Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions.
Chickenpox
Democratic Republic of Congo
Diagnostic
Monkeypox
Orthopoxvirus
Journal
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
ISSN: 1878-3511
Titre abrégé: Int J Infect Dis
Pays: Canada
ID NLM: 9610933
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
25
05
2022
revised:
22
06
2022
accepted:
30
06
2022
pubmed:
10
7
2022
medline:
9
9
2022
entrez:
9
7
2022
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 35809857
pii: S1201-9712(22)00390-3
doi: 10.1016/j.ijid.2022.06.060
pmc: PMC9628793
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
647-655Informations de copyright
Published by Elsevier Ltd.
Références
Euro Surveill. 2021 Aug;26(32):
pubmed: 34387184
J Infect Dis. 2006 Sep 15;194(6):773-80
pubmed: 16941343
Virol J. 2016 Dec 9;13(1):207
pubmed: 27938377
Int J Infect Dis. 2022 Sep;122:647-655
pubmed: 35809857
Bull World Health Organ. 1972;46(5):593-7
pubmed: 4340218
Emerg Infect Dis. 2019 May;25(5):980-983
pubmed: 30848724
Am J Trop Med Hyg. 2017 Feb 8;96(2):405-410
pubmed: 27994107
Front Public Health. 2018 Sep 04;6:241
pubmed: 30234087
MMWR Morb Mortal Wkly Rep. 2018 Mar 16;67(10):306-310
pubmed: 29543790
Acta Trop. 1988 Dec;45(4):297-307
pubmed: 2907258
MMWR Morb Mortal Wkly Rep. 2022 Apr 08;71(14):509-516
pubmed: 35389974
Proc Natl Acad Sci U S A. 2010 Sep 14;107(37):16262-7
pubmed: 20805472
Am J Trop Med Hyg. 2009 Apr;80(4):503-7
pubmed: 19346366
N Engl J Med. 2018 Jul 5;379(1):44-53
pubmed: 29972742
Infection. 2022 Jul 11;:
pubmed: 35816222
Trop Med Int Health. 2019 Jul;24(7):839-848
pubmed: 31062445
Emerg Infect Dis. 2020 Aug;26(8):1826-1830
pubmed: 32338590
N Engl J Med. 2018 Nov 22;379(21):2084-2085
pubmed: 30462945
Wilderness Environ Med. 2021 Dec;32(4):528-536
pubmed: 34563454
Vaccine. 2011 Dec 30;29 Suppl 4:D54-9
pubmed: 22185831
PLoS Negl Trop Dis. 2022 Feb 11;16(2):e0010141
pubmed: 35148313
PLoS Negl Trop Dis. 2017 Sep 11;11(9):e0005857
pubmed: 28892474
Antiviral Res. 2019 Feb;162:171-177
pubmed: 30445121
Am J Trop Med Hyg. 2020 Dec 07;104(2):604-611
pubmed: 33289470
Trop Dis Travel Med Vaccines. 2019 Apr 15;5:5
pubmed: 31016025
Lancet Infect Dis. 2022 Aug;22(8):1153-1162
pubmed: 35623380
J Infect Dis. 2022 Apr 19;225(8):1367-1376
pubmed: 32880628
Int J Trop Dis Health. 2017;25(2):
pubmed: 30123790