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Nka AD, Bouba Y, Fokam J, Ka'e AC, Gabisa JE, Mandeng N, Mfonkou DJT, Ambe CC, Mballa Mpouel ML, Djikeussi T, Tchounga BK, Ayuk Ngwese DT, Njume D, Mbala Nomo SE, Ngoufack Jagni Semengue E, Tiotsia Tsapi A, Fokou BB, Simo Kamdem IK, Tommo Tchouaket MC, Takou D, Pabo W, Sosso SM, Tandi E, Esso L, Etoundi Mballa GA, Zoung-Kanyi Bissek AC, Gregory Edie HE, Ndembi N, Colizzi V, Perno CF, Ndjolo A. Current knowledge of human Mpox viral infection among healthcare workers in Cameroon calls for capacity-strengthening for pandemic preparedness. Front Public Health 2024; 12:1288139. [PMID: 38532968 PMCID: PMC10963399 DOI: 10.3389/fpubh.2024.1288139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction An increased incidence of human Monkeypox (Mpox) cases was recently observed worldwide, including in Cameroon. To ensure efficient preparedness and interventions in the health system, we sought to assess the knowledge of Mpox's transmission, prevention, and response among healthcare workers (HCWs) in Cameroon. Methods A cross-sectional online survey was conducted among HCWs in Cameroon using 21-item questions adapted from the United States Centers for Disease Control and Prevention (US-CDC) standard questionnaire on Mpox. The overall knowledge of Mpox was assessed by cumulative score and categorized as excellent (≥80%, 17/21) or good (≥70%, ≥15/21) knowledge. The regression analysis was used to identify the predictors of Mpox knowledge. Results The survey enrolled 377 participants, but only responses from 342 participants were analyzed. Overall, 50.6% were female participants, and 59.6% aged 30 years or younger. The majority of the participants were medical doctors (50.3%); most worked in central-level hospitals (25.1%) and had 1-5 years of experience (70.7%). A total of up to 92.7% were aware of Mpox, with social media (58.7%) and radio/television (49.2%) as the main sources. The mean knowledge score was 14.0 ± 3.0 (4 to 20), with only 12.9% having excellent knowledge (≥80%) and 42.1% having good knowledge of Mpox. Younger age (26-30 years old) was associated with good knowledge, while workplace type was associated with excellent knowledge of Mpox (aOR [95% CI]: 4.01 [1.43-11.24]). Knowledge of treatment/management of Mpox was generally poor across the different professional categories. Conclusion Knowledge of Mpox among HCWs is substandard across different professionals. Thus, for optimal preparedness and immediate interventions for Mpox and similar emerging pathogens, capacity-strengthening programs should be organized for HCWs while encouraging scientific literature and organizational social media websites.
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Affiliation(s)
- Alex Durand Nka
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Yagai Bouba
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine, UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
- National AIDS Control Committee, Central Technical Group, Ministry of Public Health, Yaoundé, Cameroon
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Aude Christelle Ka'e
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Jeremiah Efakika Gabisa
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Department of Health Biotechnology, Fobang Institutes for Innovations in Science and Technology, Yaoundé, Cameroon
| | - Nadia Mandeng
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | - Chenwi Collins Ambe
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Marie-Laure Mballa Mpouel
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Tatiana Djikeussi
- Elisabeth Glaser Peadiatric AIDS Foundation (EGPAF), Douala, Cameroon
| | | | - Derrick Tambe Ayuk Ngwese
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Department of Health Biotechnology, Fobang Institutes for Innovations in Science and Technology, Yaoundé, Cameroon
| | - Debimeh Njume
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
| | | | - Ezechiel Ngoufack Jagni Semengue
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Armand Tiotsia Tsapi
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | | | | | - Michel Carlos Tommo Tchouaket
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Désiré Takou
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
| | - Willy Pabo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Sciences, University of Buea, Buea, Cameroon
- Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Samuel Martin Sosso
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
| | - Erick Tandi
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Department of Disease, Epidemics, and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Linda Esso
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Department of Disease, Epidemics, and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | - Georges Alain Etoundi Mballa
- National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon
- Department of Disease, Epidemics, and Pandemics Control, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Nicaise Ndembi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Vittorio Colizzi
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy
- Faculty of Sciences and Technologies, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Carlo-Federico Perno
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Microbiology, IRCSS Bambino Gesu' Pediatric Hospital, Rome, Italy
| | - Alexis Ndjolo
- Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB) Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Alakunle E, Kolawole D, Diaz-Cánova D, Alele F, Adegboye O, Moens U, Okeke MI. A comprehensive review of monkeypox virus and mpox characteristics. Front Cell Infect Microbiol 2024; 14:1360586. [PMID: 38510963 PMCID: PMC10952103 DOI: 10.3389/fcimb.2024.1360586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Monkeypox virus (MPXV) is the etiological agent of monkeypox (mpox), a zoonotic disease. MPXV is endemic in the forested regions of West and Central Africa, but the virus has recently spread globally, causing outbreaks in multiple non-endemic countries. In this paper, we review the characteristics of the virus, including its ecology, genomics, infection biology, and evolution. We estimate by phylogenomic molecular clock that the B.1 lineage responsible for the 2022 mpox outbreaks has been in circulation since 2016. We interrogate the host-virus interactions that modulate the virus infection biology, signal transduction, pathogenesis, and host immune responses. We highlight the changing pathophysiology and epidemiology of MPXV and summarize recent advances in the prevention and treatment of mpox. In addition, this review identifies knowledge gaps with respect to the virus and the disease, suggests future research directions to address the knowledge gaps, and proposes a One Health approach as an effective strategy to prevent current and future epidemics of mpox.
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Affiliation(s)
- Emmanuel Alakunle
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
| | - Daniel Kolawole
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
| | - Diana Diaz-Cánova
- Department of Medical Biology, UIT – The Arctic University of Norway, Tromsø, Norway
| | - Faith Alele
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Oyelola Adegboye
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ugo Moens
- Department of Medical Biology, UIT – The Arctic University of Norway, Tromsø, Norway
| | - Malachy Ifeanyi Okeke
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
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Kalaba MH, El-Sherbiny GM, Sharaf MH, Farghal EE. Biological Characteristics and Pathogenesis of Monkeypox Virus: An Overview. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:91-109. [PMID: 38801573 DOI: 10.1007/978-3-031-57165-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Although the smallpox virus has been eradicated worldwide, the World Health Organization (WHO) has issued a warning about the virus's potential to propagate globally. The WHO labeled monkeypox a world public health emergency in July 2022, requiring urgent prevention and treatment. The monkeypox virus is a part of the Poxviridae family, Orthopoxvirus genus, and is accountable for smallpox, which has killed over a million people in the past. Natural hosts of the virus include squirrels, Gambian rodents, chimpanzees, and other monkeys. The monkeypox virus has transmitted to humans through primary vectors (various animal species) and secondary vectors, including direct touch with lesions, breathing particles from body fluids, and infected bedding. The viral particles are ovoid or brick-shaped, 200-250 nm in diameter, contain a single double-stranded DNA molecule, and reproduce only in the cytoplasm of infected cells. Monkeypox causes fever, cold, muscle pains, headache, fatigue, and backache. The phylogenetic investigation distinguished between two genetic clades of monkeypox: the more pathogenic Congo Basin clade and the West Africa clade. In recent years, the geographical spread of the human monkeypox virus has accelerated despite a paucity of information regarding the disease's emergence, ecology, and epidemiology. Using lesion samples and polymerase chain reaction (PCR), the monkeypox virus was diagnosed. In the USA, the improved Ankara vaccine can now be used to protect people who are at a higher risk of getting monkeypox. Antivirals that we have now work well against smallpox and may stop the spread of monkeypox, but there is no particular therapy for monkeypox.
