJ. Design and Optimization of a Monkeypox virus Specific Serological Assay. Pathogens 2023; 12:pathogens12030396. [PMID: 36986317 PMCID: PMC10054672 DOI: 10.3390/pathogens12030396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Monkeypox virus (MPXV), a member of the Orthopoxvirus (OPXV) genus, is a zoonotic virus, endemic to central and western Africa that can cause smallpox-like symptoms in humans with fatal outcomes in up to 15% of patients. The incidence of MPXV infections in the Democratic Republic of the Congo, where the majority of cases have occurred historically, has been estimated to have increased as much as 20-fold since the end of smallpox vaccination in 1980. Considering the risk global travel carries for future disease outbreaks, accurate epidemiological surveillance of MPXV is warranted as demonstrated by the recent Mpox outbreak, where the majority of cases were occurring in non-endemic areas. Serological differentiation between childhood vaccination and recent infection with MPXV or other OPXVs is difficult due to the high level of conservation within OPXV proteins. Here, a peptide-based serological assay was developed to specifically detect exposure to MPXV. A comparative analysis of immunogenic proteins across human OPXVs identified a large subset of proteins that could potentially be specifically recognized in response to a MPXV infection. Peptides were chosen based upon MPXV sequence specificity and predicted immunogenicity. Peptides individually and combined were screened in an ELISA against serum from well-characterized Mpox outbreaks, vaccinee sera, and smallpox sera collected prior to eradication. One peptide combination was successful with ~86% sensitivity and ~90% specificity. The performance of the assay was assessed against the OPXV IgG ELISA in the context of a serosurvey by retrospectively screening a set of serum specimens from the region in Ghana believed to have harbored the MPXV-infected rodents involved in the 2003 United States outbreak.
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Affiliation(s)
- Taha Y. Taha
- Reagent and Diagnostic Services Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Michael B. Townsend
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Jan Pohl
- Biotechnology Core Facility Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Kevin L. Karem
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Inger K. Damon
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Placide Mbala Kingebeni
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa P.O. Box 1197, Democratic Republic of the Congo
| | - James W. Martin
- Department of Clinical Research, Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD 21702, USA
| | - Phillip R. Pittman
- Department of Clinical Research, Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD 21702, USA
| | - John W. Huggins
- Department of Clinical Research, Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD 21702, USA
| | - Panayampalli S. Satheshkumar
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Dennis A. Bagarozzi
- Reagent and Diagnostic Services Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Laura J. Hughes
- Reagent and Diagnostic Services Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Correspondence:
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Mauldin MR, McCollum AM, Nakazawa YJ, Mandra A, Whitehouse ER, Davidson W, Zhao H, Gao J, Li Y, Doty J, Yinka-Ogunleye A, Akinpelu A, Aruna O, Naidoo D, Lewandowski K, Afrough B, Graham V, Aarons E, Hewson R, Vipond R, Dunning J, Chand M, Brown C, Cohen-Gihon I, Erez N, Shifman O, Israeli O, Sharon M, Schwartz E, Beth-Din A, Zvi A, Mak TM, Ng YK, Cui L, Lin RTP, Olson VA, Brooks T, Paran N, Ihekweazu C, Reynolds MG. Exportation of Monkeypox Virus From the African Continent. J Infect Dis 2022; 225:1367-1376. [PMID: 32880628 PMCID: PMC9016419 DOI: 10.1093/infdis/jiaa559] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/28/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The largest West African monkeypox outbreak began September 2017, in Nigeria. Four individuals traveling from Nigeria to the United Kingdom (n = 2), Israel (n = 1), and Singapore (n = 1) became the first human monkeypox cases exported from Africa, and a related nosocomial transmission event in the United Kingdom became the first confirmed human-to-human monkeypox transmission event outside of Africa. METHODS Epidemiological and molecular data for exported and Nigerian cases were analyzed jointly to better understand the exportations in the temporal and geographic context of the outbreak. RESULTS Isolates from all travelers and a Bayelsa case shared a most recent common ancestor and traveled to Bayelsa, Delta, or Rivers states. Genetic variation for this cluster was lower than would be expected from a random sampling of genomes from this outbreak, but data did not support direct links between travelers. CONCLUSIONS Monophyly of exportation cases and the Bayelsa sample, along with the intermediate levels of genetic variation, suggest a small pool of related isolates is the likely source for the exported infections. This may be the result of the level of genetic variation present in monkeypox isolates circulating within the contiguous region of Bayelsa, Delta, and Rivers states, or another more restricted, yet unidentified source pool.
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Affiliation(s)
- Matthew R Mauldin
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andrea M McCollum
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoshinori J Nakazawa
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anna Mandra
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin R Whitehouse
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Whitni Davidson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hui Zhao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jinxin Gao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey Doty
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Olusola Aruna
- International Health Regulations Strengthening Project, Global Public Health, Public Health England, London, United Kingdom
| | - Dhamari Naidoo
- World Health Organization Country Office, Abuja, Nigeria
| | | | | | | | - Emma Aarons
- Public Health England, London, United Kingdom
| | | | | | | | - Meera Chand
- Public Health England, London, United Kingdom
| | - Colin Brown
- Public Health England, London, United Kingdom
| | - Inbar Cohen-Gihon
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Noam Erez
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Ohad Shifman
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Ofir Israeli
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Melamed Sharon
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Eli Schwartz
- Institute of Tropical Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Beth-Din
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Anat Zvi
- Department of Biochemistry and Molecular Biology, Israel Institute for Biological Research, Ness-Ziona, Israel
| | - Tze Minn Mak
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Yi Kai Ng
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Lin Cui
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Raymond T P Lin
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Victoria A Olson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tim Brooks
- Public Health England, London, United Kingdom
| | - Nir Paran
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel
| | | | - Mary G Reynolds
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Whitehouse ER, Bonwitt J, Hughes CM, Lushima RS, Likafi T, Nguete B, Kabamba J, Monroe B, Doty JB, Nakazawa Y, Damon I, Malekani J, Davidson W, Wilkins K, Li Y, Radford KW, Schmid DS, Pukuta E, Muyamuna E, Karhemere S, Tamfum JJM, Okitolonda EW, McCollum AM, Reynolds MG. Clinical and Epidemiological Findings from Enhanced Monkeypox Surveillance in Tshuapa Province, Democratic Republic of the Congo During 2011-2015. J Infect Dis 2021; 223:1870-1878. [PMID: 33728469 DOI: 10.1093/infdis/jiab133] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monkeypox is a poorly described emerging zoonosis endemic to Central and Western Africa. METHODS Using surveillance data from Tshuapa Province, Democratic Republic of the Congo during 2011-2015, we evaluated differences in incidence, exposures, and clinical presentation of polymerase chain reaction-confirmed cases by sex and age. RESULTS We report 1057 confirmed cases. The average annual incidence was 14.1 per 100 000 (95% confidence interval, 13.3-15.0). The incidence was higher in male patients (incidence rate ratio comparing males to females, 1.21; 95% confidence interval, 1.07-1.37), except among those 20-29 years old (0.70; .51-.95). Females aged 20-29 years also reported a high frequency of exposures (26.2%) to people with monkeypox-like symptoms.The highest incidence was among 10-19-year-old males, the cohort reporting the highest proportion of animal exposures (37.5%). The incidence was lower among those presumed to have received smallpox vaccination than among those presumed unvaccinated. No differences were observed by age group in lesion count or lesion severity score. CONCLUSIONS Monkeypox incidence was twice that reported during 1980-1985, an increase possibly linked to declining immunity provided by smallpox vaccination. The high proportion of cases attributed to human exposures suggests changing exposure patterns. Cases were distributed across age and sex, suggesting frequent exposures that follow sociocultural norms.
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Affiliation(s)
- Erin R Whitehouse
- Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jesse Bonwitt
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christine M Hughes
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Toutou Likafi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Beatrice Nguete
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joelle Kabamba
- US Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Benjamin Monroe
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey B Doty
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yoshinori Nakazawa
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inger Damon
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean Malekani
- Faculty of Science, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Whitni Davidson
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kimberly Wilkins
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yu Li
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kay W Radford
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia,USA
| | - D Scott Schmid
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia,USA
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Elisabeth Muyamuna
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | | | - Andrea M McCollum
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary G Reynolds
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Barbosa Costa G, Silva de Oliveira J, Townsend MB, Carson WC, Borges IA, McCollum AM, Kroon EG, Satheshkumar PS, Reynolds MG, Nakazawa YJ, de Souza Trindade G. Educational Approach to Prevent the Burden of Vaccinia Virus Infections in a Bovine Vaccinia Endemic Area in Brazil. Pathogens 2021; 10:pathogens10050511. [PMID: 33922509 PMCID: PMC8145679 DOI: 10.3390/pathogens10050511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
Bovine vaccinia (BV), caused by Vaccinia virus (VACV), is a zoonotic disease characterized by exanthematous lesions on the teats of dairy cows and the hands of milkers, and is an important public health issue in Brazil and South America. BV also results in economic losses to the dairy industry, being a burden to the regions involved in milk production. In the past 20 years, much effort has been made to increase the knowledge regarding BV epidemiology, etiologic agents, and interactions with the hosts and the environment. In the present study, we evaluated milking practices that could be associated with VACV infections in an endemic area in Brazil and proposed an educational tool to help prevent VACV infections. In our survey, 124 individuals (51.7%) from a total of 240 had previously heard of BV, 94 of which knew about it through BV outbreaks. Although most individuals involved in dairy activities (n = 85/91) reported having good hygiene practices, only 29.7% used adequate disinfecting products to clean their hands and 39.5% disinfected cows’ teats before and after milking. Furthermore, 46.7% of individuals reported having contact with other farm and domestic animals besides dairy cattle. We also evaluated the presence of IgG and IgM antibodies in the surveyed population. Overall, 6.1% of likely unvaccinated individuals were positive for anti-Orthopoxvirus IgG antibodies, and 1.7% of all individuals were positive for IgM antibodies. Based on our findings, we proposed educational materials which target individuals with permanent residence in rural areas (mainly farmers and milkers), providing an overview and basic information about preventive measures against VACV infections that could enhance BV control and prevention efforts, especially for vulnerable populations located in endemic areas.
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Affiliation(s)
- Galileu Barbosa Costa
- Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília 70723-040, Brazil
- Correspondence: or (G.B.C.); (G.d.S.T.); Tel.: +55-61-3315-7708 (G.B.C.); +55-31-3409-2747 (G.d.S.T.)
| | - Jaqueline Silva de Oliveira
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
| | - Michael B. Townsend
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - William C. Carson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Iara Apolinário Borges
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
| | - Panayampalli Subbian Satheshkumar
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Yoshinori J. Nakazawa
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Giliane de Souza Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
- Correspondence: or (G.B.C.); (G.d.S.T.); Tel.: +55-61-3315-7708 (G.B.C.); +55-31-3409-2747 (G.d.S.T.)
