Introduction of Monkeypox into a Community and Household: Risk Factors and Zoonotic Reservoirs in the Democratic Republic of the Congo

Abstract

Abstract. An increased incidence of monkeypox (MPX) infections in the Democratic Republic of the Congo was noted by the regional surveillance system in October 2013. Little information exists regarding how MPX is introduced into the community and the factors associated with transmission within the household. Sixty-eight wild animals were collected and tested for Orthopoxvirus. Two of three rope squirrels (Funisciurus sp.) were positive for antibodies to Orthopoxviruses; however, no increased risk was associated with the consumption or preparation of rope squirrels. A retrospective cohort investigation and a case-control investigation were performed to identify risk factors affecting the introduction of monkeypox virus (MPXV) into the community and transmission within the home. School-age males were the individuals most frequently identified as the first person infected in the household and were the group most frequently affected overall. Risk factors of acquiring MPXV in a household included sleeping in the same room or bed, or using the same plate or cup as the primary case. There was no significant risk associated with eating or processing of wild animals. Activities associated with an increased risk of MPXV transmission all have potential for virus exposure to the mucosa.

Monkeypox — Enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post-eradication era

“…To date human cases of monkeypox have been reported from ten African countries -Democratic Republic of the Congo, Republic of the Congo, Cameroon, Central African Republic, Nigeria, Ivory Coast, Liberia, Sierra Leone, Gabon and South Sudan (WHO, 2018a,b). Whilst the cessation of smallpox vaccination might be an important risk factor, there may be other factors which could explain the increase (Nolen et al, 2015;Sklenovská and Van Ranst, 2017) such as: (a) higher frequency of contact with animal host reservoirs by children and young adults, (b) deforestation leading to increased exposure of humans with displaced animals, (c) Wars, conflicts and poverty leading to population movement into forests, (d) reliance on rodents for food, (e) increased population density, and (f) Improved surveillance and diagnostic capability, although the latter was probably not the case due to reduced resources. Further multidisciplinary, regional collaborative research, including carefully designed case-control and cohort studies are required to fill the major knowledge gaps in the epidemiology, host reservoir, transmission, pathogenesis surveillance and prevention, as well as to explore potential prevention, infection control and treatment interventions.…”

Emerging diseases—the monkeypox epidemic in the Democratic Republic of the Congo

“…Today, entire households are mostly or completely susceptible, allowing significant potential for an additional human-to-human transmission. During the 2013 outbreak in DRC, frequent transmission was documented within households [3,7] with a median attack rate of 50% [7]. A recent study [7] observed that the group most often affected is school-aged boys.…”

“…During the 2013 outbreak in DRC, frequent transmission was documented within households [3,7] with a median attack rate of 50% [7]. A recent study [7] observed that the group most often affected is school-aged boys. Risk factors for transmission included sharing a bed or room and using the same utensils with an infected patient.…”

“…Increased transmission risk associated with factors involving introduction of virus to the oral mucosa. The researchers concluded that educating locals to limit contact with sick people is an important step in prevention [7].…”

“…The virus originated from imported West African rodents but then spread further, hosted by and transmitted to humans by prairie dogs [6]. The outbreaks seem to be continuing: in 2013, a substantial rise in the number of monkeypox cases was documented in the DRC [7]; in the Bokungu health zone with 104 suspected cases the increase was over 6-fold compared to previous years [3].…”