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Affiliation(s)
- Mohamed H Kalaba
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt
| | - Gamal M El-Sherbiny
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt.
| | - Mohammed H Sharaf
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt
| | - Eman E Farghal
- Clinical and Chemical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Jahromi AS, Jokar M, Sharifi N, Kashkooli S, Rahmanian K, Rahmanian V. Global knowledge and attitudes towards mpox (monkeypox) among healthcare workers: a systematic review and meta-analysis. Int Health 2023:ihad094. [PMID: 37861417 DOI: 10.1093/inthealth/ihad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The recent increase in human mpox (monkeypox) cases emphasizes the importance of early detection, prompt response and preventive management to control the spread of the disease. Healthcare workers (HCWs) play a crucial role in this process. This study aimed to determine the global knowledge and attitudes towards mpox among HCWs. METHODS This study searched multiple databases, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, Embase, Springer and ProQuest, to locate various publications. The search was limited to English-language articles published between May 2022 (when the increase in mpox incidence was reported) and August 2023. The Joanna Briggs Institute (JBI) quality checklist was utilized to evaluate the quality of the included studies. Data were obtained using a Microsoft Excel spreadsheet and subsequently scrutinized through STATA software, version 14. The heterogeneity of the studies was assessed using the inverse variance and Cochran Q statistics based on the I2 test statistics. The Dersimonian and Liard random effects models were used where heterogeneity existed. Subgroup analysis and univariate and multivariable metaregression techniques were used to examine the causes of heterogeneity. RESULTS A total of 22 studies, including 22 studies for knowledge (27 731 HCWs) and 6 studies for attitudes (14 388 HCWs), were included in the meta-analysis. The pooled estimates for good knowledge and positive attitudes among HCWs were 26.0% (95% confidence interval [CI] 17.8 to 34.2) and 34.6% (95% CI 19.0 to 50.2), respectively. Moreover, the knowledge was 34.8% (95% CI 24.1 to 45.6) among HCWs with <5 y of work experience and 41.6% (95% CI 33.1 to 50) among individuals possessing >5 y of professional background. CONCLUSIONS Good knowledge of HCWs is at a low level. It is suggested that training sessions should be tailored towards younger HCWs with less healthcare experience. Additionally, it is essential to identify strategies on how to improve the knowledge and attitudes for better practice about the disease in HCWs worldwide.
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Affiliation(s)
| | - Mohammad Jokar
- Faculty of Veterinary Medicine, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Nader Sharifi
- Department of Public Health, Khomein University of Medical Sciences, Khomein, Iran
| | - Sirus Kashkooli
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Karamatollah Rahmanian
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Vahid Rahmanian
- Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat Jam, Iran
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5
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Swed S, Bohsas H, Patwary MM, Alibrahim H, Rakab A, Nashwan AJ, Hafez W, Hassan NAI, Shoib S, Elsayed M, Sawaf B, Albuni MK, Battikh E, Mohamed GMK, AlBozom A, Shaddad E, Fathey S, Nu Htay MN, Sah S, Cherrez-Ojeda I, Mohanty A, Padhi BK, Rodriguez-Morales AJ, Gandhi P A, Sah R. Knowledge of mpox and its determinants among the healthcare personnel in Arabic regions: A multi-country cross-sectional study. New Microbes New Infect 2023; 54:101146. [PMID: 37363720 PMCID: PMC10251727 DOI: 10.1016/j.nmni.2023.101146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 06/28/2023] Open
Abstract
Background & aim The monkeypox virus (MPXV), an Orthopoxvirus family member, is the zoonotic agent that causes mpox (formerly known as monkeypox). The ongoing mpox pandemic has caused cases across continents involving 110 countries. This study aimed to assess mpox knowledge and its determinants among healthcare personnel. Methods This cross-sectional study was conducted from June 6 to June 25, 2022, among 17 Arab countries. The self-administered questionnaire consists of 53 questions assessing the knowledge about the monkeypox virus. Results In total, 5874 medical students and clinical doctors from 17 Arab countries participated in this study. Only 13.8% (n = 812) of respondents have ever received information about mpox during their studies in medicine. The mean knowledge score was 13.84, and the median score was 15 (range 1-34). More than half (51.3%, n = 3012) have heard about mpox before. A low proportion of the participants had a good level of knowledge on mpox. Only 11.7% of respondents had correctly identified the natural host and the incubation period of mpox. More than half (58.9%) were aware of the signs and symptoms of mpox. Few respondents (28%) believed that mpox and smallpox have similar signs and symptoms. Specialist doctors had higher knowledge of mpox (AOR = 2.96, 95% CI = 2.24-3.92, p < 0.001) than other cadres. Conclusion Mpox awareness among Arabic medical students and practitioners is low; hence immediate action in creating awareness among arab healthcare professionals is the need of the hour. This is crucial in the mpox early detection and prevention of its spread.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Muhammad Mainuddin Patwary
- Environment and Sustainability Research Initiative, Khulna, 9208, Bangladesh
- Environmental Science Discipline, Life Science School, Khulna University, Khulna, 9208, Bangladesh
| | | | | | | | - Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, United Arab Emirates
- Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo, Egypt
| | | | - Sheikh Shoib
- JLNM Hospital, Rainawari, Srinagar, India
- Directorate of Health Services, J&K, India
| | - Mohamed Elsayed
- Department of Psychiatry and Psychotherapy III, University of Ulm, Leimgrubenweg, 12-14, 89075, Ulm, Germany
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Elias Battikh
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Adel AlBozom
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mila Nu Nu Htay
- Department of Community Medicine, Faculty of Medicine, Manipal University College Malaysia, Malaysia
| | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, 442001, India
- SR Sanjeevani Hospital Kalyanpur-10, Siraha, Nepal
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador; Respiralab Research Group, Guayaquil, Ecuador
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
| | - Aravind Gandhi P
- Department of Community Medicine, ESIC Medical College & Hospital, Sanathnagar, Hyderabad, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, 46000, Nepal
- Department of Clinical Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411000, Maharashtra, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
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Abd ElHafeez S, Gebreal A, Khalil MA, Youssef N, Sallam M, Elshabrawy A, Abdel-Rahman S, Mahboob AS, Yazbek S, Elbanna EH, Adhyaru R, Rodoshi ZN, Kih YS, Jawad H, Kolotouros E, Jaworski A, AlQarni G, Gablan M, Condurat A, Elden AESSN, Bennani O, Rawat K, Ismail A, Al-Hajj Y, Elehamer NMK, Nagi J, Admassu H, Al Asaad SH, Duvuru R, Ogunlana O, Alosaimi B, Ghazy RM. Assessing disparities in medical students' knowledge and attitude about monkeypox: a cross-sectional study of 27 countries across three continents. Front Public Health 2023; 11:1192542. [PMID: 37575128 PMCID: PMC10415161 DOI: 10.3389/fpubh.2023.1192542] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/16/2023] [Indexed: 08/15/2023] Open
Abstract