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Khmaladze E, Mauldin MR, Tsaguria D, Gavashelidze M, Sidamonidze K, Tevdoradze T, Li Y, Reynolds MG, Imnadze P, Nakazawa Y. Geographic distribution and genetic characterization of poxviruses from human infections in Georgia, 2009-2014. Arch Virol 2021; 166:1729-1733. [PMID: 33745070 PMCID: PMC8163666 DOI: 10.1007/s00705-020-04922-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
Anthrax is endemic in Georgia, as are multiple zoonotic poxviruses. Poxvirus-associated infections share some clinical manifestations and exposure risks with anthrax, and so it is important to distinguish between the two. With this in mind, an archived collection of anthrax-negative DNA samples was retrospectively screened for poxviruses, and of the 148 human samples tested, 64 were positive. Sequence analysis confirmed the presence of orf virus, bovine papular stomatitis virus, and pseudocowpox virus. This study provides evidence of previously unrecognized poxvirus infections in Georgia and highlights the benefit of the timely identification of such infections by improving laboratory capacity.
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Affiliation(s)
- Ekaterine Khmaladze
- Department of Virology, Molecular Biology and Genome Research, R. G. Lugar Center for Public Health Research, The National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia.
| | - Matthew R Mauldin
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Davit Tsaguria
- Department of Virology, Molecular Biology and Genome Research, R. G. Lugar Center for Public Health Research, The National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Mari Gavashelidze
- Department of Virology, Molecular Biology and Genome Research, R. G. Lugar Center for Public Health Research, The National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Ketevan Sidamonidze
- Department of Virology, Molecular Biology and Genome Research, R. G. Lugar Center for Public Health Research, The National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Tea Tevdoradze
- Department of Virology, Molecular Biology and Genome Research, R. G. Lugar Center for Public Health Research, The National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Yu Li
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Mary G Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Paata Imnadze
- Department of Virology, Molecular Biology and Genome Research, R. G. Lugar Center for Public Health Research, The National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Yoshinori Nakazawa
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, USA
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10
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Hughes CM, Liu L, Davidson WB, Radford KW, Wilkins K, Monroe B, Metcalfe MG, Likafi T, Lushima RS, Kabamba J, Nguete B, Malekani J, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Reynolds MG, Schmid DS, McCollum AM. A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo. Am J Trop Med Hyg 2020. [PMID: 33289470 DOI: 10.4269/ajtmh.200589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Recent enhanced monkeypox (MPX) surveillance in the Democratic Republic of Congo, where MPX is endemic, has uncovered multiple cases of MPX and varicella zoster virus (VZV) coinfections. The purpose of this study was to verify if coinfections occur and to characterize the clinical nature of these cases. Clinical, epidemiological, and laboratory results were used to investigate MPX/VZV coinfections. A coinfection was defined as a patient with at least one Orthopoxvirus/MPX-positive sample and at least one VZV-positive sample within the same disease event. Between September 2009 and April 2014, 134 of the 1,107 (12.1%) suspected MPX cases were confirmed as MPX/VZV coinfections. Coinfections were more likely to report symptoms than VZV-alone cases and less likely than MPX-alone cases. Significantly higher lesion counts were observed for coinfection cases than for VZV-alone but less than MPX-alone cases. Discernible differences in symptom and rash severity were detected for coinfection cases compared with those with MPX or VZV alone. Findings indicate infection with both MPX and VZV could modulate infection severity. Collection of multiple lesion samples allows for the opportunity to detect coinfections. As this program continues, it will be important to continue these procedures to assess variations in the proportion of coinfected cases over time.
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Affiliation(s)
- Christine M Hughes
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindy Liu
- 2Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,3Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Whitni B Davidson
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kay W Radford
- 4Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G Metcalfe
- 3Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Toutou Likafi
- 5Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Joelle Kabamba
- 7U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- 5Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- 8Department of Biology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- 9Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- 9Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Mary G Reynolds
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D Scott Schmid
- 4Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea M McCollum
- 1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Hughes CM, Liu L, Davidson WB, Radford KW, Wilkins K, Monroe B, Metcalfe MG, Likafi T, Lushima RS, Kabamba J, Nguete B, Malekani J, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Reynolds MG, Schmid DS, McCollum AM. A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo. Am J Trop Med Hyg 2020; 104:604-611. [PMID: 33289470 PMCID: PMC7866336 DOI: 10.4269/ajtmh.20-0589] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022] Open
Abstract
Recent enhanced monkeypox (MPX) surveillance in the Democratic Republic of Congo, where MPX is endemic, has uncovered multiple cases of MPX and varicella zoster virus (VZV) coinfections. The purpose of this study was to verify if coinfections occur and to characterize the clinical nature of these cases. Clinical, epidemiological, and laboratory results were used to investigate MPX/VZV coinfections. A coinfection was defined as a patient with at least one Orthopoxvirus/MPX-positive sample and at least one VZV-positive sample within the same disease event. Between September 2009 and April 2014, 134 of the 1,107 (12.1%) suspected MPX cases were confirmed as MPX/VZV coinfections. Coinfections were more likely to report symptoms than VZV-alone cases and less likely than MPX-alone cases. Significantly higher lesion counts were observed for coinfection cases than for VZV-alone but less than MPX-alone cases. Discernible differences in symptom and rash severity were detected for coinfection cases compared with those with MPX or VZV alone. Findings indicate infection with both MPX and VZV could modulate infection severity. Collection of multiple lesion samples allows for the opportunity to detect coinfections. As this program continues, it will be important to continue these procedures to assess variations in the proportion of coinfected cases over time.
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Affiliation(s)
- Christine M. Hughes
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindy Liu
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Whitni B. Davidson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kay W. Radford
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G. Metcalfe
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- Department of Biology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D. Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Guagliardo SAJ, Monroe B, Moundjoa C, Athanase A, Okpu G, Burgado J, Townsend MB, Satheshkumar PS, Epperson S, Doty JB, Reynolds MG, Dibongue E, Etoundi GA, Mathieu E, McCollum AM. Asymptomatic Orthopoxvirus Circulation in Humans in the Wake of a Monkeypox Outbreak among Chimpanzees in Cameroon. Am J Trop Med Hyg 2020; 102:206-212. [PMID: 31769389 PMCID: PMC6947779 DOI: 10.4269/ajtmh.19-0467] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022] Open
Abstract
Monkeypox virus is a zoonotic Orthopoxvirus (OPXV) that causes smallpox-like illness in humans. In Cameroon, human monkeypox cases were confirmed in 2018, and outbreaks in captive chimpanzees occurred in 2014 and 2016. We investigated the OPXV serological status among staff at a primate sanctuary (where the 2016 chimpanzee outbreak occurred) and residents from nearby villages, and describe contact with possible monkeypox reservoirs. We focused specifically on Gambian rats (Cricetomys spp.) because they are recognized possible reservoirs and because contact with Gambian rats was common enough to render sufficient statistical power. We collected one 5-mL whole blood specimen from each participant to perform a generic anti-OPXV ELISA test for IgG and IgM antibodies and administered a questionnaire about prior symptoms of monkeypox-like illness and contact with possible reservoirs. Our results showed evidence of OPXV exposures (IgG positive, 6.3%; IgM positive, 1.6%) among some of those too young to have received smallpox vaccination (born after 1980, n = 63). No participants reported prior symptoms consistent with monkeypox. After adjusting for education level, participants who frequently visited the forest were more likely to have recently eaten Gambian rats (OR: 3.36, 95% CI: 1.91-5.92, P < 0.001) and primate sanctuary staff were less likely to have touched or sold Gambian rats (OR: 0.23, 95% CI: 0.19-0.28, P < 0.001). The asymptomatic or undetected circulation of OPXVs in humans in Cameroon is likely, and contact with monkeypox reservoirs is common, raising the need for continued surveillance for human and animal disease.
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Affiliation(s)
- Sarah Anne J. Guagliardo
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christian Moundjoa
- Ministry of Livestock, Fisheries, and Animal Industries, Yaoundé, Cameroon
- Field Epidemiology Training Program, U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
| | - Ateba Athanase
- Field Epidemiology Training Program, U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
- National Zoonoses Program, Ministry of Health, Yaoundé, Cameroon
| | - Gordon Okpu
- U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
| | - Jillybeth Burgado
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael B. Townsend
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Scott Epperson
- Hubert Humphrey Global Health Fellowship Program, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey B. Doty
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Els Mathieu
- U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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13
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Guagliardo SAJ, Doshi RH, Reynolds MG, Dzabatou-Babeaux A, Ndakala N, Moses C, McCollum AM, Petersen BW. Do Monkeypox Exposures Vary by Ethnicity? Comparison of Aka and Bantu Suspected Monkeypox Cases. Am J Trop Med Hyg 2020; 102:202-205. [PMID: 31769405 PMCID: PMC6947767 DOI: 10.4269/ajtmh.19-0457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/30/2019] [Indexed: 11/14/2022] Open
Abstract
In 2017, a monkeypox outbreak occurred in Likouala Department, Republic of the Congo. Many of the affected individuals were of Aka ethnicity, hunter-gatherers indigenous to Central Africa who have worse health outcomes in comparison with other forest-dwelling peoples. To test the hypothesis that Aka people have different risk factors for monkeypox, we analyzed questionnaire data for 39 suspected cases, comparing Aka and Bantu groups. Aka people were more likely to touch animal urine/feces, find dead animals in/around the home, eat an animal that was found dead, or to have been scratched or bitten by an animal (P < 0.05, all variables). They were also more likely to visit the forest ≥ once/week, sleep outside, or sleep on the ground (P < 0.001, all variables), providing opportunities for contact with monkeypox reservoirs during the night. The Aka and possibly other vulnerable groups may warrant special attention during educational and health promotion programs.
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Affiliation(s)
- Sarah Anne J. Guagliardo
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Reena H. Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nestor Ndakala
- Field Epidemiology Training Program, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Cynthia Moses
- International Communication and Education Fund, Kinshasa, Democratic Republic of the Congo
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett W. Petersen
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Gigante CM, Gao J, Tang S, McCollum AM, Wilkins K, Reynolds MG, Davidson W, McLaughlin J, Olson VA, Li Y. Genome of Alaskapox Virus, A Novel Orthopoxvirus Isolated from Alaska. Viruses 2019; 11:v11080708. [PMID: 31375015 PMCID: PMC6723315 DOI: 10.3390/v11080708] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 01/10/2023] Open
Abstract
Since the eradication of smallpox, there have been increases in poxvirus infections and the emergence of several novel poxviruses that can infect humans and domestic animals. In 2015, a novel poxvirus was isolated from a resident of Alaska. Diagnostic testing and limited sequence analysis suggested this isolate was a member of the Orthopoxvirus (OPXV) genus but was highly diverged from currently known species, including Akhmeta virus. Here, we present the complete 210,797 bp genome sequence of the Alaska poxvirus isolate, containing 206 predicted open reading frames. Phylogenetic analysis of the conserved central region of the genome suggested the Alaska isolate shares a common ancestor with Old World OPXVs and is diverged from New World OPXVs. We propose this isolate as a member of a new OPXV species, Alaskapox virus (AKPV). The AKPV genome contained host range and virulence genes typical of OPXVs but lacked homologs of C4L and B7R, and the hemagglutinin gene contained a unique 120 amino acid insertion. Seven predicted AKPV proteins were most similar to proteins in non-OPXV Murmansk or NY_014 poxviruses. Genomic analysis revealed evidence suggestive of recombination with Ectromelia virus in two putative regions that contain seven predicted coding sequences, including the A-type inclusion protein.
