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Monkeypox Rash Severity and Animal Exposures in the Democratic Republic of the Congo

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Abstract

Experimental studies have suggested a larger inoculum of monkeypox virus may be associated with increased rash severity; however, little data are available on the relationship between specific animal exposures and rash severity in endemic regions. Using cross-sectional data from an active surveillance program conducted between 2005 and 2007 in the Sankuru Province of the Democratic Republic of the Congo, we explored the possible relationship between rash severity and exposures to rodents and non-human primates among confirmed MPX cases. Among the 223 PCR-confirmed MPX cases identified during active surveillance, the majority of cases (n = 149) presented with mild rash (5–100 lesions) and 33% had a more serious presentation (> 100 lesions). No association between exposure to rodents and rash severity was found in the multivariable analysis. Those that self-reported hunting NHP 3 weeks prior to onset of MPX symptoms had 2.78 times the odds of severe rash than those that did not report such exposure (95% CI: 1.18, 6.58). This study provides a preliminary step in understanding the association between animal exposure and rash severity and demonstrates correlation with exposure to NHPs and human MPX presentation. Additional research exploring the relationship between rash severity and NHPs is warranted.

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Acknowledgements

Many individuals contributed to the design of this manuscript and data collection in the field. We thank the Congolese health workers in the Sankuru District for their surveillance efforts and the DRC Ministry of Health; and the Faucett Catalyst Fund.

Funding

This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Global Network for Women’s and Children’s Health Research; National Institute of Allergy and Infectious Disease, Division of Infectious Diseases and Microbiology.

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Authors and Affiliations

  1. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA

    Reena H. Doshi, Vivian H. Alfonso, Douglas Morier, Nicole A. Hoff, Cyrus Sinai, Alvan Cheng, Hayley Ashbaugh, Adva Gadoth & Anne W. Rimoin

  2. Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo

    Prime Mulembakani & Emile W. Okitolonda

  3. Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA

    Neville Kisalu

  4. Texas A&M School of Public Health, College Station, TX, USA

    Brian Cowell

  5. Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo

    Jean-Jacques Muyembe-Tamfum

  6. Los Angeles, USA

    Anne W. Rimoin

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  1. Reena H. Doshi
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  2. Vivian H. Alfonso
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  3. Douglas Morier
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  4. Nicole A. Hoff
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  5. Cyrus Sinai
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  6. Prime Mulembakani
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  7. Neville Kisalu
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  8. Alvan Cheng
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  9. Hayley Ashbaugh
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  10. Adva Gadoth
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  11. Brian Cowell
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  12. Emile W. Okitolonda
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  13. Jean-Jacques Muyembe-Tamfum
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  14. Anne W. Rimoin
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Correspondence to Anne W. Rimoin.

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Doshi, R.H., Alfonso, V.H., Morier, D. et al. Monkeypox Rash Severity and Animal Exposures in the Democratic Republic of the Congo. EcoHealth 17, 64–73 (2020). https://doi.org/10.1007/s10393-019-01459-7

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  • DOI: https://doi.org/10.1007/s10393-019-01459-7

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