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Besombes C, Mbrenga F, Gonofio E, Malaka C, Bationo CS, Gaudart J, Curaudeau M, Hassanin A, Gessain A, Duda R, Vernick TG, Fontanet A, Nakouné E, Landier J. Seasonal Patterns of Mpox Index Cases, Africa, 1970-2021. Emerg Infect Dis 2024; 30:1017-1021. [PMID: 38666645 PMCID: PMC11060470 DOI: 10.3201/eid3005.230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Across 133 confirmed mpox zoonotic index cases reported during 1970-2021 in Africa, cases occurred year-round near the equator, where climate is consistent. However, in tropical regions of the northern hemisphere under a dry/wet season cycle, cases occurred seasonally. Our findings further support the seasonality of mpox zoonotic transmission risk.
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2
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Piparva KG, Fichadiya N, Joshi T, Malek S. Monkeypox: From Emerging Trends to Therapeutic Concerns. Cureus 2024; 16:e58866. [PMID: 38800170 PMCID: PMC11116278 DOI: 10.7759/cureus.58866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Monkeypox is a zoonotic viral disease. Monkeypox was first reported in humans about 54 years ago. Prior to the global outbreak, monkeypox was endemic to the rainforests of central and western African countries. In the last three years, increasing numbers of human monkeypox have been reported from various countries. Responding to the severity, monkeypox was declared a Public Health Emergency of International Concern by the World Health Organization. In the absence of approved drugs or clinical studies, repurposed drugs and therapeutic medical countermeasures effective against other orthopoxviruses have been utilized to treat severe human monkeypox cases. Currently, clinical trials are underway exploring the potential therapeutic effectiveness of tecovirimate in human monkeypox cases. Monoclonal antibodies, IFN-β, resveratrol, and 15 triple-targeting FDA-approved drugs represent potential new drug targets for human monkeypox, necessitating further research.
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Affiliation(s)
- Kiran G Piparva
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Rajkot, Rajkot, IND
| | - Nilesh Fichadiya
- Department of Preventive and Social Medicine, Pandit Deendayal Upadhyay (PDU) Government Medical College, Rajkot, IND
| | - Tejal Joshi
- Department of Microbiology, Pandit Deendayal Upadhyay (PDU) Government Medical College, Rajkot, IND
| | - Shahenaz Malek
- Department of Pharmacology, Government Medical College, Surat, IND
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3
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Cadmus S, Akinseye V, Besong M, Olanipekun T, Fadele J, Cadmus E, Ansumana R, Oluwayelu D, Odemuyiwa SO, Tomori O. Dynamics of Mpox infection in Nigeria: a systematic review and meta-analysis. Sci Rep 2024; 14:7368. [PMID: 38548826 PMCID: PMC10978922 DOI: 10.1038/s41598-024-58147-y] [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: 08/11/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
The seasonal outbreaks of Mpox continue in most parts of West and Central Africa. In the past year, Nigeria had the highest number of reported cases. Here, we used the PRISMA guidelines to carry out a systematic review and meta-analysis of available evidence on Mpox in Nigeria to assess the prevalence, transmission pattern, diagnostic approach, and other associated factors useful for mitigating the transmission of the disease. All relevant observational studies in PubMed/MEDLINE, Embase, AJOL, Web of Science, Scopus and Google Scholar on Mpox in Nigeria were assessed within the last fifty years (1972 to 2022). In all, 92 relevant articles were retrieved, out of which 23 were included in the final qualitative analysis. Notably, most of the cases of Mpox in Nigeria were from the southern part of the country. Our findings showed a progressive spread from the southern to the northern region of the country. We identified the following factors as important in the transmission of Mpox in Nigeria; poverty, lack of basic healthcare facilities, and risk of exposure through unsafe sexual practices. Our findings reiterate the need to strengthen and expand existing efforts as well as establish robust multi-sectoral collaboration to understand the dynamics of Mpox Nigeria.
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Affiliation(s)
- Simeon Cadmus
- Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria.
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria.
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria.
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria.
| | - Victor Akinseye
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
- Department of Chemical Sciences, Augustine University, Ilara-Epe, Lagos, Nigeria
| | - Matthias Besong
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
- Federal Ministry of Agriculture and Food Security, Abuja, Nigeria
| | - Tobi Olanipekun
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
| | - John Fadele
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
| | - Eniola Cadmus
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Daniel Oluwayelu
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria
- Department of Microbiology, University of Ibadan, Ibadan, Nigeria
| | - Solomon O Odemuyiwa
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA
| | - Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria
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4
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Ogunleye SC, Akinsulie OC, Aborode AT, Olorunshola MM, Gbore D, Oladoye M, Adesola RO, Gbadegoye JO, Olatoye BJ, Lawal MA, Bakare AB, Adekanye O, Chinyere EC. The re-emergence and transmission of Monkeypox virus in Nigeria: the role of one health. Front Public Health 2024; 11:1334238. [PMID: 38249416 PMCID: PMC10797020 DOI: 10.3389/fpubh.2023.1334238] [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: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
The Monkeypox virus, commonly abbreviated as mpox, is a viral zoonosis that is experiencing a resurgence in prevalence. It is endemic to regions of West and Central Africa that are characterized by dense forested areas. Various measures pertaining to animals, humans, and the environment have been recognized as potential factors and catalysts for the spread of the disease throughout the impacted regions of Africa. This study examines the various factors contributing to the transmission of the virus in Nigeria, with a particular focus on the animal-human and inter-human modes of transmission in rural communities and healthcare facilities. The One Health approach was emphasized as crucial in the prevention and management of this issue. Literature suggests that preventing repeated zoonotic introductions could potentially halt the transmission of the mpox virus from animal to human hosts, leading to a potential decrease in human infections.
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Affiliation(s)
- Seto C. Ogunleye
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | - Olalekan C. Akinsulie
- Department of Veterinary Biochemistry, Nigeria College of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | | | - Mercy M. Olorunshola
- Department of Pharmaceutical Microbiology, Pharmacy, University of Ibadan, Ibada, Nigeria
| | - Damilola Gbore
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | | | - Ridwan O. Adesola
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | - Joy O. Gbadegoye
- Department of Veterinary Biochemistry, Nigeria College of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
- Healthy Africans Platform, Research and Development, Ibada, Nigeria
| | | | - Mariam A. Lawal
- Department of Biochemistry, Department of Biochemistry, Federal University of Agriculture, Abeokuta, Nigeria
| | - Akeem B. Bakare
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
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5
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Jhancy M. Poxvirus Vaccines: Past, Present, and Future. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:273-287. [PMID: 38801584 DOI: 10.1007/978-3-031-57165-7_17] [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
Smallpox was a significant cause of mortality for over three thousand years, amounting to 10% of deaths yearly. Edward Jenner discovered smallpox vaccination in 1796, which rapidly became a smallpox infection preventive practice throughout the world and eradicated smallpox infection by 1980. After smallpox eradication, monkeypox vaccines have been used primarily in research and in outbreaks in Africa, where the disease is endemic. In the present, the vaccines are being used for people who work with animals or in high-risk areas, as well as for healthcare workers treating patients with monkeypox. Among all orthopoxviruses (OPXV), monkeypox viral (MPXV) infection occurs mainly in cynomolgus monkeys, natural reservoirs, and occasionally causes severe multi-organ infection in humans, who were the incidental hosts. The first case of the present epidemic of MXPV was identified on May 7, 2022, and rapidly increased the number of cases. In this regard, the WHO declared the outbreak, an international public health emergency on July 23, 2022. The first monkeypox vaccine was developed in the 1960s by the US Army and was based on the vaccinia virus, which is also used in smallpox vaccines. In recent years, newer monkeypox vaccines have been developed based on other viruses such as Modified Vaccinia Ankara (MVA). These newer vaccines are safer and can provide longer-lasting immunity with fewer side effects. For the future, there is ongoing research to improve the current vaccines and to develop new ones. One notable advance has been the development of a recombinant vaccine that uses a genetically modified vaccinia virus to express monkeypox antigens. This vaccine has shown promising results in pre-clinical trials and is currently undergoing further testing in clinical trials. Another recent development has been the use of a DNA vaccine, which delivers genetic material encoding monkeypox antigens directly into cells. This type of vaccine has shown effectiveness in animal studies and is also undergoing clinical testing in humans. Overall, these recent advances in monkeypox vaccine development hold promise for protecting individuals against this potentially serious disease.
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Affiliation(s)
- Malay Jhancy
- RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates.
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Yano R, Terada-Hirashima J, Uemura Y, Tomita N, Shimizu Y, Iwasaki H, Okumura N, Suzuki T, Saito S, Ujiie M, Sugiura W, Ohmagari N. Efficacy and Safety of the Smallpox Vaccine for Postexposure Prophylaxis in Monkeypox: Protocol for an Open-Labeled, Single-Armed Study. JMIR Res Protoc 2023; 12:e46955. [PMID: 37624623 PMCID: PMC10492167 DOI: 10.2196/46955] [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: 03/03/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND In May 2022, a case of monkeypox (currently known as "mpox") with no history of overseas travel was reported in the United Kingdom, followed by reports of infections reported in Europe, the United States, and other countries worldwide. Due to the significant overlap in immune responses among viruses of the genus Orthopoxvirus (including smallpox virus, mpox virus, and vaccinia virus), it is believed that cross-immunity can be achieved by administering the smallpox virus vaccine. In Japan, a smallpox vaccine (LC16m8 strain vaccine) has been approved; however, there was no regulatory approval for the mpox vaccine during the design of this study. Although it is believed that individuals exposed to the mpox virus may receive smallpox vaccination as mpox prophylaxis, the existing evidence is not clear. OBJECTIVE The primary objective was to evaluate the efficacy of the LC16m8 strain vaccine, approved for smallpox in Japan, for postexposure prophylaxis against mpox when administered to close contacts of individuals with mpox. The secondary objective was to investigate the safety of the vaccine for postexposure prophylaxis against mpox. METHODS The study aimed to enroll 100 vaccinated participants who had been identified as close contacts of individuals with mpox. Consent was obtained, and the participants are inoculated with the vaccine. Daily recordings of symptoms (body temperature, headache, rash, and side effects) were made until day 21 and then again on day 28. Furthermore, additional evaluations of adverse events were performed by the investigators on days 7, 14, 21, and 28. Considering that the maximum incubation period for mpox is 21 days, the primary end point is the presence or absence of the disease 21 days after close contact. The primary analysis focused on cases within 4 days of intense contact as it has been reported that vaccination within this timeframe can reduce the incidence of the disease. RESULTS The first trial participant was enrolled on July 28, 2022, and the research period concluded in March 2023. The study results will be published in a peer-reviewed scientific journal. CONCLUSIONS This study allowed us to investigate the efficacy and safety of the LC16m8 strain vaccine in postexposure prophylaxis against mpox. TRIAL REGISTRATION Japan Registry of Clinical Trials jRCTs031220137; https://jrct.niph.go.jp/en-latest-detail/jRCTs031220137. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46955.
