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McQuiston JH, Luce R, Kazadi DM, Bwangandu CN, Mbala-Kingebeni P, Anderson M, Prasher JM, Williams IT, Phan A, Shelus V, Bratcher A, Soke GN, Fonjungo PN, Kabamba J, McCollum AM, Perry R, Rao AK, Doty J, Christensen B, Fuller JA, Baird N, Chaitram J, Brown CK, Kirby AE, Fitter D, Folster JM, Dualeh M, Hartman R, Bart SM, Hughes CM, Nakazawa Y, Sims E, Christie A, Hutson CL. U.S. Preparedness and Response to Increasing Clade I Mpox Cases in the Democratic Republic of the Congo - United States, 2024. MMWR Morb Mortal Wkly Rep 2024; 73:435-440. [PMID: 38753567 DOI: 10.15585/mmwr.mm7319a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Clade I monkeypox virus (MPXV), which can cause severe illness in more people than clade II MPXVs, is endemic in the Democratic Republic of the Congo (DRC), but the country has experienced an increase in suspected cases during 2023-2024. In light of the 2022 global outbreak of clade II mpox, the increase in suspected clade I cases in DRC raises concerns that the virus could spread to other countries and underscores the importance of coordinated, urgent global action to support DRC's efforts to contain the virus. To date, no cases of clade I mpox have been detected outside of countries in Central Africa where the virus is endemic. CDC and other partners are working to support DRC's response. In addition, CDC is enhancing U.S. preparedness by raising awareness, strengthening surveillance, expanding diagnostic testing capacity for clade I MPXV, ensuring appropriate specimen handling and waste management, emphasizing the importance of appropriate medical treatment, and communicating guidance on the recommended contact tracing, containment, behavior modification, and vaccination strategies.
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Faherty EAG, Holly T, Ogale YP, Spencer H, Becht AM, Crisler G, Wasz M, Stonehouse P, Barbian HJ, Zelinski C, Kittner A, Foulkes D, Anderson KW, Evans T, Nicolae L, Staton A, Hardnett C, Townsend MB, Carson WC, Panayampalli SS, Hutson CL, Gigante CM, Quilter LAS, Gorman S, Borah B, Black SR, Pacilli M, Kern D, Kerins J, McCollum AM, Rao AK, Tabidze I. Investigation of an mpox outbreak affecting many vaccinated persons in Chicago, IL-March 2023-June 2023. Clin Infect Dis 2024:ciae181. [PMID: 38567460 DOI: 10.1093/cid/ciae181] [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: 01/02/2024] [Revised: 02/29/2024] [Accepted: 04/01/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND After months of few mpox cases, an increased number of cases were reported in Chicago during May 2023; predominantly among fully vaccinated patients. We investigated the outbreak scope, differences between vaccinated and unvaccinated patients, and hypotheses for monkeypox virus (MPXV) infection after vaccination. METHODS We interviewed patients and reviewed medical records to assess demographic, behavioral, and clinical characteristics, mpox vaccine status, and vaccine administration routes. We evaluated serum antibody levels after infection and compared patient viral genomes with MPXV sequences in available databases. We discussed potential vaccine compromise with partners who manufactured, handled, and administered vaccine associated with breakthrough infections. RESULTS During March 18-June 27, 2023, we identified 49 mpox cases; 57% of these mpox patients were fully vaccinated (FV). FV patients received both JYNNEOS doses subcutaneously (57%), intradermally (7%), or via heterologous administration (36%). FV patients had more median sex partners (3, IQR=1-4) versus not fully vaccinated (NFV) patients (1, IQR=1-2). Thirty-six of 37 sequenced specimens belonged to lineage B.1.20 of clade IIb MPXV, which did not demonstrate any amino acid changes relative to B.1, the predominant lineage from May 2022. Vaccinated patients demonstrated expected humoral antibody responses; none were hospitalized. No vaccine storage excursions were identified. Approximately 63% of people at risk for mpox in Chicago were FV during this period. CONCLUSIONS Our investigation indicated cases were likely due to frequent behaviors associated with mpox transmission, even with relatively high vaccine effectiveness and vaccine coverage. Cases after vaccination might occur in similar populations.
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Affiliation(s)
- Emily A G Faherty
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Taylor Holly
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Yasmin P Ogale
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Hillary Spencer
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Ashley M Becht
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Gordon Crisler
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Michael Wasz
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Patrick Stonehouse
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Hannah J Barbian
- Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America
| | - Christy Zelinski
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Alyse Kittner
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Dorothy Foulkes
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Kendall W Anderson
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Tiffany Evans
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Lavinia Nicolae
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Amber Staton
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Carla Hardnett
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Michael B Townsend
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - William C Carson
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | | | - Christina L Hutson
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Crystal M Gigante
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Laura A S Quilter
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Susan Gorman
- Office of Strategic National Stockpile, Department of Health and Human Services, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Brian Borah
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Stephanie R Black
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Massimo Pacilli
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - David Kern
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Janna Kerins
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
| | - Andrea M McCollum
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Agam K Rao
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States of America
| | - Irina Tabidze
- Chicago Department of Public Health, 1340 South Damen Avenue, Chicago, Illinois, 60646, United States of America
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3
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Brien SC, LeBreton M, Doty JB, Mauldin MR, Morgan CN, Pieracci EG, Ritter JM, Matheny A, Tafon BG, Tamoufe U, Missoup AD, Nwobegahay J, Takuo JM, Nkom F, Mouiche MMM, Feussom JMK, Wilkins K, Wade A, McCollum AM. Clinical Manifestations of an Outbreak of Monkeypox Virus in Captive Chimpanzees in Cameroon, 2016. J Infect Dis 2024; 229:S275-S284. [PMID: 38164967 DOI: 10.1093/infdis/jiad601] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Monkeypox virus (MPXV) is a reemerging virus of global concern. An outbreak of clade I MPXV affected 20 captive chimpanzees in Cameroon in 2016. We describe the epidemiology, virology, phylogenetics, and clinical progression of this outbreak. Clinical signs included exanthema, facial swelling, perilaryngeal swelling, and eschar. Mpox can be lethal in captive chimpanzees, with death likely resulting from respiratory complications. We advise avoiding anesthesia in animals with respiratory signs to reduce the likelihood of death. This outbreak presented a risk to animal care staff. There is a need for increased awareness and a One Health approach to preparation for outbreaks in wildlife rescue centers in primate range states where MPXV occurs. Control measures should include quarantining affected animals, limiting human contacts, surveillance of humans and animals, use of personal protective equipment, and regular decontamination of enclosures.
