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Monkeypox or Varicella? Lessons from a Rash Outbreak Investigation in the Republic of the Congo

Monkeypox virus and varicellazoster virus (VZV) cause visually similar rash illnesses. Monkeypox is more virulent, with fatality rates up to 10%. In June 2007, reports were received of a rash illness outbreak in isolated villages in Likouala district, Republic of the Congo. Blood specimens were obtained from 142 individuals reporting rash illness between January and September 2007 from four villages in Likouala. Thirty-seven cases of probable VZV were identified based on low VZV IgG avidity; cases occurred in all four villages. No probable monkeypox cases with orthopoxvirus-positive IgM responses were observed; however, three possible monkeypox cases, in individuals < 26 years of age, with rash illness occurring > 56 days before sampling and positive orthopoxvirus-specific IgG responses, were identified. Remoteness and delays in reporting limited collection of acute diagnostic specimens. Improvements in rash illness surveillance and infection control, through training of health workers and timely acquisition of diagnostic specimens, are being undertaken.

Received September 30, 2008. Accepted for publication December 14, 2008.

Financial support: This work was funded entirely by the US Centers for Disease Control and Prevention.

Disclaimer: The findings and conclusions in this report have not been formally disseminated by the CDC and should not be construed to represent any agency or policy.

^* Address correspondence to Adam MacNeil, The Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-43, Atlanta, GA 30333. E-mail: aho3{at}cdc.gov

Authors’ addresses: Adam MacNeil, Mary G. Reynolds, Darin S. Carroll, Kevin Karem, Zach Braden, Ryan Lash, and Inger K. Damon, Poxvirus and Rabies Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G-43, Atlanta, GA 30333. Amba Moundeli and Jean-Vivien Mombouli, Department of Microbiology, Marien Ngouabi University, BP 69, Brazzville, Republic of Congo. Aisha O. Jumaan, PATH, 1455 NW Leary Way, Seattle, WA 98107. D. Scott Schmid, Measles, Mumps, Rubella, and Herpesviruses Laboratory, Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G-18, Atlanta, GA 30333.

Reprint requests: Adam MacNeil, The Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-43, Atlanta, GA 30333, E-mail: aho3{at}cdc.gov.

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