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Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report.
Lancet Infect Dis. 2019 08; 19(8):872-879.LI

Abstract

BACKGROUND

In September, 2017, human monkeypox re-emerged in Nigeria, 39 years after the last reported case. We aimed to describe the clinical and epidemiological features of the 2017-18 human monkeypox outbreak in Nigeria.

METHODS

We reviewed the epidemiological and clinical characteristics of cases of human monkeypox that occurred between Sept 22, 2017, and Sept 16, 2018. Data were collected with a standardised case investigation form, with a case definition of human monkeypox that was based on previously established guidelines. Diagnosis was confirmed by viral identification with real-time PCR and by detection of positive anti-orthopoxvirus IgM antibodies. Whole-genome sequencing was done for seven cases. Haplotype analysis results, genetic distance data, and epidemiological data were used to infer a likely series of events for potential human-to-human transmission of the west African clade of monkeypox virus.

FINDINGS

122 confirmed or probable cases of human monkeypox were recorded in 17 states, including seven deaths (case fatality rate 6%). People infected with monkeypox virus were aged between 2 days and 50 years (median 29 years [IQR 14]), and 84 (69%) were male. All 122 patients had vesiculopustular rash, and fever, pruritus, headache, and lymphadenopathy were also common. The rash affected all parts of the body, with the face being most affected. The distribution of cases and contacts suggested both primary zoonotic and secondary human-to-human transmission. Two cases of health-care-associated infection were recorded. Genomic analysis suggested multiple introductions of the virus and a single introduction along with human-to-human transmission in a prison facility.

INTERPRETATION

This study describes the largest documented human outbreak of the west African clade of the monkeypox virus. Our results suggest endemicity of monkeypox virus in Nigeria, with some evidence of human-to-human transmission. Further studies are necessary to explore animal reservoirs and risk factors for transmission of the virus in Nigeria.

FUNDING

None.

Authors+Show Affiliations

Nigeria Centre for Disease Control, Abuja, Nigeria. Electronic address: adesola.ogunleye@ncdc.gov.ng.Nigeria Centre for Disease Control, Abuja, Nigeria; International Health Regulations Strengthening Programme in Nigeria, Public Health England, Abuja, Nigeria.African Field Epidemiology Network, Abuja, Nigeria.Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Nigeria.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.Nigeria Centre for Disease Control, Abuja, Nigeria.WHO Country Office, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research, Braunschweig, Germany.Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research, Braunschweig, Germany.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.e-Health Africa, Abuja, Nigeria.Rivers State Ministry of Health, Port Harcourt, Nigeria.Bayelsa State Ministry of Health, Yenagoa, Nigeria.Cross State Ministry of Health, Calabar, Nigeria.Department of Health, Federal Capital Territory, Abuja, Nigeria.Nigeria Prison Services, Port Harcourt, Rivers State, Nigeria.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA.University Of Maryland, Abuja, Nigeria.WHO, Geneva, Switzerland.Nigeria Centre for Disease Control, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Nigeria Centre for Disease Control, Abuja, Nigeria.Helmholtz Centre for Infection Research, Braunschweig, Germany; German Centre for Infection Research, Braunschweig, Germany.Nigeria Centre for Disease Control, Abuja, Nigeria.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31285143