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Affiliation(s)
- Crystal M Gigante
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Jinxin Gao
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Shiyuyun Tang
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Andrea M McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mary G Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Whitni Davidson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Joseph McLaughlin
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, AK 99503, USA
| | - Victoria A Olson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Yu Li
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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15
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Leung J, McCollum AM, Radford K, Hughes C, Lopez AS, Guagliardo SAJ, Nguete B, Likafi T, Kabamba J, Malekani J, Shongo Lushima R, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Reynolds MG, Wemakoy Okitolonda E, Schmid DS, Marin M. Varicella in Tshuapa Province, Democratic Republic of Congo, 2009-2014. Trop Med Int Health 2019; 24:839-848. [PMID: 31062445 PMCID: PMC8786670 DOI: 10.1111/tmi.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe varicella cases in Tshuapa Province of the Democratic Republic of the Congo identified during monkeypox surveillance. METHODS Demographic, clinical and epidemiological data were collected from each suspected monkeypox case 2009-2014. Samples were tested by PCR for both Orthopoxviruses and varicella-zoster virus (VZV); a subset of VZV-positive samples was genotyped. We defined a varicella case as a rash illness with laboratory-confirmed VZV. RESULTS There were 366 varicella cases were identified; 66% were ≤19 years old. Most patients had non-typical varicella rash with lesions reported as the same size and stage of evolution (86%), deep and profound (91%), on palms of hands and/or soles of feet (86%) and not itchy (49%). Many had non-typical signs and symptoms, such as lymphadenopathy (70%) and sensitivity to light (23%). A higher proportion of persons aged ≥20 years than persons aged ≤19 years had ≥50 lesions (79% vs. 65%, P = 0.007) and were bedridden (15% vs. 9%, P = 0.056). All VZV isolates genotyped from 79 varicella cases were clade 5. During the surveillance period, one possible VZV-related death occurred in a 7-year-old child. CONCLUSIONS A large proportion of patients presented with non-typical varicella rash and clinical signs and symptoms, highlighting challenges identifying varicella in an area with endemic monkeypox. Continued surveillance and laboratory diagnosis will help in rapid identification and control of both monkeypox and varicella and improve our understanding of varicella epidemiology in Africa.
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Affiliation(s)
- Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Andrea M. McCollum
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
| | - Kay Radford
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Christine Hughes
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
| | - Adriana S Lopez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Sarah Anne J. Guagliardo
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, United States
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- University of Kinshasa, Department of Biology, Kinshasa, Democratic Republic of Congo
| | | | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | - Mary G. Reynolds
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta GA USA
| | | | - D Scott Schmid
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
| | - Mona Marin
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention Atlanta GA USA
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16
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Reynolds MG, Wauquier N, Li Y, Satheshkumar PS, Kanneh LD, Monroe B, Maikere J, Saffa G, Gonzalez JP, Fair J, Carroll DS, Jambai A, Dafae F, Khan SH, Moses LM. Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases. Emerg Infect Dis 2019; 25:1023-1025. [PMID: 30753125 PMCID: PMC6478203 DOI: 10.3201/eid2505.180832] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We note the reemergence of human monkeypox in Sierra Leone following a 44-year absence of reported disease. The persons affected were an 11-month-old boy and, several years later, a 35-year-old man. The reappearance of monkeypox in this country suggests a need for renewed vigilance and awareness of the disease and its manifestations.
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17
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Doshi RH, Guagliardo SAJ, Doty JB, Babeaux AD, Matheny A, Burgado J, Townsend MB, Morgan CN, Satheshkumar PS, Ndakala N, Kanjingankolo T, Kitembo L, Malekani J, Kalemba L, Pukuta E, N'kaya T, Kangoula F, Moses C, McCollum AM, Reynolds MG, Mombouli JV, Nakazawa Y, Petersen BW. Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Emerg Infect Dis 2019; 25:281-289. [PMID: 30666937 PMCID: PMC6346463 DOI: 10.3201/eid2502.181222] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Monkeypox, caused by a zoonotic orthopoxvirus, is endemic in Central and West Africa. Monkeypox has been sporadically reported in the Republic of the Congo. During March 22-April 5, 2017, we investigated 43 suspected human monkeypox cases. We interviewed suspected case-patients and collected dried blood strips and vesicular and crust specimens (active lesions), which we tested for orthopoxvirus antibodies by ELISA and monkeypox virus and varicella zoster virus DNA by PCR. An ecologic investigation was conducted around Manfouété, and specimens from 105 small mammals were tested for anti-orthopoxvirus antibodies or DNA. Among the suspected human cases, 22 met the confirmed, probable, and possible case definitions. Only 18 patients had available dried blood strips; 100% were IgG positive, and 88.9% (16/18) were IgM positive. Among animals, only specimens from Cricetomys giant pouched rats showed presence of orthopoxvirus antibodies, adding evidence to this species' involvement in the transmission and maintenance of monkeypox virus in nature.
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18
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Reynolds MG, Doty JB, McCollum AM, Olson VA, Nakazawa Y. Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health. Expert Rev Anti Infect Ther 2019; 17:129-139. [PMID: 30625020 PMCID: PMC6438170 DOI: 10.1080/14787210.2019.1567330] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monkeypox is a re-emerging viral zoonosis that occurs naturally in heavily forested regions of West and Central Africa. Inter-human transmission of monkeypox virus, although limited, drives outbreaks, particularly in household and health-care settings. But the available evidence suggests that without repeated zoonotic introductions, human infections would eventually cease to occur. Therefore, interrupting virus transmission from animals to humans is key to combating this disease. Areas covered: Herein we review laboratory and field studies examining the susceptibility of various animal taxa to monkeypox virus infection, and note the competence of various species to serve as reservoirs or transmission hosts. In addition, we discuss early socio-ecologic theories of monkeypox virus transmission in rural settings and review current modes of ecologic investigation - including ecologic niche modeling, and ecologic sampling - in light of their potential to identify specific animal species and features of the environment that are associated with heightened risk for human disease. Expert opinion: The role of disease ecology and scientific research in ongoing disease prevention efforts should be reinforced, particularly for wildlife-associated zoonoses such as monkeypox. Such efforts alongside those aimed at nurturing 'One Health' collaborations may ultimately hold the greatest promise for reducing human infections with this pathogen.
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Affiliation(s)
- Mary G. Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Jeffry B. Doty
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Andrea M. McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Victoria A. Olson
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Yoshinori Nakazawa
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
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19
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Petersen BW, Kabamba J, McCollum AM, Lushima RS, Wemakoy EO, Muyembe Tamfum JJ, Nguete B, Hughes CM, Monroe BP, Reynolds MG. Vaccinating against monkeypox in the Democratic Republic of the Congo. Antiviral Res 2019; 162:171-177. [PMID: 30445121 PMCID: PMC6438175 DOI: 10.1016/j.antiviral.2018.11.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 01/02/2023]
Abstract
Healthcare-associated transmission of monkeypox has been observed on multiple occasions in areas where the disease is endemic. Data collected by the US Centers for Disease Control and Prevention (CDC) from an ongoing CDC-supported program of enhanced surveillance in the Tshuapa Province of the Democratic Republic of the Congo, where the annual incidence of human monkeypox is estimated to be 3.5-5/10,000, suggests that there is approximately one healthcare worker infection for every 100 confirmed monkeypox cases. Herein, we describe a study that commenced in February 2017, the intent of which is to evaluate the effectiveness, immunogenicity, and safety of a third-generation smallpox vaccine, IMVAMUNE®, in healthcare personnel at risk of monkeypox virus (MPXV) infection. We describe procedures for documenting exposures to monkeypox virus infection in study participants, and outline lessons learned that may be of relevance for studies of other investigational medical countermeasures in hard to reach, under-resourced populations.
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Affiliation(s)
| | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | | | - Robert Shongo Lushima
- Hemorrhagic Fever and Monkeypox Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Mary G Reynolds
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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20
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Guagliardo SAJ, Reynolds MG, Kabamba J, Nguete B, Shongo Lushima R, Wemakoy OE, McCollum AM. Sounding the alarm: Defining thresholds to trigger a public health response to monkeypox. PLoS Negl Trop Dis 2018; 12:e0007034. [PMID: 30571693 PMCID: PMC6319745 DOI: 10.1371/journal.pntd.0007034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/04/2019] [Accepted: 11/28/2018] [Indexed: 11/18/2022] Open
Abstract
Endemic to the Democratic Republic of the Congo (DRC), monkeypox is a zoonotic disease that causes smallpox-like illness in humans. Observed fluctuations in reported cases over time raises questions about when it is appropriate to mount a public health response, and what specific actions should be taken. We evaluated three different thresholds to differentiate between baseline and heightened disease incidence, and propose a novel, tiered algorithm for public health action. Monkeypox surveillance data from Tshuapa Province, 2011-2013, were used to calculate three different statistical thresholds: Cullen, c-sum, and a World Health Organization (WHO) method based on monthly incidence. When the observed cases exceeded the threshold for a given month, that month was considered to be 'aberrant'. For each approach, the number of aberrant months detected was summed by year-each method produced vastly different results. The Cullen approach generated a number of aberrant signals over the period of consideration (9/36 months). The c-sum method was the most sensitive (30/36 months), followed by the WHO method (12/24 months). We conclude that triggering public health action based on signals detected by a single method may be inefficient and overly simplistic for monkeypox. We propose instead a response algorithm that integrates an objective threshold (WHO method) with contextual information about epidemiological and spatiotemporal links between suspected cases to determine whether a response should be operating under i) routine surveillance ii) alert status, or iii) outbreak status. This framework could be modified and adopted by national and zone level health workers in monkeypox-endemic countries. Lastly, we discuss considerations for selecting thresholds for monkeypox outbreaks across gradients of endemicity and public health resources.