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Affiliation(s)
- Rina Yano
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Terada-Hirashima
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Tomita
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruka Iwasaki
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobumasa Okumura
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuya Suzuki
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Mugen Ujiie
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
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7
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Shehryar A, Halappa Nagaraj R, Kanwal F, Reddy SM, Grezenko H, Raut Y, Fareed MU, Abdur Rehman, Şahin D, Bakht D, Ramteke P. Unraveling Monkeypox: An Emerging Threat in Global Health. Cureus 2023; 15:e43961. [PMID: 37753017 PMCID: PMC10518525 DOI: 10.7759/cureus.43961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/28/2023] Open
Abstract
Monkeypox, a viral zoonotic ailment originating in the Central and West African regions, has escalated into a global health issue of growing concern. The current analysis offers an exhaustive examination of monkeypox, emphasizing its historical progression, etiology, epidemiological patterns, pathophysiological mechanisms, clinical manifestations, diagnostic methodologies, treatment modalities, and preventive strategies. The worldwide discontinuation of smallpox vaccination has contributed to an increased incidence of monkeypox, driven by the expansion of vulnerable host populations. Significant strides in diagnostic procedures, prospective antiviral treatments, and vaccine development exhibit potential in managing this affliction, yet obstacles remain in terms of disease control, prevention, and treatment. Additionally, the international propagation of monkeypox underscores the need for robust public health initiatives and the significant role played by global health institutions in disease containment. Prospective research endeavors should strive to enhance our comprehension of the natural reservoirs of monkeypox and its transmission dynamics, evaluate sustained immune responses to novel vaccines, and investigate the potential impact of One Health strategies. This analysis underscores the pressing necessity for increased research and synchronized global efforts to tackle this emergent infectious malady.
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Affiliation(s)
| | | | - Fnu Kanwal
- Medicine, Chandka Medical College, Larkana, PAK
| | - Shivani M Reddy
- Student, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, IND
| | - Han Grezenko
- Translational Neuroscience, Barrow Neurological Institute, Phoenix, USA
| | - Yogesh Raut
- Medicine, Narendra Kumar Prasadrao (NKP) Salve Institute of Medical Sciences, Nagpur, IND
| | | | | | - Defne Şahin
- Internal Medicine, Psychiatry, Ege University Hospital, İzmir, TUR
| | - Danyal Bakht
- Medicine and Surgery, Mayo Hospital, Lahore, PAK
| | - Palash Ramteke
- Medicine, Narendra Kumar Prasadrao (NKP) Salve Institute of Medical Sciences, Nagpur, IND
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8
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Tajudeen YA, Oladipo HJ, Muili AO, Ikebuaso JG. Monkeypox: A review of a zoonotic disease of global public health concern. Health Promot Perspect 2023; 13:1-9. [PMID: 37309433 PMCID: PMC10257565 DOI: 10.34172/hpp.2023.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/03/2023] [Indexed: 06/14/2023] Open
Abstract
Background: The rising circulation of the monkeypox virus while the COVID-19 is still ongoing in non-endemic countries is a significant global health threat. In this article, we have discussed the epidemiology, aetiology, and pathogenesis of the monkeypox virus to provide our current knowledge of the disease. Also, we discussed the ongoing efforts of the international health organizations to curtail the present epidemic and we finally provide recommendations for early detection and response. Methods: We did a rapid literature search on PubMed, EMBASE, World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and other trusted databases for recent articles (1958-2022) published in English-focusing on the outbreaks of monkeypox disease, epidemiology, pathogenesis, aetiology, prevention, and control in endemic and non-endemic countries. Keywords such as "Monkeypox", "Monkeypox virus", "Poxviridae", "Orthopoxvirus", "Smallpox", and "Smallpox Vaccine" were considered in our search based on MESH medical subject headings. Results: Our review highlights four important findings. First, a cumulative of 1285 monkeypox cases have been documented and reported by the WHO in non-endemic countries as of June 8, 2022. Second, international travel contributes to the increase in cases in non-endemic countries. Third, the origin of the outbreak, the pattern of transmission, and the risk of infections is not fully understood. Fourth, there is an ongoing effort by the WHO, CDC, and other international health organization to control the spread of the monkeypox disease. Conclusion: Our findings underline the need to reassess research priorities on the origin, transmission pattern, and risk factors for infection of monkeypox. Also, we provide recommendations under the One Health spectrum to prevent further spread of the disease.
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Affiliation(s)
- Yusuf Amuda Tajudeen
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin 240003, Nigeria
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, P.M.B. 5017 G.P.O. Ibadan, Oyo State, Nigeria
| | - Habeebullah Jayeola Oladipo
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin 240003, Nigeria
- Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B. 1515, Ilorin 240003, Nigeria
| | - Abdulbasit Opeyemi Muili
- Faculty of Basic Medical Sciences, Ladoke Akintola University of Technology, P.M.B 4000, Ogbomosho, Oyo State, Nigeria
| | - Joy Ginika Ikebuaso
- Department of Microbiology, Faculty of Natural Sciences, Chukwuemeka Odumegwu Ojukwu University, P.M.B. 02, Uli, Anambra, Nigeria
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Ahmed SK, Dabou EA, Abdelsamad S, Mohamed MG, Chandran D, Chakraborty S, Emran TB, Dhama K. Monkeypox virus infection and myocarditis: A review of current evidence and possible pathogenesis. NARRA J 2023; 3:e104. [PMID: 38450040 PMCID: PMC10914025 DOI: 10.52225/narra.v3i1.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/17/2023] [Indexed: 09/01/2023]
Abstract
The recent spread of the monkeypox virus (MPXV), causing monkeypox (mpox), to non-endemic areas, and the atypical and unusual clinical manifestations observed during its 2022 outbreak has focused international interest on the clinical features of the disease. Mpox is usually a self-limiting disease with mild symptoms with common manifestations, including fever and skin lesions; however, severe manifestations could occur in some vulnerable groups (children and those with impaired immune systems) and may present multisystem complications and fatal outcomes. In most cases, a fever is the first sign of disease, followed by the development of various inflammatory lesions on the skin, such as vesiculopustular rashes and ulcers. Pneumonitis, encephalitis, keratitis, secondary bacterial infections, acute kidney injury, and myocarditis are all possible outcomes of the infection. Myocarditis has been reported to be caused by orthopoxviruses, and it is a serious condition of which its pathophysiology is little understood. Recent reports have indicated myocarditis with cardiac involvement as a possible atypical and unusual consequence of the MPXV infection during present outbreak. This review provides an overview of the clinical manifestations of mpox with a special focus on its effects on the heart, including myocarditis. The evidence of the myocarditis in mpox patients and its possible pathogenesis are discussed.
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Affiliation(s)
- Sirwan K. Ahmed
- Department of Pediatrics, Rania Pediatric and Maternity Teaching Hospital, Rania, Iraq
- Department of Nursing, University of Raparin, Rania, Iraq
| | - Eman A. Dabou
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Shaimaa Abdelsamad
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Mona G. Mohamed
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al Khiamah, United Arab Emirates
| | - Deepak Chandran
- Department of Veterinary Sciences and Animal Husbandry, Amrita School of Agricultural Sciences, Amrita Vishwa Vidyapeetham University, Coimbatore, India
| | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, R.K. Nagar, West Tripura, India
| | - Talha B. Emran
- Department of Pharmacy, BGC Trust University, Chittagong, Bangladesh
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
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10
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Du M, Sun H, Zhang S, Yuan J, Yan W, Liu Q, Qin C, Liu M, Liu J. Global Epidemiological Features of Human Monkeypox Cases and Their Associations With Social-Economic Level and International Travel Arrivals: A Systematic Review and Ecological Study. Int J Public Health 2023; 68:1605426. [PMID: 36743344 PMCID: PMC9894882 DOI: 10.3389/ijph.2023.1605426] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023] Open
Abstract
Objectives: We aimed to evaluate global epidemiological features of human monkeypox (mpox) cases and their associations with social-economic level and international travel arrivals. Methods: We estimated the pooled value by random-effects models. Then, we conducted an ecological study to evaluate the relationship of confirmed cases with social-economic indices and international travel arrivals using correlation analyses. Results: The average age (2022: 35.52, 95% CI [28.09, 42.94] vs. before 2022: 18.38, 95% CI [14.74, 22.02]) and comorbidity rate (2022: 15.7%, 95% CI [8.9%, 22.4%] vs. before 2022: 14.9%, 95% CI [8.5%, 21.3%]) of mpox cases in the 2022 human mpox outbreak were significantly higher than those of cases before 2022. During the 2022 mpox outbreak, the proportion of men who have sex with men (MSM) was high (79.8%, 95% CI [65.5%, 94.2%]). The number of confirmed mpox cases in 2022 significantly correlated with high social-economic levels and international travel arrivals (all p < 0.05). Conclusion: Our findings highlighted the importance of early surveillance and timely detection in high-risk populations, including older people, MSM, and travelers, which is crucial to curb the wide transmission of mpox.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Huimin Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shimo Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jie Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenxing Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China,Global Center for Infectious Disease and Policy Research, Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China,Global Center for Infectious Disease and Policy Research, Global Health and Infectious Diseases Group, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China,*Correspondence: Jue Liu,
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11
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Tiwari A, Adhikari S, Kaya D, Islam MA, Malla B, Sherchan SP, Al-Mustapha AI, Kumar M, Aggarwal S, Bhattacharya P, Bibby K, Halden RU, Bivins A, Haramoto E, Oikarinen S, Heikinheimo A, Pitkänen T. Monkeypox outbreak: Wastewater and environmental surveillance perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:159166. [PMID: 36202364 PMCID: PMC9534267 DOI: 10.1016/j.scitotenv.2022.159166] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 04/13/2023]
Abstract
Monkeypox disease (MPXD), a viral disease caused by the monkeypox virus (MPXV), is an emerging zoonotic disease endemic in some countries of Central and Western Africa but seldom reported outside the affected region. Since May 2022, MPXD has been reported at least in 74 countries globally, prompting the World Health Organization to declare the MPXD outbreak a Public Health Emergency of International Concern. As of July 24, 2022; 92 % (68/74) of the countries with reported MPXD cases had no historical MPXD case reports. From the One Health perspective, the spread of MPXV in the environment poses a risk not only to humans but also to small mammals and may, ultimately, spread to potent novel host populations. Wastewater-based surveillance (WBS) has been extensively utilized to monitor communicable diseases, particularly during the ongoing COVID-19 pandemic. It helped in monitoring infectious disease caseloads as well as specific viral variants circulating in communities. The detection of MPXV DNA in lesion materials (e.g. skin, vesicle fluid, crusts), skin rashes, and various body fluids, including respiratory and nasal secretions, saliva, urine, feces, and semen of infected individuals, supports the possibility of using WBS as an early proxy for the detection of MPXV infections. WBS of MPXV DNA can be used to monitor MPXV activity/trends in sewerage network areas even before detecting laboratory-confirmed clinical cases within a community. However, several factors affect the detection of MPXV in wastewater including, but not limited to, routes and duration time of virus shedding by infected individuals, infection rates in the relevant affected population, environmental persistence, the processes and analytical sensitivity of the used methods. Further research is needed to identify the key factors that impact the detection of MPXV biomarkers in wastewater and improve the utility of WBS of MPXV as an early warning and monitoring tool for safeguarding human health. In this review, we shortly summarize aspects of the MPXV outbreak relevant to wastewater monitoring and discuss the challenges associated with WBS.