Background and aims The recent monkeypox (Mpox) outbreak confirmed by the World Health Organization (WHO) underscores the importance of evaluating the knowledge and attitude of medical students toward emerging diseases, given their potential roles as healthcare professionals and sources of public information during outbreaks. This study aimed to assess medical students' knowledge and attitude about Mpox and to identify factors affecting their level of knowledge and attitude in low-income and high-income countries. Methods A cross-sectional study was conducted on 11,919 medical students from 27 countries. A newly-developed validated questionnaire was used to collect data on knowledge (14 items), attitude (12 items), and baseline criteria. The relationship between a range of factors with knowledge and attitude was studied using univariate and multivariate analyses. Results 46% of the study participants were males; 10.7% were in their sixth year; 54.6% knew about smallpox; 84% received the coronavirus disease 2019 (COVID-19) vaccine; and 12.5% had training on Mpox. 55.3% had good knowledge of Mpox and 51.7% had a positive attitude towards it. Medical students in their third, fifth, or sixth year high- income countries who obtained information on Mpox from friends, research articles, social media and scientific websites were positive predictors for good knowledge. Conversely, being male or coming from high-income countries showed a negative relation with good knowledge about Mpox. Additionally, a positive attitude was directly influenced by residing in urban areas, being in the fifth year of medical education, having knowledge about smallpox and a history of receiving the coronavirus disease 2019 (COVID-19) vaccine. Receiving information about Mpox from social media or scientific websites and possessing good knowledge about Mpox were also predictors of a positive attitude. On the other hand, being male, employed, or receiving a training program about Mpox were inversely predicting positive attitude about Mpox. Conclusion There were differences in knowledge and attitude towards Mpox between medical students in low and high-income countries, emphasizing the need for incorporating epidemiology of re-emerging diseases like Mpox into the medical curriculum to improve disease prevention and control.
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Affiliation(s)
- Samar Abd ElHafeez
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Assem Gebreal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohammad Adnan Khalil
- Department of Basic Medical Sciences, Faculty of Medicine, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Naglaa Youssef
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Medical-Surgical Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
| | - Abdelhamid Elshabrawy
- Department of Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt
| | - Suzan Abdel-Rahman
- Department of Biostatistics and Demography, Faculty of Graduate Studies for Statistical Research, Cairo University, Cairo, Egypt
| | - Amira Saad Mahboob
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Saja Yazbek
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Eman H. Elbanna
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | | | - Yap Siew Kih
- Taylor’s University School of Medicine, Subang Jaya, Malaysia
| | - Huda Jawad
- College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
| | - Evangelos Kolotouros
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ghadah AlQarni
- College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | | | | | - Oumayma Bennani
- Faculty Mohammed VI of Medicine and Pharmacy, Oujda, Morocco
| | - Kamna Rawat
- Government Doon Medical College, Dehradun, India
| | - Areeba Ismail
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Yasser Al-Hajj
- Faculty of Medicine, Beirut Arab University, Beirut, Lebanon
| | | | - Jasleen Nagi
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | | | - Ruthwik Duvuru
- College of Medicine, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | | | - Bandar Alosaimi
- Research Center, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Identifying the Most Probable Mammal Reservoir Hosts for Monkeypox Virus Based on Ecological Niche Comparisons. Viruses 2023; 15:v15030727. [PMID: 36992436 PMCID: PMC10057484 DOI: 10.3390/v15030727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Previous human cases or epidemics have suggested that Monkeypox virus (MPXV) can be transmitted through contact with animals of African rainforests. Although MPXV has been identified in many mammal species, most are likely secondary hosts, and the reservoir host has yet to be discovered. In this study, we provide the full list of African mammal genera (and species) in which MPXV was previously detected, and predict the geographic distributions of all species of these genera based on museum specimens and an ecological niche modelling (ENM) method. Then, we reconstruct the ecological niche of MPXV using georeferenced data on animal MPXV sequences and human index cases, and conduct overlap analyses with the ecological niches inferred for 99 mammal species, in order to identify the most probable animal reservoir. Our results show that the MPXV niche covers three African rainforests: the Congo Basin, and Upper and Lower Guinean forests. The four mammal species showing the best niche overlap with MPXV are all arboreal rodents, including three squirrels: Funisciurus anerythrus, Funisciurus pyrropus, Heliosciurus rufobrachium, and Graphiurus lorraineus. We conclude that the most probable MPXV reservoir is F. anerythrus based on two niche overlap metrics, the areas of higher probabilities of occurrence, and available data on MPXV detection.
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Hasan M, Hossain MA, Chowdhury S, Das P, Jahan I, Rahman MF, Haque MMA, Rashid MU, Khan MAS, Hossian M, Nabi MH, Hawlader MDH. Human monkeypox and preparedness of Bangladesh: A knowledge and attitude assessment study among medical doctors. J Infect Public Health 2023; 16:90-95. [PMID: 36508945 PMCID: PMC9724567 DOI: 10.1016/j.jiph.2022.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The recent increasing incidence of human monkeypox cases highlights the necessity of early detection, prompt response and preventive management to stop it in its tracks, and healthcare workers play the most crucial role here. This study aims at assessing the preparedness of Bangladeshi medical doctors by assessing their knowledge and attitude regarding monkeypox. METHODOLOGY This cross-sectional study was conducted among the practicing medical doctors all over Bangladesh. The data was collected from 26th May to 4th June of 2022 using a semi-structured and self-administered questionnaire which was distributed through the internet, and a total of 389 data was collected. The cut-off points for defining good knowledge and positive attitude towards human monkeypox were considered as 70% and 80% of total values, respectively. Multivariable logistic regression analyses were carried out to identify the factors associated with good knowledge and a positive attitude. Statistical software R version 4.2.0 was used for data analysis. RESULT Of all, 330 (84.83%) doctors displayed a positive attitude towards preventive practices, but only 119 (30.59%) participants had good knowledge regarding monkeypox. In multivariable logistic regression analysis, getting any information about monkeypox in the medical curriculum and learning about monkeypox within the last one month had a significant association with good knowledge. Apart from the participant's age, no other variables revealed any significant association with a positive attitude toward preventive practices. Good knowledge showed a significant association with positive attitude (p < 0.05). CONCLUSION Knowledge regarding human monkeypox among medical doctors in Bangladesh was comparatively lower than the attitude towards its preventive measures. Developing and implementing practical sessions regarding the virus to enhance the knowledge and capacity of the medical doctors could be an effective strategy to get prepared for the monkeypox outbreak in Bangladesh.