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Affiliation(s)
- Sarah Anne J. Guagliardo
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joelle Kabamba
- Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Beata Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Okito E. Wemakoy
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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21
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Eteng WE, Mandra A, Doty J, Yinka-Ogunleye A, Aruna S, Reynolds MG, McCollum AM, Davidson W, Wilkins K, Saleh M, Ipadeola O, Manneh L, Anebonam U, Abdulkareem Z, Okoli N, Agenyi J, Dan-Nwafor C, Mahmodu I, Ihekweazu C. Notes from the Field: Responding to an Outbreak of Monkeypox Using the One Health Approach - Nigeria, 2017-2018. MMWR Morb Mortal Wkly Rep 2018; 67:1040-1041. [PMID: 30235181 PMCID: PMC6147416 DOI: 10.15585/mmwr.mm6737a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Shiferaw ML, Doty JB, Maghlakelidze G, Morgan J, Khmaladze E, Parkadze O, Donduashvili M, Wemakoy EO, Muyembe JJ, Mulumba L, Malekani J, Kabamba J, Kanter T, Boulanger LL, Haile A, Bekele A, Bekele M, Tafese K, McCollum AA, Reynolds MG. Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases. Emerg Infect Dis 2018; 23. [PMID: 29155663 PMCID: PMC5711328 DOI: 10.3201/eid2313.170601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Preventing zoonotic diseases requires coordinated actions by government authorities responsible for human and animal health. Constructing the frameworks needed to foster intersectoral collaboration can be approached in many ways. We highlight 3 examples of approaches to implement zoonotic disease prevention and control programs. The first, rabies control in Ethiopia, was implemented using an umbrella approach: a comprehensive program designed for accelerated impact. The second, a monkeypox program in Democratic Republic of the Congo, was implemented in a stepwise manner, whereby incremental improvements and activities were incorporated into the program. The third approach, a pathogen discovery program, applied in the country of Georgia, was designed to characterize and understand the ecology, epidemiology, and pathogenesis of a new zoonotic pathogen. No one approach is superior, but various factors should be taken into account during design, planning, and implementation.
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23
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Durski KN, McCollum AM, Nakazawa Y, Petersen BW, Reynolds MG, Briand S, Djingarey MH, Olson V, Damon IK, Khalakdina A. Emergence of Monkeypox - West and Central Africa, 1970-2017. MMWR Morb Mortal Wkly Rep 2018; 67:306-310. [PMID: 29543790 PMCID: PMC5857192 DOI: 10.15585/mmwr.mm6710a5] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The recent apparent increase in human monkeypox cases across a wide geographic area, the potential for further spread, and the lack of reliable surveillance have raised the level of concern for this emerging zoonosis. In November 2017, the World Health Organization (WHO), in collaboration with CDC, hosted an informal consultation on monkeypox with researchers, global health partners, ministries of health, and orthopoxvirus experts to review and discuss human monkeypox in African countries where cases have been recently detected and also identify components of surveillance and response that need improvement. Endemic human monkeypox has been reported from more countries in the past decade than during the previous 40 years. Since 2016, confirmed cases of monkeypox have occurred in Central African Republic, Democratic Republic of the Congo, Liberia, Nigeria, Republic of the Congo, and Sierra Leone and in captive chimpanzees in Cameroon. Many countries with endemic monkeypox lack recent experience and specific knowledge about the disease to detect cases, treat patients, and prevent further spread of the virus. Specific improvements in surveillance capacity, laboratory diagnostics, and infection control measures are needed to launch an efficient response. Further, gaps in knowledge about the epidemiology and ecology of the virus need to be addressed to design, recommend, and implement needed prevention and control measures.
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24
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Borges IA, Reynolds MG, McCollum AM, Figueiredo PO, Ambrosio LLD, Vieira FN, Costa GB, Matos ACD, de Andrade Almeida VM, Ferreira PCP, Lobato ZIP, Dos Reis JKP, Kroon EG, Trindade GS. Serological Evidence of Orthopoxvirus Circulation Among Equids, Southeast Brazil. Front Microbiol 2018; 9:402. [PMID: 29568288 PMCID: PMC5852868 DOI: 10.3389/fmicb.2018.00402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/21/2018] [Indexed: 12/17/2022] Open
Abstract
Since 1999 Vaccinia virus (VACV) outbreaks involving bovines and humans have been reported in Brazil; this zoonosis is known as Bovine Vaccinia (BV) and is mainly an occupational disease of milkers. It was only in 2008 (and then again in 2011 and 2014) however, that VACV was found causing natural infections in Brazilian equids. These reports involved only equids, no infected humans or bovines were identified, and the sources of infections remain unknown up to date. The peculiarities of Equine Vaccinia outbreaks (e.g., absence of human infection), the frequently shared environments, and fomites by equids and bovines in Brazilian farms and the remaining gaps in BV epidemiology incited a question over OPV serological status of equids in Brazil. For this report, sera from 621 equids - representing different species, ages, sexes and locations of origin within Minas Gerais State, southeast Brazil – were examined for the presence of anti-Orthopoxvirus (OPV) antibodies. Only 74 of these were sampled during an Equine Vaccinia outbreak, meaning some of these specific animals presented typical lesions of OPV infections. The majority of sera, however, were sampled from animals without typical signs of OPV infection and during the absence of reported Bovine or Equine Vaccinia outbreaks. Results suggest the circulation of VACV among equids of southeast Brazil even prior to the time of the first VACV outbreak in 2008. There is a correlation of OPVs outbreaks among bovines and equids although many gaps remain to our understanding of its nature. The data obtained may even be carefully associated to recent discussion over OPVs history. Moreover, data is available to improve the knowledge and instigate new researches regarding OPVs circulation in Brazil and worldwide.
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Affiliation(s)
- Iara A Borges
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mary G Reynolds
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Andrea M McCollum
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Poliana O Figueiredo
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lara L D Ambrosio
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flavia N Vieira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Galileu B Costa
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana C D Matos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Valeria M de Andrade Almeida
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paulo C P Ferreira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Zélia I P Lobato
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jenner K P Dos Reis
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Erna G Kroon
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Giliane S Trindade
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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25
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Springer YP, Hsu CH, Werle ZR, Olson LE, Cooper MP, Castrodale LJ, Fowler N, McCollum AM, Goldsmith CS, Emerson GL, Wilkins K, Doty JB, Burgado J, Gao J, Patel N, Mauldin MR, Reynolds MG, Satheshkumar PS, Davidson W, Li Y, McLaughlin JB. Novel Orthopoxvirus Infection in an Alaska Resident. Clin Infect Dis 2018; 64:1737-1741. [PMID: 28329402 PMCID: PMC5447873 DOI: 10.1093/cid/cix219] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/08/2017] [Indexed: 01/28/2023] Open
Abstract
Background. Human infection by orthopoxviruses is being reported with increasing frequency, attributed in part to the cessation of smallpox vaccination and concomitant waning of population-level immunity. In July 2015, a female resident of interior Alaska presented to an urgent care clinic with a dermal lesion consistent with poxvirus infection. Laboratory testing of a virus isolated from the lesion confirmed infection by an Orthopoxvirus. Methods. The virus isolate was characterized by using electron microscopy and nucleic acid sequencing. An epidemiologic investigation that included patient interviews, contact tracing, and serum testing, as well as environmental and small-mammal sampling, was conducted to identify the infection source and possible additional cases. Results. Neither signs of active infection nor evidence of recent prior infection were observed in any of the 4 patient contacts identified. The patient's infection source was not definitively identified. Potential routes of exposure included imported fomites from Azerbaijan via the patient's cohabiting partner or wild small mammals in or around the patient's residence. Phylogenetic analyses demonstrated that the virus represents a distinct and previously undescribed genetic lineage of Orthopoxvirus, which is most closely related to the Old World orthopoxviruses. Conclusions. Investigation findings point to infection of the patient after exposure in or near Fairbanks. This conclusion raises questions about the geographic origins (Old World vs North American) of the genus Orthopoxvirus. Clinicians should remain vigilant for signs of poxvirus infection and alert public health officials when cases are suspected.
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Affiliation(s)
- Yuri P Springer
- Alaska Division of Public Health, Section of Epidemiology, Anchorage.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development
| | - Christopher H Hsu
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development.,Poxvirus and Rabies Branch, and
| | | | | | - Michael P Cooper
- Alaska Division of Public Health, Section of Epidemiology, Anchorage
| | | | - Nisha Fowler
- Alaska Division of Public Health, Section of Laboratories, Fairbanks
| | | | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | - Matthew R Mauldin
- Poxvirus and Rabies Branch, and.,Oak Ridge Institute for Science and Education, Tennessee
| | | | | | | | - Yu Li
- Poxvirus and Rabies Branch, and
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Usme-Ciro JA, Paredes A, Walteros DM, Tolosa-Pérez EN, Laiton-Donato K, Pinzón MDC, Petersen BW, Gallardo-Romero NF, Li Y, Wilkins K, Davidson W, Gao J, Patel N, Nakazawa Y, Reynolds MG, Satheshkumar PS, Emerson GL, Páez-Martínez A. Detection and Molecular Characterization of Zoonotic Poxviruses Circulating in the Amazon Region of Colombia, 2014. Emerg Infect Dis 2018; 23:649-653. [PMID: 28322708 PMCID: PMC5367405 DOI: 10.3201/eid2304.161041] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
During 2014, cutaneous lesions were reported in dairy cattle and farmworkers in the Amazon Region of western Colombia. Samples from 6 patients were analyzed by serologic and PCR testing, and results demonstrated the presence of vaccinia virus and pseudocowpox virus. These findings highlight the need for increased poxvirus surveillance in Colombia.
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Nolen LD, Osadebe L, Katomba J, Likofata J, Mukadi D, Monroe B, Doty J, Hughes CM, Kabamba J, Malekani J, Bomponda PL, Lokota JI, Balilo MP, Likafi T, Lushima RS, Ilunga BK, Nkawa F, Pukuta E, Karhemere S, Tamfum JJM, Nguete B, Wemakoy EO, McCollum AM, Reynolds MG. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerg Infect Dis 2018; 22:1014-21. [PMID: 27191380 PMCID: PMC4880088 DOI: 10.3201/eid2206.150579] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
During the outbreak, 50% of household members living with an infected person developed symptom of monkeypox infection. A 600-fold increase in monkeypox cases occurred in the Bokungu Health Zone of the Democratic Republic of the Congo during the second half of 2013; this increase prompted an outbreak investigation. A total of 104 possible cases were reported from this health zone; among 60 suspected cases that were tested, 50 (48.1%) cases were confirmed by laboratory testing, and 10 (9.6%) tested negative for monkeypox virus (MPXV) infection. The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%. Nine families showed >1 transmission event, and >6 transmission events occurred within this health zone. Mean incubation period was 8 days (range 4–14 days). The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases. Community education and training are needed to prevent transmission of MPXV infection during outbreaks.
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Reynolds MG, Guagliardo SAJ, Nakazawa YJ, Doty JB, Mauldin MR. Understanding orthopoxvirus host range and evolution: from the enigmatic to the usual suspects. Curr Opin Virol 2018; 28:108-115. [PMID: 29288901 DOI: 10.1016/j.coviro.2017.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022]
Abstract
In general, orthopoxviruses can be considered as falling into one of three host-utilization categories: highly specialized, single-host; broad host range; or 'cryptic', the last encompassing those viruses about which very little is known. Single-host viruses tend to exploit abundant hosts that have consistent patterns of interaction. For these viruses, observed genome reduction and loss of presumptive host-range genes is thought to be a consequence of relaxed selection. In contrast, the large genome size retained among broad host range orthopoxviruses suggests these viruses may depend on multiple host species for persistence in nature. Our understanding of the ecologic requirements of orthopoxviruses is strongly influenced by geographic biases in data collection. This hinders our ability to predict potential sources for emergence of orthopoxvirus-associated infections.
