Volume 80, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Von Magnus P, Anderson EK, Petersen KB, Birch-Andersen A, 1959. A pox-like disease in cynomolgus monkeys. Acta Pathol Microbiol Scand 46 : 156–176. [Google Scholar]
  2. Ladnyj ID, Ziegler P, Kima E, 1972. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bull World Health Organ 46 : 593–597. [Google Scholar]
  3. Foster SO, Brink EW, Hutchins DL, Pifer JM, Lourie B, Moser CR, Cummings EC, Kuteyi OE, Eke RE, Titus JB, Smith EA, Hicks JW, Foege WH, 1972. Human monkeypox. Bull World Health Organ 46 : 569–576. [Google Scholar]
  4. Lourie B, Bingham PG, Evans HH, Foster SO, Nakano JH, Herrmann KL, 1972. Human infection with monkeypox virus: laboratory investigation of six cases in West Africa. Bull World Health Organ 46 : 633–639. [Google Scholar]
  5. Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I, 1980. Human monkeypox, 1970–79. Bull World Health Organ 58 : 165–182. [Google Scholar]
  6. Jezek Z, Szczeniowski M, Paluku KM, Mutombo M, 1987. Human monkeypox: clinical features of 282 patients. J Infect Dis 156 : 293–298. [Google Scholar]
  7. Levine RS, Peterson AT, Yorita KL, Carroll D, Damon IK, Reynolds MG, 2007. Ecological niche and geographic distribution of human monkeypox in Africa. PLoS One 2 : e176. [Google Scholar]
  8. Learned LA, Reynolds MG, Wassa DW, Li Y, Olson VA, Karem K, Stempora LL, Braden ZH, Kline R, Likos A, Libama F, Moudzeo H, Bolanda JD, Tarangonia P, Boumandoki P, Formenty P, Harvey JM, Damon IK, 2005. Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo, 2003. Am J Trop Med Hyg 73 : 428–434. [Google Scholar]
  9. Jezek Z, Szczeniowski M, Paluku KM, Mutombo M, Grab B, 1988. Human monkeypox: confusion with chickenpox. Acta Trop 45 : 297–307. [Google Scholar]
  10. Breman JG, 2000. Monkeypox: an emerging infection for humans? Scheld WM, Craig WA, Hughes JM, editors. Emerging Infections 4. Washington, DC: ASM Press, 45–67.
  11. Jezek Z, Grab B, Paluku KM, Szczeniowski MV, 1988. Human monkeypox: disease pattern, incidence and attack rates in a rural area of northern Zaire. Trop Geogr Med 40 : 73–83. [Google Scholar]
  12. Jezek Z, Grab B, Szczeniowski MV, Paluku KM, Mutombo M, 1988. Human monkeypox: secondary attack rates. Bull World Health Organ 66 : 465–470. [Google Scholar]
  13. Fine PE, Jezek Z, Grab B, Dixon H, 1988. The transmission potential of monkeypox virus in human populations. Int J Epidemiol 17 : 643–650. [Google Scholar]
  14. Meyer H, Perrichot M, Stemmler M, Emmerich P, Schmitz H, Varaine F, Shungu R, Tshioko F, Formenty P, 2002. Outbreaks of disease suspected of being due to human monkeypox virus infection in the Democratic Republic of Congo in 2001. J Clin Microbiol 40 : 2919–2921. [Google Scholar]
  15. Rimoin AW, Kisalu N, Kebela-Ilunga B, Mukaba T, Wright LL, Formenty P, Wolfe ND, Shongo RL, Tshioko F, Okitolonda E, Muyembe JJ, Ryder RW, Meyer H, 2007. Endemic human monkeypox, Democratic Republic of Congo, 2001–2004. Emerg Infect Dis 13 : 934–937. [Google Scholar]
  16. Lolekha S, Tanthiphabha W, Sornchai P, Kosuwan P, Sutra S, Warachit B, Chup-Upprakarn S, Hutagalung Y, Weil J, Bock HL, 2001. Effect of climatic factors and population density on varicella zoster virus epidemiology within a tropical country. Am J Trop Med Hyg 64 : 131–136. [Google Scholar]
  17. Lee BW, 1998. Review of varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health 3 : 886–890. [Google Scholar]
  18. Christiansen D, Barnett ED, 2004. Comparison of varicella history with presence of varicella antibody in refugees. Vaccine 22 : 4233–4237. [Google Scholar]
  19. Kilgore PE, Kruszon-Moran D, Seward JF, Jumaan A, Van Loon FP, Forghani B, McQuillan GM, Wharton M, Fehrs LJ, Cossen CK, Hadler SC, 2003. Varicella in Americans from NHANES III: implications for control through routine immunization. J Med Virol 70 (Suppl 1): S111–S118. [Google Scholar]
  20. Macneil A, Reynolds MG, Braden Z, Carroll DS, Bostik V, Karem K, Smith SK, Davidson W, Li Y, Moundeli A, Mombouli JV, Jumaan AO, Schmid DS, Regnery RL, Damon IK, 2009. Transmission of atypical varicella-zoster virus infections involving palm and sole manifestations in an area with monkeypox endemicity. Clin Infect Dis 48 : e6–e8. [Google Scholar]
  21. Lederman ER, Reynolds MG, Karem K, Braden Z, Learned-Orozco LA, Wassa-Wassa D, Moundeli O, Hughes C, Harvey J, Regnery R, Mombouli JV, Damon IK, 2007. Prevalence of antibodies against orthopoxviruses among residents of Likouala Region, Republic of Congo: evidence for monkeypox virus exposure. Am J Trop Med Hyg 77 : 1150–1156. [Google Scholar]
  22. Karem KL, Reynolds M, Braden Z, Lou G, Bernard N, Patton J, Damon IK, 2005. Characterization of acute-phase humoral immunity to monkeypox: use of immunoglobulin M enzyme-linked immunosorbent assay for detection of monkeypox infection during the 2003 North American outbreak. Clin Diagn Lab Immunol 12 : 867–872. [Google Scholar]
  23. Lazzarotto T, Guerra B, Lanari M, Gabrielli L, Landini MP, 2008. New advances in the diagnosis of congenital cytomegalovirus infection. J Clin Virol 41 : 192–197. [Google Scholar]
  24. Wasmuth EH, Miller WJ, 1990. Sensitive enzyme-linked immunosorbent assay for antibody to varicella-zoster virus using purified VZV glycoprotein antigen. J Med Virol 32 : 189–193. [Google Scholar]
  25. Finger R, Hughes JP, Meade BJ, Pelletier AR, Palmer CT, 1994. Age-specific incidence of chickenpox. Public Health Rep 109 : 750–755. [Google Scholar]
  26. Wharton M, 1996. The epidemiology of varicella-zoster virus infections. Infect Dis Clin North Am 10 : 571–581. [Google Scholar]
  27. Yawn BP, Yawn RA, Lydick E, 1997. Community impact of childhood varicella infections. J Pediatr 130 : 759–765. [Google Scholar]

Data & Media loading...

  • Received : 30 Sep 2008
  • Accepted : 14 Dec 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error