Monkeypox is a zoonotic disease endemic in the Democratic Republic of Congo (DRC) but prevalent also in other countries of Central and Western Africa. The clinical presentation of monkeypox closely resembles the one of smallpox. The mortality rate is officially about 11% however rates as high as 17% have been observed. The disease has been considered rare and not much attention is paid to it. Nonetheless, the incidence of monkeypox increased 20-fold from 1981-1986 to 2005-2007 (two active surveillance programs). More research, surveillance and effective interventions are needed to ensure it would not gain the potential to become the next global pandemic.

1. Epidemiology and
laboratory diagnosis of
Monkeypox virus in Africa
Nikola Sklenovská
Master of Biomedical Sciences
KU Leuven
Supervisor: prof. dr. Marc VAN RANST
Co-supervisor: dr. Piet MAES
Instructor: Valentijn VERGOTE

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Content
• Introduction
• Epidemiological data, DRC 2014-2016
• Development of qPCR diagnostic assay
• Conclusions
• Future work

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Zoonotic diseases
MIEF zoonosis conference 2015
7,5 billion
people on earth
2,4 billion
affected/year
2,3 million
death/year
Introduction

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Monkeypox
Family Poxviridae
Subfamily Chordopoxvirinae
Genus Orthopoxvirus
Species Camelpox virus
Cowpox virus
Ecromelia virus
Monkeypox virus
Raccoonpox virus
Skunkpox virus
Taterapox virus
Vaccinia virus
Variola virus
Volepox virus
Introduction

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Introduction

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1. Assess epidemiological characteristics of the
most recent monkeypox data.
2. Develop a diagnostic assay for differentiation of
MPXV and VZV suitable for field conditions.
Aims

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Democratic Republic of Congo
• Provided by prof. dr. Muyembe
• September 2014 – February 2016
• Passive surveillance
• 223 laboratory confirmed monkeypox cases
Materials and Methods

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Results and Discussion
1981 - 1986 2014 - 2016
17 months72 months
223 cases338 cases
Geographical distribution

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Gender
42%
58%
41%
59%
1981 - 1986 2014 - 2016
ResultsResults and Discussion

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Age
ResultsResults and Discussion
0
2
4
6
8
10
12
14
16
0 5 10 15 20 25 30 35 40 45 50 55 60
Cases
Age (years)
0
20
40
60
80
100
0-2 3-4 5-6 7-9 10-14 ≥ 15
Cases
Age (years)
87%
71%
1981 - 1986
2014 - 2016
Likely vaccinated
Likely vaccinated

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Increase of MPX incidence
20-fold increase between 2005 - 2007
compared to 1981 - 1986
Rimoin et al 2010
1981-1986
(cases/month)
2014-2016
(cases/month)
DRC 4,7 13,7
Equateur 3,2 11,3
ResultsResults and Discussion
3-fold
223 cases338 cases

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neither
587
suspected
VZVMPX
223 40 78
339
tested
Results and Discussion
Monkeypox misdiagnosed

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1. Assess epidemiological characteristics of the
most recent monkeypox data.
2. Develop a diagnostic assay for differentiation of
MPXV and VZV suitable for field conditions.
Aims

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Materials and Methods
Diagnostic tools

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Assay development
• Multiplex assay for VZV and MPXV detection
• Validated with  10 VZV-positive samples
 5 MPXV-positive samples

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Results and Discussion
107 copies 107 copies
102 copies
101 copies
102 - 107 copies 101 - 107 copies
VZV standards MPX standards
Sensitivity of the assay

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Results and Discussion
VZV
MPXV
VZV coinfection in MPXV samples

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Results and Discussion
VZV coinfection in MPXV samples

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VZV
MPX
Results and Discussion
Simultaneous infection

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VZV
MPX
Simultaneous infection
Results and Discussion
Latent VZV

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Conclusions
• Monkeypox incidence is increasing  need for effective
interventions, surveillance and research
• Multiplex qPCR diagnostic assay suitable for field
conditions was developed
• VZV and MPX coinfections are not rare events?

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Future work
• Prior DNA extraction
• Lyophilization of reagents (cold chain)
• Testing cidofovir as treatment for monkeypox in humans
(clinical trial)

29. “This virus, we are sure,
cannot infect humans”
Zhengli Shi

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