Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo
Major increase in human monkeypox incidence 30 years after smallpox vaccination campaigns cease in the Democratic Republic of Congo
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DOI：
10.1073/pnas.1005769107
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发表时间：
2010-09-14
影响因子：
11.1
通讯作者：
Muyembe, Jean-Jacques
中科院分区：
文献类型：
--
作者：
Rimoin, Anne W.;Mulembakani, Prime M.;Muyembe, Jean-Jacques
关于刚果民主共和国人类猴痘负担的研究上一次是在1981年至1986年进行的。从那时起，由于停止大规模天花疫苗接种活动，对正痘病毒免疫幼稚的人口显著增加。为了评估目前的感染风险，我们分析了猴痘-地方性疫区的人类猴痘发病趋势。在刚果民主共和国中部的九个卫生区进行了积极的、以人口为基础的监测。流行病学数据和生物样本来自疑似病例。将累积发病率(每万人)和感染的主要决定因素与1981年至1986年类似地区的积极监测数据进行比较。2005年11月至2007年11月期间，在参与的卫生区确认了760例实验室确认的人类猴痘病例。各地区年平均累积发病率为5.53/万(2.18-14.42)。与感染风险增加相关的因素包括：居住在林区、男性、年龄和15岁，以及以前没有接种天花疫苗。接种疫苗的人患猴痘的风险比未接种的人低5.2倍(0.78比4.05/10,000)。比较1980年代(0.72/10,000)和2006-07(14.42/10,000)同一卫生区的主动监测数据表明，人类猴痘发病率增加了20倍。在大规模天花疫苗接种活动停止30年后，刚果民主共和国农村地区的人类猴痘发病率急剧上升。需要改进监测和流行病学分析，以便更好地评估公共卫生负担，并制定减少感染更广泛传播风险的战略。
Studies on the burden of human monkeypox in the Democratic Republic of the Congo (DRC) were last conducted from 1981 to 1986. Since then, the population that is immunologically naive to orthopoxviruses has increased significantly dueto cessation of mass smallpox vaccination campaigns. To assess the current risk of infection, we analyzed human monkeypox incidence trends in a monkeypox-enzootic region. Active, population-based surveillance was conducted in nine health zones in central DRC. Epidemiologic data and biological samples were obtained from suspected cases. Cumulative incidence (per 10,000 population) and major determinants of infection were compared with data from active surveillance in similar regions from 1981 to 1986. Between November 2005 and November 2007, 760 laboratory-confirmed human monkeypox cases were identified in participating health zones. The average annual cumulative incidence across zones was 5.53 per 10,000 (2.18-14.42). Factors associated with increased risk of infection included: living in forested areas, male gender, age < 15, and no prior smallpox vaccination. Vaccinated persons had a 5.2-fold lower risk of monkeypox than unvaccinated persons (0.78 vs. 4.05 per 10,000). Comparison of active surveillance data in the same health zone from the 1980s (0.72 per 10,000) and 2006-07 (14.42 per 10,000) suggests a 20-fold increase in human monkeypox incidence. Thirty years after mass smallpox vaccination campaigns ceased, human monkeypox incidence has dramatically increased in rural DRC. Improved surveillance and epidemiological analysis is needed to better assess the public health burden and develop strategies for reducing the risk of wider spread of infection.