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Affiliation(s)
- Mehedi Hasan
- Department of Public Health, North South University, Dhaka 1229, Bangladesh,Public Health Professional Development Society (PPDS), Dhaka 1215, Bangladesh
| | - Mohammad Ali Hossain
- Department of Public Health, North South University, Dhaka 1229, Bangladesh,Ibn Sina Medical College Hospital, Kallyanpur, Dhaka 1216, Bangladesh
| | - Sreshtha Chowdhury
- Department of Public Health, North South University, Dhaka 1229, Bangladesh,Public Health Professional Development Society (PPDS), Dhaka 1215, Bangladesh
| | - Pranta Das
- Department of Statistics, University of Dhaka, Dhaka 1000, Bangladesh
| | - Ishrat Jahan
- Department of Public Health, North South University, Dhaka 1229, Bangladesh
| | - Md. Ferdous Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | | | - Md Utba Rashid
- Department of Public Health, North South University, Dhaka 1229, Bangladesh,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md Abdullah Saeed Khan
- Department of Public Health, North South University, Dhaka 1229, Bangladesh,Pi Research Consultancy Center, Lalbagh, Dhaka 1211, Bangladesh
| | - Mosharop Hossian
- Department of Public Health, North South University, Dhaka 1229, Bangladesh,Public Health Professional Development Society (PPDS), Dhaka 1215, Bangladesh
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Knowledge and vaccination intention of monkeypox in China's general population: A cross-sectional online survey. Travel Med Infect Dis 2022; 52:102533. [PMID: 36543284 PMCID: PMC9759477 DOI: 10.1016/j.tmaid.2022.102533] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/03/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Public awareness of monkeypox is critical in the fight against this infectious disease. However, at present a survey of the Chinese population on monkeypox is lacking. This study was conducted to compensate for the lack of knowledge and identify a vaccination intention assessment for monkeypox in China. METHODS The questionnaire comprised 20 items with the following three aspects: basic information, knowledge, and willingness to vaccinate or pay. For this study, 521 valid respondents were recruited. Utilizing logistic regression, the researchers identified the factors related with knowledge and vaccination intentions. RESULTS The average total score for knowledge of monkeypox was 5.6 (score range 0-10), and 309 (59.3%) participants were categorized as having greater knowledge based on a total score of 6. Most participants (76.4%) were willing to accept a monkeypox vaccination. The average acceptable cost of the monkeypox vaccine was CNY261.2. Factors such as level of education, and working within the healthcare profession were related to monkeypox knowledge. An increased knowledge of monkeypox was related to a higher willingness to vaccinate. Participants who were willing to pay more for vaccines included those with high incomes, who suffered from chronic diseases, and healthcare workers. CONCLUSIONS The Chinese population had relatively high knowledge of monkeypox and demonstrated a willingness to receive the vaccine.
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Masood W, Khan HA, Cheema HA, Shahid A, Bilal W, Kamal MA, Essar MY, Ahmad S, Marzo RR. The Past, Present, and Future of Monkeypox: A Rapid Review Regarding Prevalence and Prevention. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221139366. [PMID: 36484333 PMCID: PMC9742718 DOI: 10.1177/00469580221139366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While monkeypox virus (MPXV) remained endemic in central and western African countries, a sudden unusual spike of global cases among non-endemic countries is an enigma for scientists. With 257 cases reported as of 26th May 2021, a multi-country outbreak of monkeypox has been declared in countries including the UK, EU/EEA states, and North America. Even though the likelihood of transmissibility of MPXV is limited compared to COVID-19, yet a coordinated multidisciplinary effort is required to prevent any further global expansion. Few appropriate responsive approaches to contain the infection could be; limiting the contact with potential animal reservoirs, isolation of confirmed cases, using PPEs to prevent human-human transmission, awareness activities, and administration of pre and post prophylactic vaccination. In this review, we have discussed the previous and current outbreaks of MPXV along with the abrupt actions that are needed to address the situation.
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Affiliation(s)
| | | | | | - Abia Shahid
- King Edward Medical University, Lahore, Pakistan
| | - Wajeeha Bilal
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Mohammad Yasir Essar
- Kabul University of Medical Sciences, Kabul, Afghanistan,Mohammad Yasir Essar, Kabul University of Medical Sciences, Kabul, 1001, Afghanistan.
| | - Shoaib Ahmad
- District Head Quarter Teaching Hospital, Faisalabad, Pakistan
| | - Roy Rillera Marzo
- Department of Community Medicine, International Medical School, Management and Science University, Malaysia,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Jalilian S, Bastani MN. The Mpox, serious menace, or paper tiger? IRANIAN JOURNAL OF MICROBIOLOGY 2022; 14:770-777. [PMID: 36721442 PMCID: PMC9867611 DOI: 10.18502/ijm.v14i6.11251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
One of the most horrible diseases in history, Smallpox is caused by the Variola from Poxvirus family, has caused great morbidity and mortality along the way since it was eradicated in the 20th century. During and after the eradication program for Variola, other Poxviruses such as the Monkeypox (Mpox) virus, which causes a smallpox-like disease, became flagrant. With its long range of enzymes and proteins, poxviruses are effectively resisting hostile immune system attacks and disrupting cell signaling pathways. After Smallpox vaccination, cross-reaction immunity develops between Orthopoxviruses. Mpox is indeed an African endemic virus; however, increasing and emerging cases have been reported globally in recent years. According to Smallpox eradication in the 1970s and vaccination ceasing, nowadays centerpieces of the world population are vulnerable to Mpox virus. Our knowledge of Mpox is severely limited due to the lack of regular surveillance methods. Increasing education, boosting surveillance, and developing diagnostic competence is the most significant policies for improving identification, treatment, and restricting further virus spread. So Mpox can play a double-edge blade role in which without monitoring and increasing awareness it could be horrific and with public awareness and boosting surveillance it could be a paper tiger. This article reviewed previous reports about the Mpox merge from PubMed and google scholar from 2018 to June 2022.
