Bulle in
o
he
Wo ld
Heal h
O ganiza ion,
66
(6):
747-752
(1988)
©
Wo ld
Heal h
O ganiza ion
1988
Monkeypox
i us:
ecology
and
public
heal h
signi icance
L.
KHODAKEVICH,1
Z.
JEEEK,2
&
D.
MESSINGER3
Recen
in es iga ions
ha e
e ealed
ha
monkeypox
i us
in ec ions
occu
wi h
a
high
p e alence
in
se e al
species
o
squi els
belonging
o
he
genus
Funisciu us,
less
equen ly
in
squi els
o
he
genus
Heliosciu us,
and
a ely
in
o es -dwelling
p ima es.
These
squi els
commonly
inhabi
he
seconda y
o es s
a ound
human
se lemen s
in
he
u al
a eas
o
Zai e,
especially
whe e
oil
palms
a e
g own,
and
a e
a e
in
he
p ima y
ain
o es .
Human
in ec ion
wi h
monkeypox
i us
occu s
mos
equen ly
in
he
5-9-yea -old
age
g oup,
pa icula ly
in
small
illages
whe e
he
child en
hun
and
ea
squi els
and
o he
small
mammals.
As
he
popula ions
a e
now
inc easing
in
numbe
and
can
no
longe
eed
on
wild
li e
alone
o
hei
animal
p o ein
equi emen s,
he
de elopmen
o
animal
husband y
as
a
sou ce
o
mea
will
ce ainly
dec ease
he
isk
and
he
incidence
o
human
monkeypox,
e en
in
a eas
whe e
monkeypox
i us
is
p esen
in
he
local
popula ion
o
squi els.
Al hough
popula ion
g ow h
and
economic
de elopmen
in
wes e n
and
cen al
A ica
will
p obably
educe
he
isk
o
human
in ec ion
wi h
monkeypox
i us,
isi o s
o
hese
a eas
who
a e
likely
o
come
in o
con ac
wi h
wild
animals
should
be
o e ed
smallpox
accina ion
as
a
p o ec ion.
INTRODUCTION
In
1959
a
new
disease
agen
in
he
genus
O ho-
pox i us,
which
was
called
monkeypox
i us,
was
disco e ed
in
cap i e
Asian
monkeys
in
Copenhagen,
and
se e al
simila
indings
we e
epo ed
subse-
quen ly
(1-3).
In e es
in
his
i us
inc eased
g ea ly
when
i
was
ound
o
be
he
cause
o
a
smallpox-like
disease
in
wes e n
and
cen al
A ica
in
1970,
and
special
in es iga ions
we e
ca ied
ou
o
de e mine
whe he
human
monkeypox
cons i u ed
a
isk
o
he
smallpox
e adica ion
p og amme.
In
Decembe
1979
he
Global
Commission
o
he
Ce i ica ion
o
Small-
pox
E adica ion
concluded,
based
on
he
e idence
hen
a ailable,
ha
i
did
no
cons i u e
such
a
isk,
bu
ecommended
ha
"WHO
should
o ganize
and
assis
a
special
su eillance
p og amme
on
human
monkeypox,
i s
epidemiology
and
i s
ecology"
(4).
Following
his
ecommenda ion,
in ensi e
s udies
on
he
epidemiology
o
human
in ec ions
we e
ca ied
l
WHO
Team
Leade ,
AIDS
p e en ion
and
con ol
p og amme,
E hiopia.
Reques s
o
ep in s
should
be
sen
o
D .
L.
Khoda-
ke ich,
c/o
WHO
Rep esen a i e,
P.O.
Box
3069,
Addis
Ababa,
E hiopia.
2
Medical
O ice ,
Global
P og amme
on
AIDS,
Wo ld
Heal h
O ganiza ion,
Gene a,
Swi ze land.
3
Resea ch
Wo ke ,
Na ional
Ins i u e
o
Biomedical
Resea ch,
Kinshasa,
Zai e.
ou
in
Zai e
om
1980
ill
1987
(5,
6).
Resea ch
on
he
ecology
o
monkeypox
i us
was
s eng hened
om
1984
onwa ds,
and
has
esul ed
in
a
be e
unde s anding
o
how
he
i us
ci cula es
in
wild
animals
and
how
i
is
ansmi ed
o
human
beings.
This
a icle
p esen s
a
summa y
o
he
esea ch
ca ied
ou
in
he
1980s
and
analyses
he
esul s.