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Affiliation(s)
- Stephanie C Brien
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, Easter Bush Campus, The University of Edinburgh, Roslin, United Kingdom
- Ape Action Africa, Mefou Park, Cameroon
| | | | - Jeffrey B Doty
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Mauldin
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint N Morgan
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily G Pieracci
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jana M Ritter
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Audrey Matheny
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Alain D Missoup
- Zoology Unit, Laboratory of Biology and Physiology of Animal Organisms, Faculty of Science, University of Douala, Cameroon
| | | | | | | | - Moctar M M Mouiche
- Mosaic, Yaoundé, Cameroon
- School of Veterinary Medicine and Sciences, University of Ngaounderé, Cameroon
| | - Jean Marc K Feussom
- Cameroon Epidemiological Network for Animal Diseases, Directorate of Veterinary Services, Ministry of Livestock, Fisheries and Animal Industries, Yaoundé, Cameroon
| | - Kimberly Wilkins
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Abel Wade
- National Veterinary Laboratory, Garoua, Cameroon
| | - Andrea M McCollum
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Charniga K, McCollum AM, Hughes CM, Monroe B, Kabamba J, Lushima RS, Likafi T, Nguete B, Pukuta E, Muyamuna E, Muyembe Tamfum JJ, Karhemere S, Kaba D, Nakazawa Y. Updating Reproduction Number Estimates for Mpox in the Democratic Republic of Congo Using Surveillance Data. Am J Trop Med Hyg 2024; 110:561-568. [PMID: 38320310 PMCID: PMC10919191 DOI: 10.4269/ajtmh.23-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/10/2023] [Accepted: 08/06/2023] [Indexed: 02/08/2024] Open
Abstract
Incidence of human monkeypox (mpox) has been increasing in West and Central Africa, including in the Democratic Republic of Congo (DRC), where monkeypox virus (MPXV) is endemic. Most estimates of the pathogen's transmissibility in the DRC are based on data from the 1980s. Amid the global 2022 mpox outbreak, new estimates are needed to characterize the virus' epidemic potential and inform outbreak control strategies. We used the R package vimes to identify clusters of laboratory-confirmed mpox cases in Tshuapa Province, DRC. Cases with both temporal and spatial data were assigned to clusters based on the disease's serial interval and spatial kernel. We used the size of the clusters to infer the effective reproduction number, Rt, and the rate of zoonotic spillover of MPXV into the human population. Out of 1,463 confirmed mpox cases reported in Tshuapa Province between 2013 and 2017, 878 had both date of symptom onset and a location with geographic coordinates. Results include an estimated Rt of 0.82 (95% CI: 0.79-0.85) and a rate of 132 (95% CI: 122-143) spillovers per year assuming a reporting rate of 25%. This estimate of Rt is larger than most previous estimates. One potential explanation for this result is that Rt could have increased in the DRC over time owing to declining population-level immunity conferred by smallpox vaccination, which was discontinued around 1982. Rt could be overestimated if our assumption of one spillover event per cluster does not hold. Our results are consistent with increased transmissibility of MPXV in Tshuapa Province.
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Affiliation(s)
- Kelly Charniga
- 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
| | - Andrea M. McCollum
- 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
| | - Christine M. Hughes
- 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
- 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
| | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | | | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Muyamuna
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Didine Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Yoshinori Nakazawa
- 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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5
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Kreuze MA, Minhaj FS, Duwell M, Gigante CM, Kim AM, Crum D, Perlmutter R, Rubin JH, Myers R, Lukula SL, Ravi-Caldwell N, Sockwell D, Chen TH, de Perio MA, Hughes CM, Davidson WB, Wilkins K, Baird N, Lowe D, Li Y, McCollum AM, Blythe D, Rao AK. How did the 2022 global mpox outbreak happen? A travel-associated case 6 months earlier may provide important clues. Travel Med Infect Dis 2023; 55:102618. [PMID: 37506963 DOI: 10.1016/j.tmaid.2023.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Molly A Kreuze
- Maryland State Department of Health, USA; Epidemic Intelligence Service, USA.
| | - Faisal S Minhaj
- Epidemic Intelligence Service, USA; Division of High Consequence Pathogens and Pathology, USA
| | | | | | | | - David Crum
- Maryland State Department of Health, USA
| | | | | | | | | | | | | | - Tai-Ho Chen
- Division of Global Migration and Quarantine, USA
| | | | | | | | - Kim Wilkins
- Division of High Consequence Pathogens and Pathology, USA
| | - Nicolle Baird
- Division of High Consequence Pathogens and Pathology, USA; Laboratory Leadership Service, USA
| | - David Lowe
- Division of High Consequence Pathogens and Pathology, USA
| | - Yu Li
- Division of High Consequence Pathogens and Pathology, USA
| | | | | | - Agam K Rao
- Division of High Consequence Pathogens and Pathology, USA
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6
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Sharpe JD, Charniga K, Byrd KM, Stefanos R, Lewis L, Watson J, Feldpausch A, Pavlick J, Hand J, Sokol T, Ortega E, Pathela P, Hennessy RR, Dulcey M, McHugh L, Pietrowski M, Perella D, Shah S, Maroufi A, Taylor M, Cope A, Belay ED, Ellington S, McCollum AM, Zilversmit Pao L, Guagliardo SAJ, Dawson P. Possible Exposures Among Mpox Patients Without Reported Male-to-Male Sexual Contact - Six U.S. Jurisdictions, November 1-December 14, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:944-948. [PMID: 37651279 DOI: 10.15585/mmwr.mm7235a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The extent to which the 2022 mpox outbreak has affected persons without a recent history of male-to-male sexual contact (MMSC) is not well understood. During November 1-December 14, 2022, CDC partnered with six jurisdictional health departments to characterize possible exposures among mpox patients aged ≥18 years who did not report MMSC during the 3 weeks preceding symptom onset. Among 52 patients included in the analysis, 14 (27%) had a known exposure to a person with mpox, including sexual activity and other close intimate contact (eight) and household contact (six). Among 38 (73%) patients with no known exposure to a person with mpox, self-reported activities before illness onset included sexual activity and other close intimate contact (17; 45%), close face-to-face contact (14; 37%), attending large social gatherings (11; 29%), and being in occupational settings involving close skin-to-skin contact (10; 26%). These findings suggest that sexual activity remains an important route of mpox exposure among patients who do not report MMSC.
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7
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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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8
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Faherty EAG, Holly T, Ogale YP, Crisler G, Becht A, Kern D, Nicolae L, Spencer H, Wasz M, Kerins JL, Kittner A, Staton A, Hardnett C, Hutson C, Gigante CM, Quilter L, Kracalik I, Black S, McCollum AM, Rao AK, Tabidze I. Notes from the Field: Emergence of an Mpox Cluster Primarily Affecting Persons Previously Vaccinated Against Mpox - Chicago, Illinois, March 18-June 12, 2023. Am J Transplant 2023; 23:1268-1270. [PMID: 37573130 DOI: 10.1016/j.ajt.2023.07.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Affiliation(s)
- Emily A G Faherty
- Epidemic Intelligence Service, CDC; Chicago Department of Public Health, Chicago, Illinois.