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Affiliation(s)
| | - Mohammad-Navid Bastani
- Corresponding author: Mohammad-Navid Bastani, MSc, Department of Virology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Tel: +98-9362045869 Fax: +98-6113738313
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12
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Knowledge, attitudes, and practices towards monkeypox during the 2022 outbreak: An online cross-sectional survey among clinicians in Ohio, USA. J Infect Public Health 2022; 15:1459-1465. [PMID: 36403402 PMCID: PMC9650995 DOI: 10.1016/j.jiph.2022.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/25/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Controlling monkeypox effectively requires clinicians have knowledge of monkeypox, attitudes supporting of controlling it, and intentions to adopt practices to address it. Little is known, however, about levels of knowledge, attitudes, and practices (KAPs) in clinician populations in Ohio, United States. METHODS A cross-sectional, internet-based questionnaire assessed knowledge related to monkeypox, attitudes toward ability to control monkeypox and the threat of monkeypox, and prior relevant practices of having received a smallpox vaccine or having knowledge of monkeypox before 2022, intentions to adopt preventive practices, and demographics. Frequency reporting was used to assess overall knowledge and attitudes. Binary logistic regression was used to predict which KAPs were associated with behavioral intentions. RESULTS A total of 197 clinicians participated. No demographic factor was associated with KAPs. Clinicians had relatively poor levels of knowledge. Participants expressed mixed attitudes about eventual control of monkeypox and about threat posed by monkeypox. About one in four participants reported previous knowledge of monkeypox, and about 40 % had received a smallpox vaccine Clinicians reported insufficient levels of intention to adopt preventive practices. Binary regression analysis suggests only perceptions of the threat of monkeypox to public health were associated with intentions to vaccinate self or others. CONCLUSIONS Educational interventions with clinicians should address inadequate knowledge to support correct diagnosis and treatment. Efforts to enhance the perception of threat of monkeypox to public health may support adherence to preventive recommendations.
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13
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Riad A, Drobov A, Rozmarinová J, Drapáčová P, Klugarová J, Dušek L, Pokorná A, Klugar M. Monkeypox Knowledge and Vaccine Hesitancy of Czech Healthcare Workers: A Health Belief Model (HBM)-Based Study. Vaccines (Basel) 2022; 10:vaccines10122022. [PMID: 36560432 PMCID: PMC9788212 DOI: 10.3390/vaccines10122022] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The recent human monkeypox virus (HMPXV) outbreak in non-endemic countries that started in May 2022 has raised concerns among public health authorities worldwide. Healthcare workers (HCWs) play a decisive role during epidemics in transmitting accurate information to the public and motivating them to pursue protective behaviours, including immunisation. METHODS A cross-sectional survey-based study was conducted in the Czech Republic in September 2022 to evaluate HMPXV-related knowledge and vaccination perceptions among HCWs. The study utilised a digital self-administered questionnaire (SAQ) to collect data from the target population. The proposed SAQ inquired about participants' sociodemographic and anamnestic characteristics, perceived knowledge of HMPXV, factual knowledge, and vaccination perceptions according to the health belief model (HBM). RESULTS A total of 341 participants were included in this study; most of them were females (88.9%), allied HCWs (89.4%), heterosexuals (87.1%), married (61.9%), and vaccinated against COVID-19 (91.2%). Only 8.8% of the participants agreed to receive vaccination against HMPXV; 44.9% rejected it, while 46.3% were hesitant. While digital news portals (47.5%) and social media (25.8%) were among the most utilised sources of information about HMPXV, the scientific journals (5.6%), ECDC (5%), and the U.S. CDC (1.5%) were the least common sources. The participants demonstrated suboptimal levels of factual knowledge, especially regarding HMPXV vaccines (1.5 ± 1.2 (0-4)) and treatments (0.9 ± 0.9 (0-4)). Additionally, several misconceptions were detectable among the participants, regarding topics such as the availability of effective vaccines and antivirals against HMPXV, the risk of vertical transmission, and homosexual stigmatisation. The HBM indicated that the cues to action and perceived susceptibility were the most important constructs to predict HMPXV vaccine acceptance. CONCLUSIONS the findings of this study call upon public health practitioners and health policymakers in the Czech Republic to act accordingly in order to determine the drivers of vaccine hesitancy among Czech HCWs. Dedicated educational campaigns should aim to counter the HCWs' misconceptions around HMPXV, and future studies should aim to explore the prevalence and drivers of HMPXV vaccine hesitancy among the general population.
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Affiliation(s)
- Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
| | - Anton Drobov
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Jana Rozmarinová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
| | - Pavla Drapáčová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
| | - Ladislav Dušek
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
| | - Andrea Pokorná
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Correspondence:
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Institute of Health Information and Statistics of the Czech Republic (IHIS-CR), 128 01 Prague, Czech Republic
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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Farahat RA, Sah R, El-Sakka AA, Benmelouka AY, Kundu M, Labieb F, Shaheen RS, Abdelaal A, Abdelazeem B, Bonilla-Aldana DK, Franco-Paredes C, Henao-Martinez AF, Garout MA, León-Figueroa DA, Pachar M, Suárez JA, Ramirez JD, Paniz-Mondolfi A, Rabaan AA, Al-Tawfiq JA, Nishiura H, Ortiz-Martínez Y, Garcia-Robledo JE, Cimerman S, Barbosa AN, Pagliano P, Zambrano-Sanchez G, Cardona-Ospina JA, Bížová B, Rodriguez-Morales AJ. Human monkeypox disease (MPX). LE INFEZIONI IN MEDICINA 2022; 30:372-391. [PMID: 36148174 PMCID: PMC9448318 DOI: 10.53854/liim-3003-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/24/2022] [Indexed: 05/24/2023]
Abstract
Monkeypox is a rare viral infection, endemic in many central and western African countries. The last international outbreak of monkeypox reported outside Africa occurred back in 2003. However, monkeypox has reemerged at a global scale with numerous confirmed cases across the globe in 2022. The rapid spread of cases through different countries has raised serious concerns among public health officials worldwide prompting accelerated investigations aimed to identify the origins and cause of the rapid expansion of cases. The current situation is reminiscent of the very early stages of the still ongoing COVID-19 pandemic. Overlapping features between these, two seemingly alike viral entities include the possibility for airborne transmission and the currently unexplained and rapid spread across borders. Early recognition of cases and timely intervention of potential transmission chains are necessary to contain further outbreaks. Measures should include rapid and accurate diagnosis of cases meeting case definitions, active surveillance efforts, and appropriate containment of confirmed cases. Governments and health policymakers must apply lessons learned from previous outbreaks and start taking active steps toward limiting the recent global spread of monkeypox. Herein, we discuss the status of the current monkeypox outbreaks worldwide, the epidemiological and public health situation at a global scale and what can be done to keep at bay its further expansion and future global implications.