Ea ly
s udies
on
he
ecology
o
monkeypox
i us
The
ac
ha
he
i us
was
isola ed
om
monkeys
and
ha
se e al
ou b eaks
had
occu ed
in
p ima es
in
cap i i y
ini ially
di ec ed
he
sea ch
o
ese oi
hos s
owa ds
his
g oup
o
animals.
Monkeypox-
i us-speci ic
an ibodies
we e
de ec ed
in
se e al
species
o
o es -dwelling
monkeys:
Ce copi hecus
ascanius,
C.
pe au is a,
Colobus
badius
and
Alleno-
pi hecus
nig o i idis
(3,
7,
8).
Epidemiological
in es iga ions
o
67
p ima y
human
monkeypox
cases
e ealed
ha
64.5
%
o
he
pa ien s
had
been
in
con ac
wi h
monkeys
a
he
p esumed
ime
o
con ac ing
he
in ec ion
and
ha
11.8%
had
con ac
wi h
bo h
squi els
and
an elopes
(6).
Mos
o
he
animal
con ac s
we e
desc ibed
as
heal hy,
hough
in
wo
epo s
a
sick
squi el
and
a
chimpanzee
we e
associa ed
wi h
he
occu ence
o
he disease
in
child en
(9,
10).
4935
-747-
L.
KHODAKEVICH
ET
AL.
MATERIALS
AND
METHODS
Iden i ica ion
o
he
ese oi
o
monkeypox
i us
was
conside ed
by
he
WHO
Commi ee
on
O ho-
pox i us
In ec ions
in
1984
o
be
a
high
p io i y in
he
esea ch
on
monkeypox
(5).
In
1985
a
specialized
eam
was
es ablished
in
Zai e
o
his
pu pose.
Led
by
a
biologis ,
he
eam
ca ied
ou
a
se ies
o
su eys
in
a ious
pa s
o
he
coun y
(Fig.
1),
which
included
s udies
on
he
lo a
and
auna
in
monkeypox
enzoo ic
a eas
and
he
collec ion
and
sampling
o
animals
(wi h
p elimina y
axonomic
iden i ica ion)
o
i ological
and
se ological
s udies.
The
p ese ed
se a
and
o gan
samples
we e
shipped
o
he
wo
WHO
Collabo a ing
Cen es
in
CDC
(Cen e s
o
Disease
Con ol),
A lan a,
GA,
USA
(Chie ,
D
J.
Nakano)
and
a
he
Moscow
Resea ch
Ins i u e
o
Vi al
P epa a ions,
Moscow,
USSR
(Chie ,
D
S.
S.
Ma enniko a),
whe e
hey
we e
es ed.
The
inal
iden i ica ion
o
he
animals
was
ca ied
ou
by
D
Ma c
Colyn
in
he
Musee
Royal
de
l'A ique
Cen al
in
Te u en,
Belgium.
In
Oc obe
1986
an
expe imen al
labo a o y
was
se
up
in
he
i ology
depa men
(Chie ,
D
B.
Gous-
sa d)
o
he
Ins i u
Na ional
de
Reche che
Bio-
Medicale
in
Kinshasa
(Di ec o ,
D
J.-J.
Salaun),
whe e
a
eam
o
esea che s
(D .
E.
Shelukhina,
D
S.
Polie,
M s
D.
Messinge ,
and
suppo ing
s a )
s udied
he
ansmission
o
monkeypox
i us
among
squi els
and
some
e es ial
oden s.
A
new
app oach
o
esea ch
on
i us
ecology,
in
which
e es ial
and
a bo eal
oden s
and
ba s
we e
gi en
p io i y
o e
p ima es
and
o he
la ge
mammals
o
he
opical
ain
o es ,
ollowed
om
he
esul s
o
he
ea lie
su eys
and
o
human
su eillance
in
Zai e
(11,
12).
The
si es
o
he
su eys
we e
de e -
mined
mo e
p ecisely
by
an
analysis
o
he
loca ions
whe e
humans
had
con ac ed
he
disease,
and
he
beha iou
and
mo emen s
o
pe sons
o
di e en
age
g oups.
RESULTS
Ecological
ea u es
The
s udies
ini ially
co e ed
12
illages
in
se e al
pa s
o
Bumba
zone
and
e ealed
h ee
clea ly
dema ca ed
a eas
a ound
he
dwellings:
he
se le-
men
a ea,
comp ising
he
illage
and
immedia e
su -
oundings;
he
adjacen
ag icul u al
a ea,
wi h
bo h
cul i a ed
and
abandoned
ag icul u al
ields;
and
he
p ima y
(closed)
ain
o es ,
which
was
usually
3
o
4
km
away
om
he
illage
(11).