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Affiliation(s)
- Mary G Reynolds
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA.
| | - Sarah Anne J Guagliardo
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA; United States Centers for Disease Control and Prevention, Epidemic Intelligence Service, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
| | - Yoshinori J Nakazawa
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
| | - Jeffrey B Doty
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
| | - Matthew R Mauldin
- United States Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, 1600 Clifton Rd., NE Atlanta, GA 30333, USA
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29
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Townsend MB, Gallardo-Romero NF, Khmaladze E, Vora NM, Maghlakelidze G, Geleishvili M, Carroll DS, Emerson GL, Reynolds MG, Satheshkumar PS. Retrospective Proteomic Analysis of Serum After Akhmeta Virus Infection: New Suspect Case Identification and Insights Into Poxvirus Humoral Immunity. J Infect Dis 2017; 216:1505-1512. [PMID: 29029254 PMCID: PMC10863730 DOI: 10.1093/infdis/jix534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/29/2017] [Indexed: 11/12/2022] Open
Abstract
Serologic cross-reactivity, a hallmark of orthopoxvirus (OPXV) infection, makes species-specific diagnosis of infection difficult. In this study, we used a variola virus proteome microarray to characterize and differentiate antibody responses to nonvaccinia OPXV infections from smallpox vaccination. The profile of 2 case patients infected with newly discovered OPXV, Akhmeta virus, exhibited antibody responses of greater intensity and broader recognition of viral proteins and includes the B21/22 family glycoproteins not encoded by vaccinia virus strains used as vaccines. An additional case of Akhmeta virus, or nonvaccinia OPXV infection, was identified through community surveillance of individuals with no or uncertain history of vaccination and no recent infection. The results demonstrate the utility of microarrays for high-resolution mapping of antibody response to determine the nature of OPXV exposure.
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Affiliation(s)
| | | | - Ekaterine Khmaladze
- Divisions of National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Neil M Vora
- Divisions of High-Consequence Pathogens and Pathology, Tbilisi, Georgia
| | | | - Marika Geleishvili
- Divisions of National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Darin S Carroll
- Divisions of High-Consequence Pathogens and Pathology, Tbilisi, Georgia
| | - Ginny L Emerson
- Divisions of High-Consequence Pathogens and Pathology, Tbilisi, Georgia
| | - Mary G Reynolds
- Divisions of High-Consequence Pathogens and Pathology, Tbilisi, Georgia
| | - P S Satheshkumar
- Divisions of High-Consequence Pathogens and Pathology, Tbilisi, Georgia
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Reynolds MG, McCollum AM, Nguete B, Shongo Lushima R, Petersen BW. Improving the Care and Treatment of Monkeypox Patients in Low-Resource Settings: Applying Evidence from Contemporary Biomedical and Smallpox Biodefense Research. Viruses 2017; 9:E380. [PMID: 29231870 PMCID: PMC5744154 DOI: 10.3390/v9120380] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/16/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022] Open
Abstract
Monkeypox is a smallpox-like illness that can be accompanied by a range of significant medical complications. To date there are no standard or optimized guidelines for the clinical management of monkeypox (MPX) patients, particularly in low-resource settings. Consequently, patients can experience protracted illness and poor outcomes. Improving care necessitates developing a better understanding of the range of clinical manifestations-including complications and sequelae-as well as of features of illness that may be predictive of illness severity and poor outcomes. Experimental and natural infection of non-human primates with monkeypox virus can inform the approach to improving patient care, and may suggest options for pharmaceutical intervention. These studies have traditionally been performed to address the threat of smallpox bioterrorism and were designed with the intent of using MPX as a disease surrogate for smallpox. In many cases this necessitated employing high-dose, inhalational or intravenous challenge to recapitulate the severe manifestations of illness seen with smallpox. Overall, these data-and data from biomedical research involving burns, superficial wounds, herpes, eczema vaccinatum, and so forth-suggest that MPX patients could benefit from clinical support to mitigate the consequences of compromised skin and mucosa. This should include prevention and treatment of secondary bacterial infections (and other complications), ensuring adequate hydration and nutrition, and protecting vulnerable anatomical locations such as the eyes and genitals. A standard of care that considers these factors should be developed and assessed in different settings, using clinical metrics specific for MPX alongside consideration of antiviral therapies.
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Affiliation(s)
- Mary G Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA 30329, USA.
| | - Andrea M McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA 30329, USA.
| | | | | | - Brett W Petersen
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA 30329, USA.
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Osadebe L, Hughes CM, Shongo Lushima R, Kabamba J, Nguete B, Malekani J, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Wemakoy Okitolonda E, Reynolds MG, McCollum AM. Enhancing case definitions for surveillance of human monkeypox in the Democratic Republic of Congo. PLoS Negl Trop Dis 2017; 11:e0005857. [PMID: 28892474 PMCID: PMC5593177 DOI: 10.1371/journal.pntd.0005857] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 08/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human monkeypox (MPX) occurs at appreciable rates in the Democratic Republic of Congo (DRC). Infection with varicella zoster virus (VZV) has a similar presentation to that of MPX, and in areas where MPX is endemic these two illnesses are commonly mistaken. This study evaluated the diagnostic utility of two surveillance case definitions for MPX and specific clinical characteristics associated with laboratory-confirmed MPX cases. METHODOLOGY/PRINCIPAL FINDINGS Data from a cohort of suspect MPX cases (identified by surveillance over the course of a 42 month period during 2009-2014) from DRC were used; real-time PCR diagnostic test results were used to establish MPX and VZV diagnoses. A total of 333 laboratory-confirmed MPX cases, 383 laboratory-confirmed VZV cases, and 36 cases that were determined to not be either MPX or VZV were included in the analyses. Significant (p<0.05) differences between laboratory-confirmed MPX and VZV cases were noted for several signs/symptoms including key rash characteristics. Both surveillance case definitions had high sensitivity and low specificities for individuals that had suspected MPX virus infections. Using 12 signs/symptoms with high sensitivity and/or specificity values, a receiver operator characteristic analysis showed that models for MPX cases that had the presence of 'fever before rash' plus at least 7 or 8 of the 12 signs/symptoms demonstrated a more balanced performance between sensitivity and specificity. CONCLUSIONS Laboratory-confirmed MPX and VZV cases presented with many of the same signs and symptoms, and the analysis here emphasized the utility of including 12 specific signs/symptoms when investigating MPX cases. In order to document and detect endemic human MPX cases, a surveillance case definition with more specificity is needed for accurate case detection. In the absence of a more specific case definition, continued emphasis on confirmatory laboratory-based diagnostics is warranted.
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Affiliation(s)
- Lynda Osadebe
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christine M. Hughes
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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32
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Borges IA, McCollum AM, Mehal JM, Haberling D, Dutra LAL, Vieira FN, Andrade LAO, Kroon EG, Holman RC, Reynolds MG, Trindade GS. Dairy production practices and associated risks for bovine vaccinia exposure in cattle, Brazil. New Microbes New Infect 2017; 20:43-50. [PMID: 29158908 PMCID: PMC5682884 DOI: 10.1016/j.nmni.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 10/31/2022] Open
Abstract
A cross-sectional serosurvey was performed to identify environmental features or practices of dairy farms associated with risk for exposure to vaccinia-like viruses in dairy cattle in Brazil. Sera from 103 cows from 18 farms in Minas Gerais state were examined for Orthopoxvirus-neutralizing antibodies. A database of 243 binary or multiple-selection categorical variables regarding the physical features and surrounding ecology of each property was obtained. Thirteen of 46 presumptive predictor variables were found to be significantly associated with Orthopoxvirus serostatus by univariate logistic regression methods. Use of teat sanitizer and having felids on the property were independently associated with virus exposure by multivariable analysis. Rodents have long been suspected of serving as maintenance reservoirs for vaccinia-like viruses in Brazil. Therefore, domestic felids are not only effective predators of small rodent pests, but also their urine can serve as a deterrent to rodent habitation in buildings such as stables and barns. These results corroborate previous evidence of the high significance of rodents in the Vaccinia virus transmission cycle, and they also raise questions regarding the common use of teat sanitizers in dairy production areas.
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Affiliation(s)
| | - A M McCollum
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J M Mehal
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Haberling
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - F N Vieira
- Departamento de Biologia Geral, Universidade Federal de Minas Gerais, Brazil
| | | | - E G Kroon
- Departamento de Microbiologia, Brazil
| | - R C Holman
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M G Reynolds
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Quiner CA, Moses C, Monroe BP, Nakazawa Y, Doty JB, Hughes CM, McCollum AM, Ibata S, Malekani J, Okitolonda E, Carroll DS, Reynolds MG. Presumptive risk factors for monkeypox in rural communities in the Democratic Republic of the Congo. PLoS One 2017; 12:e0168664. [PMID: 28192435 PMCID: PMC5305065 DOI: 10.1371/journal.pone.0168664] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
Monkeypox virus (MPXV), a close relative of Variola virus, is a zoonotic virus with an unknown reservoir. Interaction with infected wildlife, bites from peri-domestic animals, and bushmeat hunting are hypothesized routes of infection from wildlife to humans. Using a Risk Questionnaire, performed in monkeypox-affected areas of rural Democratic Republic of the Congo, we describe the lifestyles and demographics associated with presumptive risk factors for MPXV infection. We generated two indices to assess risk: Household Materials Index (HMI), a proxy for socioeconomic status of households and Risk Activity Index (RAI), which describes presumptive risk for animal-to-human transmission of MPXV. Based on participant self-reported activity patterns, we found that people in this population are more likely to visit the forest than a market to fulfill material needs, and that the reported occupation is limited in describing behavior of individuals may participate. Being bitten by rodents in the home was commonly reported, and this was significantly associated with a low HMI. The highest scoring RAI sub-groups were 'hunters' and males aged ≥ 18 years; however, several activities involving MPXV-implicated animals were distributed across all sub-groups. The current analysis may be useful in identifying at-risk groups and help to direct education, outreach and prevention efforts more efficiently.