| | - Taylor Holly
- Chicago Department of Public Health, Chicago, Illinois
| | - Yasmin P Ogale
- Epidemic Intelligence Service, CDC; Division of Sexually Transmitted Diseases Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | | | - Ashley Becht
- Chicago Department of Public Health, Chicago, Illinois
| | - David Kern
- Chicago Department of Public Health, Chicago, Illinois
| | - Lavinia Nicolae
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Hillary Spencer
- Epidemic Intelligence Service, CDC; Chicago Department of Public Health, Chicago, Illinois
| | - Michael Wasz
- Chicago Department of Public Health, Chicago, Illinois
| | | | - Alyse Kittner
- Chicago Department of Public Health, Chicago, Illinois
| | - Amber Staton
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carla Hardnett
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Christina Hutson
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Crystal M Gigante
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Laura Quilter
- Division of Sexually Transmitted Diseases Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Ian Kracalik
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Andrea M McCollum
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Agam K Rao
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Irina Tabidze
- Chicago Department of Public Health, Chicago, Illinois
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9
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Faherty EAG, Holly T, Ogale YP, Crisler G, Becht A, Kern D, Nicolae L, Spencer H, Wasz M, Kerins JL, Kittner A, Staton A, Hardnett C, Hutson C, Gigante CM, Quilter L, Kracalik I, Black S, McCollum AM, Rao AK, Tabidze I. Notes from the Field: Emergence of an Mpox Cluster Primarily Affecting Persons Previously Vaccinated Against Mpox - Chicago, Illinois, March 18-June 12, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:696-698. [PMID: 37347713 PMCID: PMC10328474 DOI: 10.15585/mmwr.mm7225a6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
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10
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Nemechek K, Stefanos R, Miller EL, Riser A, Kebede B, Galang RR, Hufstetler K, Descamps D, Balenger A, Hennessee I, Neelam V, Hutchins HJ, Labuda SM, Davis KM, McCormick DW, Marx GE, Kimball A, Ruberto I, Williamson T, Rzucidlo P, Willut C, Harold RE, Mangla AT, English A, Brikshavana D, Blanding J, Kim M, Finn LE, Marutani A, Lockwood M, Johnson S, Ditto N, Wilton S, Edmond T, Stokich D, Shinall A, Alravez B, Crawley A, Nambiar A, Gateley EL, Schuman J, White SL, Davis K, Milleron R, Mendez M, Kawakami V, Segaloff HE, Bower WA, Ellington SR, McCollum AM, Pao LZ. Notes from the Field: Exposures to Mpox Among Cases in Children Aged ≤12 Years - United States, September 25-December 31, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:633-635. [PMID: 37289653 PMCID: PMC10328459 DOI: 10.15585/mmwr.mm7223a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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McQuiston JH, Braden CR, Bowen MD, McCollum AM, McDonald R, Carnes N, Carter RJ, Christie A, Doty JB, Ellington S, Fehrenbach SN, Gundlapalli AV, Hutson CL, Kachur RE, Maitland A, Pearson CM, Prejean J, Quilter LAS, Rao AK, Yu Y, Mermin J. The CDC Domestic Mpox Response - United States, 2022-2023. MMWR Morb Mortal Wkly Rep 2023; 72:547-552. [PMID: 37200231 DOI: 10.15585/mmwr.mm7220a2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Monkeypox (mpox) is a serious viral zoonosis endemic in west and central Africa. An unprecedented global outbreak was first detected in May 2022. CDC activated its emergency outbreak response on May 23, 2022, and the outbreak was declared a Public Health Emergency of International Concern on July 23, 2022, by the World Health Organization (WHO),* and a U.S. Public Health Emergency on August 4, 2022, by the U.S. Department of Health and Human Services.† A U.S. government response was initiated, and CDC coordinated activities with the White House, the U.S. Department of Health and Human Services, and many other federal, state, and local partners. CDC quickly adapted surveillance systems, diagnostic tests, vaccines, therapeutics, grants, and communication systems originally developed for U.S. smallpox preparedness and other infectious diseases to fit the unique needs of the outbreak. In 1 year, more than 30,000 U.S. mpox cases were reported, more than 140,000 specimens were tested, >1.2 million doses of vaccine were administered, and more than 6,900 patients were treated with tecovirimat, an antiviral medication with activity against orthopoxviruses such as Variola virus and Monkeypox virus. Non-Hispanic Black (Black) and Hispanic or Latino (Hispanic) persons represented 33% and 31% of mpox cases, respectively; 87% of 42 fatal cases occurred in Black persons. Sexual contact among gay, bisexual, and other men who have sex with men (MSM) was rapidly identified as the primary risk for infection, resulting in profound changes in our scientific understanding of mpox clinical presentation, pathogenesis, and transmission dynamics. This report provides an overview of the first year of the response to the U.S. mpox outbreak by CDC, reviews lessons learned to improve response and future readiness, and previews continued mpox response and prevention activities as local viral transmission continues in multiple U.S. jurisdictions (Figure).
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12
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Riser AP, Hanley A, Cima M, Lewis L, Saadeh K, Alarcón J, Finn L, Kim M, Adams J, Holt D, Feldpausch A, Pavlick J, English A, Smith M, Rehman T, Lubelchek R, Black S, Collins M, Mounsey L, Blythe D, Avalos MH, Lee EH, Samson O, Wong M, Stokich BD, Salehi E, Denny L, Waller K, Talley P, Schuman J, Fischer M, White S, Davis K, Caeser Cuyler A, Sabzwari R, Anderson RN, Byrd K, Gold JAW, Kindilien S, Lee JT, O’Connor S, O’Shea J, Salmon-Trejo LAT, Velazquez-Kronen R, Zelaya C, Bower W, Ellington S, Gundlapalli AV, McCollum AM, Zilversmit Pao L, Rao AK, Wong KK, Guagliardo SAJ. Epidemiologic and Clinical Features of Mpox-Associated Deaths - United States, May 10, 2022-March 7, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:404-410. [PMID: 37053126 PMCID: PMC10121256 DOI: 10.15585/mmwr.mm7215a5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
As of March 7, 2023, a total of 30,235 confirmed and probable monkeypox (mpox) cases were reported in the United States,† predominantly among cisgender men§ who reported recent sexual contact with another man (1). Although most mpox cases during the current outbreak have been self-limited, cases of severe illness and death have been reported (2-4). During May 10, 2022-March 7, 2023, 38 deaths among persons with probable or confirmed mpox¶ (1.3 per 1,000 mpox cases) were reported to CDC and classified as mpox-associated (i.e., mpox was listed as a contributing or causal factor). Among the 38 mpox-associated deaths, 94.7% occurred in cisgender men (median age = 34 years); 86.8% occurred in non-Hispanic Black or African American (Black) persons. The median interval from symptom onset to death was 68 days (IQR = 50-86 days). Among 33 decedents with available information, 93.9% were immunocompromised because of HIV. Public health actions to prevent mpox deaths include integrated testing, diagnosis, and early treatment for mpox and HIV, and ensuring equitable access to both mpox and HIV prevention and treatment, such as antiretroviral therapy (ART) (5).