A
simila
pa e n
was
obse ed
in
o he
places
like
Mosenge
and
Djima
(Fig.
1)
(D
Lubini
Ayingweu,
unpublished
epo ).
I
was
also
ound
ha
mos
membe s
o
he
popu-
la ion
emained
in
he
se lemen
o
ag icul u al
a eas
Fig.
1.
Map
o
Zai e
showing
su ey
zones
o
in es i-
ga ing
he
ecology
o
monkeypox
i us
in
he
no h,
cen al
and
wes e n
egions
o
he
coun y.
h oughou
he
yea .
Only
adul
and
adolescen
males
mo ed
ou
occasionally
o
isi
he
p ima y
o es
o
hun ing.
The
la ge
wild
mammals
occupying
he
o iginal
o es
had
abandoned
he
ag icul u al
a eas
whe e
only
e es ial
oden s,
a bo eal
oden s
and
ba s
now
emain.
The
se lemen
a ea
is
inhabi ed
by
commensal
a s
and
mice;
domes ic
ca s,
goa s
and
sheep
usually
dwell
a ound
he
houses
and
in
he
nea by
ag icul u al
a eas.
No
sys emic
s udy
was
made
on
he
auna
o
he
p ima y
o es ,
bu
hese
we e
appa en ly
less
a ec ed
by
human
ac i i ies.
The
ac
ha
human
monkeypox
was
mos
common
among
child en
who
s ayed
in
he
se lemen
and
ag icul u al
a eas,
a he
han
among
he
hun e s,
ocused
a en ion
on
he
animals
ound
in
hese
a eas.
Se ological
s udies
Du ing
he
i s
su ey
ca ied
ou
in
he
no h o
Zai e
(Bumba
zone)
blood
samples
we e
collec ed
om
120
sheep
and
goa s,
67
domes ic
ca s,
172
e es ial
oden s
and
21
squi els
om
he
a eas
whe e
human
monkeypox
cases
had
p e iously
been
epo ed.
Monkeypox- i us-speci ic
an ibodies
we e
no
de ec ed
in
he
samples
collec ed
om
he
domes ic
animals
and
e es ial
oden s,
bu
wo
ou
o
18
squi els
(Funisciu us
ane y h us)
we e
se o-
posi i e.
One
o
he
wo
se oposi i e
animals
had
pock-like
lesions
on
i s
skin,
and
cul u e
o
i s
skin
and
o gans
yielded
monkeypox
i us
(13).
Following
hese
indings
he
s udy
a eas
we e
748
ECOLOGY
OF
MONKEYPOX
VIRUS
Table
1.
Resul s
o
he
su eys,
using
adioimmunoassay,
on
he
ecology
o
monkeypox
i us
in
ou
a eas
Bumba
Ikela
Bandundu
Bas-Zai e
To al
No. No.
No.
No. No.
No. No.
No. No.
No.
Animals
es ed
posi i e'
es ed
posi i e
es ed
posi i e
es ed
posi i e
es ed
posi i e
Te es ial
oden s
1024
0
()"b
-
-
98
0
(0)
-
-
1122
0
(0)
and
insec i o es
P ima es
41
3
(7.3)
112
9
(8)
-
-
-
_
153
12
(7.8)
Squi els:
Funisciu us
spp.
320
79
(24.7)
96
16
(16.7)
124
3
(2.4)
119
58
(48.7)
659
156
(23.7)
Heliosciu us
spp.
37
6
(16.2)
23
3
(13)
10
0
(0)
31
6
(19.4)
101
15
(14.9)
To al
1422
231
232
150
2035
Monkeypox
posi i e
by
adioimmunoassay.
Figu es
in
pa en heses
a e
pe cen ages.
ex ended
o
he
cen al
and
wes e n
pa s
o
Zai e
(Fig.
1),
and
sc eening
was
concen a ed
on
a bo eal
animals
such
as
squi els
and
p ima es
in
he
o es s;
e es ial
oden s
and
insec i o es
we e
also
s udied
in
pa allel.
None
o
he
1122
e es ial
oden s
and
insec i o es
es ed
was
ound
o
ha e
an ibodies
o
monkeypox
i us
(Table
1).
Among
he
p ima es
(mainly
Ce copi hecus
ascanius)
he
an ibody
p e-
alence
a es
anged
om
7.3%
o
8.0%
.