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Affiliation(s)
- Ananda Tiwari
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Department of Health Security, Expert Microbiology Research Unit, Finnish Institute for Health and Welfare, Finland.
| | - Sangeet Adhikari
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA
| | - Devrim Kaya
- School of Chemical, Biological, and Environmental Engineering, Oregon State University (OSU), Corvallis, OR, USA
| | - Md Aminul Islam
- COVID-19 Diagnostic Laboratory, Department of Microbiology, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh; Advanced Molecular Laboratory, Department of Microbiology, President Abdul Hamid Medical College, Karimganj, Kishoreganj, Bangladesh
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Samendra P Sherchan
- Department of Biology, Morgan State University, Baltimore, MD, USA; Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ahmad I Al-Mustapha
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Oyo State, Nigeria; Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Kwara State, Nigeria
| | - Manish Kumar
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
| | - Srijan Aggarwal
- Department of Civil, Geological and Environmental Engineering, College of Engineering and Mines, University of Alaska Fairbanks, PO Box 755900, Fairbanks, AK 99775, USA
| | - Prosun Bhattacharya
- Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, SE-10044 Stockholm, Sweden
| | - Kyle Bibby
- Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, IN 46556, USA
| | - Rolf U Halden
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA
| | - Aaron Bivins
- Department of Civil & Environmental Engineering, Louisiana State University, LA, USA
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Sami Oikarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Annamari Heikinheimo
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Finnish Food Authority, Seinäjoki, Finland
| | - Tarja Pitkänen
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Department of Health Security, Expert Microbiology Research Unit, Finnish Institute for Health and Welfare, Finland
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12
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Thakur M, Das P, Sobti RC, Kaur T. Human monkeypox: epidemiology, transmission, pathogenesis, immunology, diagnosis and therapeutics. Mol Cell Biochem 2023:10.1007/s11010-022-04657-0. [PMID: 36626099 PMCID: PMC9838351 DOI: 10.1007/s11010-022-04657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
"Zoonoses" describe diseases that may be acquired by humans from animals. Due to the constant contact between humans and other animals, many infectious diseases are disseminated. This may happen via direct contact, such as bites or scratches, or by indirect contact, such as when eating bush meat or using contaminated animal parts. Monkeypox disease is one such zoonotic infection which is now emerging as a disease of global concern, and the World Health Organization has already labelled it a public health emergency. The virus is related to other orthopox viruses and may be further classified into two genetically separate clades, the West African and the Central African. The latter is far more pathogenic than the former. Utilizing virotransducer and virostealth proteins, the virus is able to control the host's T-cell-mediated responses and impede the release of cytokines and chemokines.Monkeypox may be treated with tecovirimat, cidofovir, or brincidofovir, and prevention with the vaccination JYNNEOS is recommended. The disease's fast global expansion warrants concern despite the fact that it is less fatal than that caused by the variola virus. Before the sickness reaches catastrophic proportions, we must draw on our prior experiences and act prudently. This article serves as an introduction to the monkeypox virus and its associated pathology, treatments, diagnostics, and preventative measures.
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Affiliation(s)
- Manish Thakur
- grid.472261.40000 0004 5376 7555Department of Microbiology, DAV University, Jalandhar, India
| | - Pratikshya Das
- grid.472261.40000 0004 5376 7555Department of Zoology, DAV University, Jalandhar, India
| | - Ranbir Chander Sobti
- grid.261674.00000 0001 2174 5640Department of Biotechnology, Panjab University, Chandigarh, India
| | - Tejinder Kaur
- grid.472261.40000 0004 5376 7555Department of Zoology, DAV University, Jalandhar, India
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13
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Nakhaie M, Arefinia N, Charostad J, Bashash D, Haji Abdolvahab M, Zarei M. Monkeypox virus diagnosis and laboratory testing. Rev Med Virol 2023; 33:e2404. [PMID: 36331049 DOI: 10.1002/rmv.2404] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/15/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
The multi-country outbreak of monkeypox virus (MPXV) infection, while the coronavirus disease 2019 pandemic is still an ongoing issue, has caused a new challenge. The re-emergence of MPXV and the rising incidence in non-endemic countries is turning into an upcoming threat to global health. Hence, rapid identification of the virus with appropriate methodology with the lowest false results plays a critical role in estimating the global extent of the crisis and providing preventive measures. This review summarised the main applicable strategies for primary detection and confirmation of MPXV and highlighted available data in biosafety, requirements, standard operating procedures, specimen collection, transportation and storage of clinical samples, and waste disposal of the viral agent. Also, various assays including molecular techniques, immunoassays, histopathological methods, electron microscopy, genomic sequencing, and cell culture have been illustrated. Moreover, we reflected on current knowledge of the advantages and disadvantages of each approach.
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Affiliation(s)
- Mohsen Nakhaie
- Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Nasir Arefinia
- Department of Medical Microbiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Charostad
- Department of Microbiology, Shahid Sadoghi University of Medical Science, Yazd, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Haji Abdolvahab
- Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | - Mohammad Zarei
- Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,John B. Little Center for Radiation Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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14
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Abstract
Human monkeypox is a viral zoonosis endemic to West and Central Africa that has recently generated increased interest and concern on a global scale as an emerging infectious disease threat in the midst of the slowly relenting COVID-2019 disease pandemic. The hallmark of infection is the development of a flu-like prodrome followed by the appearance of a smallpox-like exanthem. Precipitous person-to-person transmission of the virus among residents of 100 countries where it is nonendemic has motivated the immediate and widespread implementation of public health countermeasures. In this review, we discuss the origins and virology of monkeypox virus, its link with smallpox eradication, its record of causing outbreaks of human disease in regions where it is endemic in wildlife, its association with outbreaks in areas where it is nonendemic, the clinical manifestations of disease, laboratory diagnostic methods, case management, public health interventions, and future directions.
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Affiliation(s)
- Sameer Elsayed
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Pathology & Laboratory Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Lise Bondy
- Department of Medicine, Western University, London, Ontario, Canada
| | - William P. Hanage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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15
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Characterization of the Cytopathic Effects of Monkeypox Virus Isolated from Clinical Specimens and Differentiation from Common Viral Exanthems. J Clin Microbiol 2022; 60:e0133622. [PMID: 36445152 PMCID: PMC9769861 DOI: 10.1128/jcm.01336-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
While the practice of viral culture has largely been replaced by nucleic acid amplification tests, circumstances still exist in which the availability of viral culture will allow for the diagnosis of infections not included in a provider's differential diagnosis. Here, we examine the cytopathic effects (CPE) and clinical data associated with 18 cases of monkeypox virus (MPXV) isolated from 19 clinical samples submitted for viral culture. During the study period, a total of 3,468 viral cultures were performed with herpes simplex virus (HSV) most commonly isolated (646/3,468; 18.6%), followed by MPXV (19/3,468; 0.6%) and varicella-zoster virus (VZV) (12/3,468; 0.4%). Most MPXV-positive samples were obtained from males (14/19) and taken from genital (7/19) or rectal lesions (5/19). Cycle threshold values of tested samples ranged from 15.3 to 29.0. Growth of MPXV in cell culture was rapid, yielding detectable CPE at a median of 2 days (range: 1 to 4) often with >50% of the monolayer affected in RMK, BGM, A549, and MRC-5 cell lines. As clinical features of MPXV, HSV, and VZV lesions may overlap, CPE patterns were compared between viruses. HSV CPE developed in a similar time frame (median: 2 days, range: 1 to 7) but was more often negative in RMK cells relative to MPXV. VZV grew more slowly (median: 9 days, range: 5 to 11) and demonstrated CPE affecting ≤25% of cell monolayers when positive. Viral culture remains an important tool for the detection of rare or emerging viral pathogens, particularly when high viral load specimens are easily obtained.
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16
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Desingu PA, Rubeni TP, Sundaresan NR. Evolution of monkeypox virus from 2017 to 2022: In the light of point mutations. Front Microbiol 2022; 13:1037598. [PMID: 36590408 PMCID: PMC9795006 DOI: 10.3389/fmicb.2022.1037598] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Monkeypox virus (MPXV) causing multi-country outbreak-2022 is related to viruses caused outbreak-2017-2018 in West Africa. Still not fully understood which proteins of the MPXV discovered in Nigeria in 2017 have mutated through different lineages to the extent that it could cause a multi-country outbreak in 2022; similarly, codon usage bias, host adaptation indices, and the role of selection or mutation pressure in the mutated genes are also not fully studied. Here we report that according to the available sequence data this monkeypox virus acquires point mutations in multiple proteins in each period, and these point mutations accumulate and become a virus that can root outbreak-2022. Viruses exported from Nigeria to Singapore, Israel, and the United Kingdom in 2018-2019 were developed as evolutionary ancestors to B.1 viruses (MPXVs causing multi-country outbreak-2022) through MPXV/United States/2021/MD virus. Although these exported viruses have different amino acid mutations in different proteins, amino acid mutations in 10 proteins are common among them. The MPXV-United Kingdom-P2 virus evolved with only mutations in these 10 proteins and further evolved into MPXV/United States/2021/MD with amino acid mutations in 26 (including amino acid mutations in 10 proteins of the MPXV-United States-P2) proteins. It is noteworthy that specific amino acid mutations in these 22/26 (presence in MPXV/United States/2021/MD) proteins are present in B.1 viruses. Further, analysis of Relative Synonymous Codon Usage (RSCU), Synonymous Codon Usage Fraction (SCUF), and Effective Number of Codons (ENc) revealed codon usage bias in genes that exhibited nucleotide mutations in lineage B.1. Also, host adaptation indices analyzes such as Codon Adaptation Index (CAI), Expected-CAI (eCAI), Relative Codon Deoptimization Index (RCDI) and Expected value for the RCDI (eRCDI) analyzes reveal that the genes that demonstrated nucleotide mutations in lineage B.1 are favorable for human adaptation. Similarly, ENc-GC3s plot, Neutrality plot, and Parity Rule 2 (PR2)-bias plot analyzes suggest a major role of selection pressure than mutation pressure in the evolution of genes displaying nucleotide mutations in lineage B.1. Overall, from 2017 to 2022, MPXV's mutation and spread suggests that this virus continues to evolve through point mutation in the genes according to the available sequence data.
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17
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Sofyantoro F, Kusuma HI, Vento S, Rademaker M, Frediansyah A. Global research profile on monkeypox-related literature (1962-2022): A bibliometric analysis. NARRA J 2022; 2:e96. [PMID: 38449907 PMCID: PMC10914125 DOI: 10.52225/narra.v2i3.96] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/12/2022] [Indexed: 09/22/2023]
Abstract
The recent monkeypox or mpox outbreak has been a global concern. The present study evaluated the global research outputs, research trends, and topics of published research on monkeypox using a bibliometric approach. The Scopus database was searched for terms associated with "monkeypox" or "monkey pox" up until 19 November 2022. Maps and bibliometric indicators of the retrieved documents were shown and analyzed. A total of 1,422 documents were obtained from Scopus. Other than monkeypox, the most commonly used terms included epidemic, disease outbreaks, smallpox vaccine, and orthopoxvirus. In total, 90.3% of the documents were published between 2002 and 2022. The United States, the United Kingdom, and India were the top three countries in terms of productivity. Most of the institutions were from the United States. The International Journal of Surgery, the Journal of Medical Virology, and the Travel Medicine and Infectious Disease are some of the top journals currently publishing research on monkeypox. Tecovirimat, coronavirus disease 2019 (COVID-19), homosexuality, and pandemic are emerging topics related to monkeypox.
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Affiliation(s)
- Fajar Sofyantoro
- Department of Tropical Biology, Faculty of Biology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hendrix I. Kusuma
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Biology Education, Faculty of Tarbiyah and Teacher Training, Universitas Islam Negeri Ar-Raniry, Banda Aceh, Indonesia
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
| | - Marius Rademaker
- Clinical Trial New Zealand, Waikato Hospital Campus, Hamilton, New Zealand
| | - Andri Frediansyah
- PRTPP, National Research and Innovation Agency (BRIN), Yogyakarta, Indonesia
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18
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Kumar R, Singh S, Singh SK. A Systematic Review of 5110 Cases of Monkeypox: What Has Changed Between 1970 and 2022? Cureus 2022; 14:e30841. [DOI: 10.7759/cureus.30841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
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19
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Kipkorir V, Dhali A, Srichawla B, Kutikuppala S, Cox M, Ochieng D, Nyaanga F, Găman MA. The re-emerging monkeypox disease. Trop Med Int Health 2022; 27:961-969. [PMID: 36229989 DOI: 10.1111/tmi.13821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND On 7th May 2022, human monkeypox was identified in the United Kingdom, a non-endemic zone, with subsequent multi-country outbreaks. About 6 weeks later, the European Centre for Disease Prevention and Control reported 1158 confirmed cases in non-endemic countries scattered within the European Economic Area (EEA), and a total of 1882 cases confirmed worldwide, inclusive of the EEA. These numbers are expected to increase with high alert and amplified surveillance established in non-endemic regions. In light of a looming epidemic, current understanding of the virus, and identification of gaps in the literature remain critical hence warranting a scoping review of available literature. METHODS Literature searches were performed through PubMed, SCOPUS, ScienceDirect and Hinari to identify studies eligible for inclusion in accordance with PRISMA guidelines. RESULTS Seventy-seven articles were included in the review. Majority of the cases were from the Central African clade (n = 29,905) versus the West African clade (n = 252). 6/16 articles that reported vaccination status stated that none of the cases were vaccinated. In the remaining articles, approximately 80%-96% cases were unvaccinated. It was noted that 4%-21% of the vaccinated individuals got infected. The secondary attack rate ranged from 0% to 10.2%, while the calculated pooled estimated case fatality rate was 8.7%. CONCLUSION This scoping review provides an extensive look at our current understanding on monkeypox disease. Further studies are needed to better understand its risk factors, genetics and natural history, in order for public health strategists to generate prevention strategies and management decisions.