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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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14
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Beeson AM, Haston J, McCormick DW, Reynolds M, Chatham-Stephens K, McCollum AM, Godfred-Cato S. Mpox in Children and Adolescents: Epidemiology, Clinical Features, Diagnosis, and Management. Pediatrics 2023; 151:e2022060179. [PMID: 36471498 PMCID: PMC9995221 DOI: 10.1542/peds.2022-060179] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Although mpox is rare among children in the United States, pediatric cases are being reported during the 2022 multinational mpox outbreak. Vaccines and antiviral medications developed for other orthopoxviruses have recently become widely used to prevent and treat mpox in both children and adults in the United States. Although scientific literature regarding mpox in children and adolescents is scant, prior case reports can provide valuable information about the clinical features and potential complications of untreated clade II mpox in these age groups. In this review, we summarize the epidemiology and clinical features of mpox in children and adolescents and provide recommendations for clinicians regarding its diagnosis, management, and prevention. Robust, dedicated surveillance of pediatric exposures and cases in the current outbreak, including the use of vaccines and therapeutics, are needed to guide clinical management and public health strategies.
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Affiliation(s)
- Amy M Beeson
- Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Atlanta, Georgia
| | - Julia Haston
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mary Reynolds
- Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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McCollum AM, Shelus V, Hill A, Traore T, Onoja B, Nakazawa Y, Doty JB, Yinka-Ogunleye A, Petersen BW, Hutson CL, Lewis R. Epidemiology of Human Mpox - Worldwide, 2018-2021. MMWR Morb Mortal Wkly Rep 2023; 72:68-72. [PMID: 36656790 PMCID: PMC9869741 DOI: 10.15585/mmwr.mm7203a4] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Monkeypox (mpox) is a zoonotic disease caused by Monkeypox virus (MPXV), an Orthopoxvirus; the wild mammalian reservoir species is not known. There are two genetic clades of MPXV: clade I and clade II (historically found in central and west Africa, respectively), with only Cameroon reporting both clades (1). Human cases have historically been reported from 1) mostly rural, forested areas in some central and west African countries; 2) countries reporting cases related to population migration or travel of infected persons; and 3) exposure to imported infected mammals (2). The annual number of cases in Africa has risen since 2014 and cumulatively surpassed reports from the previous 40 years for most countries. This reemergence of mpox might be due to a combination of environmental and ecological changes, animal or human movement, the cessation of routine smallpox vaccination since its eradication in 1980, improvements in disease detection and diagnosis, and genetic changes in the virus (2). This report describes the epidemiology of mpox since 1970 and during 2018-2021, using data from national surveillance programs, World Health Organization (WHO) bulletins, and case reports, and addresses current diagnostic and treatment challenges in countries with endemic disease. During 2018-2021, human cases were recognized and confirmed in six African countries, with most detected in the Democratic Republic of the Congo (DRC) and Nigeria. The reemergence and increase in cases resulted in its being listed in 2019 as a priority disease for immediate and routine reporting through the Integrated Disease Surveillance and Response strategy in the WHO African region.* In eight instances, patients with mpox were identified in four countries outside of Africa after travel from Nigeria. Since 2018, introductory and intermediate training courses on prevention and control of mpox for public health and health care providers have been available online at OpenWHO.†,§ The global outbreak that began in May 2022¶ has further highlighted the need for improvements in laboratory-based surveillance and access to treatments and vaccines to prevent and contain the infection, including in areas of Africa with endemic mpox.
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16
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Priyamvada L, Carson WC, Ortega E, Navarra T, Tran S, Smith TG, Pukuta E, Muyamuna E, Kabamba J, Nguete BU, Likafi T, Kokola G, Lushima RS, Tamfum JJM, Okitolonda EW, Kaba DK, Monroe BP, McCollum AM, Petersen BW, Satheshkumar PS, Townsend MB. Serological responses to the MVA-based JYNNEOS monkeypox vaccine in a cohort of participants from the Democratic Republic of Congo. Vaccine 2022; 40:7321-7327. [PMID: 36344361 PMCID: PMC9635871 DOI: 10.1016/j.vaccine.2022.10.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 09/12/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
The current worldwide monkepox outbreak has reaffirmed the continued threat monkeypox virus (MPXV) poses to public health. JYNNEOS, a Modified Vaccinia Ankara (MVA)-based live, non-replicating vaccine, was recently approved for monkeypox prevention for adults at high risk of MPXV infection in the United States. Although the safety and immunogenicity of JYNNEOS have been examined previously, the clinical cohorts studied largely derive from regions where MPXV does not typically circulate. In this study, we assess the quality and longevity of serological responses to two doses of JYNNEOS vaccine in a large cohort of healthcare workers from the Democratic Republic of Congo (DRC). We show that JYNNEOS elicits a strong orthopoxvirus (OPXV)-specific antibody response in participants that peaks around day 42, or 2 weeks after the second vaccine dose. Participants with no prior history of smallpox vaccination or exposure have lower baseline antibody levels, but experience a similar fold-rise in antibody titers by day 42 as those with a prior history of vaccination. Both previously naïve and vaccinated participants generate vaccinia virus and MPXV-neutralizing antibody in response to JYNNEOS vaccination. Finally, even though total OPXV-specific IgG titers and neutralizing antibody titers declined from their peak and returned close to baseline levels by the 2-year mark, most participants remain IgG seropositive at the 2-year timepoint. Taken together, our data demonstrates that JYNNEOS vaccination triggers potent OPXV neutralizing antibody responses in a cohort of healthcare workers in DRC, a monkeypox-endemic region. MPXV vaccination with JYNNEOS may help ameliorate the disease and economic burden associated with monkeypox and combat potential outbreaks in areas with active virus circulation.