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Affiliation(s)
| | - Ranjit Sah
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Amro A. El-Sakka
- Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt
| | | | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, India
| | - Fatma Labieb
- Faculty of Medicine, Beni-Suef Univesity, Beni-Suef 62511, Egypt
| | | | - Abdelaziz Abdelaal
- Harvard Medical School, Boston, MA 02115, USA
- Boston University, MA 02215, USA
- Tanta University Hospitals, 31516 Egypt
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, Michigan 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan 48823, USA
| | - D. Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Latin American Network on MOnkeypox VIrus research (LAMOVI), Pereira, Risaralda, Colombia
| | | | | | - Mohammed A. Garout
- Community Medicine and Pilgrims Health Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Darwin A. León-Figueroa
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
- Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica Pachar
- Medicine Department-Infectious Diseases Service, Hospital Santo Tomas, Panama City, Panama
| | - José Antonio Suárez
- Investigador SNI Senacyt Panamá, Clinical Research Deparment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | - Juan David Ramirez
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hiroshi Nishiura
- Kyoto University School of Public Health, Yoshidakonoecho, Sakyoku, Kyoto City 6068501, Japan
| | - Yeimer Ortiz-Martínez
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Department of Internal Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | | | - Sergio Cimerman
- Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Alexandre Naime Barbosa
- Infectious Diseases Department, Botucatu Medical School, UNESP Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Pasquale Pagliano
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | | | - Jaime A. Cardona-Ospina
- Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, 660003, Pereira, Risaralda, Colombia
| | - Beatrice Bížová
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Latin American Network on MOnkeypox VIrus research (LAMOVI), Pereira, Risaralda, Colombia
- Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, 660003, Pereira, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 4861, Peru
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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] [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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16
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Mummah RO, Hoff NA, Rimoin AW, Lloyd-Smith JO. Controlling emerging zoonoses at the animal-human interface. ONE HEALTH OUTLOOK 2020; 2:17. [PMID: 33073176 PMCID: PMC7550773 DOI: 10.1186/s42522-020-00024-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/09/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND For many emerging or re-emerging pathogens, cases in humans arise from a mixture of introductions (via zoonotic spillover from animal reservoirs or geographic spillover from endemic regions) and secondary human-to-human transmission. Interventions aiming to reduce incidence of these infections can be focused on preventing spillover or reducing human-to-human transmission, or sometimes both at once, and typically are governed by resource constraints that require policymakers to make choices. Despite increasing emphasis on using mathematical models to inform disease control policies, little attention has been paid to guiding rational disease control at the animal-human interface. METHODS We introduce a modeling framework to analyze the impacts of different disease control policies, focusing on pathogens exhibiting subcritical transmission among humans (i.e. pathogens that cannot establish sustained human-to-human transmission). We quantify the relative effectiveness of measures to reduce spillover (e.g. reducing contact with animal hosts), human-to-human transmission (e.g. case isolation), or both at once (e.g. vaccination), across a range of epidemiological contexts. RESULTS We provide guidelines for choosing which mode of control to prioritize in different epidemiological scenarios and considering different levels of resource and relative costs. We contextualize our analysis with current zoonotic pathogens and other subcritical pathogens, such as post-elimination measles, and control policies that have been applied. CONCLUSIONS Our work provides a model-based, theoretical foundation to understand and guide policy for subcritical zoonoses, integrating across disciplinary and species boundaries in a manner consistent with One Health principles.
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Affiliation(s)
- Riley O. Mummah
- Department of Ecology and Evolutionary Biology, University of California, 610 Charles E Young Dr S, Los Angeles, CA 90095 USA
- Department of Epidemiology, University of California, Los Angeles, CA 90095 USA
| | - Nicole A. Hoff
- Department of Epidemiology, University of California, Los Angeles, CA 90095 USA
| | - Anne W. Rimoin
- Department of Epidemiology, University of California, Los Angeles, CA 90095 USA
| | - James O. Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, 610 Charles E Young Dr S, Los Angeles, CA 90095 USA
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892 USA
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17
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Harapan H, Setiawan AM, Yufika A, Anwar S, Wahyuni S, Asrizal FW, Sufri MR, Putra RP, Wijayanti NP, Salwiyadi S, Maulana R, Khusna A, Nusrina I, Shidiq M, Fitriani D, Muharrir M, Husna CA, Yusri F, Maulana R, Andalas M, Wagner AL, Mudatsir M. Knowledge of human monkeypox viral infection among general practitioners: a cross-sectional study in Indonesia. Pathog Glob Health 2020; 114:68-75. [PMID: 32202967 PMCID: PMC7170312 DOI: 10.1080/20477724.2020.1743037] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
After the first, imported, laboratory-confirmed case of monkeypox in human was reported in Singapore on May 2019, countries in Asia started to strengthen disease surveillance systems. One challenge in preventing monkeypox is a lack of knowledge, particularly among healthcare workers. The aim of this study was to assess the knowledge of monkeypox among general practitioners (GPs) in Indonesia. A cross-sectional online survey was conducted. The survey collected participants' knowledge on a 21-item scale and explanatory variables. A two-step logistic regression analysis was employed to assess the predictors of knowledge of monkeypox. A total of 432 GPs were included; 10.0% and 36.5% of them had a good knowledge using an 80% and 70% cutoff point for knowledge domain, respectively. No explanatory variables were associated with knowledge when using 80% cutoff point. Using the lower cutoff, there was lower knowledge among GPs who graduated from universities located in Sumatra or other islands versus Java (adjusted odds ratio (aOR): 0.53; 95%CI: 0.28-0.97, p = 0.041) and among those were older than 30 years compared to younger GPs (aOR: 0.61; 95%CI: 0.39-0.96, p = 0.033). GPs working in private clinics had less knowledge compared to GPs in community health centers (aOR: 0.55; 95%CI: 0.31-0.99, p = 0.047). In conclusion, knowledge of monkeypox among GPs in Indonesia is relatively low in all groups. Increasing knowledge of monkeypox will be key to improving the capacity of GPs to respond to human monkeypox cases and to report into a disease surveillance system.
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Affiliation(s)
- Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Abdul M. Setiawan
- Department of Microbiology, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim State Islamic University of Malang, Malang, Indonesia
| | - Amanda Yufika
- Department of Family Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Samsul Anwar
- Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Sri Wahyuni
- Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Indonesia
| | | | - Muhammad R. Sufri
- Banda Aceh Port Health Office, Ministry of Health, Aceh Besar, Indonesia
| | - Reza P. Putra
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | | | - Salwiyadi Salwiyadi
- Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Razi Maulana
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Obstetrics and Gynecology, Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | | | - Ina Nusrina
- Department of Health Service, District Health Office, Aceh Besar, Indonesia
| | - Muhammad Shidiq
- Nusa Jaya Community Health Center, Halmahera Timur, Indonesia
| | - Devi Fitriani
- Teunom Community Health Center, Aceh Jaya, Indonesia
| | - Muharrir Muharrir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Cut A. Husna
- Department of Microbiology, Universitas Malikussaleh, Lhokseumawe, Indonesia
| | - Fitria Yusri
- Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Indonesia
| | - Reza Maulana
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Mohd Andalas
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Obstetrics and Gynecology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Obstetrics and Gynecology, Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Abram L. Wagner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mudatsir Mudatsir
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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18
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Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, Zumla A. Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Infect Dis Clin North Am 2019; 33:1027-1043. [PMID: 30981594 PMCID: PMC9533922 DOI: 10.1016/j.idc.2019.03.001] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recently, concern has been raised about the emergence of human monkeypox virus and the occasionally severe clinical presentation bearing resemblance to that of smallpox. In 2018 3 patients in the UK were diagnosed with monkeypox, and the frequency and geographic distribution of cases across West and Central Africa have increased in recent years. In Nigeria, most monkeypox patients are aged <40 years and lack cross-protective immunity because they were born after discontinuation of the smallpox eradication campaign. This article reviews the epidemiology, clinical features, and management of monkeypox and discusses its growing public health threat in this context.
