From: Subject: 1997 - Monkeypox changes its pattern of human infection Date: Mon, 9 Jun 2003 21:10:21 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0025_01C32ECB.893904C0"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 This is a multi-part message in MIME format. ------=_NextPart_000_0025_01C32ECB.893904C0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.who.int/disease-outbreak-news/n1997/april/n14apr1997.html 1997 - Monkeypox changes its pattern of human = infection

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EMC=20 Home Out= break=20 news Disease=20 info Surveillance

Disease = outbreaks
reported

14 April=20 1997=20


Monkeypox changes its pattern of human=20 infection
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Following reports of ongoing cases of human monkeypox in Zaire = representing=20 a new pattern of the disease, the Ministry of Health in Zaire and the = World=20 Health Organization (WHO) organized an investigation in February 1997. = Monkeypox, a disease which closely resembles smallpox, is preventable = by the=20 vaccination against smallpox.

The study revealed that this outbreak represents the largest = cluster of=20 monkeypox cases ever reported, and the proportion of patients that = were 15=20 years of age or older (27%) was higher than previously reported (8%). = Young=20 children have been most affected in previous outbreaks. These findings = contradict previously accepted findings on the nature of the disease.=20


The investigation
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Studies over a twenty year period have shown that the rate of = transmission=20 of monkeypox within households was low, suggesting that the disease = had a low=20 potential for transmission from person to person and that an outbreak = could=20 not last long after the first patients recovered. However, the recent = study=20 has shown that active cases in February 1997 were linked to cases that = occurred during the preceding 12 month period. The study also revealed = the=20 following:

The rate of transmission from person to person (73%) was higher = than=20 previously reported (30%). This was associated with the clustering of = cases in=20 household compounds and prolonged chains of transmission from person = to=20 person.

The proportion of deaths (3%) was lower than previously reported = (10%).=20


The disease
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Monkeypox disease closely resembles ordinary forms of smallpox. The = viruses=20 causing the two diseases are related and vaccination against smallpox = also=20 protects against monkeypox. The emergence of monkeypox does not mean = that=20 smallpox, which has been eradicated, is re-emerging.=20

All age groups are affected, but children who have not been = vaccinated are=20 at the highest risk of death, about a 10% case fatality rate. Most = cases occur=20 in remote villages of Central and West Africa close to tropical = rainforests=20 where there is frequent contact with infected animals. Monkeypox is = usually=20 transmitted to humans from squirrels and primates.=20

In the past, an outbreak of monkeypox would not go very far in the = village=20 or last long because it did not spread extensively after the first = patients=20 recovered. However, what concerns WHO is that the present study = indicates that=20 monkeypox disease is changing its pattern of infection in humans. This = outbreak has a much higher rate of person-to-person transmission than = seen=20 before, and spread through many generations of transmission, thus = maintaining=20 the outbreak for more than a year.


Concern for WHO
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The ending of vaccination programmes against smallpox in the late = 1970's=20 has probably led to an increase in susceptibility to monkeypox and = could=20 explain the larger size of the outbreak, the higher proportion of = patients=20 aged 15 and over, and the spread through many generations of = transmission.

The changing nature of monkeypox disease is of concern to WHO. In = the past,=20 before the eradication of smallpox in 1980, smallpox vaccination was=20 widespread and protected against both smallpox and monkeypox. Since = the=20 eradication of smallpox, vaccination programmes have been discontinued = as=20 recommended by WHO and WHO is concerned that monkeypox could pose a = localized=20 public health problem. WHO will therefore continue to maintain = vigilance by=20 strengthening detection systems for monkeypox and completely = investigating=20 future outbreaks so that the best strategy for prevention and control = may be=20 developed.=20

Articles describing the investigation will simultaneously appear on = 11April=20 1997, in the WHO Weekly Epidemiological Record, in the U.S. = Centers for=20 Disease Control and Prevention Morbidity and Mortality Weekly = Report,=20 and in the next edition of Eurosurveillance. In addition to WHO = the=20 study partners were from: Centers for Disease Control and Prevention, = Institut=20 national de Recherche biom=E9dicale, Kinshasa; Ecole de Sant=E9 = publique,=20 Kinshasa; the European Programme for Intervention Epidemiology = Training=20 (EPIET), Brussels; and M=E9dicins Sans Fronti=E8res.

 

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       =A9 WHO/OMS, 1998 =  |  Acknowledgements =

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