Varicella Coinfection in Patients with Active Monkeypox in the Democratic Republic of the Congo

Hoff, Nicole A.; Morier, Douglas; Kisalu, Neville K.; Johnston, Sara C.; Doshi, Reena H.; Hensley, Lisa E.; Okitolonda-Wemakoy, Emile; Muyembe-Tamfum, Jean Jacques; Lloyd‐Smith, James O.; Rimoin, Anne W.

doi:10.1007/s10393-017-1266-5

Cited by 54 publications

(59 citation statements)

References 24 publications

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“…One case-control study and one conference abstract measured risk of animal-to-human transmission by animal-type and exposure-type (see S3 Table). [68, 69] Another case-control study compared behavioural risk factors. [40] Primary cases were reportedly more likely to sleep on the floor, less likely to eat duiker, prepare wild animal meat to cook or live in a house that had a door than healthy household controls in the Bokungu outbreak, DRC (n = 15 primary cases, n = 50 matched community controls).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy

2019

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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 a...

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Section: Resultsmentioning

confidence: 99%

A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy

2019

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“…The most common misdiagnosis [up to 50% of suspected MPX cases in the DRC ( 8 , 9 )] is chickenpox, also known as varicella, caused by varicella zoster virus (VZV). Coinfections with both MPXV and VZV were reported only a few times ( 8 , 10 , 11 ), however it was recently suggested that it is a relatively common phenomenon ( 12 ). The role of the VZV in MPXV epidemiology is not clear.…”

Section: Introductionmentioning

confidence: 99%

Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans

Sklenovská

Ranst

2018

Front. Public Health

442

490

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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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“…16 Patients with MPXV and VZV coinfections have been previously noted in the DRC. 3,[17][18][19] We describe the detection of both MPXV and VZV in persons investigated for suspected MPX infection via an enhanced MPX surveillance program in Tshuapa Province, DRC. The unexpectedly large number of detected coinfections was examined for biological plausibility.…”

Section: Introductionmentioning

confidence: 99%

A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo

Hughes

Liu

Davidson

et al. 2021

The American Journal of Tropical Medicine and Hygiene

101

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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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Varicella Coinfection in Patients with Active Monkeypox in the Democratic Republic of the Congo

Cited by 54 publications

References 24 publications

A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy

A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy

Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans

A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo

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