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Affiliation(s)
- Vincent Kipkorir
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Arkadeep Dhali
- Internal Medicine Trainee, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bahadar Srichawla
- Department of Neurology, University of Massachussetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Madeleine Cox
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dennis Ochieng
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Fiona Nyaanga
- Department of Human Anatomy and Physiology, University of Nairobi, Nairobi, Kenya
| | - Mihnea Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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20
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Atypical and Unique Transmission of Monkeypox Virus during the 2022 Outbreak: An Overview of the Current State of Knowledge. Viruses 2022; 14:v14092012. [PMID: 36146818 PMCID: PMC9501469 DOI: 10.3390/v14092012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 12/30/2022] Open
Abstract
An ongoing monkeypox outbreak in non-endemic countries has resulted in the declaration of a public health emergency of international concern by the World Health Organization (WHO). Though monkeypox has long been endemic in regions of sub-Saharan Africa, relatively little is known about its ecology, epidemiology, and transmission. Here, we consider the relevant research on both monkeypox and smallpox, a close relative, to make inferences about the current outbreak. Undetected circulation combined with atypical transmission and case presentation, including mild and asymptomatic disease, have facilitated the spread of monkeypox in non-endemic regions. A broader availability of diagnostics, enhanced surveillance, and targeted education, combined with a better understanding of the routes of transmission, are critical to identify at-risk populations and design science-based countermeasures to control the current outbreak.
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21
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Mandja BA, Handschumacher P, Bompangue D, Gonzalez JP, Muyembe JJ, Sauleau EA, Mauny F. Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo. ECOHEALTH 2022; 19:354-364. [PMID: 36029356 DOI: 10.1007/s10393-022-01610-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30 years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail.
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Affiliation(s)
- Bien-Aimé Mandja
- Département des Sciences de Base, Service d'Écologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Quartier Lemba, BP 834 KIN XI, Kinshasa, Democratic Republic of the Congo.
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | | | - Didier Bompangue
- Département des Sciences de Base, Service d'Écologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Quartier Lemba, BP 834 KIN XI, Kinshasa, Democratic Republic of the Congo
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Jean-Paul Gonzalez
- Department of Microbiology and Immunology, Division of Biomedical Graduate Research Organization, Georgetown University School of Medicine, 4000 Reservoir Road, Washington, DC, 20057, USA
| | - Jean-Jacques Muyembe
- Département des Sciences de Base, Service d'Écologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Quartier Lemba, BP 834 KIN XI, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Gombe, Kinshasa, Democratic Republic of the Congo
| | - Erik-André Sauleau
- Laboratoire de Biostatistique et Informatique Médicale, Faculté de Médecine, Laboratoire ICube UMR CNRS 7357, Université de Strasbourg, Strasbourg, France
| | - Frédéric Mauny
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, uMETh Inserm CIC 1431, Besançon, France
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22
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Tiecco G, Degli Antoni M, Storti S, Tomasoni LR, Castelli F, Quiros-Roldan E. Monkeypox, a Literature Review: What Is New and Where Does This concerning Virus Come From? Viruses 2022; 14:v14091894. [PMID: 36146705 PMCID: PMC9501516 DOI: 10.3390/v14091894] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/13/2022] Open
Abstract
Among the Poxviridae family, orthopoxvirus is the most notorious genus. Several DNA viruses belonging to this group are known to produce human disease from the life-threatening variola virus (VARV) (the causative agent of smallpox), monkeypox virus (MPXV), cowpox virus (CPXV), and vaccinia virus (VACV). These orthopoxviruses still remain a public health concern as VACV or CPXV still cause emerging endemic threads, especially in developing countries. MPXV is able to cause sporadic human outbreaks of a smallpox-like zoonotic disease and, in May 2022, hundreds of cases related to MPXV have been reported from more than 30 countries around the globe. At the end of July, monkeypox (MPX) outbreak was even declared a global health emergency by the World Health Organization (WHO). Many aspects remain unclear regarding this outbreak and a deep understanding of orthopoxvirus might have crucial and evident implications. During the era in which people under 45 years old are not protected against VACV, the potential use of orthopoxviruses as a biological weapon raises global concern considering the rapid spreading of the current MPX outbreak in vulnerable populations. Hence, we review the most recent evidence about phylogenesis, pathogenesis, prevention, and treatment for this concerning disease.
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Affiliation(s)
- Giorgio Tiecco
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Melania Degli Antoni
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Samuele Storti
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Lina Rachele Tomasoni
- Unit of Infectious and Tropical Diseases, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Clinical and Experimental Sciences, Unit of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Correspondence: ; Tel.: +39-0303995677
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Al-Gburi S, Namuq Z. A Review of the Recent Monkeypox Outbreak in 2022. Cureus 2022; 14:e27880. [PMID: 36134109 PMCID: PMC9481199 DOI: 10.7759/cureus.27880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
The coincidence of the monkeypox outbreak with the coronavirus disease 2019 (COVID-19) pandemic raises a global concern about a potential new pandemic and the possible consequences. As the World Health Organization declared the international monkeypox outbreak a global emergency, there is apprehension about the complications and mortality of monkeypox infection. The monkeypox virus is a zoonosis: a disease that is transmitted from animals to humans. It is an enveloped double-stranded DNA virus that belongs to the Orthopoxvirus genus. Human-to-human transmission occurs with close contact with respiratory secretions, sores on an infected person's skin, or contaminated items like clothing. Monkeypox is endemic in regions of Africa, however, because of smallpox eradication and a decrease in vaccination efforts, this led to an outbreak in the United States of America in 2003 and a new world outbreak in 2022. Most patients experience prodromal sickness with fever, malaise, and enlarged lymph nodes before developing a rash. In addition to skin lesions, individuals may also experience secondary skin and/or soft tissue infection, pneumonitis, ocular problems, and encephalitis. There is an increased risk of infection among men who have sex with men and human immunodeficiency virus infection (HIV) patients. The polymerase chain reaction is the gold standard for diagnosis. Management is usually supportive but some cases may require tecovirimat. This is a comprehensive review of monkeypox virus epidemiology, clinical features, and the most up-to-date, effective management and prevention.
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24
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Benites-Zapata VA, Ulloque-Badaracco JR, Alarcon-Braga EA, Hernandez-Bustamante EA, Mosquera-Rojas MD, Bonilla-Aldana DK, Rodriguez-Morales AJ. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2022; 21:36. [PMID: 35948973 PMCID: PMC9364300 DOI: 10.1186/s12941-022-00527-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00527-1.
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Affiliation(s)
| | | | - Esteban A Alarcon-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Enrique A Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Perú.,Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Melany D Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - D Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia.,Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia. .,Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia. .,Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Perú. .,Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia.
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25
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Kmiec D, Kirchhoff F. Monkeypox: A New Threat? Int J Mol Sci 2022; 23:ijms23147866. [PMID: 35887214 PMCID: PMC9321130 DOI: 10.3390/ijms23147866] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023] Open
Abstract
The global vaccination programme against smallpox led to its successful eradication and averted millions of deaths. Monkeypox virus (MPXV) is a close relative of the Variola (smallpox) virus. Due to antigenic similarity, smallpox vaccines cross-protect against MPXV. However, over 70% of people living today were never vaccinated against smallpox. Symptoms of monkeypox (MPX) include fever, head- and muscle ache, lymphadenopathy and a characteristic rash that develops into papules, vesicles and pustules which eventually scab over and heal. MPX is less often fatal (case fatality rates range from <1% to up to 11%) than smallpox (up to 30%). MPXV is endemic in sub-Saharan Africa, infecting wild animals and causing zoonotic outbreaks. Exotic animal trade and international travel, combined with the increasing susceptibility of the human population due to halted vaccination, facilitated the spread of MPXV to new areas. The ongoing outbreak, with >10,000 cases in >50 countries between May and July 2022, shows that MPXV can significantly spread between people and may thus become a serious threat to public health with global consequences. Here, we summarize the current knowledge about this re-emerging virus, discuss available strategies to limit its spread and pathogenicity and evaluate its risk to the human population.
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26
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Yao KH. [Learning from the past: the history of human monkeypox and the atypical multi-country outbreak in 2022]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:717-727. [PMID: 35894184 PMCID: PMC9336622 DOI: 10.7499/j.issn.1008-8830.2206019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2022, the outbreak of human monkeypox (HMPX) occurred in many non-endemic countries. World Health Organization (WHO) assesses that this outbreak is "atypical". The history of monkeypox and HMPX must be reviewed to clearly recognize the "typical" outbreaks to fully understand this comment. Therefore, this paper reviews the epidemiological history of monkeypox, especially HMPX, and discusses and analyzes the atypical manifestations and the possible causes of the present outbreak based on the recent views of WHO, other organizations/institutions, and experts. The text describes the thought-provoking history of the interaction between the monkeypox virus and the human being in the past 64 years, and provides various information and views on the outbreak of HMPX, which is helpful to understand risk assessment and the potential impact of this outbreak on clinical and public health in future.
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Affiliation(s)
- Kai-Hu Yao
- National Center for Children's Health/Beijing Children's Hospital, Capital Medical University/Laboratory of Dermatology, Beijing Pediatric Research Institute/National Key Discipline of Pediatrics (Capital Medical University)/Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
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27
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Vandenbogaert M, Kwasiborski A, Gonofio E, Descorps-Declère S, Selekon B, Nkili Meyong AA, Ouilibona RS, Gessain A, Manuguerra JC, Caro V, Nakoune E, Berthet N. Nanopore sequencing of a monkeypox virus strain isolated from a pustular lesion in the Central African Republic. Sci Rep 2022; 12:10768. [PMID: 35750759 PMCID: PMC9232561 DOI: 10.1038/s41598-022-15073-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/17/2022] [Indexed: 12/16/2022] Open
Abstract
Monkeypox is an emerging and neglected zoonotic disease whose number of reported cases has been gradually increasing in Central Africa since 1980. This disease is caused by the monkeypox virus (MPXV), which belongs to the genus Orthopoxvirus in the family Poxviridae. Obtaining molecular data is particularly useful for establishing the relationships between the viral strains involved in outbreaks in countries affected by this disease. In this study, we evaluated the use of the MinION real-time sequencer as well as different polishing tools on MinION-sequenced genome for sequencing the MPXV genome originating from a pustular lesion in the context of an epidemic in a remote area of the Central African Republic. The reads corresponding to the MPXV genome were identified using two taxonomic classifiers, Kraken2 and Kaiju. Assembly of these reads led to a complete sequence of 196,956 bases, which is 6322 bases longer than the sequence previously obtained with Illumina sequencing from the same sample. The comparison of the two sequences showed mainly indels at the homopolymeric regions. However, the combined use of Canu with specific polishing tools such as Medaka and Homopolish was the best combination that reduced their numbers without adding mismatches. Although MinION sequencing is known to introduce a number of characteristic errors compared to Illumina sequencing, the new polishing tools allow a better-quality MinION-sequenced genome, thus to be used to help determine strain origin through phylogenetic analysis.