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Affiliation(s)
- Lalita Priyamvada
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William C. Carson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eddy Ortega
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terese Navarra
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie Tran
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Todd G. Smith
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elisabeth Pukuta
- Institut National pour la Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Elisabeth Muyamuna
- Institut National pour la Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Joelle Kabamba
- Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Beatrice U. Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Gaston Kokola
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | - Emile W. Okitolonda
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Didine K. Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Benjamin P. Monroe
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brett W. Petersen
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Michael B. Townsend
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA,Corresponding author
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17
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Hennessee I, Shelus V, McArdle CE, Wolf M, Schatzman S, Carpenter A, Minhaj FS, Petras JK, Cash-Goldwasser S, Maloney M, Sosa L, Jones SA, Mangla AT, Harold RE, Beverley J, Saunders KE, Adams JN, Stanek DR, Feldpausch A, Pavlick J, Cahill M, O’Dell V, Kim M, Alarcón J, Finn LE, Goss M, Duwell M, Crum DA, Williams TW, Hansen K, Heddy M, Mallory K, McDermott D, Cuadera MKQ, Adler E, Lee EH, Shinall A, Thomas C, Ricketts EK, Koonce T, Rynk DB, Cogswell K, McLafferty M, Perella D, Stockdale C, Dell B, Roskosky M, White SL, Davis KR, Milleron RS, Mackey S, Barringer LA, Bruce H, Barrett D, D’Angeli M, Kocharian A, Klos R, Dawson P, Ellington SR, Mayer O, Godfred-Cato S, Labuda SM, McCormick DW, McCollum AM, Rao AK, Salzer JS, Kimball A, Gold JAW. Epidemiologic and Clinical Features of Children and Adolescents Aged <18 Years with Monkeypox - United States, May 17-September 24, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1407-1411. [PMID: 36331124 PMCID: PMC9639439 DOI: 10.15585/mmwr.mm7144a4] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data on monkeypox in children and adolescents aged <18 years are limited (1,2). During May 17–September 24, 2022, a total of 25,038 monkeypox cases were reported in the United States,† primarily among adult gay, bisexual, and other men who have sex with men (3). During this period, CDC and U.S. jurisdictional health departments identified Monkeypox virus (MPXV) infections in 83 persons aged <18 years, accounting for 0.3% of reported cases. Among 28 children aged 0–12 years with monkeypox, 64% were boys, and most had direct skin-to-skin contact with an adult with monkeypox who was caring for the child in a household setting. Among 55 adolescents aged 13–17 years, most were male (89%), and male-to-male sexual contact was the most common presumed exposure route (66%). Most children and adolescents with monkeypox were non-Hispanic Black or African American (Black) (47%) or Hispanic or Latino (Hispanic) (35%). Most (89%) were not hospitalized, none received intensive care unit (ICU)–level care, and none died. Monkeypox in children and adolescents remains rare in the United States. Ensuring equitable access to monkeypox vaccination, testing, and treatment is a critical public health priority. Vaccination for adolescents with risk factors and provision of prevention information for persons with monkeypox caring for children might prevent additional infections.
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18
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Gigante CM, Korber B, Seabolt MH, Wilkins K, Davidson W, Rao AK, Zhao H, Smith TG, Hughes CM, Minhaj F, Waltenburg MA, Theiler J, Smole S, Gallagher GR, Blythe D, Myers R, Schulte J, Stringer J, Lee P, Mendoza RM, Griffin-Thomas LA, Crain J, Murray J, Atkinson A, Gonzalez AH, Nash J, Batra D, Damon I, McQuiston J, Hutson CL, McCollum AM, Li Y. Multiple lineages of monkeypox virus detected in the United States, 2021-2022. Science 2022; 378:560-565. [PMID: 36264825 DOI: 10.1126/science.add4153] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Monkeypox is a viral zoonotic disease endemic in Central and West Africa. In May 2022, dozens of non-endemic countries reported hundreds of monkeypox cases, most with no epidemiological link to Africa. We identified two lineages of monkeypox virus (MPXV) among two 2021 and seven 2022 US monkeypox cases: the major 2022 outbreak variant called B.1 and a minor contemporaneously sampled variant called A.2. Analyses of mutations among these two variants revealed an extreme preference for GA-to-AA mutations indicative of human APOBEC3 cytosine deaminase activity among Clade IIb MPXV (previously West African, Nigeria) sampled since 2017. Such mutations were not enriched within other MPXV clades. These findings suggest that APOBEC3 editing may be a recurrent and a dominant driver of MPXV evolution within the current outbreak.
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Affiliation(s)
- Crystal M Gigante
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bette Korber
- T-6: Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico, USA; New Mexico Consortium, Los Alamos, NM, USA
| | - Matthew H Seabolt
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Leidos Inc., Reston, VA 20190, USA
| | - Kimberly Wilkins
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Whitni Davidson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Agam K Rao
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hui Zhao
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Todd G Smith
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine M Hughes
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Faisal Minhaj
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle A Waltenburg
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James Theiler
- ISR-3: Space Data Science and Systems, Los Alamos National Laboratory, Los Alamos, NM, USA
| | - Sandra Smole
- Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - Glen R Gallagher
- Massachusetts Department of Public Health, Jamaica Plain, MA, USA
| | - David Blythe
- Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, MD, USA
| | - Robert Myers
- Infectious Disease Epidemiology and Outbreak Response Bureau, Maryland Department of Health, Baltimore, MD, USA
| | - Joann Schulte
- Dallas County Health and Human Services Public Health Laboratory, Dallas, Texas, USA
| | - Joey Stringer
- Dallas County Health and Human Services Public Health Laboratory, Dallas, Texas, USA
| | - Philip Lee
- Florida Department of Health Bureau of Public Health Laboratories-Jacksonville, Jacksonville, FL, USA
| | - Rafael M Mendoza
- Florida Department of Health in Broward County, Hollywood, FL, USA
| | - LaToya A Griffin-Thomas
- Virginia Department of General Services, Division of Consolidated Laboratory Services, Richmond, VA, USA
| | - Jenny Crain
- Virginia Department of Health, Richmond, VA, USA
| | - Jade Murray
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | - Annette Atkinson
- Utah Department of Health and Human Services, Salt Lake City, UT, USA
| | | | - June Nash
- Sacramento County Public Health, Sacramento, CA, USA
| | - Dhwani Batra
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Inger Damon
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer McQuiston
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- National Center for Emerging and Zoonotic Infectious 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
| | - Yu Li
