부산대학교 도서관

Summary 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. Author Affiliation: (a) Nigeria Centre for Disease Control, Abuja, Nigeria (b) International Health Regulations Strengthening Programme in Nigeria, Public Health England, Abuja, Nigeria (c) African Field Epidemiology Network, Abuja, Nigeria (d) Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Nigeria (e) Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA (f) WHO Country Office, Abuja, Nigeria (g) Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria (h) Helmholtz Centre for Infection Research, Braunschweig, Germany (i) German Centre for Infection Research, Braunschweig, Germany (j) e-Health Africa, Abuja, Nigeria (k) Rivers State Ministry of Health, Port Harcourt, Nigeria (l) Bayelsa State Ministry of Health, Yenagoa, Nigeria (m) Cross State Ministry of Health, Calabar, Nigeria (n) Department of Health, Federal Capital Territory, Abuja, Nigeria (o) Nigeria Prison Services, Port Harcourt, Rivers State, Nigeria (p) University Of Maryland, Abuja, Nigeria (q) WHO, Geneva, Switzerland * Correspondence to: Adesola Yinka-Ogunleye, Nigeria Centre for Disease Control, Jabi, Abuja 900108, Nigeria (footnote)* These authors contributed equally (footnote)[Dagger] Members listed at end of Article Byline: Adesola Yinka-Ogunleye, MPH [adesola.ogunleye@ncdc.gov.ng] (a), Olusola Aruna, FFPH (a,b), Mahmood Dalhat, MBBS (c), Prof Dimie Ogoina, FMCP (d), Andrea McCollum, PhD (e), Yahyah Disu, MPH (a), Ibrahim Mamadu, MPH (f), Afolabi Akinpelu, BSc (a), Adama Ahmad, MPH (a), Joel Burga, BSc (a), Adolphe Ndoreraho, BSc (g), Edouard Nkunzimana, BSc (g), Lamin Manneh, BSc (g), Amina Mohammed, BSc (a), Olawunmi Adeoye, MBBS (a), Daniel Tom-Aba, MSc (h,i), Bernard Silenou, MSc (h,i), Oladipupo Ipadeola, MPH (e), Muhammad Saleh, MBBS (e), Ayodele Adeyemo, BTech (j), Ifeoma Nwadiutor, MBBS (k), Neni Aworabhi, MBBS (l), Patience Uke, MPH (m), Doris John, MBBS (n), Paul Wakama, MBBS (o), Mary Reynolds, PhD (e), Matthew R Mauldin, PhD (e), Jeffrey Doty, MS (e), Kimberly Wilkins, BS (e), Joy Musa, MSc (p), Asheena Khalakdina, PhD (q), Adebayo Adedeji, PhD (a), Nwando Mba, MSc (a), Olubunmi Ojo, MSc (a), Prof Gerard Krause, MD (h,i), Chikwe Ihekweazu, FFPH (a), Anna Mandra, Whitni Davidson, Victoria Olson, Yu Li, Kay Radford, Hui Zhao, Michael Townsend, Jillybeth Burgado, Panayampalli S. Satheshkumar