In
all
a eas,
he
highes
p e alence
a es
we e
obse ed
among
squi els
o
genus
Funisciu us
ollowed
by
ano he
squi el
(Heliosciu us
u ob achium),
in
which
he
an ibody
p e alence
a es
anged
om
13.0%
o
19.4%
(Table
1).
S udies
on
ansmission
The
expe imen al
s udies
ca ied
ou
a
he
Kinshasa
labo a o y
showed
ha
monkeypox
i us
was
e y
e icien ly
ansmi ed
h ough
ai
and
exc e a
( omi
and
aeces)
among
cap i e
squi els,
and
by
skin
sca i ica ion.
An s
(C ema ogas e
species)
we e
also
es ed
because
in
na u e
hey
ep esen
a
signi ican
pa
o
he
die
o
squi els
and
hey
consume
he
issues
o
dead
mammals.
No
i us
was
ound
in
an s
ed
on
he
in ec ed
issues
o
squi els
(E.
Shelukhina,
J.
Nakano,
unpublished
obse a ions).
Incidence
o
in ec ion
in
di e en
animals
The
o egoing
da a
and
he
monkeypox
an ibody
p e alence
a es
among
human
beings
(14)
indica e
he
o de
o
p e e ence
o
a ious
animals
and
man
in
he
ci cula ion
o
he
i us
in
na u e
(Table
2).
Among
he
animals
s udied,
squi els
o
he
genus
Funisciu us
s and
ou
as
he
po en ial
ese oi
hos ,
i.e.,
a
hos
which
ensu es
main enance
o
he
i us
popula ion
in
na u e
(Fig.
2).
These
animals
a e
e y
common
in
he
ag icul u al
a eas,
hei
numbe s
in
a ou able
condi ions
eaching
se e al
hund eds
pe
kM2
(15).
Du ing
hei
daily
ac i i ies
hey
o m
g oups
o
se e al
indi iduals
and
equen ly
sha e
he
nes s
o
hei
neighbou s,
e en
hose
o
di e en
species.
Heliosciu us
species
o
squi els
a e
also
in ol ed
in
i us
ansmission,
bu
appea
o
be
less
equen ly
in ec ed
and
p obably
may
no
be
able
o
sus ain
ci cula ion
o
he
i us
in
a eas
whe e
Funisciu us
does
no
occu .
The
incidence
a e
among
non-human
p ima es
is
less
han
ha
among
squi els,
hence
hey
may
be
conside ed
as
occasional
o
inciden al
hos s.
The
incidence
in
man
is
he
lowes ,
p obably
because
o
he
ela i ely
a e
con ac
wi h wild
li e
and
he
p ac ice
o
ood
hygiene
and
cooking.
Among
wild
animals
i
is
possible
ha
he
i us
is
ansmi ed
h ough
di ec
physical
con ac ,
o
ia
he
ai
o
exc e a.
Man
is
in ec ed
mainly
by
ea ing
he
unp o-
cessed
o gans
om
any
mammal
which
is
in ec ious
wi h
monkeypox
i us
a
he ime.
As
he
in ec ious
pe iod
in
animals
only
las s
a
ew
days
(as
indica ed
Table
2.
Es ima ed
incidence
o
monkeypox
i us
in ec ion
among
a ious
animals
and
human
beings'
An ibody
Incidence
(I)
p e alence
Li espan
( )
(cases/yea /
a es
(P)
(yea s)
1000
indi iduals)
Funisciu us
spp.
0.24
2
240
Heliosciu us
spp.
0.15
4
75
Non-human
p ima es
0.08
7
23
Human
beings
0.01
50
0.04
a
The
calcula ion
o
he
incidence
a es
is
based
on
he
ollowing
o mula
adap ed
om
F eeman
&
Hu chison
(24):1-
P/I
/2)
xl
000.
749
L.
KHODAKEVICH
ET
AL.
Common_
Less
common
m>
n equen
_ _
Ra e
Fig.
2.
Diag am
o
illus a e
he
ansmission
o
monkey-
pox
i us
in
na u e
and
om
animals
o
man.
by
he
Kinshasa
s udies)
and
a ely
coincides
wi h
hei
consump ion
by
man,
human
monkeypox
is
a
a e
spo adic
disease.
DISCUSSION
Ex en
o
he
monkeypox
enzoo ic
a ea
Al hough
he
p esen
s udies
we e
conduc ed
only
in
Zai e,
i
should
be
possible
o
de e mine
he
a eas
in
o he
A ican
coun ies
whe e
he
i us
could
ci cula e,
he
c i ical
equi emen
being
he
p esence
o
he
ese oi
hos .