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Miller MJ, Cash-Goldwasser S, Marx GE, Schrodt CA, Kimball A, Padgett K, Noe RS, McCormick DW, Wong JM, Labuda SM, Borah BF, Zulu I, Asif A, Kaur G, McNicholl JM, Kourtis A, Tadros A, Reagan-Steiner S, Ritter JM, Yu Y, Yu P, Clinton R, Parker C, Click ES, Salzer JS, McCollum AM, Petersen B, Minhaj FS, Brown E, Fischer MP, Atmar RL, DiNardo AR, Xu Y, Brown C, Goodman JC, Holloman A, Gallardo J, Siatecka H, Huffman G, Powell J, Alapat P, Sarkar P, Hanania NA, Bruck O, Brass SD, Mehta A, Dretler AW, Feldpausch A, Pavlick J, Spencer H, Ghinai I, Black SR, Hernandez-Guarin LN, Won SY, Shankaran S, Simms AT, Alarcón J, O’Shea JG, Brooks JT, McQuiston J, Honein MA, O’Connor SM, Chatham-Stephens K, O’Laughlin K, Rao AK, Raizes E, Gold JAW, Morris SB, Duessel S, Danaie D, Hickman A, Griffith B, Sanneh H, Hutchins H, Phyathep C, Carpenter A, Shelus V, Petras J, Hennessee I, Davis M, McArdle C, Dawson P, Gutelius B, Bisgard K, Wong K, Galang RR, Perkins KM, Filardo TD, Davidson W, Hutson C, Lowe D, Zucker JE, Wheeler DA, He L, Jain AK, Semeniuk O, Chatterji D, McClure M, Li LX, Mata J, Beselman S, Cross SL, Menzies B, Keller M, Chaturvedi V, Thet A, Carroll R, Hebert C, Patel G, Gandhi V, Abrams-Downey A, Nawab M, Landon E, Lee G, Kaplan-Lewis E, Miranda C, Carmack AE, Traver EC, Lazarte S, Perl TM, Chow J, Kitchell E, Nijhawan A, Habib O, Bernus A, Andujar G, Davar K, Holtom P, Wald-Dickler N, Lorio MA, Gaviria J, Chu V, Wolfe CR, McKellar MS, Farran S, Diaz Wong RA, Schliep T, Shaw R, Tebas P, Richterman A, Aurelius M, Peterson L, Trible R, Rehman T, Sabzwari R, Hines E, Birkey T, Stokich D, King J, Farabi A, Jenny-Avital E, Touleyrou L, Sandhu A, Newman G, Bhamidipati D, Bhamidipati D, Vigil K, Caro M, Banowski K, Chinyadza TW, Rosenzweig J, Jones MS, Camargo JF, Marsh KJ, Liu EW, Guerrero-Wooley R, Pottinger P. Severe Monkeypox in Hospitalized Patients - United States, August 10-October 10, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1412-1417. [PMID: 36327164 PMCID: PMC9639440 DOI: 10.15585/mmwr.mm7144e1] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [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: 11/22/2022]
Abstract
As of October 21, 2022, a total of 27,884 monkeypox cases (confirmed and probable) have been reported in the United States.§ Gay, bisexual, and other men who have sex with men have constituted a majority of cases, and persons with HIV infection and those from racial and ethnic minority groups have been disproportionately affected (1,2). During previous monkeypox outbreaks, severe manifestations of disease and poor outcomes have been reported among persons with HIV infection, particularly those with AIDS (3-5). This report summarizes findings from CDC clinical consultations provided for 57 patients aged ≥18 years who were hospitalized with severe manifestations of monkeypox¶ during August 10-October 10, 2022, and highlights three clinically representative cases. Overall, 47 (82%) patients had HIV infection, four (9%) of whom were receiving antiretroviral therapy (ART) before monkeypox diagnosis. Most patients were male (95%) and 68% were non-Hispanic Black (Black). Overall, 17 (30%) patients received intensive care unit (ICU)-level care, and 12 (21%) have died. As of this report, monkeypox was a cause of death or contributing factor in five of these deaths; six deaths remain under investigation to determine whether monkeypox was a causal or contributing factor; and in one death, monkeypox was not a cause or contributing factor.** Health care providers and public health professionals should be aware that severe morbidity and mortality associated with monkeypox have been observed during the current outbreak in the United States (6,7), particularly among highly immunocompromised persons. Providers should test all sexually active patients with suspected monkeypox for HIV at the time of monkeypox testing unless a patient is already known to have HIV infection. Providers should consider early commencement and extended duration of monkeypox-directed therapy†† in highly immunocompromised patients with suspected or laboratory-diagnosed monkeypox.§§ Engaging all persons with HIV in sustained care remains a critical public health priority.
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20
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Cash-Goldwasser S, Labuda SM, McCormick DW, Rao AK, McCollum AM, Petersen BW, Chodosh J, Brown CM, Chan-Colenbrander SY, Dugdale CM, Fischer M, Forrester A, Griffith J, Harold R, Furness BW, Huang V, Kaufman AR, Kitchell E, Lee R, Lehnertz N, Lynfield R, Marsh KJ, Madoff LC, Nicolasora N, Patel D, Pineda R, Powrzanas T, Roberts A, Seville MT, Shah A, Wong JM, Ritter JM, Schrodt CA, Raizes E, Morris SB, Gold JAW. Ocular Monkeypox - United States, July-September 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1343-1347. [PMID: 36264836 PMCID: PMC9590292 DOI: 10.15585/mmwr.mm7142e1] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
As of October 11, 2022, a total of 26,577 monkeypox cases had been reported in the United States.* Although most cases of monkeypox are self-limited, lesions that involve anatomically vulnerable sites can cause complications. Ocular monkeypox can occur when Monkeypox virus (MPXV) is introduced into the eye (e.g., from autoinoculation), potentially causing conjunctivitis, blepharitis, keratitis, and loss of vision (1). This report describes five patients who acquired ocular monkeypox during July-September 2022. All patients received treatment with tecovirimat (Tpoxx)†; four also received topical trifluridine (Viroptic).§ Two patients had HIV-associated immunocompromise and experienced delays between clinical presentation with monkeypox and initiation of monkeypox-directed treatment. Four patients were hospitalized, and one experienced marked vision impairment. To decrease the risk for autoinoculation, persons with monkeypox should be advised to practice hand hygiene and to avoid touching their eyes, which includes refraining from using contact lenses (2). Health care providers and public health practitioners should be aware that ocular monkeypox, although rare, is a sight-threatening condition. Patients with signs and symptoms compatible with ocular monkeypox should be considered for urgent ophthalmologic evaluation and initiation of monkeypox-directed treatment. Public health officials should be promptly notified of cases of ocular monkeypox. Increased clinician awareness of ocular monkeypox and of approaches to prevention, diagnosis, and treatment might reduce associated morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - CDC Monkeypox Clinical Escalations Team
- CDC Monkeypox Emergency Response Team; Epidemic Intelligence Service, CDC; Minnesota Department of Health; University of New Mexico School of Medicine, Albuquerque, New Mexico; Massachusetts Department of Public Health; University of Minnesota Medical Center, Minneapolis, Minnesota; Massachusetts General Hospital, Boston, Massachusetts; Texas Department of State Health Services; Dallas County Health and Human Services, Dallas, Texas; District of Columbia Department of Health, Washington, D.C.; Maricopa County Department of Health, Phoenix, Arizona; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; University of Texas Southwestern Medical Center, Dallas, Texas; The George Washington University School of Medicine and Health Sciences, Washington, D.C.; Banner University Medical Center, University of Arizona, Phoenix, Arizona; Mayo Clinic Hospital, Phoenix, Arizona; Pueblo Family Physicians, Phoenix, Arizona
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Morgan CN, Whitehill F, Doty JB, Schulte J, Matheny A, Stringer J, Delaney LJ, Esparza R, Rao AK, McCollum AM. Environmental Persistence of Monkeypox Virus on Surfaces in Household of Person with Travel-Associated Infection, Dallas, Texas, USA, 2021. Emerg Infect Dis 2022; 28:1982-1989. [PMID: 35951009 PMCID: PMC9514334 DOI: 10.3201/eid2810.221047] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In July 2021, we conducted environmental sampling at the residence of a person in Dallas, Texas, USA, who had travel-associated human West African monkeypox virus (MPXV-WA). Targeted environmental swab sampling was conducted 15 days after the person who had monkeypox left the household. Results indicate extensive MPXV-WA DNA contamination, and viable virus from 7 samples was successfully isolated in cell culture. There was no statistical difference (p = 0.94) between MPXV-WA PCR positivity of porous (9/10, 90%) vs. nonporous (19/21, 90.5%) surfaces, but there was a significant difference (p<0.01) between viable virus detected in cultures of porous (6/10, 60%) vs. nonporous (1/21, 5%) surfaces. These findings indicate that porous surfaces (e.g., bedding, clothing) may pose more of a MPXV exposure risk than nonporous surfaces (e.g., metal, plastic). Viable MPXV was detected on household surfaces after at least 15 days. However, low titers (<102 PFU) indicate a limited potential for indirect transmission.
