The Experts below are selected from a list of 300 Experts worldwide ranked by ideXlab platform
Mary G. Reynolds - One of the best experts on this subject based on the ideXlab platform.
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Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health.
Expert review of anti-infective therapy, 2019Co-Authors: Mary G. Reynolds, Andrea M. Mccollum, Victoria A Olson, Jeffry B. Doty, Yoshinori NakazawaAbstract:Introduction: Monkeypox is a re-emerging viral zoonosis that occurs naturally in heavily forested regions of West and Central Africa. Inter-human transmission of Monkeypox virus, although limited, ...
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Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases
Centers for Disease Control and Prevention, 2019Co-Authors: Mary G. Reynolds, Panayampalli Subbian Satheshkumar, Jean-paul Gonzalez, Benjamin Monroe, Nadia Wauquier, Lansana D. Kanneh, Jacob Maikere, Gbessay Saffa, Joseph FairAbstract:We note the reemergence of human Monkeypox in Sierra Leone following a 44-year absence of reported disease. The persons affected were an 11-month-old boy and, several years later, a 35-year-old man. The reappearance of Monkeypox in this country suggests a need for renewed vigilance and awareness of the disease and its manifestations
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Vaccinating against Monkeypox in the Democratic Republic of the Congo
Antiviral research, 2018Co-Authors: Brett W. Petersen, Christine M. Hughes, Andrea M. Mccollum, Joelle Kabamba, Robert Shongo Lushima, Emile Okitolonda Wemakoy, Jean-jacques Muyembe Tamfum, Beatrice Nguete, Benjamin Monroe, Mary G. ReynoldsAbstract:Abstract Healthcare-associated transmission of Monkeypox has been observed on multiple occasions in areas where the disease is endemic. Data collected by the US Centers for Disease Control and Prevention (CDC) from an ongoing CDC-supported program of enhanced surveillance in the Tshuapa Province of the Democratic Republic of the Congo, where the annual incidence of human Monkeypox is estimated to be 3.5–5/10,000, suggests that there is approximately one healthcare worker infection for every 100 confirmed Monkeypox cases. Herein, we describe a study that commenced in February 2017, the intent of which is to evaluate the effectiveness, immunogenicity, and safety of a third-generation smallpox vaccine, IMVAMUNE®, in healthcare personnel at risk of Monkeypox virus (MPXV) infection. We describe procedures for documenting exposures to Monkeypox virus infection in study participants, and outline lessons learned that may be of relevance for studies of other investigational medical countermeasures in hard to reach, under-resourced populations.
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Emergence of Monkeypox - West and Central Africa, 1970-2017.
MMWR. Morbidity and mortality weekly report, 2018Co-Authors: Kara N. Durski, Inger K. Damon, Mary G. Reynolds, Yoshinori Nakazawa, Andrea M. Mccollum, Victoria A Olson, Brett W. Petersen, Sylvie Briand, Mamoudou H. Djingarey, Asheena KhalakdinaAbstract:The recent apparent increase in human Monkeypox cases across a wide geographic area, the potential for further spread, and the lack of reliable surveillance have raised the level of concern for this emerging zoonosis. In November 2017, the World Health Organization (WHO), in collaboration with CDC, hosted an informal consultation on Monkeypox with researchers, global health partners, ministries of health, and orthopoxvirus experts to review and discuss human Monkeypox in African countries where cases have been recently detected and also identify components of surveillance and response that need improvement. Endemic human Monkeypox has been reported from more countries in the past decade than during the previous 40 years. Since 2016, confirmed cases of Monkeypox have occurred in Central African Republic, Democratic Republic of the Congo, Liberia, Nigeria, Republic of the Congo, and Sierra Leone and in captive chimpanzees in Cameroon. Many countries with endemic Monkeypox lack recent experience and specific knowledge about the disease to detect cases, treat patients, and prevent further spread of the virus. Specific improvements in surveillance capacity, laboratory diagnostics, and infection control measures are needed to launch an efficient response. Further, gaps in knowledge about the epidemiology and ecology of the virus need to be addressed to design, recommend, and implement needed prevention and control measures.
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Considerations for thresholds and response goals across gradients of endemicity and resources available for public health.