The
su eys
in
Zai e
showed
ha
he
ci cula ion
o
monkeypox
i us
was
main-
ained
h ough
squi els
inhabi ing
a ious
ypes
o
deg aded
o
seconda y
humid
opical
ain
o es s.
E en
in
he
mos
emo e
a eas
o
Bumba
and
Ikela
zones
o
Zai e,
a
leas
50%
o
he
p ima y
(closed)
o es s
ha e
been
con e ed
in o
seconda y
o es ,
and
in
places
a
om
human
se lemen s,
o es s
o
his
ype
suppo ing
Funisciu us
(16)
a e
ound
alongside
s eams
and
on
hills
which
a e
no
capable
o
sus aining
he
p ima y
ain
o es
(17).
The
squi els
o
he
genus
Funisciu us
make
hei
nes s
2-10
me es
abo e
he
g ound.
In
he
p ima y
(closed)
o es s
no
small
mammals
a e
ound
a
his
le el,
whe eas,
on
he con a y,
a ious
ypes
o
seconda y
o es s
a e
densely
popula ed
by
squi els.
The
nu s
o
oil-palm
ees
(Elaeis
guineensis)
p o ide
plen i ul
ood
o
squi els
and
acili a e
main enance
o
hei
popula ion.
These
ees
g ow
widely
in
seconda y
o es s
and
in
plan a ions
h oughou
Wes
A ica,
occupying
an
almos
unin e up ed
bel
o
50-250
km
wid h
along
he
coas line
om
Sie a
Leone
in
he
wes
o
sou he n
Came oon
(18,
19).
This
bel
widens
in
Gabon
and
Congo
and
occupies
nea ly
he
whole
basin
o
he
Zai e
i e
up
o
250
Eas .
In
gene al
he
known
a eas
whe e
monkeypox
i us
occu s
ex end
om
longi ude
abou
120
Wes
o
250
Eas ,
and
is
limi ed
by
he
en h
pa allel
on
he
No h
and
by
he
eigh h
on
he
Sou h.
Wi hin
his
wide
a ea
he
i us
ci cula ion
is
de e mined
by
he
p e alence
o
popula ions
o
Funsiciu us,
which
in
hei
u n
a e
de e mined
by
he
ype
o
o es .
The
a eas
co e ed
by
ei he
deg aded,
seconda y
humid
opical
o es s
o
semi-deciduous
o es s
wi h
a
signi ican
numbe
o
oil-palm
ees
may
be
conside ed
as
monkeypox
enzoo ic
a eas.
Whe he
o
no
monkeypox
i us
is
ac ually
p esen
in
any
pa icula
a ea
may
be
de e mined
by
es ing
he
squi els
o
an ibodies
o
his
i us.
Public
heal h
signi icance
o
monkeypox
i us
Th ee
ac o s
de e mine
he
chances
o
ansmission
o
monkeypox
i us
o
human
beings
in
enzoo ic
a eas.
(1)
Me hods
o
ood
p epa a ion.
The
impo ance
o
ood
p epa a ion
me hods
in
he
in ec ion
o
human
beings
om
a
wild
animal
sou ce
was
es ablished
by
ou
obse a ions
in
se e al
monkeypox
enzoo ic
a eas
whe e
he
cul u al
and
economic
condi ions
o
he
popula ion
we e
di e en .
The
wo
a eas
ha
we e
compa ed,
Bumba
zone
in
he
no h
and
Tshela
zone
in
he
wes ,
ha e
popula ions
o
Funisciu us
wi h
25
%
and
49%
monkeypox
an ibody
p e alence
a es,
espec i ely.
In
Bumba
zone
107
human
monkeypox
cases
we e
eco ded
om
1972
o
1985,
while
none
was
epo ed
in
he
whole
o
he
wes e n
(Bas-Zai e)
egion,
whe e
he e
a e
ela i ely
ad-
anced
heal h
se ices
as
compa ed
wi h
he
no he n
egion
o
he
coun y.
The
nu i ional
habi s
in
Bumba
and
Ikela
zones
di e
om
hose
in
Tshela.
In
he
o me ,
oden s
which
a e
apped
by
child en
om
he
age
o
5-6
yea s
onwa ds,
ep esen
60-85%
o
all
wild
animals
cap u ed
by
he
u al
popula ion
and
a e
some imes
consumed
wi hou
cooking.
A e
he
age
o
9-10
yea s
he
child en
copy
hei
pa en s
and
cook
750
ECOLOGY
OF
MONKEYPOX
VIRUS
he
mea .