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Affiliation(s)
- Mathias Vandenbogaert
- Unité Environnement et Risque Infectieux, Cellule d'Intervention Biologique d'Urgence, Institut Pasteur, Paris, France
| | - Aurélia Kwasiborski
- Unité Environnement et Risque Infectieux, Cellule d'Intervention Biologique d'Urgence, Institut Pasteur, Paris, France
| | - Ella Gonofio
- Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Stéphane Descorps-Declère
- Centre of Bioinformatics, Biostatistics and Integrative Biology (C3BI), Institut Pasteur, Paris, France
| | | | | | | | - Antoine Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, UMR3569, Institut Pasteur, Centre National de la Recherche Scientifique (CNRS, Paris, France
| | - Jean-Claude Manuguerra
- Unité Environnement et Risque Infectieux, Cellule d'Intervention Biologique d'Urgence, Institut Pasteur, Paris, France
| | - Valérie Caro
- Unité Environnement et Risque Infectieux, Cellule d'Intervention Biologique d'Urgence, Institut Pasteur, Paris, France
| | | | - Nicolas Berthet
- Unité Environnement et Risque Infectieux, Cellule d'Intervention Biologique d'Urgence, Institut Pasteur, Paris, France.
- The Center for Microbes, Development and Health, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai-Chinese Academy of Sciences, Discovery and Molecular Characterization of Pathogens, No. 320 Yueyang Road, XuHui District, Shanghai, 200031, China.
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28
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Silva NIO, de Oliveira JS, Kroon EG, Trindade GDS, Drumond BP. Here, There, and Everywhere: The Wide Host Range and Geographic Distribution of Zoonotic Orthopoxviruses. Viruses 2020; 13:E43. [PMID: 33396609 PMCID: PMC7823380 DOI: 10.3390/v13010043] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
The global emergence of zoonotic viruses, including poxviruses, poses one of the greatest threats to human and animal health. Forty years after the eradication of smallpox, emerging zoonotic orthopoxviruses, such as monkeypox, cowpox, and vaccinia viruses continue to infect humans as well as wild and domestic animals. Currently, the geographical distribution of poxviruses in a broad range of hosts worldwide raises concerns regarding the possibility of outbreaks or viral dissemination to new geographical regions. Here, we review the global host ranges and current epidemiological understanding of zoonotic orthopoxviruses while focusing on orthopoxviruses with epidemic potential, including monkeypox, cowpox, and vaccinia viruses.
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Affiliation(s)
| | | | | | | | - Betânia Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais: Belo Horizonte, Minas Gerais 31270-901, Brazil; (N.I.O.S.); (J.S.d.O.); (E.G.K.); (G.d.S.T.)
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29
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Hughes CM, Liu L, Davidson WB, Radford KW, Wilkins K, Monroe B, Metcalfe MG, Likafi T, Lushima RS, Kabamba J, Nguete B, Malekani J, Pukuta E, Karhemere S, Muyembe Tamfum JJ, Okitolonda Wemakoy E, Reynolds MG, Schmid DS, McCollum AM. A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo. Am J Trop Med Hyg 2020; 104:604-611. [PMID: 33289470 PMCID: PMC7866336 DOI: 10.4269/ajtmh.20-0589] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022] Open
Abstract
Recent enhanced monkeypox (MPX) surveillance in the Democratic Republic of Congo, where MPX is endemic, has uncovered multiple cases of MPX and varicella zoster virus (VZV) coinfections. The purpose of this study was to verify if coinfections occur and to characterize the clinical nature of these cases. Clinical, epidemiological, and laboratory results were used to investigate MPX/VZV coinfections. A coinfection was defined as a patient with at least one Orthopoxvirus/MPX-positive sample and at least one VZV-positive sample within the same disease event. Between September 2009 and April 2014, 134 of the 1,107 (12.1%) suspected MPX cases were confirmed as MPX/VZV coinfections. Coinfections were more likely to report symptoms than VZV-alone cases and less likely than MPX-alone cases. Significantly higher lesion counts were observed for coinfection cases than for VZV-alone but less than MPX-alone cases. Discernible differences in symptom and rash severity were detected for coinfection cases compared with those with MPX or VZV alone. Findings indicate infection with both MPX and VZV could modulate infection severity. Collection of multiple lesion samples allows for the opportunity to detect coinfections. As this program continues, it will be important to continue these procedures to assess variations in the proportion of coinfected cases over time.
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Affiliation(s)
- Christine M. Hughes
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lindy Liu
- Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Whitni B. Davidson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kay W. Radford
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly Wilkins
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen G. Metcalfe
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Toutou Likafi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Joelle Kabamba
- U.S. Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - Beatrice Nguete
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Jean Malekani
- Department of Biology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Elisabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | | | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D. Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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30
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Alakunle E, Moens U, Nchinda G, Okeke MI. Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution. Viruses 2020; 12:E1257. [PMID: 33167496 PMCID: PMC7694534 DOI: 10.3390/v12111257] [Citation(s) in RCA: 337] [Impact Index Per Article: 84.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022] Open
Abstract
Monkeypox is a zoonotic disease caused by monkeypox virus (MPXV), which is a member of orthopoxvirus genus. The reemergence of MPXV in 2017 (at Bayelsa state) after 39 years of no reported case in Nigeria, and the export of travelers' monkeypox (MPX) from Nigeria to other parts of the world, in 2018 and 2019, respectively, have raised concern that MPXV may have emerged to occupy the ecological and immunological niche vacated by smallpox virus. This review X-rays the current state of knowledge pertaining the infection biology, epidemiology, and evolution of MPXV in Nigeria and worldwide, especially with regard to the human, cellular, and viral factors that modulate the virus transmission dynamics, infection, and its maintenance in nature. This paper also elucidates the role of recombination, gene loss and gene gain in MPXV evolution, chronicles the role of signaling in MPXV infection, and reviews the current therapeutic options available for the treatment and prevention of MPX. Additionally, genome-wide phylogenetic analysis was undertaken, and we show that MPXV isolates from recent 2017 outbreak in Nigeria were monophyletic with the isolate exported to Israel from Nigeria but do not share the most recent common ancestor with isolates obtained from earlier outbreaks, in 1971 and 1978, respectively. Finally, the review highlighted gaps in knowledge particularly the non-identification of a definitive reservoir host animal for MPXV and proposed future research endeavors to address the unresolved questions.
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Affiliation(s)
- Emmanuel Alakunle
- Department of Natural and Environmental Sciences, Biomedical Science Concentration, School of Arts and Sciences, American University of Nigeria, 98 Lamido Zubairu Way, PMB 2250 Yola, Nigeria;
| | - Ugo Moens
- Molecular Inflammation Research Group, Institute of Medical Biology, University i Tromsø (UIT)—The Arctic University of Norway, N-9037 Tromsø, Norway;
| | - Godwin Nchinda
- Laboratory of Vaccinology and Immunology, The Chantal Biya International Reference Center for Research on the Prevention and Management HIV/AIDS (CIRCB), P.O Box 3077 Yaoundé-Messa, Cameroon;
- Department of Pharmaceutical Microbiology & Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, P.O Box 420110 Awka, Nigeria
| | - Malachy Ifeanyi Okeke
- Department of Natural and Environmental Sciences, Biomedical Science Concentration, School of Arts and Sciences, American University of Nigeria, 98 Lamido Zubairu Way, PMB 2250 Yola, Nigeria;
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31
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Han BA, O'Regan SM, Paul Schmidt J, Drake JM. Integrating data mining and transmission theory in the ecology of infectious diseases. Ecol Lett 2020; 23:1178-1188. [PMID: 32441459 PMCID: PMC7384120 DOI: 10.1111/ele.13520] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/21/2020] [Accepted: 03/27/2020] [Indexed: 01/07/2023]
Abstract
Our understanding of ecological processes is built on patterns inferred from data. Applying modern analytical tools such as machine learning to increasingly high dimensional data offers the potential to expand our perspectives on these processes, shedding new light on complex ecological phenomena such as pathogen transmission in wild populations. Here, we propose a novel approach that combines data mining with theoretical models of disease dynamics. Using rodents as an example, we incorporate statistical differences in the life history features of zoonotic reservoir hosts into pathogen transmission models, enabling us to bound the range of dynamical phenomena associated with hosts, based on their traits. We then test for associations between equilibrium prevalence, a key epidemiological metric and data on human outbreaks of rodent-borne zoonoses, identifying matches between empirical evidence and theoretical predictions of transmission dynamics. We show how this framework can be generalized to other systems through a rubric of disease models and parameters that can be derived from empirical data. By linking life history components directly to their effects on disease dynamics, our mining-modelling approach integrates machine learning and theoretical models to explore mechanisms in the macroecology of pathogen transmission and their consequences for spillover infection to humans.
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Affiliation(s)
- Barbara A Han
- Cary Institute of Ecosystem Studies, Box AB Millbrook, NY, 12571, USA
| | - Suzanne M O'Regan
- Department of Mathematics and Statistics, North Carolina A&T State University, 1601 E. Market St., Greensboro, NC, 27411, USA
| | - John Paul Schmidt
- Odum School of Ecology, University of Georgia, 140 E. Green St., Athens, GA, 30602, USA.,Center for the Ecology of Infectious Diseases, University of Georgia, 203 D.W. Brooks Drive, Athens, GA, 30602, USA
| | - John M Drake
- Odum School of Ecology, University of Georgia, 140 E. Green St., Athens, GA, 30602, USA.,Center for the Ecology of Infectious Diseases, University of Georgia, 203 D.W. Brooks Drive, Athens, GA, 30602, USA
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32
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Systematic Review of Important Viral Diseases in Africa in Light of the 'One Health' Concept. Pathogens 2020; 9:pathogens9040301. [PMID: 32325980 PMCID: PMC7238228 DOI: 10.3390/pathogens9040301] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Emerging and re-emerging viral diseases are of great public health concern. The recent emergence of Severe Acute Respiratory Syndrome (SARS) related coronavirus (SARS-CoV-2) in December 2019 in China, which causes COVID-19 disease in humans, and its current spread to several countries, leading to the first pandemic in history to be caused by a coronavirus, highlights the significance of zoonotic viral diseases. Rift Valley fever, rabies, West Nile, chikungunya, dengue, yellow fever, Crimean-Congo hemorrhagic fever, Ebola, and influenza viruses among many other viruses have been reported from different African countries. The paucity of information, lack of knowledge, limited resources, and climate change, coupled with cultural traditions make the African continent a hotspot for vector-borne and zoonotic viral diseases, which may spread globally. Currently, there is no information available on the status of virus diseases in Africa. This systematic review highlights the available information about viral diseases, including zoonotic and vector-borne diseases, reported in Africa. The findings will help us understand the trend of emerging and re-emerging virus diseases within the African continent. The findings recommend active surveillance of viral diseases and strict implementation of One Health measures in Africa to improve human public health and reduce the possibility of potential pandemics due to zoonotic viruses.
