Maternal and Fetal Outcomes Among Pregnant Women With Human Monkeypox Infection in the Democratic Republic of Congo (original) (raw)
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Clinical characterization of human monkeypox infections in the Democratic Republic of the Congo
We describe the results of a prospective observational study of the clinical natural history of human monkeypox virus (MPXV) infections at the remote General Reference Hospital of Kole (Kole hospital), the rainforest of the Congo River basin of the Democratic Republic of the Congo (DRC) from March 2007 until August 2011. The research was conducted jointly by the Institute National de Recherche Biomedical (INRB) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The Kole hospital was one of the two previous WHO Monkeypox (MPX) study sites (1981-1986). The hospital is staffed by a Spanish Order of Catholic Nuns from La Congregation Des Seours Missionnaires Du Christ Jesus including two Spanish physicians, who were members of the Order as well, were part of the WHO study on human monkeypox. Of 244 patients admitted with a clinical diagnosis of MPXV infection, 216 were positive in both the Pan-Orthopox and MPXV specific PCR. The cardinal observations of these ...
Perinatal Journal
The World Health Organization in May 2022 declared the monkeypox virus (MPXV) a health emergency. Since then, over 45,355 cases have been reported, mostly from countries where the disease is not endemic. At the moment, most confirmed cases with travel history are reported to countries in Europe and North America, rather than West or Central Africa where the monkeypox virus is endemic. Its transmission depends on large respiratory droplets and skin-to-skin or skin-to-lesion close physical contact, including oral, anal, and vaginal intercourse therefore, women are also at risk of acquiring it. Given few data available, women’s and clinicians’ concerns about the uncertainty of the clinical course and management are more than understandable, especially so after the SARS-CoV-2 pandemic. Lessons must be learnt from our prior mistakes and pregnant individuals should be included in international registries as well as any studies evaluating new treatments or vaccines. The following recommend...
The American journal of tropical medicine and hygiene, 2005
This report describes the first reported outbreak of human monkeypox in the Republic of Congo. Eleven confirmed and probable monkeypox cases were observed during this outbreak, all were less than 18 years old, and most resided on the grounds of the Government Hospital in Impfondo. Molecular, virologic, and serologic, and diagnostic assays were used to detect evidence of monkeypox (or orthopox) virus infection in individuals with striking dermatologic and other clinical manifestations. The majority of cases in this outbreak experienced significant, symptomatic illnesses; there was one death, possibly involving secondary complications, and one instance of profound sequelae. Up to six sequential transmissions of monkeypox virus from person to person are hypothesized to have occurred, making this the longest uninterrupted chain of human monkeypox fully documented to date. The pattern of sustained human-to-human transmission observed during this outbreak may influence our current percept...
Endemic human monkeypox, Democratic Republic of Congo, 2001–2004
2007
By analyzing vesicle fl uids and crusted scabs from 136 persons with suspected monkeypox, we identifi ed 51 cases of monkeypox by PCR, sequenced the hemagglutinin gene, and confi rmed 94% of cases by virus culture. PCR demonstrated chickenpox in 61 patients. Coinfection with both viruses was found in 1 additional patient.
American Journal of Obstetrics & Gynecology MFM
In May 2022, the World Health Organization reported an emerging global outbreak of monkeypox virus infection. Clinical manifestations of monkeypox allow us to quickly suspect the disease. Until now, no pregnant women infected with this virus have been reported; however, because of its speed of spread worldwide, it is possible that we will soon observe such cases. Thus, it is necessary for obstetrician−gynecologists to know the disease, its clinical manifestations, and the experiences reported in the few previous cases in pregnant women.
Clinical Characteristics of Human Monkeypox, and Risk Factors for Severe Disease
Clinical Infectious Diseases, 2005
Background. Human monkeypox is an emerging smallpox-like illness that was identified for the first time in the United States during an outbreak in 2003. Knowledge of the clinical manifestations of monkeypox in adults is limited, and clinical laboratory findings have been unknown. Methods. Demographic information; medical history; smallpox vaccination status; signs, symptoms, and duration of illness, and laboratory results (hematologic and serum chemistry findings) were extracted from medical records of patients with a confirmed case of monkeypox in the United States. Two-way comparisons were conducted between pediatric and adult patients and between patients with and patients without previous smallpox vaccination. Bivariate and multivariate analyses of risk factors for severe disease (fever [temperature, у38.3ЊC] and the presence of rash [у100 lesions]), activity and duration of hospitalization, and abnormal clinical laboratory findings were performed. Results. Of 34 patients with a confirmed case of monkeypox, 5 (15%) were defined as severely ill, and 9 (26%) were hospitalized for 148 h; no patients died. Previous smallpox vaccination was not associated with disease severity or hospitalization. Pediatric patients (age, р18 years) were more likely to be hospitalized in an intensive care unit. Nausea and/or vomiting and mouth sores were independently associated with a hospitalization duration of 148 h and with having у3 laboratory tests with abnormal results. Conclusion. Monkeypox can cause a severe clinical illness, with systemic signs and symptoms and abnormal clinical laboratory findings. In the appropriate epidemiologic context, monkeypox should be included in the differential diagnosis for patients with unusual vesiculopustular exanthems, mucosal lesions, gastrointestinal symptoms, and abnormal hematologic or hepatic laboratory findings. Clinicians evaluating a rash illness consistent with possible orthopoxvirus infection should alert public health officials and consider further evaluation. Monkeypox is a smallpox-like illness caused by infection with a zoonotic orthopoxvirus. Human infections were first described in central Africa in 1970 [1-3]. The disease is endemic in the Congo basin countries of Africa and, possibly, west Africa as well; the majority of human cases have been detected in the Congo basin countries [4-8].
