Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo

Proceedings of the National Academy of Sciences of the United States of America - Tập 107 Số 37 - Trang 16262-16267 - 2010
Anne W. Rimoin1,2, Prime Mulembakani3, Sara C. Johnston4,5, James O. Lloyd‐Smith6,1, Neville K. Kisalu7,8, Timothée L. Kinkela3, Seth Blumberg6,1, Henri A. Thomassen9,10, Brian L. Pike11, Joseph N. Fair11, Nathan Wolfe11, Robert Shongo12, Barney S. Graham13, Pierre Formenty14, Andrea M. McCollum3, Lisa E. Hensley4,5, Helmut E. Meyer15, Linda L. Wright16, Jean‐Jacques Muyembe17
1Fogarty International Center, National Institutes of Health, Bethesda, MD 20892;
2University of California, Los Angeles School of Public Health, Los Angeles, CA 90095;
3Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
4US Army Research Institute for Infectious Diseases, Frederick, MD 21702; Departments of e Ecology and Evolutionary Biology and f Microbiology,
5University of California, Los Angeles, CA 90095
6Departments of eEcology and Evolutionary Biology and
7Microbiology, University of California, Los Angeles, CA 90095;
8National Institutes of Health, Bethesda, MD
9Center for Tropical Research,
10Center for Tropical Research, Institute of the Environment, University of California, Los Angeles, CA 90095;
11Global Viral Forecasting Initiative, San Francisco, CA 94105; i Ministry of Health, BP 9030 Kinshasa, Democratic Republic of Congo;
12Ministry of Health, BP 9030 Kinshasa, Democratic Republic of Congo;
13Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892;
14Department of Global Alert and Response, World Health Organization, 1211 Geneva 27, Switzerland;
15Bundeswehr Institute of Microbiology, D-80937 Munich, Germany
16Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892; and
17National Institute of Biomedical Research, BP 1197 Kinshasa, Democratic Republic of Congo

Tóm tắt

Studies on the burden of human monkeypox in the Democratic Republic of the Congo (DRC) were last conducted from 1981 to 1986. Since then, the population that is immunologically naïve to orthopoxviruses has increased significantly due to cessation of mass smallpox vaccination campaigns. To assess the current risk of infection, we analyzed human monkeypox incidence trends in a monkeypox-enzootic region. Active, population-based surveillance was conducted in nine health zones in central DRC. Epidemiologic data and biological samples were obtained from suspected cases. Cumulative incidence (per 10,000 population) and major determinants of infection were compared with data from active surveillance in similar regions from 1981 to 1986. Between November 2005 and November 2007, 760 laboratory-confirmed human monkeypox cases were identified in participating health zones. The average annual cumulative incidence across zones was 5.53 per 10,000 (2.18–14.42). Factors associated with increased risk of infection included: living in forested areas, male gender, age < 15, and no prior smallpox vaccination. Vaccinated persons had a 5.2-fold lower risk of monkeypox than unvaccinated persons (0.78 vs. 4.05 per 10,000). Comparison of active surveillance data in the same health zone from the 1980s (0.72 per 10,000) and 2006–07 (14.42 per 10,000) suggests a 20-fold increase in human monkeypox incidence. Thirty years after mass smallpox vaccination campaigns ceased, human monkeypox incidence has dramatically increased in rural DRC. Improved surveillance and epidemiological analysis is needed to better assess the public health burden and develop strategies for reducing the risk of wider spread of infection.

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Proceedings of the National Academy of Sciences of the United States of America

Tập 107 Số 37

16262-16267

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