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Affiliation(s)
- Claire A. Quiner
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Cynthia Moses
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Benjamin P. Monroe
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Yoshinori Nakazawa
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Jeffrey B. Doty
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Christine M. Hughes
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Andrea M. McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Saturnin Ibata
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Jean Malekani
- University of Kinshasa, Department of Biology, Kinshasa, Democratic Republic of Congo
| | - Emile Okitolonda
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Darin S. Carroll
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Mary G. Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
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Li D, Wilkins K, McCollum AM, Osadebe L, Kabamba J, Nguete B, Likafi T, Balilo MP, Lushima RS, Malekani J, Damon IK, Vickery MCL, Pukuta E, Nkawa F, Karhemere S, Tamfum JJM, Okitolonda EW, Li Y, Reynolds MG. Evaluation of the GeneXpert for Human Monkeypox Diagnosis. Am J Trop Med Hyg 2017; 96:405-410. [PMID: 27994107 PMCID: PMC5303045 DOI: 10.4269/ajtmh.16-0567] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022] Open
Abstract
Monkeypox virus (MPXV), a zoonotic orthopoxvirus (OPX), is endemic in the Democratic Republic of Congo (DRC). Currently, diagnostic assays for human monkeypox (MPX) focus on real-time quantitative polymerase chain reaction (PCR) assays, which are typically performed in sophisticated laboratory settings. Herein, we evaluated the accuracy and utility of a multiplex MPX assay using the GeneXpert platform, a portable rapid diagnostic device that may serve as a point-of-care test to diagnose infections in endemic areas. The multiplex MPX/OPX assay includes a MPX-specific PCR test, OPX-generic PCR test, and an internal control PCR test. In total, 164 diagnostic specimens (50 crusts and 114 vesicular swabs) were collected from suspected MPX cases in Tshuapa Province, DRC, under national surveillance guidelines. The specimens were tested with the GeneXpert MPX/OPX assay and an OPX PCR assay at the Institut National de Recherche Biomedicale (INRB) in Kinshasa. Aliquots of each specimen were tested in parallel with a MPX-specific PCR assay at the Centers for Disease Control and Prevention. The results of the MPX PCR were used as the gold standard for all analyses. The GeneXpert MPX/OPX assay performed at INRB had a sensitivity of 98.8% and specificity of 100%. The GeneXpert assay performed well with both crust and vesicle samples. The GeneXpert MPX/OPX test incorporates a simple methodology that performs well in both laboratory and field conditions, suggesting its viability as a diagnostic platform that may expand and expedite current MPX detection capabilities.
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Affiliation(s)
- Daniel Li
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lynda Osadebe
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joelle Kabamba
- Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Marcel Pie Balilo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Jean Malekani
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Inger K. Damon
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Frida Nkawa
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | - Yu Li
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Enteric and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hsu CH, Rokni GR, Aghazadeh N, Brinster N, Li Y, Muehlenbachs A, Goldsmith CS, Zhao H, Petersen B, McCollum AM, Reynolds MG. Unique Presentation of Orf Virus Infection in a Thermal-Burn Patient After Receiving an Autologous Skin Graft. J Infect Dis 2016; 214:1171-4. [PMID: 27456708 DOI: 10.1093/infdis/jiw307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/14/2016] [Indexed: 12/23/2022] Open
Abstract
We describe a burn patient who developed skin lesions on her skin-graft harvest and skin-graft recipient (burn) sites. Orf virus infection was confirmed by a combination of diagnostic assays, including molecular tests, immunohistochemical analysis, pathologic analysis, and electron microscopy. DNA sequence analysis grouped this orf virus isolate among isolates from India. Although no definitive source of infection was determined from this case, this is the first reported case of orf virus infection in a skin graft harvest. Skin graft recipients with exposures to animals may be at risk for this viral infection.
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Affiliation(s)
- Christopher H Hsu
- Poxvirus and Rabies Branch Epidemic Intelligence Service, Atlanta, Georgia
| | | | - Nessa Aghazadeh
- Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Brinster
- Department of Dermatology, New York University Medical Center, New York
| | - Yu Li
- Poxvirus and Rabies Branch
| | - Atis Muehlenbachs
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention
| | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention
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Petersen BW, Harms TJ, Reynolds MG, Harrison LH. Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses - Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Morb Mortal Wkly Rep 2016; 65:257-62. [PMID: 26985679 DOI: 10.15585/mmwr.mm6510a2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On June 25, 2015, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination with live smallpox (vaccinia) vaccine (ACAM2000) for laboratory personnel who directly handle 1) cultures or 2) animals contaminated or infected with replication-competent vaccinia virus, recombinant vaccinia viruses derived from replication-competent vaccinia strains (i.e., those that are capable of causing clinical infection and producing infectious virus in humans), or other orthopoxviruses that infect humans (e.g., monkeypox, cowpox, and variola) (recommendation category: A, evidence type 2 [Box]). Health care personnel (e.g., physicians and nurses) who currently treat or anticipate treating patients with vaccinia virus infections and whose contact with replication-competent vaccinia viruses is limited to contaminated materials (e.g., dressings) and persons administering ACAM2000 smallpox vaccine who adhere to appropriate infection prevention measures can be offered vaccination with ACAM2000 (recommendation category: B, evidence type 2 [Box]). These revised recommendations update the previous ACIP recommendations for nonemergency use of vaccinia virus smallpox vaccine for laboratory and health care personnel at risk for occupational exposure to orthopoxviruses (1). Since 2001, when the previous ACIP recommendations were developed, ACAM2000 has replaced Dryvax as the only smallpox vaccine licensed by the U.S. Food and Drug Administration (FDA) and available for use in the United States (2). These recommendations contain information on ACAM2000 and its use in laboratory and health care personnel at risk for occupational exposure to orthopoxviruses.
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McCollum AM, Nakazawa Y, Ndongala GM, Pukuta E, Karhemere S, Lushima RS, Ilunga BK, Kabamba J, Wilkins K, Gao J, Li Y, Emerson G, Damon IK, Carroll DS, Reynolds MG, Malekani J, Tamfum JJM. Human Monkeypox in the Kivus, a Conflict Region of the Democratic Republic of the Congo. Am J Trop Med Hyg 2015; 93:718-21. [PMID: 26283752 PMCID: PMC4596588 DOI: 10.4269/ajtmh.15-0095] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/31/2015] [Indexed: 11/07/2022] Open
Abstract
Monkeypox (MPX) is a zoonotic Orthopoxvirus infection endemic in central and western Africa. Human MPX cases occur in the central and northern regions of the Democratic Republic of the Congo (DRC), and this is the first report of confirmed MPX cases in the forested areas of North and South Kivu Provinces, with a detailed epidemiological investigation for one case. The location of each case is within areas predicted to be suitable for MPX virus transmission based on an ecological niche model. Phylogenetic analysis places these viruses in the Congo Basin clade.
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Affiliation(s)
- Andrea M McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yoshinori Nakazawa
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Guy Mutombo Ndongala
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Elisabeth Pukuta
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Stomy Karhemere
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Robert Shongo Lushima
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Benoit Kebela Ilunga
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joelle Kabamba
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jinxin Gao
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Yu Li
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ginny Emerson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Inger K Damon
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Darin S Carroll
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Mary G Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Malekani
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Division Provinciale de la Santé, Ministère de la Santé Publique, Goma, Nord-Kivu, Democratic Republic of the Congo; Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo; U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Nolen LD, Osadebe L, Katomba J, Likofata J, Mukadi D, Monroe B, Doty J, Kalemba L, Malekani J, Kabamba J, Bomponda PL, Lokota JI, Balilo MP, Likafi T, Lushima RS, Tamfum JJM, Okitolonda EW, McCollum AM, Reynolds MG. Introduction of Monkeypox into a Community and Household: Risk Factors and Zoonotic Reservoirs in the Democratic Republic of the Congo. Am J Trop Med Hyg 2015; 93:410-5. [PMID: 26013374 PMCID: PMC4530773 DOI: 10.4269/ajtmh.15-0168] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/02/2015] [Indexed: 11/07/2022] Open
Abstract
An increased incidence of monkeypox (MPX) infections in the Democratic Republic of the Congo was noted by the regional surveillance system in October 2013. Little information exists regarding how MPX is introduced into the community and the factors associated with transmission within the household. Sixty-eight wild animals were collected and tested for Orthopoxvirus. Two of three rope squirrels (Funisciurus sp.) were positive for antibodies to Orthopoxviruses; however, no increased risk was associated with the consumption or preparation of rope squirrels. A retrospective cohort investigation and a case-control investigation were performed to identify risk factors affecting the introduction of monkeypox virus (MPXV) into the community and transmission within the home. School-age males were the individuals most frequently identified as the first person infected in the household and were the group most frequently affected overall. Risk factors of acquiring MPXV in a household included sleeping in the same room or bed, or using the same plate or cup as the primary case. There was no significant risk associated with eating or processing of wild animals. Activities associated with an increased risk of MPXV transmission all have potential for virus exposure to the mucosa.
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Affiliation(s)
- Leisha Diane Nolen
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Lynda Osadebe
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Jacques Katomba
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Jacques Likofata
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Daniel Mukadi
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Benjamin Monroe
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Jeffrey Doty
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Lem's Kalemba
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Jean Malekani
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Pierre Lokwa Bomponda
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Jules Inonga Lokota
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Marcel Pie Balilo
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Toutou Likafi
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Robert Shongo Lushima
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Jean-Jacques Muyembe Tamfum
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Emile Wemakoy Okitolonda
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Andrea M McCollum
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
| | - Mary G Reynolds
- U.S. Centers for Disease Control and Prevention, Bacterial Special Pathogens Branch, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia; U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Minstere de la Santé, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention, Field Epidemiology Training Program, Kinshasa, The Democratic Republic of Congo; National Institute for Biomedical Research, Kinshasa, The Democratic Republic of Congo; U.S. Centers for Disease Control and Prevention Kinshasa, The Democratic Republic of Congo; University of Kinshasa, Department of Biology, Kinshasa, The Democratic Republic of Congo; Minstere de la Santé, Tshuapa Health District, The Democratic Republic of Congo; Kinshasa School of Public Health, The Democratic Republic of Congo
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39
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Nakazawa Y, Mauldin MR, Emerson GL, Reynolds MG, Lash RR, Gao J, Zhao H, Li Y, Muyembe JJ, Kingebeni PM, Wemakoy O, Malekani J, Karem KL, Damon IK, Carroll DS. A phylogeographic investigation of African monkeypox. Viruses 2015; 7:2168-84. [PMID: 25912718 PMCID: PMC4411695 DOI: 10.3390/v7042168] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022] Open
Abstract
Monkeypox is a zoonotic disease caused by a virus member of the genus Orthopoxvirus and is endemic to Central and Western African countries. Previous work has identified two geographically disjuct clades of monkeypox virus based on the analysis of a few genomes coupled with epidemiological and clinical analyses; however, environmental and geographic causes of this differentiation have not been explored. Here, we expand previous phylogenetic studies by analyzing a larger set of monkeypox virus genomes originating throughout Sub-Saharan Africa to identify possible biogeographic barriers associated with genetic differentiation; and projected ecological niche models onto environmental conditions at three periods in the past to explore the potential role of climate oscillations in the evolution of the two primary clades. Analyses supported the separation of the Congo Basin and West Africa clades; the Congo Basin clade shows much shorter branches, which likely indicate a more recent diversification of isolates within this clade. The area between the Sanaga and Cross Rivers divides the two clades and the Dahomey Gap seems to have also served as a barrier within the West African clade. Contraction of areas with suitable environments for monkeypox virus during the Last Glacial Maximum, suggests that the Congo Basin clade of monkeypox virus experienced a severe bottleneck and has since expanded its geographic range.