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Affiliation(s)
- Eskild Petersen
- Institute of Clinical Medicine, University of Aarhus, Palle Juul-Jensens Boulevard 82, Aarhus N DK-8200, Denmark; The Royal Hospital, Muscat, Oman; European Society for Clinical Microbiology and Infectious Diseases, Task Force for Emerging Infections, Basel, Switzerland.
| | - Anu Kantele
- Inflammation Center, Helsinki University Hospital and Helsinki University, Stenbäckinkatu 9, PO BOX 100, Helsinki FI-00029 HUS, Finland
| | - Marion Koopmans
- Viroscience Department, Erasmus Medical Centre, Postbus 2040, Rotterdam 3000 CA, the Netherlands
| | - Danny Asogun
- Department of Public Health, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria; Department of Public Health, and Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - Chikwe Ihekweazu
- Nigeria Centre for Disease Control, Plot 801, Ebitu Ukiwe Street, Jabi, Abuja, Nigeria
| | - Alimuddin Zumla
- Division of Infection and Immunity, Center for Clinical Microbiology, University College London, The National Institute of Health Research Biomedical Research Centre at UCL Hospitals, Gower Street, London WC1E 6BT, UK
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19
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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] [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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20
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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] [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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21
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Petersen E, Abubakar I, Ihekweazu C, Heymann D, Ntoumi F, Blumberg L, Asogun D, Mukonka V, Lule SA, Bates M, Honeyborne I, Mfinanga S, Mwaba P, Dar O, Vairo F, Mukhtar M, Kock R, McHugh TD, Ippolito G, Zumla A. Monkeypox - Enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication era. Int J Infect Dis 2019; 78:78-84. [PMID: 30453097 PMCID: PMC7129336 DOI: 10.1016/j.ijid.2018.11.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The identification of monkeypox in 3 separate patients in the United Kingdom in September raised media and political attention on an emerging public health threat. Nigeria, whose last confirmed case of monkeypox was in 1978, is currently experiencing an unusually large and outbreak of human monkeypox cases, a 'One Human-Environmental-Animal Health' approach is being effectively used to define and tackle the outbreak. As of 13th October 2018, there have been one hundred and sixteen confirmed cases the majority of whom are under 40 years. Over the past 20 years ten Central and West African countries have reported monkeypox cases which have risen exponentially. We review the history and evolution of monkeypox outbreaks in Africa and USA, the changing clinical presentations, and discuss possible factors underlying the increasing numbers being detected including the cessation of smallpox vaccination programs. Major knowledge gaps remain on the epidemiology, host reservoir, and emergence, transmission, pathogenesis and prevention of monkeypoz.
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Affiliation(s)
- Eskild Petersen
- Institute of Clinical Medicine, University of Aarhus, Denmark; The Royal Hospital, Muscat, Oman; ESCMID Emerging Infections Task Force, Basel, Switzerland.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, United Kingdom.
| | | | - David Heymann
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Francine Ntoumi
- University Marien NGouabi and Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Congo.
| | - Lucille Blumberg
- National Institute for Communicable Diseases, Johannesburg, South Africa.
| | - Danny Asogun
- Department of Public Health, Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria.
| | - Victor Mukonka
- Zambia National Public Health Institute, Ministry of Health, Lusaka, Zambia.
| | - Swaib Abubaker Lule
- Institute for Global Health, University College London, London, United Kingdom.
| | - Matthew Bates
- HerpeZ and UNZA-UCLMS Project, University Teaching Hospital, Lusaka, Zambia; School of Life Sciences, University of Lincoln, Lincoln, United Kingdom.
| | - Isobella Honeyborne
- Division of Infection and Immunity, Center for Clinical Microbiology, University College London, London, United Kingdom.
| | - Sayoki Mfinanga
- National Institute of Medical Research Muhimbili, Dar es Salaam, Tanzania.
| | - Peter Mwaba
- UNZA-UCLMS Project, and Lusaka Apex University Medical School, Lusaka, Zambia.
| | - Osman Dar
- Public Health England, London, United Kingdom; Chatham House Centre on Global Health Security, London, United Kingdom.
| | - Francesco Vairo
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Rome, Italy.
| | - Maowia Mukhtar
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan.
| | - Richard Kock
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hertfordshire, United Kingdom.
| | - Timothy D McHugh
- Division of Infection and Immunity, Center for Clinical Microbiology, University College London, London, United Kingdom.
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Rome, Italy.
| | - Alimuddin Zumla
- Division of Infection and Immunity, Center for Clinical Microbiology, University College London, United Kingdom; The National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, United Kingdom.
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22
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Sklenovská N, Van Ranst M. Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans. Front Public Health 2018; 6:241. [PMID: 30234087 PMCID: PMC6131633 DOI: 10.3389/fpubh.2018.00241] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/10/2018] [Indexed: 01/15/2023] Open
Abstract
Monkeypox is an emerging zoonotic disease recognized as the most important orthopoxvirus infection in humans in the smallpox post-eradication era. The clinical presentation of monkeypox is similar to the one of smallpox. The case fatality rate of monkeypox (10%) lies between the case fatality rate of variola major (30%) and variola minor (1%). The disease is endemic in the Democratic Republic of the Congo, but other countries of Central and West Africa either reported cases of monkeypox in humans or circulation in wildlife. The disease was also imported once into the USA. The disease has always been considered rare and self-limiting, however recent sporadic reports suggest otherwise. Unfortunately, the collected data is limited, dispersed and often incomplete. Therefore, the objective of this review is to trace all reported human monkeypox outbreaks and relevant epidemiological information. The frequency and geographical spread of human monkeypox cases have increased in recent years, and there are huge gaps in our understanding of the disease's emergence, epidemiology, and ecology. The monkeypox virus is considered a high threat pathogen causing a disease of public health importance. Therefore, there is an urgent need to focus on building surveillance capacities which will provide valuable information for designing appropriate prevention, preparedness and response activities.