In
Bas-Zai e,
on
he
o he
hand,
child en
s a
hun ing
wild
animals
a
he
age
o
12-13
yea s
and
small
mammals
a e
ela i ely
a e
a ge s.
Mo e-
o e ,
consump ion
o
uncooked
mea
is
unusual,
p obably
because
o
be e
gene al
educa ion;
in
Bas-
Zai e
egion
nea ly
wice
as
many
child en
comple e
p ima y
and
seconda y
schooling
compa ed
wi h
Equa eu
egion
in
he
no h,
whe e
Bumba
zone
is
si ua ed
(20).
Fu he ,
he
popula ion
densi y
in
Bas-
Zai e
is
ou
imes
highe
han
in
Equa eu
egion
(36.6
and
8.4
pe sons
pe
kM2,
espec i ely),
and
animal
husband y
is
mo e
ad anced
han
in
he
no h.
Human
monkey
is
a
disease
o
mainly
he
u al
popula ion,
90%
o
he
pa ien s
li ing
in
small
illages
inhabi ed
by
less
han
a
housand
pe sons;
only
h ee
cases
we e
epo ed
om
owns
o
mo e
han
i e
housand
esiden s
(6).
This
di e ence
is
p obably
ela ed
o
he
ac
ha
in
he
u al
a eas
wi h
low
popula ion
densi ies
he
people
ely
almos
en i ely
on
wild
animals
as
he
sou ce
o
animal
p o ein.
Wi h
he
inc ease
in
popula ion
densi y,
animal
a ming
was
es ablished
as
a
sou ce
o
p o ein.
Thus
in
he
cou se
o
gene al
economic
de elopmen ,
adi ional
nu i ional
p ac ices
a e
disappea ing
and
i
is
expec ed
ha
in ec ion
wi h
monkeypox
i us
will
dec ease.
(2)
Pas
accina ion
agains
smallpox.
The
second
ac o
ela es
o
he
suscep ibili y
o
he
popula ion
o
monkeypox
i us,
which
is
de e mined
mainly
by
smallpox
accina ion
ca ied
ou
in
he
pas
(6).
Be ween
1980,
when
smallpox
accina ion
was
s opped
in
Zai e
(and
in
mos
coun ies
o
wes
and
cen al
A ica),
and
1983
he
p opo ion
o
accina ed
child en
below
5
yea s
o
age
in
Zai e
declined
om
43.7%
o
12.4%
and
he e
is
a
g adual
dec ease
in
he
olde
popula ion
as
well.
In
se e al
yea s
he e o e
he
whole
popula ion
will
become
suscep ible,
and
e e y
close
con ac
wi h
a
monkeypox-a ec ed
animal
may
be
expec ed
o
esul in
in ec ion
in
a
human.
Thus
he
p obabili y
o
he
i us
en e ing
a
human
popula ion
depends
on
he
balance
be ween
he
a e
o
decline
o
immuni y
due
o
smallpox
accina ion
and
he
a e
o
ad ance
o
social
and
economic
de elopmen
o
he
popula ion
in
he
enzoo ic
a eas.
(3)
Pe son- o-pe son
ansmission.
The
hi d
ac o
a ec ing
he
incidence
o
human
monkeypox
is
he
ansmissibili y
o
he
i us
be ween
humans.
Se e al
episodes
o
pe son- o-pe son
ansmission
ha e
been
epo ed
in
Zai e
(5,
6),
in
one
o
which
he e
we e
p obably
ou
gene a ions
o
ansmission
(21).
Seconda y
a ack
a es
o
human
monkeypox
in
un accina ed
con ac s
a e
12.3%
wi hin
a ec ed
households
and
3.3%
o
o he s
(6),
igu es
ha
a e
se e al
imes
lowe
han
he
a es
eco ded
o
smallpox
in
Asia
and
A ica
(22).
Using
he
da a
on
human
ansmission
in
Zai e,
a
s ochas ic
model
was
de eloped
o
pe son- o-pe son
in ec ions
wi h
monkeypox
i us
among
he
popu-
la ion
acco ding
o
h ee
le els
o
accina ion
co e age
-50%,
25%,
and
ze o
(23).
The
model
clea ly
indica ed
a
diminishing
numbe
o
cases
in
successi e
gene a ions
and
e en ual
cessa ion
o
ansmission.
Risk
o
in ec ion
o
isi o s
o
enzoo ic
a eas
So
a
we
ha e
discussed
he
monkeypox
h ea
o
he
local
popula ion
in
enzoo ic
a eas.
