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

Adam MacNeil Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Mary G. Reynolds Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Darin S. Carroll Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Kevin Karem Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Zach Braden Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Ryan Lash Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Amba Moundeli Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Jean-Vivien Mombouli Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Aisha O. Jumaan Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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D. Scott Schmid Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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Inger K. Damon Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; District Health Office, Impfondo, Republic of Congo; National Laboratory, Brazzaville, Republic of Congo

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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.

Author Notes

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

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 6

    Jezek Z, Szczeniowski M, Paluku KM, Mutombo M, 1987. Human monkeypox: clinical features of 282 patients. J Infect Dis 156 :293–298.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 9

    Jezek Z, Szczeniowski M, Paluku KM, Mutombo M, Grab B, 1988. Human monkeypox: confusion with chickenpox. Acta Trop 45 :297–307.

  • 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.

    • Search Google Scholar
    • Export Citation
  • 12

    Jezek Z, Grab B, Szczeniowski MV, Paluku KM, Mutombo M, 1988. Human monkeypox: secondary attack rates. Bull World Health Organ 66 :465–470.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 17

    Lee BW, 1998. Review of varicella zoster seroepidemiology in India and Southeast Asia. Trop Med Int Health 3 :886–890.

  • 18

    Christiansen D, Barnett ED, 2004. Comparison of varicella history with presence of varicella antibody in refugees. Vaccine 22 :4233–4237.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 25

    Finger R, Hughes JP, Meade BJ, Pelletier AR, Palmer CT, 1994. Age-specific incidence of chickenpox. Public Health Rep 109 :750–755.

    • Search Google Scholar
    • Export Citation
  • 26

    Wharton M, 1996. The epidemiology of varicella-zoster virus infections. Infect Dis Clin North Am 10 :571–581.

  • 27

    Yawn BP, Yawn RA, Lydick E, 1997. Community impact of childhood varicella infections. J Pediatr 130 :759–765.

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