Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children
In west and central Africa, monkeypox occurs mainly in older children, adolescents and young adults. In two large epidemiology studies of monkeypox outbreaks, the investigators observed a sizable number of coinfections of chickenpox (varicella) and monkeypox. Based on a review of the literature, we...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/14/12/2800 |
| _version_ | 1797454923969855488 |
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| author | Ola Khallafallah Charles Grose |
| author_facet | Ola Khallafallah Charles Grose |
| author_sort | Ola Khallafallah |
| collection | DOAJ |
| description | In west and central Africa, monkeypox occurs mainly in older children, adolescents and young adults. In two large epidemiology studies of monkeypox outbreaks, the investigators observed a sizable number of coinfections of chickenpox (varicella) and monkeypox. Based on a review of the literature, we propose that chickenpox (human herpesvirus-3 infection) is a risk factor for acquisition of monkeypox infection. Our hypothesis states that the chickenpox skin lesion provides an entry site for the monkeypox virus, which is harbored on a fomite in the environment of the patient. The fact that monkeypox can enter via a scratch or abrasion is a known mechanism of spread for three other poxviruses, including mousepox (ectromelia), orf and molluscum contagiosum. There are many similarities in pathogenesis between certain poxviruses and chickenpox, including a viremia with a cellular stress response leading to high levels of the IL-6 cytokine. One very revealing observation in the two epidemiology studies was that the number of pox as well as the severity of disease in children with chickenpox and monkeypox coinfection was not greater than found in children with monkeypox alone. Based on the above observations, we conclude that, when chickenpox precedes monkeypox, priming of the immune system by the earlier chickenpox infection moderates the severity of the secondary infection with monkeypox. This conclusion also has important public health implications about chickenpox surveillance. |
| first_indexed | 2024-03-09T15:45:04Z |
| format | Article |
| id | doaj.art-b4adb0447f4a4cbf91aa97fec95bdc21 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-09T15:45:04Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-b4adb0447f4a4cbf91aa97fec95bdc212023-11-24T18:39:55ZengMDPI AGViruses1999-49152022-12-011412280010.3390/v14122800Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African ChildrenOla Khallafallah0Charles Grose1Division of Infectious Diseases, Virology Laboratory, Department of Pediatrics, University Hospital/Room BT2001, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USADivision of Infectious Diseases, Virology Laboratory, Department of Pediatrics, University Hospital/Room BT2001, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USAIn west and central Africa, monkeypox occurs mainly in older children, adolescents and young adults. In two large epidemiology studies of monkeypox outbreaks, the investigators observed a sizable number of coinfections of chickenpox (varicella) and monkeypox. Based on a review of the literature, we propose that chickenpox (human herpesvirus-3 infection) is a risk factor for acquisition of monkeypox infection. Our hypothesis states that the chickenpox skin lesion provides an entry site for the monkeypox virus, which is harbored on a fomite in the environment of the patient. The fact that monkeypox can enter via a scratch or abrasion is a known mechanism of spread for three other poxviruses, including mousepox (ectromelia), orf and molluscum contagiosum. There are many similarities in pathogenesis between certain poxviruses and chickenpox, including a viremia with a cellular stress response leading to high levels of the IL-6 cytokine. One very revealing observation in the two epidemiology studies was that the number of pox as well as the severity of disease in children with chickenpox and monkeypox coinfection was not greater than found in children with monkeypox alone. Based on the above observations, we conclude that, when chickenpox precedes monkeypox, priming of the immune system by the earlier chickenpox infection moderates the severity of the secondary infection with monkeypox. This conclusion also has important public health implications about chickenpox surveillance.https://www.mdpi.com/1999-4915/14/12/2800varicella-zoster virusherpesvirusvariolamousepoxorthopox virusmurid herpesvirus-4 |
| spellingShingle | Ola Khallafallah Charles Grose Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children Viruses varicella-zoster virus herpesvirus variola mousepox orthopox virus murid herpesvirus-4 |
| title | Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children |
| title_full | Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children |
| title_fullStr | Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children |
| title_full_unstemmed | Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children |
| title_short | Reassessment of Evidence about Coinfection of Chickenpox and Monkeypox (Mpox) in African Children |
| title_sort | reassessment of evidence about coinfection of chickenpox and monkeypox mpox in african children |
| topic | varicella-zoster virus herpesvirus variola mousepox orthopox virus murid herpesvirus-4 |
| url | https://www.mdpi.com/1999-4915/14/12/2800 |
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