Visi o s
o
hese
a eas,
including
pe sons
om
o he
coun ies,
may
also
come
in
con ac
wi h
monkeypox
in ec ed
animals
in
he
cou se
o
hei
occupa ional
ac i i ies
o
hobbies.
Though
humans
a e
mainly
in ec ed
h ough
ood,
i
is
possible
ha
he
i us
could
en e
he
human
body
h ough
skin
ab asions
(like
accinia
i us)
o
he
espi a o y
ac
(like
smallpox
i us);
bo h
ou es
o
i us
ansmission
we e
p o ed
o
be
e y
e icien
among
animals
in
he
Kinshasa
s udy.
Some
pe sons
in
he
enzoo ic
a eas
a e
equen ly
equi ed
o
handle wild
animals
du ing
hei
wo k
(e.g.,
o
cap u e
hem
ali e,
nu se
he
ecen ly
cap-
u ed
ones,
o
dissec
hem).
These
pe sons
should
be
conside ed
a
isk,
i.e.,
hey
belong
o
he
ca ego y
o
"in es iga o s
a
isk"
which
was
men ioned
by
he
Global
Commission
o
he
Ce i ica ion
o
Smallpox
E adica ion
(4),
so
ha
in
addi ion
o
en o cing
pe -
sonal
p ecau ions
i
may
be
wise
o
o e
hem
small-
pox
accina ion.
Fo
he
popula ions
li ing
in
he
endemic
a eas,
heal h
educa ion
on
ood
hygiene,
especially
o
child en
a ending
p ima y
schools,
may
signi ican ly
educe
he
chances
o
con ac ing
he
in ec ion
om
wild
li e.
ACKNOWLEDGEMENTS
The
au ho s
a e
g a e ul
o
M
Ma k
Szczeniowski
who
coo dina ed
all
ope a ions
and
logis ic
suppo
o
he
esea ch
ac i i ies
in
Zai e,
he
membe s
o
he
mobile
eams
who
pa icipa ed
in
he
esea ch,
he
adminis a ion
and
s a
o
he
Na ional
Labo a o y
o
Bio-Medical
Resea ch
in
Kinshasa
and
i s
i ology
labo a o y
who
in
a
e y
sho
ime
es ablished
he
expe imen al
labo a o y,
he
scien is s
who
pa icipa ed
in
he
expe imen al
wo k,
and
he
s a
o
he
WHO
e e ence
labo a o ies
and
he
Musee
Royal
de
l'A ique
Cen al
who
p ocessed
he
samples
om
he
ield
and
backed
up
he
expe imen al
wo k
in
Kinshasa.
We
hank
D
F ank
Fenne
o
ad ice
du ing
he
s udies
and
o
inalizing
he
p epa a ion
o
his
pape .
751
752
L.
KHODAKEVICH
ET
AL.
RESUME
ORTHOPOXVIRUS
SIMIEN:
ECOLOGIE
ET
IMPORTANCE
EN
SANTE
PUBLIQUE
Des
a aux
ecen s
on
mon e
que
les
in ec ions
a
o ho-
pox i us simien
su iennen
a ec
une
o e
p d alence
chez
plusieu s
especes
d'ecu euils
appa enan
au
gen e
Funi-
sciu us,
son
moins
equen es
chez
les
ecu euils
appa -
enan
au
gen e
Heliosciu us,
e
son
a es
chez
les
p ima es
a bo icoles.
Ces
especes
d'ecu euils
i en
en
gene al
dans
les
o e s
secondai es
qui
se
de eloppen
au ou
des
6 ablis-
semen s
humains
dans
les
zones
u ales
du
Zai e,
no am-
men
dans
les
egions
de
plan a ions
de
palmie s
a
huile,
e
son
a es
dans
la
o e
omb ophile
p imi i e.
L'in ec ion
humaine
pa
l'o hopox i us
simien
su ien
es
6quemmen
en e
5
e
9
ans,
no ammen
dans
les
pe i s
illages
oii
les
en an s
chassen
pou
les
mange
des
dcu-
euils
e
d'au es
pe i s
mammi e es.
Tou e ois,
les
popu-
la ions
de
ces
dgions
de iennen
plus
nomb euses
e
ne
peu en
plus
se
sa is ai e
des
seuls
animaux
sau ages
comme
sou ce
de
p o eines
animales;
le
de eloppemen
de
l'ele age
edui a
ce ainemen
le
isque
comme
l'incidence
de
l'o hopox i ose
simienne
de
l'homme,
meme
dans
les
dgions
oiu
l'o hopox i us
simien
es
p dsen
dans
la
popu-
la ion
locale
d'ecu euils.