2018Co-Authors: Sarah Anne J. Guagliardo, Mary G. Reynolds, Joelle Kabamba, Robert Shongo Lushima, Beata Nguete, Okito E. Wemakoy, Andrea M. MccollumAbstract:Thresholds for defining aberrant disease events are most relevant in the context of endemic disease; when disease is rare, contrastingly, a single case can serve as an alarm. Response goals should be prioritized—the minimal goal is always to halt transmission, but when resources are available and/or burden of disease is high, public health authorities should strive to improve surveillance and education. For Monkeypox, high endemicity and low resources are exemplified by Tshuapa Province, DRC. Nigeria might be an example of high burden of disease and ample public health resources—recently confirmed Monkeypox cases indicate frequent autochthonous transmission, but more data is required to determine the true burden of disease. Nigeria is currently in the process of laying the groundwork for long-term Monkeypox surveillance programs—a major contrasting point with Tshuapa Province is better access to real-time case confirmation. Low Monkeypox endemicity might be exemplified by the high-resource Republic of the Congo (ROC) and low-resource Liberia or Sierra Leone. In this framework, resources available for public health are defined as the general domestic health expenditures per capita.
Inger K. Damon - One of the best experts on this subject based on the ideXlab platform.
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Emergence of Monkeypox - West and Central Africa, 1970-2017.
MMWR. Morbidity and mortality weekly report, 2018Co-Authors: Kara N. Durski, Inger K. Damon, Mary G. Reynolds, Yoshinori Nakazawa, Andrea M. Mccollum, Victoria A Olson, Brett W. Petersen, Sylvie Briand, Mamoudou H. Djingarey, Asheena KhalakdinaAbstract:The recent apparent increase in human Monkeypox cases across a wide geographic area, the potential for further spread, and the lack of reliable surveillance have raised the level of concern for this emerging zoonosis. In November 2017, the World Health Organization (WHO), in collaboration with CDC, hosted an informal consultation on Monkeypox with researchers, global health partners, ministries of health, and orthopoxvirus experts to review and discuss human Monkeypox in African countries where cases have been recently detected and also identify components of surveillance and response that need improvement. Endemic human Monkeypox has been reported from more countries in the past decade than during the previous 40 years. Since 2016, confirmed cases of Monkeypox have occurred in Central African Republic, Democratic Republic of the Congo, Liberia, Nigeria, Republic of the Congo, and Sierra Leone and in captive chimpanzees in Cameroon. Many countries with endemic Monkeypox lack recent experience and specific knowledge about the disease to detect cases, treat patients, and prevent further spread of the virus. Specific improvements in surveillance capacity, laboratory diagnostics, and infection control measures are needed to launch an efficient response. Further, gaps in knowledge about the epidemiology and ecology of the virus need to be addressed to design, recommend, and implement needed prevention and control measures.
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Monkeypox Virus: Insights on Its Emergence in Human Populations
Emerging Infections 7, 2014Co-Authors: Inger K. DamonAbstract:This chapter focuses on epidemiologic, ecologic, and biologic observations made since the publication of Emerging Infections 4 which enhance the understanding of Human Monkeypox, zoonotic disease and the pathogen that causes it. Ecologic studies, usually using convenient samples of animals collected in areas surrounding human patients in West Africa and central Africa, demonstrated orthopoxvirus- and sometimes Monkeypox virus-specific seroprevalence in various members of these species, but it was not reported for Cricetomys species. In 2003, two concurrent outbreaks of disease, one in the United States and one in the Republic of the Congo, permitted additional analyses and studies which have substantially amplified the understanding of Monkeypox viruses and their pathogeneses in various animal species, which in turn will allow the design of public health control measures. Gambian rats (Cricetomys sp.) and rope squirrels (Funisciurus spp.) separated from the shipment immediately on arrival in the United States, discovered moribund and later dead in Texas and New Jersey, respectively, were found positive for Monkeypox virus. As the animal distribution was traced across the United States, African dormice (Graphiurus spp.) were also found moribund, and on autopsy they were positive for the presence of Monkeypox virus. Monkeypox virus continues to emerge in new populations; recent reports from Sudan indicate that the virus has the capacity to cause human illness in yet another ecologically distinct environment.
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Mapping Monkeypox transmission risk through time and space in the Congo Basin.
