Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions
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: Households with at least one active generalized vesicular-pustular rash case were visited, and c...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | International Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971222003903 |
| _version_ | 1817995073167556608 |
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| author | Gaspard Mande Innocent Akonda Anja De Weggheleire Isabel Brosius Laurens Liesenborghs Emmanuel Bottieau Noam Ross Guy-Crispin Gembu Robert Colebunders Erik Verheyen Dauly Ngonda Herwig Leirs Anne Laudisoit |
| author_facet | Gaspard Mande Innocent Akonda Anja De Weggheleire Isabel Brosius Laurens Liesenborghs Emmanuel Bottieau Noam Ross Guy-Crispin Gembu Robert Colebunders Erik Verheyen Dauly Ngonda Herwig Leirs Anne Laudisoit |
| author_sort | Gaspard Mande |
| collection | DOAJ |
| description | 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: 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: 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: 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. |
| first_indexed | 2024-04-14T02:00:31Z |
| format | Article |
| id | doaj.art-c5db235351e74e70bce35a866b31604d |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-04-14T02:00:31Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-c5db235351e74e70bce35a866b31604d2022-12-22T02:18:50ZengElsevierInternational Journal of Infectious Diseases1201-97122022-09-01122647655Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitionsGaspard Mande0Innocent Akonda1Anja De Weggheleire2Isabel Brosius3Laurens Liesenborghs4Emmanuel Bottieau5Noam Ross6Guy-Crispin Gembu7Robert Colebunders8Erik Verheyen9Dauly Ngonda10Herwig Leirs11Anne Laudisoit12University of Kisangani, Faculty of Medicine and Pharmacy, BP 2012, Kisangani, Democratic Republic of CongoMinistry of Health, Buta, Democratic Republic of CongoOutbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, BelgiumOutbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, BelgiumOutbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, BelgiumOutbreak research team, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, BelgiumEcohealth Alliance, 520 8th Avenue, 10018 New York, NY, United States of AmericaUniversity of Kisangani, Faculty of Science and Center for Biodiversity Monitoring, BP2012, Kisangani, Democratic Republic of CongoGlobal Health Institute, University of Antwerp, Campus drie Eiken, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610 Wilrijk, BelgiumRoyal Belgian Institute of Natural Sciences, Rue Vautier 29, 1000 Brussels, Belgium; Evolutionary Ecology Group, University of Antwerp, Campus Drie EikenUniversity of Kisangani, Faculty of Medicine and Pharmacy, BP 2012, Kisangani, Democratic Republic of CongoEvolutionary Ecology Group, University of Antwerp, Campus Drie EikenEcohealth Alliance, 520 8th Avenue, 10018 New York, NY, United States of America; Evolutionary Ecology Group, University of Antwerp, Campus Drie Eiken; Correspondence: Anne Laudisoit, Tel: +1-917-912-2155Background: 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: 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: 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: 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.http://www.sciencedirect.com/science/article/pii/S1201971222003903MonkeypoxDemocratic Republic of CongoChickenpoxDiagnosticOrthopoxvirus |
| spellingShingle | Gaspard Mande Innocent Akonda Anja De Weggheleire Isabel Brosius Laurens Liesenborghs Emmanuel Bottieau Noam Ross Guy-Crispin Gembu Robert Colebunders Erik Verheyen Dauly Ngonda Herwig Leirs Anne Laudisoit Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions International Journal of Infectious Diseases Monkeypox Democratic Republic of Congo Chickenpox Diagnostic Orthopoxvirus |
| title | Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions |
| title_full | Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions |
| title_fullStr | Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions |
| title_full_unstemmed | Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions |
| title_short | Enhanced surveillance of monkeypox in Bas-Uélé, Democratic Republic of Congo: the limitations of symptom-based case definitions |
| title_sort | enhanced surveillance of monkeypox in bas uele democratic republic of congo the limitations of symptom based case definitions |
| topic | Monkeypox Democratic Republic of Congo Chickenpox Diagnostic Orthopoxvirus |
| url | http://www.sciencedirect.com/science/article/pii/S1201971222003903 |
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