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Affiliation(s)
- Nikola Sklenovská
- Laboratory of Clinical Virology, Department of Microbiology & Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Laboratory of Clinical Virology, Department of Microbiology & Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
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23
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Shiferaw ML, Doty JB, Maghlakelidze G, Morgan J, Khmaladze E, Parkadze O, Donduashvili M, Wemakoy EO, Muyembe JJ, Mulumba L, Malekani J, Kabamba J, Kanter T, Boulanger LL, Haile A, Bekele A, Bekele M, Tafese K, McCollum AA, Reynolds MG. Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases. Emerg Infect Dis 2018; 23. [PMID: 29155663 PMCID: PMC5711328 DOI: 10.3201/eid2313.170601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Preventing zoonotic diseases requires coordinated actions by government authorities responsible for human and animal health. Constructing the frameworks needed to foster intersectoral collaboration can be approached in many ways. We highlight 3 examples of approaches to implement zoonotic disease prevention and control programs. The first, rabies control in Ethiopia, was implemented using an umbrella approach: a comprehensive program designed for accelerated impact. The second, a monkeypox program in Democratic Republic of the Congo, was implemented in a stepwise manner, whereby incremental improvements and activities were incorporated into the program. The third approach, a pathogen discovery program, applied in the country of Georgia, was designed to characterize and understand the ecology, epidemiology, and pathogenesis of a new zoonotic pathogen. No one approach is superior, but various factors should be taken into account during design, planning, and implementation.
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24
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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] [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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25
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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. MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:306-310. [PMID: 29543790 PMCID: PMC5857192 DOI: 10.15585/mmwr.mm6710a5] [Citation(s) in RCA: 271] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [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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26
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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: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [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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Hoff NA, Doshi RH, Colwell B, Kebela-Illunga B, Mukadi P, Mossoko M, Spencer D, Muyembe-Tamfum JJ, Okitolonda-Wemakoy E, Lloyd-Smith J, Rimoin AW. Evolution of a Disease Surveillance System: An Increase in Reporting of Human Monkeypox Disease in the Democratic Republic of the Congo, 2001-2013. ACTA ACUST UNITED AC 2017; 25. [PMID: 30123790 PMCID: PMC6095679 DOI: 10.9734/ijtdh/2017/35885] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Evaluating the effectiveness of a surveillance system, and how it improves over time has significant implications for disease control and prevention. In the Democratic Republic of Congo (DRC), the Integrated Disease Surveillance and Response (IDSR) was implemented to estimate the burden of disease, monitor changes in disease occurrence, and inform resource allocation. For this effort we utilized national passive surveillance data from DRC's IDSR to explore reporting trends of human monkeypox (MPX) from 2001 to 2013. Methods We obtained surveillance data on MPX cases occurring between January 2001 and December 2013 from the DRC Ministry of Health (MoH). Phases of the surveillance system, yearly trends in reporting and estimated incidence for MPX were analyzed using SAS v9.2 and Health Mapper. Results Between 2001 and 2013, three discrete surveillance phases were identified that described the evolution of the surveillance system. Overall, an increase in suspected MPX cases was reported, beyond what would be expected from simply an improved reporting system. When restricting the analysis to the "stable phase," national estimated incidence increased from 2.13 per 100,000 in 2008 to 2.84 per 100,000 in 2013. Conclusions The reported increase in MPX, based on an evolving surveillance system, is likely to be a true increase in disease occurrence rather than simply improvements to the surveillance system. Further analyses should provide critical information for improved prevention and control strategies and highlight areas of improvement for future data collection efforts.
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Affiliation(s)
- Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Brian Colwell
- Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Benoit Kebela-Illunga
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Democratic Republic of the Congo
| | - Mathias Mossoko
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - D'Andre Spencer
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | | | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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28
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Cross-sectional study involving healthcare professionals in a Vaccinia virus endemic area. Vaccine 2017; 35:3281-3285. [PMID: 28495317 DOI: 10.1016/j.vaccine.2017.04.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 12/30/2022]
Abstract
Orthopoxviruses (OPV) are emerging viruses with great importance in human and veterinary medicine, such as Vaccinia virus (VACV), which causes outbreaks of bovine vaccinia (BV) in South America. The clinical aspects of BV are similar to other vesicular infections, complicating the clinical diagnosis. This cross-sectional study evaluated the knowledge of Healthcare Professionals about BV and revealed their unpreparedness about BV in a VACV hyper-endemic area in Brazil, highlighting the public health issues associated with VACV infections. This study presents an opportunity to discuss the importance of vaccination for healthcare professionals who work in areas of VACV circulation and brings an educational measure on VACV infections for health professionals around the world.
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Nakazawa Y, Mauldin MR, Emerson GL, Reynolds MG, Lash RR, Gao J, Zhao H, Li Y, Muyembe JJ, Kingebeni PM, Wemakoy O, Malekani J, Karem KL, Damon IK, Carroll DS. A phylogeographic investigation of African monkeypox. Viruses 2015; 7:2168-84. [PMID: 25912718 PMCID: PMC4411695 DOI: 10.3390/v7042168] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022] Open
Abstract
Monkeypox is a zoonotic disease caused by a virus member of the genus Orthopoxvirus and is endemic to Central and Western African countries. Previous work has identified two geographically disjuct clades of monkeypox virus based on the analysis of a few genomes coupled with epidemiological and clinical analyses; however, environmental and geographic causes of this differentiation have not been explored. Here, we expand previous phylogenetic studies by analyzing a larger set of monkeypox virus genomes originating throughout Sub-Saharan Africa to identify possible biogeographic barriers associated with genetic differentiation; and projected ecological niche models onto environmental conditions at three periods in the past to explore the potential role of climate oscillations in the evolution of the two primary clades. Analyses supported the separation of the Congo Basin and West Africa clades; the Congo Basin clade shows much shorter branches, which likely indicate a more recent diversification of isolates within this clade. The area between the Sanaga and Cross Rivers divides the two clades and the Dahomey Gap seems to have also served as a barrier within the West African clade. Contraction of areas with suitable environments for monkeypox virus during the Last Glacial Maximum, suggests that the Congo Basin clade of monkeypox virus experienced a severe bottleneck and has since expanded its geographic range.
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Affiliation(s)
- Yoshinori Nakazawa
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Matthew R Mauldin
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
- Oak Ridge Institute for Science and Education (ORISE) CDC Fellowship Program, Oak Ridge, TN 37831, USA.
| | - Ginny L Emerson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Mary G Reynolds
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - R Ryan Lash
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Jinxin Gao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Hui Zhao
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Yu Li
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Jean-Jacques Muyembe
- INRB Laboratory, Avenue de la Démocratie. Kinshasa-Gombe B.P. 1197 Kinshasa 1, Democratic Republic of the Congo.
| | - Placide Mbala Kingebeni
- INRB Laboratory, Avenue de la Démocratie. Kinshasa-Gombe B.P. 1197 Kinshasa 1, Democratic Republic of the Congo.
| | - Okito Wemakoy
- Kinshasa School of Public Health, University of Kinshasa, 11850 Kinshasa, Democratic Republic of the Congo.
| | - Jean Malekani
- Biology Department, University of Kinshasa, P.O. Box 218 Kinshasa XI, Democratic Republic of the Congo.
| | - Kevin L Karem
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Inger K Damon
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
| | - Darin S Carroll
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
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