Bien
que
l'expansion
demog aphique
e
le
de eloppemen
economique
de
l'A ique
occiden ale
e
cen ale
puissen
p obablemen
6dui e
le
isque
d'in ec ion
humaine
pa
l'o hopox i us
simien,
les
isi eu s
de
ces
egions
qui
son
suscep ibles
d'en e
en
con ac
a ec
des
animaux
sau ages
se
e on
p opose
la
accina ion
an i a iolique
a
i e
de
p o ec ion.
REFERENCES
1.
VON
MAGNUS,
P.
ET
AL.
A
pox-like
disease
in
cyno-
molgus
monkeys.
Ac a
pa hologica
e
mic obiologica
Scandina ica,
46:
156-176
(1959).
2.
ARITA,
I.
&
HENDERSON,
D. A.
Smallpox
and
monkey-
pox
in
non-human
p ima es.
Bulle in
o
he
Wo ld
Heal h
O ganiza ion,
39:
277-283
(1968).
3.
AR A,
I.
ET
AL.
Ou b eaks
o
monkeypox
and
se o-
logical
su eys
in
non-human
p ima es.
Bulle in
o
he
Wo ld
Heal h
O ganiza ion,
46:
625-631
(1972).
4.
The
global
e adica ion
o
smallpox.
77Te inal
epo
o
he
Global
Commission
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he
Ce i ica ion
o
Small-
pox
E adica ion.
Wo ld
Heal h
O ganiza ion,
Gene a,
1980.
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The
cu en
s a us
o
human
monkeypox:
Memo andum
om
a
WHO
Mee ing.
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o
he
Wo ld
Heal h
O ganiza ion,
62:
703-713
(1984).
6.
ARITA,
I.
ET
AL.
Human
monkeypox:
a
newly
eme ged
o hopox i us
zoonosis
in
he
opical
ain
o es s
o
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Ame ican
jou nal
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opical
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hygiene,
34:
781-789
(1985).
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BREMAN,
J.
G.
ET
AL.
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in
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A ican
non-
human
p ima es:
se ological
su ey
esul s.
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o
he
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Heal h
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605-612
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GISPEN,
R.
ET
AL.
Monkeypox-speci ic
an ibodies
in
human
and
simian
se a
om
he
I o y
Coas
and
Nige ia.
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o
he
Wo ld
Heal h
O ganiza ion,
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355-360
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MARENNIKOVA,
S.
S.
ET
AL.
[On
he
con agiousness
o
monkeypox
o
humans:
he
esul s
o
he
in es iga ion
o
wo
ou b eaks
o
in ec ion
in
Zai e.]
Zu nal
mik o-
biologii,
epidemiologii
i
immunobiologii,
No.
8:
38-43
(1985)
(in
Russian
wi h
English
abs ac ).
10.
MUTOMBO,
M.
ET
AL.
Human
monkeypox
ansmi ed
by
a
chimpanzee
in
a
opical
ain- o es
a ea
o
Zai e.
Lance ,
1:
735-737
(1983).
11.
KHODAKEVICH,
L.
ET
AL.
Monkeypox
i us
in
ela ion
o
he
ecological
ea u es
su ounding
human
se le-
men s
in
Bumba
zone,
Zai e.
T opical
and
geog aphical
medicine,
39:
56-63
(1987).
12.
KHODAKEVICH,
L.
ET
AL.
The
ole
o
squi els
in
sus-
aining
monkeypox
i us
ansmission.
T opical
and
geog aphical
medicine,
39:
115-122
(1987).
13.
KHODAKEVICH,
L.
ET
AL.
Isola ion
o
monkeypox
i us
om
wild
squi el
in ec ed
in
na u e.
Lance ,
1:
98-99
(1986).
14.
JEIEK,
Z.
ETAL.
Se ological
su ey
o
human
monkey-
pox
in ec ions
in
a
selec ed
popula ion
in
Zai e.
Jou nal
o
opical
medicine
and
hygiene,
90:
31-38
(1987).
15.
EMMONS,
L.
H.
Ecology
and
esou ce
pa i ioning
among
nine
species
o
A ican
ain
o es
squi els.
Ecological
monog aphs,
50:
31-54
(1980).
16.
EMMONS,
L.
H.
Ecology
and
beha iou
o
A ican
ain o es
squi els.
Co nell
Uni e si y,
1975.
17.
RICHARDS,
P.
W.
The
opical
ain
o es .
An
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