PloS one, 2013Co-Authors: Yoshinori Nakazawa, Inger K. Damon, Darin S. Carroll, Mary G. Reynolds, R. Ryan Lash, K. L. Karem, Jorge E. Osorio, Tonie E. Rocke, Jean Malekani, Jean-jacques MuyembeAbstract:Monkeypox is a major public health concern in the Congo Basin area, with changing patterns of human case occurrences reported in recent years. Whether this trend results from better surveillance and detection methods, reduced proportions of vaccinated vs. non-vaccinated human populations, or changing environmental conditions remains unclear. Our objective is to examine potential correlations between environment and transmission of Monkeypox events in the Congo Basin. We created ecological niche models based on human cases reported in the Congo Basin by the World Health Organization at the end of the smallpox eradication campaign, in relation to remotely-sensed Normalized Difference Vegetation Index datasets from the same time period. These models predicted independent spatial subsets of Monkeypox occurrences with high confidence; models were then projected onto parallel environmental datasets for the 2000s to create present-day Monkeypox suitability maps. Recent trends in human Monkeypox infection are associated with broad environmental changes across the Congo Basin. Our results demonstrate that ecological niche models provide useful tools for identification of areas suitable for transmission, even for poorly-known diseases like Monkeypox.
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Ecology and geography of human Monkeypox case occurrences across Africa.
Journal of wildlife diseases, 2012Co-Authors: Christine K. Ellis, Inger K. Damon, A. Townsend Peterson, Darin S. Carroll, R. Ryan Lash, Jean Malekani, Pierre FormentyAbstract:As ecologic niche modeling (ENM) evolves as a tool in spatial epidemiology and public health, selection of the most appropriate and informative environmental data sets becomes increasingly important. Here, we build on a previous ENM analysis of the potential distribution of human Monkeypox in Africa by refining georeferencing criteria and using more-diverse environmental data to identify environmental parameters contributing to Monkeypox distributional ecology. Significant environmental variables include annual precipitation, several temperature-related variables, primary productivity, evapotranspiration, soil moisture, and pH. The potential distribution identified with this set of variables was broader than that identified in previous analyses but does not include areas recently found to hold Monkeypox in southern Sudan. Our results emphasize the importance of selecting the most appropriate and informative environmental data sets for ENM analyses in pathogen transmission mapping.
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Status of human Monkeypox: clinical disease, epidemiology and research.
Vaccine, 2011Co-Authors: Inger K. DamonAbstract:Monkeypox, a vesiculo-pustular rash illness, was initially discovered to cause human infection in 1970 through the World Health Organization (WHO)-sponsored efforts of the Commission to Certify Smallpox Eradication in Western Africa and the Congo Basin. The virus had been discovered to cause a nonhuman primate rash illness in 1958, and was thus named Monkeypox. The causative agents of Monkeypox and smallpox diseases both are species of Orthopoxvirus. Orthopoxvirus Monkeypox, when it infects humans as an epizootic, produces a similar clinical picture to that of ordinary human smallpox. Since 1970, extensive epidemiology, virology, ecology and public health research has enabled better characterization of Monkeypox virus and the associated human disease. This work reviews the progress in this body of research, and reviews studies of this "newly" emerging zoonotic disease.
Chikwe Ihekweazu - One of the best experts on this subject based on the ideXlab platform.
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human Monkeypox after 40 years an unintended consequence of smallpox eradication
Vaccine, 2020Co-Authors: Karl Simpson, David L. Heymann, Colin S Brown, Jesper Elsgaard, Paul E. M. Fine, Hubertus Hochrein, Nicole A. Hoff, Andrew Green, John W Edmunds, Chikwe IhekweazuAbstract:Abstract Smallpox eradication, coordinated by the WHO and certified 40 years ago, led to the cessation of routine smallpox vaccination in most countries. It is estimated that over 70% of the world’s population is no longer protected against smallpox, and through cross-immunity, to closely related orthopox viruses such as Monkeypox. Monkeypox is now a re-emerging disease. Monkeypox is endemic in as yet unconfirmed animal reservoirs in sub-Saharan Africa, while its human epidemiology appears to be changing. Monkeypox in small animals imported from Ghana as exotic pets was at the origin of an outbreak of human Monkeypox in the USA in 2003. Travellers infected in Nigeria were at the origin of Monkeypox cases in the UK in 2018 and 2019, Israel in 2018 and Singapore in2019. Together with sporadic reports of human infections with other orthopox viruses, these facts invite speculation that emergent or re-emergent human Monkeypox might fill the epidemiological niche vacated by smallpox. An ad-hoc and unofficial group of interested experts met to consider these issues at Chatham House, London in June 2019, in order to review available data and identify Monkeypox-related research gaps. Gaps identified by the experts included: • understanding of zoonotic hosts, reservoirs and vectors. • risks associated with transmission. • full description of the clinical spectrum and the natural history of infection including an estimation of the prevalence of Monkeypox specific antibodies in humans living in areas of emergence. The experts further agreed on the need for a better understanding of the genomic evolution and changing epidemiology of orthopox viruses, the usefulness of in-field genomic diagnostics, and the best disease control strategies, including the possibility of vaccination with new generation non-replicating smallpox vaccines and treatment with recently developed antivirals.