Citation

Yinka-Ogunleye, Adesola, et al. "Outbreak of Human Monkeypox in Nigeria in 2017-18: a Clinical and Epidemiological Report." The Lancet. Infectious Diseases, vol. 19, no. 8, 2019, pp. 872-879.
Yinka-Ogunleye A, Aruna O, Dalhat M, et al. Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. Lancet Infect Dis. 2019;19(8):872-879.
Yinka-Ogunleye, A., Aruna, O., Dalhat, M., Ogoina, D., McCollum, A., Disu, Y., Mamadu, I., Akinpelu, A., Ahmad, A., Burga, J., Ndoreraho, A., Nkunzimana, E., Manneh, L., Mohammed, A., Adeoye, O., Tom-Aba, D., Silenou, B., Ipadeola, O., Saleh, M., ... Ihekweazu, C. (2019). Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. The Lancet. Infectious Diseases, 19(8), 872-879. https://doi.org/10.1016/S1473-3099(19)30294-4
Yinka-Ogunleye A, et al. Outbreak of Human Monkeypox in Nigeria in 2017-18: a Clinical and Epidemiological Report. Lancet Infect Dis. 2019;19(8):872-879. PubMed PMID: 31285143.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. AU - Yinka-Ogunleye,Adesola, AU - Aruna,Olusola, AU - Dalhat,Mahmood, AU - Ogoina,Dimie, AU - McCollum,Andrea, AU - Disu,Yahyah, AU - Mamadu,Ibrahim, AU - Akinpelu,Afolabi, AU - Ahmad,Adama, AU - Burga,Joel, AU - Ndoreraho,Adolphe, AU - Nkunzimana,Edouard, AU - Manneh,Lamin, AU - Mohammed,Amina, AU - Adeoye,Olawunmi, AU - Tom-Aba,Daniel, AU - Silenou,Bernard, AU - Ipadeola,Oladipupo, AU - Saleh,Muhammad, AU - Adeyemo,Ayodele, AU - Nwadiutor,Ifeoma, AU - Aworabhi,Neni, AU - Uke,Patience, AU - John,Doris, AU - Wakama,Paul, AU - Reynolds,Mary, AU - Mauldin,Matthew R, AU - Doty,Jeffrey, AU - Wilkins,Kimberly, AU - Musa,Joy, AU - Khalakdina,Asheena, AU - Adedeji,Adebayo, AU - Mba,Nwando, AU - Ojo,Olubunmi, AU - Krause,Gerard, AU - Ihekweazu,Chikwe, AU - ,, Y1 - 2019/07/05/ PY - 2018/12/09/received PY - 2019/03/25/revised PY - 2019/04/05/accepted PY - 2019/7/10/pubmed PY - 2020/6/11/medline PY - 2019/7/10/entrez SP - 872 EP - 879 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 19 IS - 8 N2 - BACKGROUND: In September, 2017, human monkeypox re-emerged in Nigeria, 39 years after the last reported case. We aimed to describe the clinical and epidemiological features of the 2017-18 human monkeypox outbreak in Nigeria. METHODS: We reviewed the epidemiological and clinical characteristics of cases of human monkeypox that occurred between Sept 22, 2017, and Sept 16, 2018. Data were collected with a standardised case investigation form, with a case definition of human monkeypox that was based on previously established guidelines. Diagnosis was confirmed by viral identification with real-time PCR and by detection of positive anti-orthopoxvirus IgM antibodies. Whole-genome sequencing was done for seven cases. Haplotype analysis results, genetic distance data, and epidemiological data were used to infer a likely series of events for potential human-to-human transmission of the west African clade of monkeypox virus. FINDINGS: 122 confirmed or probable cases of human monkeypox were recorded in 17 states, including seven deaths (case fatality rate 6%). People infected with monkeypox virus were aged between 2 days and 50 years (median 29 years [IQR 14]), and 84 (69%) were male. All 122 patients had vesiculopustular rash, and fever, pruritus, headache, and lymphadenopathy were also common. The rash affected all parts of the body, with the face being most affected. The distribution of cases and contacts suggested both primary zoonotic and secondary human-to-human transmission. Two cases of health-care-associated infection were recorded. Genomic analysis suggested multiple introductions of the virus and a single introduction along with human-to-human transmission in a prison facility. INTERPRETATION: This study describes the largest documented human outbreak of the west African clade of the monkeypox virus. Our results suggest endemicity of monkeypox virus in Nigeria, with some evidence of human-to-human transmission. Further studies are necessary to explore animal reservoirs and risk factors for transmission of the virus in Nigeria. FUNDING: None. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/31285143/Outbreak_of_human_monkeypox_in_Nigeria_in_2017_18:_a_clinical_and_epidemiological_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(19)30294-4 DB - PRIME DP - Unbound Medicine ER -