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33
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Guagliardo SAJ, Monroe B, Moundjoa C, Athanase A, Okpu G, Burgado J, Townsend MB, Satheshkumar PS, Epperson S, Doty JB, Reynolds MG, Dibongue E, Etoundi GA, Mathieu E, McCollum AM. Asymptomatic Orthopoxvirus Circulation in Humans in the Wake of a Monkeypox Outbreak among Chimpanzees in Cameroon. Am J Trop Med Hyg 2020; 102:206-212. [PMID: 31769389 PMCID: PMC6947779 DOI: 10.4269/ajtmh.19-0467] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022] Open
Abstract
Monkeypox virus is a zoonotic Orthopoxvirus (OPXV) that causes smallpox-like illness in humans. In Cameroon, human monkeypox cases were confirmed in 2018, and outbreaks in captive chimpanzees occurred in 2014 and 2016. We investigated the OPXV serological status among staff at a primate sanctuary (where the 2016 chimpanzee outbreak occurred) and residents from nearby villages, and describe contact with possible monkeypox reservoirs. We focused specifically on Gambian rats (Cricetomys spp.) because they are recognized possible reservoirs and because contact with Gambian rats was common enough to render sufficient statistical power. We collected one 5-mL whole blood specimen from each participant to perform a generic anti-OPXV ELISA test for IgG and IgM antibodies and administered a questionnaire about prior symptoms of monkeypox-like illness and contact with possible reservoirs. Our results showed evidence of OPXV exposures (IgG positive, 6.3%; IgM positive, 1.6%) among some of those too young to have received smallpox vaccination (born after 1980, n = 63). No participants reported prior symptoms consistent with monkeypox. After adjusting for education level, participants who frequently visited the forest were more likely to have recently eaten Gambian rats (OR: 3.36, 95% CI: 1.91-5.92, P < 0.001) and primate sanctuary staff were less likely to have touched or sold Gambian rats (OR: 0.23, 95% CI: 0.19-0.28, P < 0.001). The asymptomatic or undetected circulation of OPXVs in humans in Cameroon is likely, and contact with monkeypox reservoirs is common, raising the need for continued surveillance for human and animal disease.
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Affiliation(s)
- Sarah Anne J. Guagliardo
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin Monroe
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christian Moundjoa
- Ministry of Livestock, Fisheries, and Animal Industries, Yaoundé, Cameroon
- Field Epidemiology Training Program, U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
| | - Ateba Athanase
- Field Epidemiology Training Program, U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
- National Zoonoses Program, Ministry of Health, Yaoundé, Cameroon
| | - Gordon Okpu
- U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
| | - Jillybeth Burgado
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael B. Townsend
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Scott Epperson
- Hubert Humphrey Global Health Fellowship Program, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey B. Doty
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Els Mathieu
- U.S. Centers for Disease Control and Prevention Cameroon Office, Yaoundé, Cameroon
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. PLoS Negl Trop Dis 2019; 13:e0007791. [PMID: 31618206 PMCID: PMC6816577 DOI: 10.1371/journal.pntd.0007791] [Citation(s) in RCA: 318] [Impact Index Per Article: 63.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/28/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023] Open
Abstract
Monkeypox is a vesicular-pustular illness that carries a secondary attack rate in the order of 10% in contacts unvaccinated against smallpox. Case fatality rates range from 1 to 11%, but scarring and other sequelae are common in survivors. It continues to cause outbreaks in remote populations in Central and West Africa, in areas with poor access and weakened or disrupted surveillance capacity and information networks. Recent outbreaks in Nigeria (2017-18) and Cameroon (2018) have occurred where monkeypox has not been reported for over 20 years. This has prompted concerns over whether there have been changes in the biology and epidemiology of the disease that may in turn have implications for how outbreaks and cases should best be managed. A systematic review was carried out to examine reported data on human monkeypox outbreaks over time, and to identify if and how epidemiology has changed. Published and grey literature were critically analysed, and data extracted to inform recommendations on outbreak response, use of case definitions and public health advice. The level of detail, validity of data, geographical coverage and consistency of reporting varied considerably across the 71 monkeypox outbreak documents obtained. An increase in cases reported over time was supported by literature from the Democratic Republic of Congo (DRC). Data were insufficient to measure trends in secondary attack rates and case fatality rates. Phylogenetic analyses consistently identify two strains of the virus without evidence of emergence of a new strain. Understanding of monkeypox virulence with regard to clinical presentation by strain is minimal, with infrequent sample collection and laboratory analysis. A variety of clinical and surveillance case definitions are described in the literature: two definitions have been formally evaluated and showed high sensitivity but low specificity. These were specific to a Congo-Basin (CB) strain-affected area of the DRC where they were used. Evidence on use of antibiotics for prophylaxis against secondary cutaneous infection is anecdotal and limited. Current evidence suggests there has been an increase in total monkeypox cases reported by year in the DRC irrespective of advancements in the national Integrated Disease Surveillance and Response (IDSR) system. There has been a marked increase in number of individual monkeypox outbreak reports, from outside the DRC in between 2010 and 2018, particularly in the Central African Republic (CAR) although this does not necessarily indicate an increase in annual cases over time in these areas. The geographical pattern reported in the Nigeria outbreak suggests a possible new and widespread zoonotic reservoir requiring further investigation and research. With regards to outbreak response, increased attention is warranted for high-risk patient groups, and nosocomial transmission risks. The animal reservoir remains unknown and there is a dearth of literature informing case management and successful outbreak response strategies. Up-to-date complete, consistent and longer-term research is sorely needed to inform and guide evidence-based response and management of monkeypox outbreaks.
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Affiliation(s)
- Ellen M. Beer
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - V. Bhargavi Rao
- Manson Unit, Médecins sans Frontières (MSF) UK, London, United Kingdom
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Mandja BAM, Bompangue D, Handschumacher P, Gonzalez JP, Salem G, Muyembe JJ, Mauny F. The score of integrated disease surveillance and response adequacy (SIA): a pragmatic score for comparing weekly reported diseases based on a systematic review. BMC Public Health 2019; 19:624. [PMID: 31118016 PMCID: PMC6532185 DOI: 10.1186/s12889-019-6954-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Integrated Disease Surveillance and Response (IDSR) strategy implemented by the World Health Organization (WHO) in Africa has produced a large amount of data on participating countries, and in particular on the Democratic Republic of Congo (DRC). These data are increasingly considered as unevaluable and, therefore, as requiring a rigorous process of validation before they can be used for research or public health purposes. The aim of this study was to propose a method to assess the level of adequacy of IDSR morbidity data in reflecting actual morbidity. METHODS A systematic search of English- and French-language articles was performed in Scopus, Medline, Science Direct, Springer Link, Cochrane, Cairn, Persée, and Erudit databases. Other types of documents were identified through manual searches. Selected articles focused on the determinants of the discrepancies (differences) between reported morbidity and actual morbidity. An adequacy score was constructed using some of the identified determinants. This score was applied to the 15 weekly reported diseases monitored by IDSR surveillance in the DRC. A classification was established using the Jenks method and a sensitivity analysis was performed. Twenty-three classes of determinants were identified in 35 IDSR technical guides and reports of outbreak investigations and in 71 out of 2254 researched articles. For each of the 15 weekly reported diseases, the SIA was composed of 12 items grouped in 6 dimensions. RESULTS The SIA classified the 15 weekly reported diseases into 3 categories or types: high score or good adequacy (value > = 14), moderate score or fair adequacy (value > = 8 and < 14), and low score or low or non-adequacy (value < 8). Regardless of the criteria used in the sensitivity analysis, there was no notable variation in SIA values or categories for any of the 15 weekly reported diseases. CONCLUSION In a context of sparse health information in low- and middle-income countries, this study developed a score to help classify IDSR morbidity data as usable, usable after adjustment, or unusable. This score can serve to prioritize, optimize, and interpret data analyses for epidemiological research or public health purposes.
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Affiliation(s)
- Bien-Aimé Makasa Mandja
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo.
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | - Didier Bompangue
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | | | - Jean-Paul Gonzalez
- Department of Microbiology and Immunology, Division of Biomedical Graduate Research Organization, Georgetown University School of Medicine, 4000 Reservoir Road, Washington, D.C., NW, 20057, USA
| | | | - Jean-Jacques Muyembe
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Frédéric Mauny
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, uMETh, Besançon, France
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Reynolds MG, Doty JB, McCollum AM, Olson VA, Nakazawa Y. Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health. Expert Rev Anti Infect Ther 2019; 17:129-139. [PMID: 30625020 PMCID: PMC6438170 DOI: 10.1080/14787210.2019.1567330] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Monkeypox is a re-emerging viral zoonosis that occurs naturally in heavily forested regions of West and Central Africa. Inter-human transmission of monkeypox virus, although limited, drives outbreaks, particularly in household and health-care settings. But the available evidence suggests that without repeated zoonotic introductions, human infections would eventually cease to occur. Therefore, interrupting virus transmission from animals to humans is key to combating this disease. Areas covered: Herein we review laboratory and field studies examining the susceptibility of various animal taxa to monkeypox virus infection, and note the competence of various species to serve as reservoirs or transmission hosts. In addition, we discuss early socio-ecologic theories of monkeypox virus transmission in rural settings and review current modes of ecologic investigation - including ecologic niche modeling, and ecologic sampling - in light of their potential to identify specific animal species and features of the environment that are associated with heightened risk for human disease. Expert opinion: The role of disease ecology and scientific research in ongoing disease prevention efforts should be reinforced, particularly for wildlife-associated zoonoses such as monkeypox. Such efforts alongside those aimed at nurturing 'One Health' collaborations may ultimately hold the greatest promise for reducing human infections with this pathogen.
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Affiliation(s)
- Mary G. Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Jeffry B. Doty
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Andrea M. McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Victoria A. Olson
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
| | - Yoshinori Nakazawa
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, GA, USA
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Petersen 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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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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Yinka-Ogunleye A, Aruna O, Ogoina D, Aworabhi N, Eteng W, Badaru S, Mohammed A, Agenyi J, Etebu EN, Numbere TW, Ndoreraho A, Nkunzimana E, Disu Y, Dalhat M, Nguku P, Mohammed A, Saleh M, McCollum A, Wilkins K, Faye O, Sall A, Happi C, Mba N, Ojo O, Ihekweazu C. Reemergence of Human Monkeypox in Nigeria, 2017. Emerg Infect Dis 2018; 24:1149-1151. [PMID: 29619921 PMCID: PMC6004876 DOI: 10.3201/eid2406.180017] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In Nigeria, before 2017 the most recent case of human monkeypox had been reported in 1978. By mid-November 2017, a large outbreak caused by the West African clade resulted in 146 suspected cases and 42 laboratory-confirmed cases from 14 states. Although the source is unknown, multiple sources are suspected.
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Karumathil S, Raveendran NT, Ganesh D, Kumar Ns S, Nair RR, Dirisala VR. Evolution of Synonymous Codon Usage Bias in West African and Central African Strains of Monkeypox Virus. Evol Bioinform Online 2018; 14:1176934318761368. [PMID: 29551886 PMCID: PMC5846927 DOI: 10.1177/1176934318761368] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
The evolution of bias in synonymous codon usage in chosen monkeypox viral genomes and the factors influencing its diversification have not been reported so far. In this study, various trends associated with synonymous codon usage in chosen monkeypox viral genomes were investigated, and the results are reported. Identification of factors that influence codon usage in chosen monkeypox viral genomes was done using various codon usage indices, such as the relative synonymous codon usage, the effective number of codons, and the codon adaptation index. The Spearman rank correlation analysis and a correspondence analysis were used for correlating various factors with codon usage. The results revealed that mutational pressure due to compositional constraints, gene expression level, and selection at the codon level for utilization of putative optimal codons are major factors influencing synonymous codon usage bias in monkeypox viral genomes. A cluster analysis of relative synonymous codon usage values revealed a grouping of more virulent strains as one major cluster (Central African strains) and a grouping of less virulent strains (West African strains) as another major cluster, indicating a relationship between virulence and synonymous codon usage bias. This study concluded that a balance between the mutational pressure acting at the base composition level and the selection pressure acting at the amino acid level frames synonymous codon usage bias in the chosen monkeypox viruses. The natural selection from the host does not seem to have influenced the synonymous codon usage bias in the analyzed monkeypox viral genomes.