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Affiliation(s)
- Yoshinori Nakazawa
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Matthew R Mauldin
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
- Oak Ridge Institute for Science and Education (ORISE) CDC Fellowship Program, Oak Ridge, TN 37831, USA.
| | - Ginny L Emerson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Mary G Reynolds
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - R Ryan Lash
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Jinxin Gao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Hui Zhao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Yu Li
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Jean-Jacques Muyembe
- INRB Laboratory, Avenue de la Démocratie. Kinshasa-Gombe B.P. 1197 Kinshasa 1, Democratic Republic of the Congo.
| | - Placide Mbala Kingebeni
- INRB Laboratory, Avenue de la Démocratie. Kinshasa-Gombe B.P. 1197 Kinshasa 1, Democratic Republic of the Congo.
| | - Okito Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, 11850 Kinshasa, Democratic Republic of the Congo.
| | - Jean Malekani
- Biology Department, University of Kinshasa, P.O. Box 218 Kinshasa XI, Democratic Republic of the Congo.
| | - Kevin L Karem
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Inger K Damon
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Darin S Carroll
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
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Vora NM, Li Y, Geleishvili M, Emerson GL, Khmaladze E, Maghlakelidze G, Navdarashvili A, Zakhashvili K, Kokhreidze M, Endeladze M, Mokverashvili G, Satheshkumar PS, Gallardo-Romero N, Goldsmith CS, Metcalfe MG, Damon I, Maes EF, Reynolds MG, Morgan J, Carroll DS. Human infection with a zoonotic orthopoxvirus in the country of Georgia. N Engl J Med 2015; 372:1223-30. [PMID: 25806914 PMCID: PMC4692157 DOI: 10.1056/nejmoa1407647] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
During 2013, cutaneous lesions developed in two men in the country of Georgia after they were exposed to ill cows. The men had never received vaccination against smallpox. Tests of lesion material with the use of a quantitative real-time polymerase-chain-reaction assay for non-variola virus orthopoxviruses were positive, and DNA sequence analysis implicated a novel orthopoxvirus species. During the ensuing epidemiologic investigation, no additional human cases were identified. However, serologic evidence of exposure to an orthopoxvirus was detected in cows in the patients' herd and in captured rodents and shrews. A third case of human infection that occurred in 2010 was diagnosed retrospectively during testing of archived specimens that were originally submitted for tests to detect anthrax. Orthopoxvirus infection should be considered in persons in whom cutaneous lesions develop after contact with animals.
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Affiliation(s)
- Neil M Vora
- From the Epidemic Intelligence Service (N.M.V.), Division of High-Consequence Pathogens and Pathology (N.M.V., Y.L., G.L.E., P.S.S., N.G.-R., C.S.G., M.G.M., I.D., M.G.R., D.S.C.), and the Division of Global Health Protection (N.M.V., M.G., E.F.M., J.M.), Centers for Disease Control and Prevention (CDC), Atlanta; CDC Georgia Country Office (M.G., J.M.), National Center for Disease Control and Public Health (E.K., A.N., K.Z.), Laboratory of the Ministry of Agriculture (G. Maghlakelidze, M.K.), and Infectious Diseases, AIDS, and Clinical Immunology Research Center (M.E.), Tbilisi, and National Food Agency, Tianeti (G. Mokverashvili) - all in Georgia
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Osadebe LU, Manthiram K, McCollum AM, Li Y, Emerson GL, Gallardo-Romero NF, Doty JB, Wilkins K, Zhao H, Drew CP, Metcalfe MG, Goldsmith CS, Muehlenbachs A, Googe PB, Dunn J, Duenckel T, Henderson H, Carroll DS, Zaki SR, Denison MR, Reynolds MG, Damon IK. Novel poxvirus infection in 2 patients from the United States. Clin Infect Dis 2015; 60:195-202. [PMID: 25301210 PMCID: PMC5854477 DOI: 10.1093/cid/ciu790] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some human poxvirus infections can be acquired through zoonotic transmission. We report a previously unknown poxvirus infection in 2 patients, 1 of whom was immunocompromised; both patients had known equine contact. METHODS The patients were interviewed and clinical information was abstracted from the patients' medical files. Biopsies of the skin lesions were collected from both patients for histopathology, immunohistochemistry, and transmission electron microscopy analysis. Oral and skin swabs were collected from animals with frequent contact with the patients, and environmental sampling including rodent trapping was performed on the farm where the immunosuppressed patient was employed. "Pan-pox and high Guanine-cytosine" polymerase chain reaction assays were performed on patient, animal, and environmental isolates. Amplicon sequences of the viral DNA were used for agent identification and phylogenetic analysis. RESULTS Specimens from both human cases revealed a novel poxvirus. The agent shares 88% similarity to viruses in the Parapoxvirus genus and 78% to those in the Molluscipoxvirus genus but is sufficiently divergent to resist classification as either. All animal and environmental specimens were negative for poxvirus and both patients had complete resolution of lesions. CONCLUSIONS This report serves as a reminder that poxviruses should be considered in cutaneous human infections, especially in individuals with known barnyard exposures. The clinical course of the patients was similar to that of parapoxvirus infections, and the source of this virus is currently unknown but is presumed to be zoonotic. This report also demonstrates the importance of a comprehensive approach to diagnosis of human infections caused by previously unknown pathogens.
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Affiliation(s)
- Lynda U. Osadebe
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kalpana Manthiram
- Division of Pediatric Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrea M. McCollum
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yu Li
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ginny L. Emerson
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nadia F. Gallardo-Romero
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey B. Doty
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hui Zhao
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clifton P. Drew
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G. Metcalfe
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia S. Goldsmith
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Atis Muehlenbachs
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul B. Googe
- Knoxville Dermatopathology Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John Dunn
- Tennessee Department of Health, Nashville, Tennessee
| | - Todd Duenckel
- Animal and Plant Health Inspection Service, US Department of Agriculture Regional Office, Nashville, Tennessee
| | | | - Darin S. Carroll
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherif R. Zaki
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark R. Denison
- Knoxville Dermatopathology Laboratory, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary G. Reynolds
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Inger K. Damon
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
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Monroe BP, Nakazawa YJ, Reynolds MG, Carroll DS. Estimating the geographic distribution of human Tanapox and potential reservoirs using ecological niche modeling. Int J Health Geogr 2014; 13:34. [PMID: 25255815 PMCID: PMC4189193 DOI: 10.1186/1476-072x-13-34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tanapox virus is a zoonotic infection that causes mild febrile illness and one to several nodular skin lesions. The disease is endemic in parts of Africa. The principal reservoir for the virus that causes Tanapox is unknown, but has been hypothesized to be a non-human primate. This study employs ecological niche modeling (ENM) to determine areas of tropical Africa suitable for the occurrence of human Tanapox and a list of hypothetical reservoirs. The resultant niche model will be a useful tool to guide medical surveillance activities in the region. METHODS This study uses the Desktop GARP software to predict regions where human Tanapox might be expected to occur based on historical human case locations and environmental data. Additional modeling of primate species, using occurrence data from museum records was performed to determine suitable disease reservoirs. RESULTS The final ENM predicts a potential distribution of Tanapox over much of equatorial Africa, exceeding the borders of Kenya and Democratic Republic of Congo (DRC) where it has been historically reported. Five genera of non-human primates were found to be potential reservoir taxa. CONCLUSIONS Validity testing suggests the model created here is robust (p < 0.04). Several genera of primates were identified as having ENMs overlapping with that of Tanapox and are suggested as potential reservoirs, mainly members of the Genus Cercopithecus. The ENM modeling technique has several limitations and results should be interpreted with caution. This study may increase knowledge and engage further research in this neglected disease.
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Affiliation(s)
- Benjamin P Monroe
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-30, Atlanta, GA 30333, USA.
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Abstract
Although it has been >30 years since the eradication of smallpox, the unearthing of well-preserved tissue material in which the virus may reside has called into question the viability of variola virus decades or centuries after its original occurrence. Experimental data to address the long-term stability and viability of the virus are limited. There are several instances of well-preserved corpses and tissues that have been examined for poxvirus viability and viral DNA. These historical specimens cause concern for potential exposures, and each situation should be approached cautiously and independently with the available information. Nevertheless, these specimens provide information on the history of a major disease and vaccination against it.
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McCollum AM, Li Y, Wilkins K, Karem KL, Davidson WB, Paddock CD, Reynolds MG, Damon IK. Poxvirus viability and signatures in historical relics. Emerg Infect Dis 2014; 20:177-84. [PMID: 24447382 DOI: 10.3201/eid2002/131098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although it has been >30 years since the eradication of smallpox, the unearthing of well-preserved tissue material in which the virus may reside has called into question the viability of variola virus decades or centuries after its original occurrence. Experimental data to address the long-term stability and viability of the virus are limited. There are several instances of well-preserved corpses and tissues that have been examined for poxvirus viability and viral DNA. These historical specimens cause concern for potential exposures, and each situation should be approached cautiously and independently with the available information. Nevertheless, these specimens provide information on the history of a major disease and vaccination against it.
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McCollum AM, Holman RC, Hughes CM, Mehal JM, Folkema AM, Redd JT, Cheek JE, Damon IK, Reynolds MG. Molluscum contagiosum in a pediatric American Indian population: incidence and risk factors. PLoS One 2014; 9:e103419. [PMID: 25072249 PMCID: PMC4114779 DOI: 10.1371/journal.pone.0103419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/30/2014] [Indexed: 11/18/2022] Open
Abstract
Background Molluscum contagiosum virus (MCV) causes an innocuous yet persistent skin infection in immunocompetent individuals and is spread by contact with lesions. Studies point to atopic dermatitis (AD) as a risk factor for MCV infection; however, there are no longitudinal studies that have evaluated this hypothesis. Methods Outpatient visit data from fiscal years 2001–2009 for American Indian and Alaska Native (AI/AN) children were examined to describe the incidence of molluscum contagiosum (MC). We conducted a case-control study of patients <5 years old at an Indian Health Service (IHS) clinic to evaluate dermatological risk factors for infection. Results The incidence rate for MC in children <5 years old was highest in the West and East regions. MC cases were more likely to have a prior or co-occurring diagnosis of eczema, eczema or dermatitis, impetigo, and scabies (p<0.05) compared to controls; 51.4% of MC cases had a prior or co-occurring diagnosis of eczema or dermatitis. Conclusions The present study is the first demonstration of an association between AD and MC using a case-control study design. It is unknown if the concurrent high incidence of eczema and MC is related, and this association deserves further investigation.