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Human Monkeypox – After 40 years, an unintended consequence of smallpox eradication
Vaccine, 2020Co-Authors: Karl Simpson, David L. Heymann, Colin S Brown, W. John Edmunds, Jesper Elsgaard, Paul E. M. Fine, Hubertus Hochrein, Nicole A. Hoff, Andrew Green, Chikwe IhekweazuAbstract:Abstract Smallpox eradication, coordinated by the WHO and certified 40 years ago, led to the cessation of routine smallpox vaccination in most countries. It is estimated that over 70% of the world’s population is no longer protected against smallpox, and through cross-immunity, to closely related orthopox viruses such as Monkeypox. Monkeypox is now a re-emerging disease. Monkeypox is endemic in as yet unconfirmed animal reservoirs in sub-Saharan Africa, while its human epidemiology appears to be changing. Monkeypox in small animals imported from Ghana as exotic pets was at the origin of an outbreak of human Monkeypox in the USA in 2003. Travellers infected in Nigeria were at the origin of Monkeypox cases in the UK in 2018 and 2019, Israel in 2018 and Singapore in2019. Together with sporadic reports of human infections with other orthopox viruses, these facts invite speculation that emergent or re-emergent human Monkeypox might fill the epidemiological niche vacated by smallpox. An ad-hoc and unofficial group of interested experts met to consider these issues at Chatham House, London in June 2019, in order to review available data and identify Monkeypox-related research gaps. Gaps identified by the experts included: • understanding of zoonotic hosts, reservoirs and vectors. • risks associated with transmission. • full description of the clinical spectrum and the natural history of infection including an estimation of the prevalence of Monkeypox specific antibodies in humans living in areas of emergence. The experts further agreed on the need for a better understanding of the genomic evolution and changing epidemiology of orthopox viruses, the usefulness of in-field genomic diagnostics, and the best disease control strategies, including the possibility of vaccination with new generation non-replicating smallpox vaccines and treatment with recently developed antivirals.
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human Monkeypox epidemiologic and clinical characteristics diagnosis and prevention
Infectious Disease Clinics of North America, 2019Co-Authors: Eskild Petersen, Chikwe Ihekweazu, D Asogun, Anu Kantele, Marion Koopmans, Adesola Yinkaogunleye, Alimuddin ZumlaAbstract:Recently, concern has been raised about the emergence of human Monkeypox virus and the occasionally severe clinical presentation bearing resemblance to that of smallpox. In 2018 3 patients in the UK were diagnosed with Monkeypox, and the frequency and geographic distribution of cases across West and Central Africa have increased in recent years. In Nigeria, most Monkeypox patients are aged <40 years and lack cross-protective immunity because they were born after discontinuation of the smallpox eradication campaign. This article reviews the epidemiology, clinical features, and management of Monkeypox and discusses its growing public health threat in this context.
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Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention.
