We present the clinical features and course of 282 patients with human monkeypox in Zaire during 1980-1985. The ages of the patients ranged from one month to 69 years; 90% were less than 15 years of age. The clinical picture was similar to that of the ordinary and modified forms of smallpox. Lymphadenopathy, occurring in the early stage of the illness, was the most important sign differentiating human monkeypox from smallpox and chickenpox. The symptoms, signs, and the course of the disease in patients who had been vaccinated against smallpox differed significantly from those in unvaccinated subjects. Pleomorphism and "cropping" similar to that in chickenpox occurred in 31% of vaccinated and 18% of unvaccinated patients. The prognosis depended largely on the presence of severe complications. No deaths occurred among vaccinated patients. In unvaccinated patients the crude case-fatality rate was 11% but was higher among the youngest children (15%).

This paper examines an outbreak of five cases of human monkeypox which occurred in children belonging to two families living in the West Kasai region of Zaire during May-July 1983. Epidemiologic investigations suggest that the first case was infected from an animal source, possibly a monkey, and that each of the other four cases was infected from a previous human case. Three of these cases of presumed person-to-person transmission occurred in close household contacts. The other case infection occurred either by casual contact within the hospital compound, or possibly because of infection due to use of the same syringe for injections. Human monkeypox is the most important orthopoxvirus infection in the post-smallpox eradication period. The disease is a zoonosis and person-to-person transmission is rather difficult. Thus, this episode is a rare event and special analysis of the circumstances is discussed. However, it supports the necessity to carry out surveillance and research on this disease as recently reported by Arita et al.

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Background The elderly population keeps growing and a lot are living in nursing homes, where infections are frequent as patients are weak and the risk of transmission is high. PurposeNursing home physicians wanted to standardise practise for antibiotic treatment. With the aim of quality and safety of care, prescriptions for antibiotics for urinary infections (UIs) and lower respiratory tract infections (LRTIs) were assessed. Materials and MethodsA prospective study: for two months, each prescription for antibiotics was studied. For each antibiotic, the site of infection, dose, duration and reassessment of the treatment after 48 to 72 hours were checked. These criteria were compared to guidelines approved by our ‘antibiotics committee’. Results of bacteriological samples, history of antibiotic treatment in the previous three months were also checked. Results82 patients were treated with antibiotics. Mean age was 81.4 years old. There were 56 LRTIs, 13 UIs. There are no guidelines for the treatment of bronchitis in the elderly so assessment of antibiotic treatment was not possible. The choice of drug was appropriate in 100% of UIs and LRTIs. The dose was adequate in 100% of the cases. Duration of treatment was adequate in 50% for cystitis, 0% for prostatitis, and 97.4% for LRTIs. Most of treatment was empirical (95.5%), few bacteriological samples were taken: 3% for pneumonia, 7.10% for bronchitis, 0% for exacerbations of chronic obstructive pulmonary disease, 62.5% for cystitis, and 33.3% for prostatitis. Traceability of reassessment after 48–72 hours couldn’t be found in 98.7% of cases. Conclusions Specific guidelines for antibiotic treatment were written to facilitate and standardise the prescribing process. Pharmacists and physicians decided to treat bronchitis like pneumonia. Indeed, this study underlined the specificity of patient care in nursing homes. However, more bacteriological samples need to be taken to prescribe the right treatment and to prevent antibiotic resistance. No conflict of interest.