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Affiliation(s)
- Andrea M. McCollum
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Robert C. Holman
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christine M. Hughes
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jason M. Mehal
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Arianne M. Folkema
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John T. Redd
- Division of Epidemiology and Disease Prevention, Office of Public Health Support, Indian Health Service, Albuquerque, New Mexico, United States of America
| | - James E. Cheek
- Division of Epidemiology and Disease Prevention, Office of Public Health Support, Indian Health Service, Albuquerque, New Mexico, United States of America
| | - Inger K. Damon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary G. Reynolds
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Bass J, Tack DM, McCollum AM, Kabamba J, Pakuta E, Malekani J, Nguete B, Monroe BP, Doty JB, Karhemere S, Damon IK, Balilo M, Okitolonda E, Shongo RL, Reynolds MG. Enhancing health care worker ability to detect and care for patients with monkeypox in the Democratic Republic of the Congo. Int Health 2013; 5:237-43. [PMID: 24246742 PMCID: PMC5688513 DOI: 10.1093/inthealth/iht029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Monkeypox (MPX) is an endemic disease of public health importance in the Democratic Republic of the Congo (DRC). In 2010, the DRC Ministry of Health joined with external partners to improve MPX surveillance in the Tshuapa Health District of DRC. A pivotal component of the program is training of health zone personnel in surveillance methods and patient care. In this report we evaluate outcomes of the training program. METHODS Health care worker knowledge of key concepts in the MPX training curriculum was assessed using an anonymous self-administered survey. Additionally, evaluators collected feedback about the capacity of participants to perform the surveillance tasks. Training impacts were determined by assessing various surveillance performance metrics. RESULTS Correct trainee responses to questions about MPX symptoms and patient care increased significantly upon completion of training events. During the 12 months after the initial training, the proportion of suspected cases investigated increased significantly (from 6.7 to 37.3%), as compared to the 5 months prior. However, the proportion of reported cases that were ultimately confirmed remained unchanged, 20.1% (5/24) vs 23.3% (60/257). CONCLUSIONS We have demonstrated that the MPX curriculum developed for this initiative was effective in transferring knowledge and was associated with improved detection of human MPX cases.
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Affiliation(s)
- Jennifer Bass
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA USA
| | - Danielle M. Tack
- US Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA USA
| | - Andrea M. McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA USA
| | - Joelle Kabamba
- US Centers for Disease Control and Prevention, Country Operations Branch, Kinshasa, Democratic Republic of the Congo
| | - Elisabeth Pakuta
- National Institute for Biomedical Research, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Jean Malekani
- University of Kinshasa, Department of Biological Sciences, Kinshasa, Democratic Republic of the Congo
| | - Beatrice Nguete
- University of Kinshasa, Center for HIV/AIDS Strategic Information, Kinshasa, Democratic Republic of the Congo
| | - Benjamin P. Monroe
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA USA
| | - Jeffrey B. Doty
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA USA
| | - Stomy Karhemere
- National Institute for Biomedical Research, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Inger K. Damon
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA USA
| | - Marcel Balilo
- Hemorrhagic Fever and Monkeypox Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Emile Okitolonda
- University of Kinshasa, Center for HIV/AIDS Strategic Information, Kinshasa, Democratic Republic of the Congo
| | - Robert L. Shongo
- Hemorrhagic Fever and Monkeypox Program, Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Mary G. Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA USA
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Hughes CM, Damon IK, Reynolds MG. Understanding U.S. healthcare providers' practices and experiences with molluscum contagiosum. PLoS One 2013; 8:e76948. [PMID: 24155912 PMCID: PMC3796559 DOI: 10.1371/journal.pone.0076948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/27/2013] [Indexed: 11/29/2022] Open
Abstract
Introduction Molluscum contagiosum is a common superficial skin infection caused by the poxvirus, Molluscum Contagiosum virus. The study objective is to obtain a better understanding of physician practices and experiences with molluscum contagiosum in order to focus informational and guidance material. Methods A cross-sectional survey to assess medical practitioners’ knowledge and practices with molluscum contagiosum was conducted using the 2009 DocStyles survey. Questions regarding category and number of molluscum contagiosum patients seen, treatments used and advice given to patients were included in the survey. Results Dermatologists saw the most cases, with the majority seeing 51–100 molluscum contagiosum cases/year. The most common cases seen were children with multiple lesions and adults with genital lesions. Respondents were most likely to recommend treatment to immunocompromised individuals, HIV patients, adults with genital lesions and children with multiple lesions. Cryotherapy was the top choice for all specialties with the exception of OB/GYNs, whose top choice was curettage. “Avoid intimate contact until lesions resolve”, “Avoid touching lesions to reduce further spread”, and “Don’t be concerned, this will go away” were the top advice choices. Discussion Most survey respondents have dealt with molluscum contagiosum in their practice during the previous year. Overall, respondents picked appropriate choices for treatment and advice given; however some ineffective or unnecessary treatments were chosen and recommendations to prevent spread were chosen infrequently. Knowledge gaps for appropriate transmission precaution advice might cause unnecessary spread or autoinoculation. This survey has demonstrated that molluscum contagiosum is a common infection seen by many types of practitioners and therefore guidance on treatment considerations and infection control is valuable.
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Affiliation(s)
- Christine M. Hughes
- Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
- * E-mail:
| | - Inger K. Damon
- Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Mary G. Reynolds
- Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
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Nakazawa Y, Lash RR, Carroll DS, Damon IK, Karem KL, Reynolds MG, Osorio JE, Rocke TE, Malekani JM, Muyembe JJ, Formenty P, Peterson AT. Mapping monkeypox transmission risk through time and space in the Congo Basin. PLoS One 2013; 8:e74816. [PMID: 24040344 PMCID: PMC3764067 DOI: 10.1371/journal.pone.0074816] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/09/2013] [Indexed: 11/22/2022] Open
Abstract
Monkeypox is a major public health concern in the Congo Basin area, with changing patterns of human case occurrences reported in recent years. Whether this trend results from better surveillance and detection methods, reduced proportions of vaccinated vs. non-vaccinated human populations, or changing environmental conditions remains unclear. Our objective is to examine potential correlations between environment and transmission of monkeypox events in the Congo Basin. We created ecological niche models based on human cases reported in the Congo Basin by the World Health Organization at the end of the smallpox eradication campaign, in relation to remotely-sensed Normalized Difference Vegetation Index datasets from the same time period. These models predicted independent spatial subsets of monkeypox occurrences with high confidence; models were then projected onto parallel environmental datasets for the 2000s to create present-day monkeypox suitability maps. Recent trends in human monkeypox infection are associated with broad environmental changes across the Congo Basin. Our results demonstrate that ecological niche models provide useful tools for identification of areas suitable for transmission, even for poorly-known diseases like monkeypox.
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Affiliation(s)
- Yoshinori Nakazawa
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America
| | - R. Ryan Lash
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Darin S. Carroll
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Inger K. Damon
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin L. Karem
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary G. Reynolds
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jorge E. Osorio
- Department of Pathological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Tonie E. Rocke
- USGS National Wildlife Health Center, Madison, Wisconsin, United States of America
| | | | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Pierre Formenty
- Department of Communicable Diseases Surveillance and Response, World Health Organization, Geneva, Switzerland
| | - A. Townsend Peterson
- Biodiversity Institute, University of Kansas, Lawrence, Kansas, United States of America
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Keckler MS, Reynolds MG, Damon IK, Karem KL. The effects of post-exposure smallpox vaccination on clinical disease presentation: addressing the data gaps between historical epidemiology and modern surrogate model data. Vaccine 2013; 31:5192-201. [PMID: 23994378 DOI: 10.1016/j.vaccine.2013.08.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 08/05/2013] [Accepted: 08/13/2013] [Indexed: 11/28/2022]
Abstract
Decades after public health interventions - including pre- and post-exposure vaccination - were used to eradicate smallpox, zoonotic orthopoxvirus outbreaks and the potential threat of a release of variola virus remain public health concerns. Routine prophylactic smallpox vaccination of the public ceased worldwide in 1980, and the adverse event rate associated with the currently licensed live vaccinia virus vaccine makes reinstatement of policies recommending routine pre-exposure vaccination unlikely in the absence of an orthopoxvirus outbreak. Consequently, licensing of safer vaccines and therapeutics that can be used post-orthopoxvirus exposure is necessary to protect the global population from these threats. Variola virus is a solely human pathogen that does not naturally infect any other known animal species. Therefore, the use of surrogate viruses in animal models of orthopoxvirus infection is important for the development of novel vaccines and therapeutics. Major complications involved with the use of surrogate models include both the absence of a model that accurately mimics all aspects of human smallpox disease and a lack of reproducibility across model species. These complications limit our ability to model post-exposure vaccination with newer vaccines for application to human orthopoxvirus outbreaks. This review seeks to (1) summarize conclusions about the efficacy of post-exposure smallpox vaccination from historic epidemiological reports and modern animal studies; (2) identify data gaps in these studies; and (3) summarize the clinical features of orthopoxvirus-associated infections in various animal models to identify those models that are most useful for post-exposure vaccination studies. The ultimate purpose of this review is to provide observations and comments regarding available model systems and data gaps for use in improving post-exposure medical countermeasures against orthopoxviruses.
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Affiliation(s)
- M Shannon Keckler
- Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, United States.
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Reynolds MG, Emerson GL, Pukuta E, Karhemere S, Muyembe JJ, Bikindou A, McCollum AM, Moses C, Wilkins K, Zhao H, Damon IK, Karem KL, Li Y, Carroll DS, Mombouli JV. Detection of human monkeypox in the Republic of the Congo following intensive community education. Am J Trop Med Hyg 2013; 88:982-985. [PMID: 23400570 PMCID: PMC3752768 DOI: 10.4269/ajtmh.12-0758] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/16/2013] [Indexed: 11/24/2022] Open
Abstract
Monkeypox is an acute viral infection with a clinical course resembling smallpox. It is endemic in northern and central Democratic Republic of the Congo (DRC), but it is reported only sporadically in neighboring Republic of the Congo (ROC). In October 2009, interethnic violence in northwestern DRC precipitated the movement of refugees across the Ubangi River into ROC. The influx of refugees into ROC heightened concerns about monkeypox in the area, because of the possibility that the virus could be imported, or that incidence could increase caused by food insecurity and over reliance on bush meat. As part of a broad-based campaign to improve health standards in refugee settlement areas, the United Nations International Children's Emergency Fund (UNICEF) sponsored a program of intensive community education that included modules on monkeypox recognition and prevention. In the 6 months immediately following the outreach, 10 suspected cases of monkeypox were reported to health authorities. Laboratory testing confirmed monkeypox virus infection in two individuals, one of whom was part of a cluster of four suspected cases identified retrospectively. Anecdotes collected at the time of case reporting suggest that the outreach campaign contributed to detection of suspected cases of monkeypox.
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Affiliation(s)
- Mary G. Reynolds
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia; Institut National de Recherche Biomédicale, Kinshasa, République Démocratique du Congo; Medecins d'Afrique, Brazzaville, République du Congo; International Conservation and Education Fund, Washington, District of Columbia; Délégation Générale pour la Recherche Scientifique et Technique, Brazzaville, République du Congo
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