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Affiliation(s)
- Sudeesh Karumathil
- Centre for Evolutionary Ecology, Aushmath Biosciences, Coimbatore, India
| | - Nimal T Raveendran
- Amrita Centre for Nanosciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Doss Ganesh
- Department of Plant Biotechnology, School of Biotechnology, Madurai Kamaraj University, Madurai, India
| | | | - Rahul R Nair
- Centre for Evolutionary Ecology, Aushmath Biosciences, Coimbatore, India
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Abstract
BACKGROUND Varicella zoster virus (VZV) causes both varicella (chickenpox) and herpes zoster (shingles) and is associated with significant global morbidity. Most epidemiological data on VZV come from high-income countries, and to date there are limited data on the burden of VZV in Africa. METHODS We assessed the seroprevalence of VZV antibodies among children in the Democratic Republic of Congo in collaboration with the 2013-2014 Demographic and Health Survey. Dried blood spot samples collected from children 6-59 months of age were run on Dynex™ Technologies Multiplier FLEX® chemiluminescent immunoassay platform to assess serologic response. Multivariate logistic regression was then used to determine risk factors for VZV seropositivity. RESULTS Serologic and survey data were matched for 7,195 children 6-59 months of age, among whom 8% were positive and 2% indeterminate for VZV antibodies in weighted analyses. In multivariate analyses, the odds of seropositivity increased with increasing age, increasing socioeconomic status, mother's education level, rural residence, and province (South Kivu, North Kivu, Bandundu, Bas Congo had the highest odds of a positive test result compared with Kinshasa). CONCLUSION Our data suggest that VZV is circulating in DRC, and seropositivity is low among children 6-59 months. Seropositivity increased with age and varied by other sociodemographic factors, such as geographic location. This study provides the first nationally representative estimates of VZV infection among children in the DRC.
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Doty JB, Malekani JM, Kalemba LN, Stanley WT, Monroe BP, Nakazawa YU, Mauldin MR, Bakambana TL, Liyandja Dja Liyandja T, Braden ZH, Wallace RM, Malekani DV, McCollum AM, Gallardo-Romero N, Kondas A, Peterson AT, Osorio JE, Rocke TE, Karem KL, Emerson GL, Carroll DS. Assessing Monkeypox Virus Prevalence in Small Mammals at the Human-Animal Interface in the Democratic Republic of the Congo. Viruses 2017; 9:E283. [PMID: 28972544 PMCID: PMC5691634 DOI: 10.3390/v9100283] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
During 2012, 2013 and 2015, we collected small mammals within 25 km of the town of Boende in Tshuapa Province, the Democratic Republic of the Congo. The prevalence of monkeypox virus (MPXV) in this area is unknown; however, cases of human infection were previously confirmed near these collection sites. Samples were collected from 353 mammals (rodents, shrews, pangolins, elephant shrews, a potamogale, and a hyrax). Some rodents and shrews were captured from houses where human monkeypox cases have recently been identified, but most were trapped in forests and agricultural areas near villages. Real-time PCR and ELISA were used to assess evidence of MPXV infection and other Orthopoxvirus (OPXV) infections in these small mammals. Seven (2.0%) of these animal samples were found to be anti-orthopoxvirus immunoglobulin G (IgG) antibody positive (six rodents: two Funisciurus spp.; one Graphiurus lorraineus; one Cricetomys emini; one Heliosciurus sp.; one Oenomys hypoxanthus, and one elephant shrew Petrodromus tetradactylus); no individuals were found positive in PCR-based assays. These results suggest that a variety of animals can be infected with OPXVs, and that epidemiology studies and educational campaigns should focus on animals that people are regularly contacting, including larger rodents used as protein sources.
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Affiliation(s)
- Jeffrey B Doty
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Jean M Malekani
- University of Kinshasa, Department of Biology, P.O. Box 218 Kinshasa XI, Democratic Republic of the Congo.
| | - Lem's N Kalemba
- University of Kinshasa, Department of Biology, P.O. Box 218 Kinshasa XI, Democratic Republic of the Congo.
| | - William T Stanley
- Field Museum of Natural History, 1400 S. Lake Shore Dr., Chicago, IL 60605, USA.
| | - Benjamin P Monroe
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Yoshinori U Nakazawa
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Matthew R Mauldin
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Trésor L Bakambana
- University of Kinshasa, Department of Biology, P.O. Box 218 Kinshasa XI, Democratic Republic of the Congo.
| | | | - Zachary H Braden
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Ryan M Wallace
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Divin V Malekani
- University of Kinshasa, Department of Biology, P.O. Box 218 Kinshasa XI, Democratic Republic of the Congo.
| | - Andrea M McCollum
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Nadia Gallardo-Romero
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Ashley Kondas
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - A Townsend Peterson
- Biodiversity Institute, University of Kansas, 1345 Jayhawk Blvd., Lawrence, KS 66045, USA.
| | - Jorge E Osorio
- University of Wisconsin, School of Veterinary Medicine, 2015 Linden Dr., Madison, WI 53706, USA.
| | - Tonie E Rocke
- U.S. Geological Survey, National Wildlife Health Center, 6006 Schroeder Rd., Madison, WI 53711, USA.
| | - Kevin L Karem
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Ginny L Emerson
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
| | - Darin S Carroll
- U.S. Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA.
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Leendertz SAJ, Stern D, Theophil D, Anoh E, Mossoun A, Schubert G, Wiersma L, Akoua-Koffi C, Couacy-Hymann E, Muyembe-Tamfum JJ, Karhemere S, Pauly M, Schrick L, Leendertz FH, Nitsche A. A Cross-Sectional Serosurvey of Anti-Orthopoxvirus Antibodies in Central and Western Africa. Viruses 2017; 9:v9100278. [PMID: 28961172 PMCID: PMC5691630 DOI: 10.3390/v9100278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/17/2022] Open
Abstract
Since the eradication of smallpox and the subsequent discontinuation of the worldwide smallpox vaccination program, other Orthopoxviruses beside Variola virus have been increasingly representing a risk to human health. To investigate the extent of natural contact with Orthopoxviruses and possible demographic risk factors for such an exposure, we performed a cross-sectional serosurvey of anti-Orthopoxvirus IgG antibodies in West and Central Africa. To this end, people living in forest regions in Côte d’Ivoire (CIV, n = 737) and the Democratic Republic of the Congo (COD, n = 267) were assigned into groups according to their likely smallpox vaccination status. The overall prevalence of anti-Orthopoxvirus antibodies was 51% in CIV and 60% in COD. High rates of seropositivity among the vaccinated part of the population (80% in CIV; 96% COD) indicated a long-lasting post vaccination immune response. In non-vaccinated participants, seroprevalences of 19% (CIV) and 26% (COD) indicated regular contact with Orthopoxviruses. Multivariate logistic regression revealed that the antibody level in the vaccinated part of the population was higher in COD than in CIV, increased with age and was slightly higher in females than males. In the unvaccinated part of the population none of these factors influenced antibody level significantly. In conclusion, our results confirm expectedly high anti-Orthopoxvirus seroprevalences in previously smallpox-vaccinated people living in CIV and the COD but more unexpectedly imply regular contact with Orthopoxviruses both in Western and Central Africa, even in the absence of recognized outbreaks.
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Affiliation(s)
- Siv Aina J Leendertz
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, 13353 Berlin, Germany.
- Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany.
| | - Daniel Stern
- Centre for Biological Threats and Special Pathogens ZBS 1, Highly Pathogenic Viruses Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany.
| | - Dennis Theophil
- Centre for Biological Threats and Special Pathogens ZBS 1, Highly Pathogenic Viruses Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany.
| | - Etile Anoh
- Université Felix Houphouët Boigny, Abidjan BP 1174, Cote D'Ivoire.
- Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké BP 1174, Cote D'Ivoire.
| | - Arsène Mossoun
- Université Felix Houphouët Boigny, Abidjan BP 1174, Cote D'Ivoire.
- Laboratoire National D'appui au Développement Agricole/Laboratoire Central de Pathologie Animale, Bingerville BP 206, Cote D'Ivoire.
| | - Grit Schubert
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, 13353 Berlin, Germany.
| | - Lidewij Wiersma
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, 13353 Berlin, Germany.
| | - Chantal Akoua-Koffi
- Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké BP 1174, Cote D'Ivoire.
| | - Emmanuel Couacy-Hymann
- Laboratoire National D'appui au Développement Agricole/Laboratoire Central de Pathologie Animale, Bingerville BP 206, Cote D'Ivoire.
| | | | - Stomy Karhemere
- Institut National de Recherche Biomédicale, Kinshasa BP 1197, Democratic Republic of the Congo.
| | - Maude Pauly
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, 13353 Berlin, Germany.
- Department of Infection and Immunity, Luxembourg Institute of Health, 4354 Esch-sur-Alzette, Luxembourg.
| | - Livia Schrick
- Centre for Biological Threats and Special Pathogens ZBS 1, Highly Pathogenic Viruses Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany.
| | - Fabian H Leendertz
- Epidemiology of Highly Pathogenic Microorganisms, Robert Koch Institute, 13353 Berlin, Germany.
| | - Andreas Nitsche
- Centre for Biological Threats and Special Pathogens ZBS 1, Highly Pathogenic Viruses Centre for Biological Threats and Special Pathogens, Robert Koch Institute, 13353 Berlin, Germany.
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Plowright RK, Parrish CR, McCallum H, Hudson PJ, Ko AI, Graham AL, Lloyd-Smith JO. Pathways to zoonotic spillover. Nat Rev Microbiol 2017; 15:502-510. [PMID: 28555073 PMCID: PMC5791534 DOI: 10.1038/nrmicro.2017.45] [Citation(s) in RCA: 508] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Zoonotic spillover, which is the transmission of a pathogen from a vertebrate animal to a human, presents a global public health burden but is a poorly understood phenomenon. Zoonotic spillover requires several factors to align, including the ecological, epidemiological and behavioural determinants of pathogen exposure, and the within-human factors that affect susceptibility to infection. In this Opinion article, we propose a synthetic framework for animal-to-human transmission that integrates the relevant mechanisms. This framework reveals that all zoonotic pathogens must overcome a hierarchical series of barriers to cause spillover infections in humans. Understanding how these barriers are functionally and quantitatively linked, and how they interact in space and time, will substantially improve our ability to predict or prevent spillover events. This work provides a foundation for transdisciplinary investigation of spillover and synthetic theory on zoonotic transmission.
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Affiliation(s)
- Raina K Plowright
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59717, USA
| | - Colin R Parrish
- Baker Institute for Animal Health, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA
| | - Hamish McCallum
- Griffith School of Environment, Griffith University, Brisbane, Queensland 4111, Australia
| | - Peter J Hudson
- Center for Infectious Disease Dynamics, Pennsylvania State University, State College, Pennsylvania 16802, USA
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut 06520-8034, USA
| | - Andrea L Graham
- Department of Ecology &Evolutionary Biology, Princeton University, Princeton, New Jersey 08544, USA
| | - James O Lloyd-Smith
- Department of Ecology &Evolutionary Biology, University of California, Los Angeles, Los Angeles, California 90095-7239, USA; and at Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892-2220, USA
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45
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Quiner CA, Moses C, Monroe BP, Nakazawa Y, Doty JB, Hughes CM, McCollum AM, Ibata S, Malekani J, Okitolonda E, Carroll DS, Reynolds MG. Presumptive risk factors for monkeypox in rural communities in the Democratic Republic of the Congo. PLoS One 2017; 12:e0168664. [PMID: 28192435 PMCID: PMC5305065 DOI: 10.1371/journal.pone.0168664] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
Monkeypox virus (MPXV), a close relative of Variola virus, is a zoonotic virus with an unknown reservoir. Interaction with infected wildlife, bites from peri-domestic animals, and bushmeat hunting are hypothesized routes of infection from wildlife to humans. Using a Risk Questionnaire, performed in monkeypox-affected areas of rural Democratic Republic of the Congo, we describe the lifestyles and demographics associated with presumptive risk factors for MPXV infection. We generated two indices to assess risk: Household Materials Index (HMI), a proxy for socioeconomic status of households and Risk Activity Index (RAI), which describes presumptive risk for animal-to-human transmission of MPXV. Based on participant self-reported activity patterns, we found that people in this population are more likely to visit the forest than a market to fulfill material needs, and that the reported occupation is limited in describing behavior of individuals may participate. Being bitten by rodents in the home was commonly reported, and this was significantly associated with a low HMI. The highest scoring RAI sub-groups were 'hunters' and males aged ≥ 18 years; however, several activities involving MPXV-implicated animals were distributed across all sub-groups. The current analysis may be useful in identifying at-risk groups and help to direct education, outreach and prevention efforts more efficiently.