Infectious disease clinics of North America, 2019Co-Authors: Eskild Petersen, Chikwe Ihekweazu, D Asogun, Anu Kantele, Marion Koopmans, Adesola Yinka-ogunleye, Alimuddin ZumlaAbstract:Recently, concern has been raised about the emergence of human Monkeypox virus and the occasionally severe clinical presentation bearing resemblance to that of smallpox. In 2018 3 patients in the UK were diagnosed with Monkeypox, and the frequency and geographic distribution of cases across West and Central Africa have increased in recent years. In Nigeria, most Monkeypox patients are aged
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Monkeypox enhancing public health preparedness for an emerging lethal human zoonotic epidemic threat in the wake of the smallpox post eradication era
International Journal of Infectious Diseases, 2019Co-Authors: Eskild Petersen, David L. Heymann, Chikwe Ihekweazu, Ibrahim Abubakar, Francine Ntoumi, Lucille Blumberg, D Asogun, Victor Mukonka, Swaib A Lule, Matthew BatesAbstract:The identification of Monkeypox in 3 separate patients in the United Kingdom in September raised media and political attention on an emerging public health threat. Nigeria, whose last confirmed case of Monkeypox was in 1978, is currently experiencing an unusually large and outbreak of human Monkeypox cases, a 'One Human-Environmental-Animal Health' approach is being effectively used to define and tackle the outbreak. As of 13th October 2018, there have been one hundred and sixteen confirmed cases the majority of whom are under 40 years. Over the past 20 years ten Central and West African countries have reported Monkeypox cases which have risen exponentially. We review the history and evolution of Monkeypox outbreaks in Africa and USA, the changing clinical presentations, and discuss possible factors underlying the increasing numbers being detected including the cessation of smallpox vaccination programs. Major knowledge gaps remain on the epidemiology, host reservoir, and emergence, transmission, pathogenesis and prevention of monkeypoz.
Victoria A Olson - One of the best experts on this subject based on the ideXlab platform.
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Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health.
Expert review of anti-infective therapy, 2019Co-Authors: Mary G. Reynolds, Andrea M. Mccollum, Victoria A Olson, Jeffry B. Doty, Yoshinori NakazawaAbstract:Introduction: Monkeypox is a re-emerging viral zoonosis that occurs naturally in heavily forested regions of West and Central Africa. Inter-human transmission of Monkeypox virus, although limited, ...
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Emergence of Monkeypox - West and Central Africa, 1970-2017.
MMWR. Morbidity and mortality weekly report, 2018Co-Authors: Kara N. Durski, Inger K. Damon, Mary G. Reynolds, Yoshinori Nakazawa, Andrea M. Mccollum, Victoria A Olson, Brett W. Petersen, Sylvie Briand, Mamoudou H. Djingarey, Asheena KhalakdinaAbstract:The recent apparent increase in human Monkeypox cases across a wide geographic area, the potential for further spread, and the lack of reliable surveillance have raised the level of concern for this emerging zoonosis. In November 2017, the World Health Organization (WHO), in collaboration with CDC, hosted an informal consultation on Monkeypox with researchers, global health partners, ministries of health, and orthopoxvirus experts to review and discuss human Monkeypox in African countries where cases have been recently detected and also identify components of surveillance and response that need improvement. Endemic human Monkeypox has been reported from more countries in the past decade than during the previous 40 years. Since 2016, confirmed cases of Monkeypox have occurred in Central African Republic, Democratic Republic of the Congo, Liberia, Nigeria, Republic of the Congo, and Sierra Leone and in captive chimpanzees in Cameroon. Many countries with endemic Monkeypox lack recent experience and specific knowledge about the disease to detect cases, treat patients, and prevent further spread of the virus. Specific improvements in surveillance capacity, laboratory diagnostics, and infection control measures are needed to launch an efficient response. Further, gaps in knowledge about the epidemiology and ecology of the virus need to be addressed to design, recommend, and implement needed prevention and control measures.
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Strengthening of Surveillance during Monkeypox Outbreak, Republic of the Congo, 2017.
Emerging infectious diseases, 2018Co-Authors: Reena H. Doshi, Sarah Anne J. Guagliardo, Nestor Ndakala, Andrea M. Mccollum, Cynthia Moses, Victoria A Olson, Angelie Dzabatou-babeaux, Camille Likouayoulou, Brett W. PetersenAbstract:Reports of 10 suspected cases of Monkeypox in Likouala Department, Republic of the Congo, triggered an investigation and response in March 2017 that included community education and surveillance strengthening. Increasing numbers of outbreaks suggest that Monkeypox virus is becoming a more prevalent human pathogen. Diverse approaches are necessary for disease control and prevention.