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22
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Minhaj FS, Petras JK, Brown JA, Mangla AT, Russo K, Willut C, Lee M, Beverley J, Harold R, Milroy L, Pope B, Gould E, Beeler C, Schneider J, Mostafa HH, Godfred-Cato S, Click ES, Borah BF, Galang RR, Cash-Goldwasser S, Wong JM, McCormick DW, Yu PA, Shelus V, Carpenter A, Schatzman S, Lowe D, Townsend MB, Davidson W, Wynn NT, Satheshkumar PS, O'Connor SM, O'Laughlin K, Rao AK, McCollum AM, Negrón ME, Hutson CL, Salzer JS. Orthopoxvirus Testing Challenges for Persons in Populations at Low Risk or Without Known Epidemiologic Link to Monkeypox — United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1155-1158. [PMID: 36074752 PMCID: PMC9470221 DOI: 10.15585/mmwr.mm7136e1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Pfeiffer JA, Collingwood A, Rider LE, Minhaj FS, Matheny AM, Kling C, McCollum AM, Nolen LD, Morgan CN. High-Contact Object and Surface Contamination in a Household of Persons with Monkeypox Virus Infection — Utah, June 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1092-1094. [PMID: 36006842 PMCID: PMC9422960 DOI: 10.15585/mmwr.mm7134e1] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Philpott D, Hughes CM, Alroy KA, Kerins JL, Pavlick J, Asbel L, Crawley A, Newman AP, Spencer H, Feldpausch A, Cogswell K, Davis KR, Chen J, Henderson T, Murphy K, Barnes M, Hopkins B, Fill MMA, Mangla AT, Perella D, Barnes A, Hughes S, Griffith J, Berns AL, Milroy L, Blake H, Sievers MM, Marzan-Rodriguez M, Tori M, Black SR, Kopping E, Ruberto I, Maxted A, Sharma A, Tarter K, Jones SA, White B, Chatelain R, Russo M, Gillani S, Bornstein E, White SL, Johnson SA, Ortega E, Saathoff-Huber L, Syed A, Wills A, Anderson BJ, Oster AM, Christie A, McQuiston J, McCollum AM, Rao AK, Negrón ME. Epidemiologic and Clinical Characteristics of Monkeypox Cases - United States, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:1018-1022. [PMID: 35951487 PMCID: PMC9400536 DOI: 10.15585/mmwr.mm7132e3] [Citation(s) in RCA: 198] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Minhaj FS, Ogale YP, Whitehill F, Schultz J, Foote M, Davidson W, Hughes CM, Wilkins K, Bachmann L, Chatelain R, Donnelly MA, Mendoza R, Downes BL, Roskosky M, Barnes M, Gallagher GR, Basgoz N, Ruiz V, Kyaw NTT, Feldpausch A, Valderrama A, Alvarado-Ramy F, Dowell CH, Chow CC, Li Y, Quilter L, Brooks J, Daskalakis DC, McClung RP, Petersen BW, Damon I, Hutson C, McQuiston J, Rao AK, Belay E, McCollum AM. Monkeypox Outbreak - Nine States, May 2022. MMWR Morb Mortal Wkly Rep 2022; 71:764-769. [PMID: 35679181 PMCID: PMC9181052 DOI: 10.15585/mmwr.mm7123e1] [Citation(s) in RCA: 171] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
On May 17, 2022, the Massachusetts Department of Public Health (MDPH) Laboratory Response Network (LRN) laboratory confirmed the presence of orthopoxvirus DNA via real-time polymerase chain reaction (PCR) from lesion swabs obtained from a Massachusetts resident. Orthopoxviruses include Monkeypox virus, the causative agent of monkeypox. Subsequent real-time PCR testing at CDC on May 18 confirmed that the patient was infected with the West African clade of Monkeypox virus. Since then, confirmed cases* have been reported by nine states. In addition, 28 countries and territories,† none of which has endemic monkeypox, have reported laboratory-confirmed cases. On May 17, CDC, in coordination with state and local jurisdictions, initiated an emergency response to identify, monitor, and investigate additional monkeypox cases in the United States. This response has included releasing a Health Alert Network (HAN) Health Advisory, developing interim public health and clinical recommendations, releasing guidance for LRN testing, hosting clinician and public health partner outreach calls, disseminating health communication messages to the public, developing protocols for use and release of medical countermeasures, and facilitating delivery of vaccine postexposure prophylaxis (PEP) and antivirals that have been stockpiled by the U.S. government for preparedness and response purposes. On May 19, a call center was established to provide guidance to states for the evaluation of possible cases of monkeypox, including recommendations for clinical diagnosis and orthopoxvirus testing. The call center also gathers information about possible cases to identify interjurisdictional linkages. As of May 31, this investigation has identified 17§ cases in the United States; most cases (16) were diagnosed in persons who identify as gay, bisexual, or men who have sex with men (MSM). Ongoing investigation suggests person-to-person community transmission, and CDC urges health departments, clinicians, and the public to remain vigilant, institute appropriate infection prevention and control measures, and notify public health authorities of suspected cases to reduce disease spread. Public health authorities are identifying cases and conducting investigations to determine possible sources and prevent further spread. This activity was reviewed by CDC and conducted consistent with applicable federal law and CDC policy.¶.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Monkeypox Response Team 2022
- Epidemic Intelligence Service, CDC; Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC; Massachusetts Department of Public Health; New York City Department of Health and Mental Hygiene, New York, New York; Salt Lake County Health Department, Salt Lake City, Utah; Florida Department of Health; Fairfax County Health Department, Fairfax, Virginia; Public Health - Seattle & King County, Seattle, Washington; Colorado Department of Public Health and Environment; Massachusetts General Hospital, Boston Massachusetts; Georgia Department of Health; Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC; Division of Global Migration and Quarantine, National Center of Emerging Zoonotic Infectious Diseases, CDC; National Institute for Occupational Safety and Health; Division of Global Health Protection, Center for Global Health, CDC; Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
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27
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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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Rao AK, Schulte J, Chen TH, Hughes CM, Davidson W, Neff JM, Markarian M, Delea KC, Wada S, Liddell A, Alexander S, Sunshine B, Huang P, Honza HT, Rey A, Monroe B, Doty J, Christensen B, Delaney L, Massey J, Waltenburg M, Schrodt CA, Kuhar D, Satheshkumar PS, Kondas A, Li Y, Wilkins K, Sage KM, Yu Y, Yu P, Feldpausch A, McQuiston J, Damon IK, McCollum AM. Monkeypox in a Traveler Returning from Nigeria - Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep 2022; 71:509-516. [PMID: 35389974 PMCID: PMC8989376 DOI: 10.15585/mmwr.mm7114a1] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Monkeypox is a rare, sometimes life-threatening zoonotic infection that occurs in west and central Africa. It is caused by Monkeypox virus, an orthopoxvirus similar to Variola virus (the causative agent of smallpox) and Vaccinia virus (the live virus component of orthopoxvirus vaccines) and can spread to humans. After 39 years without detection of human disease in Nigeria, an outbreak involving 118 confirmed cases was identified during 2017-2018 (1); sporadic cases continue to occur. During September 2018-May 2021, six unrelated persons traveling from Nigeria received diagnoses of monkeypox in non-African countries: four in the United Kingdom and one each in Israel and Singapore. In July 2021, a man who traveled from Lagos, Nigeria, to Dallas, Texas, became the seventh traveler to a non-African country with diagnosed monkeypox. Among 194 monitored contacts, 144 (74%) were flight contacts. The patient received tecovirimat, an antiviral for treatment of orthopoxvirus infections, and his home required large-scale decontamination. Whole genome sequencing showed that the virus was consistent with a strain of Monkeypox virus known to circulate in Nigeria, but the specific source of the patient's infection was not identified. No epidemiologically linked cases were reported in Nigeria; no contact received postexposure prophylaxis (PEP) with the orthopoxvirus vaccine ACAM2000.