DISPATCHES Endemic Human Monkeypox, Democratic Republic of Congo
2013
By analyzing vesicle fl uids and crusted scabs from 136 persons with suspected monkeypox, we identifi ed 51 cases of monkeypox by PCR, sequenced the hemagglutinin gene, and confi rmed 94 % of cases by virus culture. PCR demonstrated chickenpox in 61 patients. Coinfection with both viruses was found in 1 additional patient. Monkeypox (MPX) virus is an orthopoxvirus that causes human MPX, a smallpoxlike disease reported in the African rainforests. Humans acquire the virus through direct contact with infected animals or patients (1). To determine whether MPX virus could potentially occupy the niche vacated by smallpox virus, the World Health Organization (WHO) conducted an active surveillance program during 1981–1986 in the Democratic Republic of Congo (DRC) and identified 338 MPX cases (67 % confirmed by virus culture). Epidemiologic data led to the conclusion that MPX was a sporadic disease with a low potential for person-to-person transmission and that infection could not sustain it...
Outbreak of Human Monkeypox, Democratic Republic of Congo, 1996 to 1997
Emerging Infectious Diseases, 2001
Human monkeypox, a sporadic smallpox-like zoonotic viral exanthema that occurs in the rain forests of Central and West Africa, was discovered in 1970 (1-3). The illness is caused by an orthopoxvirus, monkeypox virus, which was first isolated from primate tissues (4). Animal antibody surveys in the Democratic Republic of Congo (DRC; former Zaire) suggested that squirrels play a major role as a reservoir of the virus and that humans are sporadically infected (3,5,6). Human-to-human transmission occurs with an incubation period of 12 days (range 7-21 days) (3). After smallpox eradication, surveillance for human monkeypox from 1981 to 1986 in the DRC identified 338 cases (67% confirmed by virus culture). The case-fatality rate was 9.8% for persons not vaccinated with vaccinia (smallpox) vaccine, which was about 85% efficacious in preventing human monkeypox (3,7). The secondary attack rate in unvaccinated household members was 9.3%, and 28% of casepatients reported an exposure to another case-patient during the incubation period. Transmission chains beyond secondary were rare (8,9). A mathematical model to assess the potential for monkeypox to spread in susceptible populations after cessation of vaccinia vaccination indicated that person-toperson transmission would not sustain monkeypox in humans without repeated reintroduction of the virus from the wild (7). In 1996, 71 suspected human monkeypox cases were reported from the Katako-Kombe Health Zone, Kasai Oriental, DRC. These initial reports suggested predominant person-to-person transmission and prolonged chains of transmission. Two cases were confirmed by monkeypox virus isolation from lesion material (10). In February 1997, an investigation was initiated (11). Our report describes epidemiologic observations and laboratory results supporting the conclusion that repeated animal reintroduction of monkeypox virus is needed to sustain the disease in the local human population. Methods Epidemiologic and Clinical Studies Before civil unrest in the area curtailed the study, a dwelling-to-dwelling search was conducted for cases that occurred from February 1996 and February 1997 in 12 villages (total population 4,057) in the Katako-Kombe Health Zone, located around Akungula, a village reported to be the epicenter of the current outbreak. A clinical case of monkeypox was defined as the occurrence of fever with a rash recognized as being similar to that in a reference photo provided by the World Health Organization. Monkeypox cases were classified as active until desquamation of the rash. After desquamation, cases were identified retrospectively by interview and examination for residual scars. Onset dates were estimated by using local event calendars. Patients (or their adult respondent) who agreed to participate were queried by using a standardized data collection instrument to obtain information on demographics, signs and symptoms of disease, exposures to wild animals, presence of a smallpox vaccination scar, and exposure to another patient. Consenting participants underwent a physical examination, and a blood sample for serum was obtained.