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Monkeypox zoonotic associations insights from laboratory evaluation of animals associated with the multi state us outbreak
American Journal of Tropical Medicine and Hygiene, 2007Co-Authors: Christina L Hutson, Darin S. Carroll, Christine M. Hughes, Kemba N Lee, Jason Abel, Joel M Montgomery, Victoria A Olson, Whitni Davidson, Michael Dillon, Paul SpurlockAbstract:At the onset of the 2003 US Monkeypox outbreak, virologic data were unavailable regarding which animal species were involved with virus importation and/or subsequent transmission to humans and whether there was a risk for establishment of zoonotic Monkeypox in North America. Similarly, it was unclear which specimens would be best for virus testing. Monkeypox DNA was detected in at least 33 animals, and virus was cultured from 22. Virus-positive animals included three African species associated with the importation event (giant pouched rats, Cricetomys spp.; rope squirrels, Funisciuris sp.; and dormice, Graphiuris sp.). Virologic evidence from North American prairie dogs (Cynomys sp.) was concordant with their suspected roles as vectors for human Monkeypox. Multiple tissues were found suitable for DNA detection and/or virus isolation. These data extend the potential host range for Monkeypox virus infection and supports concern regarding the potential for establishment in novel reservoir species and ecosystems.
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Detection of Monkeypox virus with real-time PCR assays
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology, 2006Co-Authors: Victoria A Olson, Thomas Laue, Miriam Laker, Inger K. DamonAbstract:Abstract Background Human Monkeypox, a zoonotic disease, was first reported outside of Africa during the 2003 US outbreak. Objectives We present two real-time PCR assays critical for laboratory diagnosis of Monkeypox during the 2003 US outbreak. Study design A TaqMan-based assay (E9L-NVAR) targets the orthopoxvirus DNA polymerase gene and detects Eurasian orthopoxviruses other than Variola. A hybridization assay, utilizing a MGB Eclipse™ (Epoch Biosciences) probe, targets an envelope protein gene (B6R) and specifically detects Monkeypox virus (MPXV). Assays were validated using coded orthopoxvirus DNA samples and used to evaluate lesion samples from five confirmed US Monkeypox cases. Results E9L-NVAR did not detect variola (48 strains), North American orthopoxviruses (2), or DNA derived from non-poxviral rash illnesses. The assay reproducibly identified various concentrations of 13 Eurasian orthopoxvirus strains and was sensitive to 12.5 vaccinia genomes. The B6R assay recognized 15 different MPXV strains, while other orthopoxvirus (9) and bacteria (15) strains did not cross-react. Of the 13 human samples tested from confirmed cases, both assays identified 100% as containing MPXV DNA. Conclusions E9L-NVAR and B6R assays demonstrate 100% specificity for non-variola Eurasian orthopoxvirus and MPXV, respectively. Using two discrete viral gene targets, these assays together provide a reliable and sensitive method for quickly confirming Monkeypox infections.
Kevin L. Karem - One of the best experts on this subject based on the ideXlab platform.
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Factors affecting the likelihood of Monkeypox's emergence and spread in the post-smallpox era.
Current opinion in virology, 2012Co-Authors: Mary G. Reynolds, Darin S. Carroll, Kevin L. KaremAbstract:In 1980, the World Health Assembly announced that smallpox had been successfully eradicated as a disease of humans. The disease clinically and immunologically most similar to smallpox is Monkeypox, a zoonosis endemic to moist forested regions in West and Central Africa. Smallpox vaccine provided protection against both infections. Monkeypox virus is a less efficient human pathogen than the agent of smallpox, but absent smallpox and the population-wide immunity engendered during eradication efforts, could Monkeypox now gain a foothold in human communities? We discuss possible ecologic and epidemiologic limitations that could impede Monkeypox's emergence as a significant pathogen of humans, and evaluate whether genetic constrains are sufficient to diminish Monkeypox virus' capacity for enhanced specificity as a parasite of humans.
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Monkeypox or Varicella? Lessons from a Rash Outbreak Investigation in the Republic of the Congo
The American journal of tropical medicine and hygiene, 2009Co-Authors: Adam Macneil, Darin S. Carroll, Mary G. Reynolds, Kevin L. Karem, R. Ryan Lash, Zach Braden, Amba Moundeli, Jean-vivien Mombouli, Aisha O. Jumaan, D. Scott SchmidAbstract: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 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.