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29
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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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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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32
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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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Duggan AT, Klunk J, Porter AF, Dhody AN, Hicks R, Smith GL, Humphreys M, McCollum AM, Davidson WB, Wilkins K, Li Y, Burke A, Polasky H, Flanders L, Poinar D, Raphenya AR, Lau TTY, Alcock B, McArthur AG, Golding GB, Holmes EC, Poinar HN. The origins and genomic diversity of American Civil War Era smallpox vaccine strains. Genome Biol 2020; 21:175. [PMID: 32684155 PMCID: PMC7370420 DOI: 10.1186/s13059-020-02079-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/30/2019] [Accepted: 06/19/2020] [Indexed: 12/11/2022] Open
Abstract
Vaccination has transformed public health, most notably including the eradication of smallpox. Despite its profound historical importance, little is known of the origins and diversity of the viruses used in smallpox vaccination. Prior to the twentieth century, the method, source and origin of smallpox vaccinations remained unstandardised and opaque. We reconstruct and analyse viral vaccine genomes associated with smallpox vaccination from historical artefacts. Significantly, we recover viral molecules through non-destructive sampling of historical materials lacking signs of biological residues. We use the authenticated ancient genomes to reveal the evolutionary relationships of smallpox vaccination viruses within the poxviruses as a whole.
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Affiliation(s)
- Ana T Duggan
- Department of Anthropology, McMaster University, Hamilton, L8S 4L9, Canada.
| | - Jennifer Klunk
- Department of Biology, McMaster University, Hamilton, L8S 4L9, Canada.,Present address: Arbor Biosciences, Ann Arbor, MI, 48103, USA
| | - Ashleigh F Porter
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and School of Medical Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anna N Dhody
- Mütter Research Institute, Philadelphia, PA, 19103, USA.,Mütter Museum of The College of Physicians of Philadelphia, Philadelphia, PA, 19103, USA
| | - Robert Hicks
- Mütter Research Institute, Philadelphia, PA, 19103, USA.,Mütter Museum of The College of Physicians of Philadelphia, Philadelphia, PA, 19103, USA
| | - Geoffrey L Smith
- Department of Pathology, University of Cambridge, Cambridge, CB2 1QP, UK
| | | | - Andrea M McCollum
- U.S. Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, GA, 30333, USA
| | - Whitni B Davidson
- U.S. Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, GA, 30333, USA
| | - Kimberly Wilkins
- U.S. Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, GA, 30333, USA
| | - Yu Li
- U.S. Centers for Disease Control and Prevention, Division of High-Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, GA, 30333, USA
| | - Amanda Burke
- Mütter Museum of The College of Physicians of Philadelphia, Philadelphia, PA, 19103, USA
| | - Hanna Polasky
- Mütter Museum of The College of Physicians of Philadelphia, Philadelphia, PA, 19103, USA
| | - Lowell Flanders
- Mütter Museum of The College of Physicians of Philadelphia, Philadelphia, PA, 19103, USA
| | - Debi Poinar
- Department of Anthropology, McMaster University, Hamilton, L8S 4L9, Canada
| | | | - Tammy T Y Lau
- Present address: BC Cancer Research Centre, Vancouver, V5Z 1G1, Canada.,M.G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, DeGroote School of Medicine, McMaster University, Hamilton, L8S 4K1, Canada
| | - Brian Alcock
- Present address: BC Cancer Research Centre, Vancouver, V5Z 1G1, Canada
| | - Andrew G McArthur
- Present address: BC Cancer Research Centre, Vancouver, V5Z 1G1, Canada
| | - G Brian Golding
- Department of Biology, McMaster University, Hamilton, L8S 4L9, Canada
| | - Edward C Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and School of Medical Sciences, University of Sydney, Sydney, NSW, 2006, Australia
| | - Hendrik N Poinar
- Department of Anthropology, McMaster University, Hamilton, L8S 4L9, Canada.,Present address: BC Cancer Research Centre, Vancouver, V5Z 1G1, Canada.,Department of Biochemistry, McMaster University, Hamilton, L8S 4L9, Canada
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34
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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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35
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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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36
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Whitehouse ER, Rao AK, Yu YC, Yu PA, Griffin M, Gorman S, Angel KA, McDonald EC, Manlutac AL, de Perio MA, McCollum AM, Davidson W, Wilkins K, Ortega E, Satheshkumar PS, Townsend MB, Isakari M, Petersen BW. Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick - San Diego, California, 2019. MMWR Morb Mortal Wkly Rep 2019; 68:943-946. [PMID: 31647789 PMCID: PMC6812835 DOI: 10.15585/mmwr.mm6842a2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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37
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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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38
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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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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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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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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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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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43
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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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44
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Hsu CH, Champaloux SW, Keïta S, Martel L, Bilivogui P, Knust B, McCollum AM. Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic. Emerg Infect Dis 2018; 24:9-14. [PMID: 29260687 PMCID: PMC5749454 DOI: 10.3201/eid2401.161678] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March-October 2014; n = 2,847 persons) to identify patients who satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculated sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (p<0.05 by χ2 test). Multiple components of the EVD case definition used in Guinea contributed to improved overall sensitivity and specificity.
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Doshi RH, Guagliardo SAJ, Dzabatou-Babeaux A, Likouayoulou C, Ndakala N, Moses C, Olson V, McCollum AM, Petersen BW. Strengthening of Surveillance during Monkeypox Outbreak, Republic of the Congo, 2017. Emerg Infect Dis 2018; 24:1158-1160. [PMID: 29774865 PMCID: PMC6004878 DOI: 10.3201/eid2406.180248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Reports of 10 suspected cases of monkeypox in Likouala Department, Republic of the Congo, triggered an investigation and response in March 2017 that included community education and surveillance strengthening. Increasing numbers of outbreaks suggest that monkeypox virus is becoming a more prevalent human pathogen. Diverse approaches are necessary for disease control and prevention.
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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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47
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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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48
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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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49
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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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50
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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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