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Affiliation(s)
- Claire A. Quiner
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Cynthia Moses
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Benjamin P. Monroe
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Yoshinori Nakazawa
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Jeffrey B. Doty
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Christine M. Hughes
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Andrea M. McCollum
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Saturnin Ibata
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Jean Malekani
- University of Kinshasa, Department of Biology, Kinshasa, Democratic Republic of Congo
| | - Emile Okitolonda
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Darin S. Carroll
- International Conservation Education Fund, Washington, D.C., United States of America
| | - Mary G. Reynolds
- US Centers for Disease Control and Prevention, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
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46
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Human Monkeypox: Current State of Knowledge and Implications for the Future. Trop Med Infect Dis 2016; 1:tropicalmed1010008. [PMID: 30270859 PMCID: PMC6082047 DOI: 10.3390/tropicalmed1010008] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 12/14/2022] Open
Abstract
The zoonosis human monkeypox (MPX) was discovered in 1970, twelve years after the discovery of monkeypox virus (MPXV) in a Danish laboratory in 1958. Historically confined to West Africa (WA) and the Congo basin (CB), new epidemics in Sudan and the United States of America (USA) have fuelled new research highlighting environmental factors contributing to the expanded geographical spread of monkeypox virus (MPXV). A systematic literature review was conducted in MEDLINE® (Ovid), MEDLINE® (PubMed) and Google Scholar databases using the search terms: monkeypox, MPXV and “human monkeypox”. The literature revealed MPX has classic prodromal symptoms followed by a total body rash. The sole distinguishing clinical characteristic from other pox-like illnesses is the profound lymphadenopathy. Laboratory diagnosis of MPX is essential, a suitable test for endemic areas is under development but not yet available. For the time being anti-poxvirus antibodies in an unvaccinated individual with a history of severe illness and rash can suggest MPX infection. The reservoir host remains elusive yet the rope squirrel and Gambian pouched rat appear to be the most likely candidates. Transmission includes fomite, droplet, direct contact with infected humans or animals and consumption of infected meat. Though smallpox vaccination is protective against MPXV, new non-immune generations contribute to increasing incidence. Environmental factors are increasing the frequency of contact with potential hosts, thus increasing the risk of animal-to-human transmission. Increased risk of transmission through globalisation, conflict and environmental influences makes MPX a more realistic threat to previously unaffected countries. Health worker training and further development and accessibility of suitable diagnostic tests, vaccinations and anti-viral treatment is becoming increasingly necessary.
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Mauldin MR, Doty JB, Nakazawa Y, Emerson GL, Carroll DS. The Importance of Mammalogy, Infectious Disease Research, and Biosafety in the Field. MANTER (LINCOLN, NEB.) 2016; 2016:3. [PMID: 29177206 PMCID: PMC5701287 DOI: 10.13014/k27p8w9z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Large amounts of data and multitudes of publications have been independently generated by researchers in mammalogy and infectious diseases. The frequent confluence of these fields in epidemiological research as well as the facility of the data generated to be used in applied methods (e.g., conservation, public outreach, public health interventions) suggests that the intersection of these fields is important not only to their committed scientists but also to other areas of investigation, including public health. Given the increased frequency with which researchers in these fields interact with potentially infected humans, animals, and tissues, their occupations present a higher risk of exposure to a variety of pathogens than those in other fields of biology or among most jobs of the general public. However, a variety of methods are available for minimizing this risk, including increasing awareness of potential risks, using medical prophylaxes (when available), properly employing personal protective equipment, and using adequate disinfectants. Although instances of serious illness from zoonotic diseases among field researchers may be uncommon, they do occur; the purpose of this document is to increase awareness of risks that researchers-principal investigators and students alike-face and highlight steps and resources that can mitigate those risks.
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Affiliation(s)
- Matthew R Mauldin
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education (ORISE), CDC Fellowship Program, Oak Ridge, Tennessee, USA
| | - Jeffrey B Doty
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, USA
| | - Yoshinori Nakazawa
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, USA
| | - Ginny L Emerson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, USA
| | - Darin S Carroll
- Environmental, Safety, and Health Compliance Office, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, Georgia, USA
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48
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Abstract
Smallpox has shaped human history, from the earliest human civilizations well into the 20th century. With high mortality rates, rapid transmission, and serious long-term effects on survivors, smallpox was a much-feared disease. The eradication of smallpox represents an unprecedented medical victory for the lasting benefit of human health and prosperity. Concerns remain, however, about the development and use of the smallpox virus as a biological weapon, which necessitates the need for continued vaccine development. Smallpox vaccine development is thus a much-reviewed topic of high interest. This review focuses on the current state of smallpox vaccines and their context in biodefense efforts.
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Affiliation(s)
- Emily A Voigt
- a Mayo Vaccine Research Group , Mayo Clinic , Rochester , MN , USA
| | | | - Gregory A Poland
- a Mayo Vaccine Research Group , Mayo Clinic , Rochester , MN , USA
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Falendysz EA, Lopera JG, Lorenzsonn F, Salzer JS, Hutson CL, Doty J, Gallardo-Romero N, Carroll DS, Osorio JE, Rocke TE. Further Assessment of Monkeypox Virus Infection in Gambian Pouched Rats (Cricetomys gambianus) Using In Vivo Bioluminescent Imaging. PLoS Negl Trop Dis 2015; 9:e0004130. [PMID: 26517839 PMCID: PMC4627722 DOI: 10.1371/journal.pntd.0004130] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
Monkeypox is a zoonosis clinically similar to smallpox in humans. Recent evidence has shown a potential risk of increased incidence in central Africa. Despite attempts to isolate the virus from wild rodents and other small mammals, no reservoir host has been identified. In 2003, Monkeypox virus (MPXV) was accidentally introduced into the U.S. via the pet trade and was associated with the Gambian pouched rat (Cricetomys gambianus). Therefore, we investigated the potential reservoir competence of the Gambian pouched rat for MPXV by utilizing a combination of in vivo and in vitro methods. We inoculated three animals by the intradermal route and three animals by the intranasal route, with one mock-infected control for each route. Bioluminescent imaging (BLI) was used to track replicating virus in infected animals and virological assays (e.g. real time PCR, cell culture) were used to determine viral load in blood, urine, ocular, nasal, oral, and rectal swabs. Intradermal inoculation resulted in clinical signs of monkeypox infection in two of three animals. One severely ill animal was euthanized and the other affected animal recovered. In contrast, intranasal inoculation resulted in subclinical infection in all three animals. All animals, regardless of apparent or inapparent infection, shed virus in oral and nasal secretions. Additionally, BLI identified viral replication in the skin without grossly visible lesions. These results suggest that Gambian pouched rats may play an important role in transmission of the virus to humans, as they are hunted for consumption and it is possible for MPXV-infected pouched rats to shed infectious virus without displaying overt clinical signs.
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Affiliation(s)
- Elizabeth A. Falendysz
- U.S. Geological Survey-National Wildlife Health Center, Madison, Wisconsin, United States of America
| | - Juan G. Lopera
- Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Faye Lorenzsonn
- Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Johanna S. Salzer
- Centers for Disease Control and Prevention, National Centers for Zoonotic and Vector-Borne and Enteric Diseases, Division of High Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Christina L. Hutson
- Centers for Disease Control and Prevention, National Centers for Zoonotic and Vector-Borne and Enteric Diseases, Division of High Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Jeffrey Doty
- Centers for Disease Control and Prevention, National Centers for Zoonotic and Vector-Borne and Enteric Diseases, Division of High Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Nadia Gallardo-Romero
- Centers for Disease Control and Prevention, National Centers for Zoonotic and Vector-Borne and Enteric Diseases, Division of High Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Darin S. Carroll
- Centers for Disease Control and Prevention, National Centers for Zoonotic and Vector-Borne and Enteric Diseases, Division of High Consequence Pathogens and Pathology, Poxvirus and Rabies Branch, Atlanta, Georgia, United States of America
| | - Jorge E. Osorio
- Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Tonie E. Rocke
- U.S. Geological Survey-National Wildlife Health Center, Madison, Wisconsin, United States of America
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50
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Hutson CL, Nakazawa YJ, Self J, Olson VA, Regnery RL, Braden Z, Weiss S, Malekani J, Jackson E, Tate M, Karem KL, Rocke TE, Osorio JE, Damon IK, Carroll DS. Laboratory Investigations of African Pouched Rats (Cricetomys gambianus) as a Potential Reservoir Host Species for Monkeypox Virus. PLoS Negl Trop Dis 2015; 9:e0004013. [PMID: 26517724 PMCID: PMC4627651 DOI: 10.1371/journal.pntd.0004013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022] Open
Abstract
Monkeypox is a zoonotic disease endemic to central and western Africa, where it is a major public health concern. Although Monkeypox virus (MPXV) and monkeypox disease in humans have been well characterized, little is known about its natural history, or its maintenance in animal populations of sylvatic reservoir(s). In 2003, several species of rodents imported from Ghana were involved in a monkeypox outbreak in the United States with individuals of three African rodent genera (Cricetomys, Graphiurus, Funisciurus) shown to be infected with MPXV. Here, we examine the course of MPXV infection in Cricetomys gambianus (pouched Gambian rats) and this rodent species' competence as a host for the virus. We obtained ten Gambian rats from an introduced colony in Grassy Key, Florida and infected eight of these via scarification with a challenge dose of 4X104 plaque forming units (pfu) from either of the two primary clades of MPXV: Congo Basin (C-MPXV: n = 4) or West African (W-MPXV: n = 4); an additional 2 animals served as PBS controls. Viral shedding and the effect of infection on activity and physiological aspects of the animals were measured. MPXV challenged animals had significantly higher core body temperatures, reduced activity and increased weight loss than PBS controls. Viable virus was found in samples taken from animals in both experimental groups (C-MPXV and W-MPXV) between 3 and 27 days post infection (p.i.) (up to 1X108 pfu/ml), with viral DNA found until day 56 p.i. The results from this work show that Cricetomys gambianus (and by inference, probably the closely related species, Cricetomys emini) can be infected with MPXV and shed viable virus particles; thus suggesting that these animals may be involved in the maintenance of MPXV in wildlife mammalian populations. More research is needed to elucidate the epidemiology of MPXV and the role of Gambian rats and other species.
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Affiliation(s)
- Christina L. Hutson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yoshinori J. Nakazawa
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joshua Self
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victoria A. Olson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Russell L. Regnery
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zachary Braden
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sonja Weiss
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jean Malekani
- Department of Biology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Eddie Jackson
- Animal Resources Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mallory Tate
- Animal Resources Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin L. Karem
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tonie E. Rocke
- U.S. Geological Survey-National Wildlife Health Center, Madison, Wisconsin, United States of America
| | - Jorge E. Osorio
- Department of Pathobiological Science, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Inger K. Damon
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Darin S. Carroll
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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