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Monkeypox-Induced Immunity and Failure of Childhood Smallpox Vaccination To Provide Complete Protection
Clinical and vaccine immunology : CVI, 2007Co-Authors: Kevin L. Karem, Mary G. Reynolds, Christine M. Hughes, Zach Braden, Pragati Nigam, Shane Crotty, John Glidewell, Rafi Ahmed, Rama Rao Amara, Inger K. DamonAbstract:Following the U.S. Monkeypox outbreak of 2003, blood specimens and clinical and epidemiologic data were collected from cases, defined by standard definition, and household contacts of cases to evaluate the role of preexisting (smallpox vaccine-derived) and acquired immunity in susceptibility to Monkeypox disease and clinical outcomes. Orthopoxvirus-specific immunoglobulin G (IgG), IgM, CD4, CD8, and B-cell responses were measured at approximately 7 to 14 weeks and 1 year postexposure. Associations between immune responses, smallpox vaccination, and epidemiologic and clinical data were assessed. Participants were categorized into four groups: (i) vaccinated cases, (ii) unvaccinated cases, (iii) vaccinated contacts, and (iv) unvaccinated contacts. Cases, regardless of vaccination status, were positive for orthopoxvirus-specific IgM, IgG, CD4, CD8, and B-cell responses. Antiorthopoxvirus immune responses consistent with infection were observed in some contacts who did not develop Monkeypox. Vaccinated contacts maintained low levels of antiorthopoxvirus IgG, CD4, and B-cell responses, with most lacking IgM or CD8 responses. Preexisting immunity, assessed by high antiorthopoxvirus IgG levels and childhood smallpox vaccination, was associated (in a nonsignificant manner) with mild disease. Vaccination failed to provide complete protection against human Monkeypox. Previously vaccinated Monkeypox cases manifested antiorthopoxvirus IgM and changes in antiorthopoxvirus IgG, CD4, CD8, or B-cell responses as markers of recent infection. Antiorthopoxvirus IgM and CD8 responses occurred most frequently in Monkeypox cases (vaccinated and unvaccinated), with IgG, CD4, and memory B-cell responses indicative of vaccine-derived immunity. Immune markers provided evidence of asymptomatic infections in some vaccinated, as well as unvaccinated, individuals.
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EXTENDED INTERHUMAN TRANSMISSION OF Monkeypox IN A HOSPITAL COMMUNITY IN THE REPUBLIC OF THE CONGO, 2003
The American journal of tropical medicine and hygiene, 2005Co-Authors: Lynne A. Learned, Mary G. Reynolds, Kevin L. Karem, Victoria A Olson, Demole Wassa Wassa, Linda L. Stempora, Zach Braden, Richard Kline, Anna LikosAbstract: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 perception of the capacity for this zoonotic virus to adapt to humans.
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Evaluation of Human-to-Human Transmission of Monkeypox from Infected Patients to Health Care Workers
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2005Co-Authors: Aaron T. Fleischauer, James C. Kile, Molly Davidson, Marc Fischer, Kevin L. Karem, Robert Teclaw, Hans Messersmith, Pamela Pontones, Bradley Beard, Zachary BradenAbstract:BACKGROUND In 2003, human Monkeypox was first identified in the United States. The outbreak was associated with exposure to infected prairie dogs, but the potential for person-to-person transmission was a concern. This study examines health care worker (HCW) exposure to 3 patients with confirmed Monkeypox. METHODS Exposed HCWs, defined as HCWs who entered a 2-m radius surrounding case patients with confirmed Monkeypox, were identified by infection-control practitioners. A self-administered questionnaire and analysis of paired serum specimens determined exposure status, immune response, and postexposure signs and symptoms of Monkeypox. RESULTS Of 81 exposed HCWs, 57 (70%) participated in the study. Among 57 participants, 40 (70%) had > or =1 unprotected exposure; none reported signs or symptoms consistent with Monkeypox illness. One exposed HCW (2%), who had been vaccinated for smallpox within the past year, had serological evidence of recent orthopoxvirus infection; acute- and convalescent-phase serum specimens tested positive for anti-orthopoxvirus IgM. No exposed HCWs had signs and symptoms consistent with Monkeypox. CONCLUSION More than three-quarters of exposed HCWs reported at least 1 unprotected encounter with a patient who had Monkeypox. One asymptomatic HCW showed laboratory evidence of recent orthopoxvirus infection, which was possibly attributable to either recent infection or smallpox vaccination. Transmission of Monkeypox likely is a rare event in the health care setting.