Gaspard Mande1, Innocent Akonda2, Anja De Weggheleire3, Isabel Brosius4, Laurens Liesenborghs5, Emmanuel Bottieau6, Noam Ross7, Guy-Crispin Gembu8, Robert Colebunders9, Erik Verheyen10, Dauly Ngonda11, Herwig Leirs12, Anne Laudisoit13. 1. University of Kisangani, Faculty of Medicine and Pharmacy, BP 2012, Kisangani, Democratic Republic of Congo. Electronic address: gaspard.mande@unikis.ac.cd. 2. Ministry of Health, Buta, Democratic Republic of Congo. Electronic address: boseluc@gmail.com. 3. Outbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. Electronic address: Adeweggheleire@ext.itg.be. 4. Outbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. Electronic address: ibrosius@itg.be. 5. Outbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. Electronic address: lliesenborghs@itg.be. 6. Outbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium. Electronic address: EBottieau@itg.be. 7. Ecohealth Alliance, 520 8(th) Avenue, 10018 New York, NY, United States of America. Electronic address: ross@ecohealthalliance.org. 8. University of Kisangani, Faculty of Science and Center for Biodiversity Monitoring, BP2012, Kisangani, Democratic Republic of Congo. Electronic address: guycrispin.gembu@unikis.ac.cd. 9. Global Health Institute, University of Antwerp, Campus drie Eiken, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Wilrijk, Belgium. Electronic address: robert.colebunders@uantwerpen.be. 10. Royal Belgian Institute of Natural Sciences, Rue Vautier 29, 1000 Brussels, Belgium; Evolutionary Ecology Group, University of Antwerp, Campus Drie Eiken. Electronic address: erik.verheyen@uantwerpen.be. 11. University of Kisangani, Faculty of Medicine and Pharmacy, BP 2012, Kisangani, Democratic Republic of Congo. Electronic address: dauly_ngbonda@yahoo.com. 12. Evolutionary Ecology Group, University of Antwerp, Campus Drie Eiken. Electronic address: herwig.leirs@uantwerpen.be. 13. Ecohealth Alliance, 520 8(th) Avenue, 10018 New York, NY, United States of America; Evolutionary Ecology Group, University of Antwerp, Campus Drie Eiken. Electronic address: laudisoit@ecohealthalliance.org.
Abstract
BACKGROUND: Following an outbreak of cases of vesicular-pustular rash with fever, evocative of human monkeypox, in Bas-Uélé province, Democratic Republic of Congo, surveillance was strengthened. METHODS: Households with at least one active generalized vesicular-pustular rash case were visited, and contact and clinical history information were collected from all household members. Whenever possible, skin lesions were screened by polymerase chain reaction for the monkeypox virus, followed by the varicella-zoster virus, when negative for the former. RESULTS: Polymerase chain reaction results were obtained for 77 suspected cases, distributed in 138 households, of which 27.3% were positive for monkeypox, 58.4% positive for chickenpox, and 14.3% negative for both. Confirmed monkeypox cases presented more often with monomorphic skin lesions on the palms of the hands and on the soles of the feet. Integrating these three features into the case definition raised the specificity to 85% but would miss 50% of true monkeypox cases. A predictive model fit on patient demographics and symptoms had 97% specificity and 80% sensitivity but only 80% and 33% in predicting out-of-sample cases. CONCLUSION: Few discriminating features were identified and the performance of clinical case definitions was suboptimal. Rapid field diagnostics are needed to optimize worldwide early detection and surveillance of monkeypox. Published by Elsevier Ltd.
BACKGROUND: Following an outbreak of cases of vesicular-pustular rash with fever, evocative of human monkeypox, in Bas-Uélé province, Democratic Republic of Congo, surveillance was strengthened. METHODS: Households with at least one active generalized vesicular-pustular rash case were visited, and contact and clinical history information were collected from all household members. Whenever possible, skin lesions were screened by polymerase chain reaction for the monkeypox virus, followed by the varicella-zoster virus, when negative for the former. RESULTS: Polymerase chain reaction results were obtained for 77 suspected cases, distributed in 138 households, of which 27.3% were positive for monkeypox, 58.4% positive for chickenpox, and 14.3% negative for both. Confirmed monkeypox cases presented more often with monomorphic skin lesions on the palms of the hands and on the soles of the feet. Integrating these three features into the case definition raised the specificity to 85% but would miss 50% of true monkeypox cases. A predictive model fit on patient demographics and symptoms had 97% specificity and 80% sensitivity but only 80% and 33% in predicting out-of-sample cases. CONCLUSION: Few discriminating features were identified and the performance of clinical case definitions was suboptimal. Rapid field diagnostics are needed to optimize worldwide early detection and surveillance of monkeypox. Published by Elsevier Ltd.
Entities:
Keywords:
Chickenpox; Democratic Republic of Congo; Diagnostic; Monkeypox; Orthopoxvirus
Authors: Vicente A Benites-Zapata; Juan R Ulloque-Badaracco; Esteban A Alarcon-Braga; Enrique A Hernandez-Bustamante; Melany D Mosquera-Rojas; D Katterine Bonilla-Aldana; Alfonso J Rodriguez-Morales Journal: Ann Clin Microbiol Antimicrob Date: 2022-08-10 Impact factor: 6.781