The epidemiological trend of monkeypox and monkeypox-varicella zoster viruses co-infection in North-Eastern Nigeria

Abstract

BackgroundMonkeypox (MPX) is endemic in Nigeria, but it was first reported in Adamawa state, North-Eastern Nigeria, in January 2022. There are currently 172 cases of MPX in Nigeria, with four reported deaths, and Adamawa has the second-highest case count. Therefore, this study was undertaken to evaluate the epidemiological profile of this viral disease.MethodsThis is a cross-sectional study. The skin and blood samples were screened for the presence for Monkeypox virus (MPXV) and Varicella Zoster virus (VZV) DNA by real-time PCR; the clinical diagnosis was based on symptoms of visual signs of skin lesions and other clinical symptoms from January to July 2022.ResultsA total of 33 suspected cases aged 1–57 years [26 (79%) males vs. 7 (21%) females] were screened for MPX and VZV. Twenty-four (72.7%) were positive (6.1% were MPX only, 39% were VZV only, and 27% were both MPX and VZV). Most cases of MPX (82%), VZV (69%) and MPX-VZV co-infection (78%) occurred in males. More than half (54%) of those infected were children and adolescents between 0 and 19 years. All patients experienced body rashes and itching, and other clinical symptoms included fever, headache, mouth sores, muscle aches and lymphadenopathy. Over 64 and 86% of patients had contact with livestock and rodents, respectively.ConclusionMPXV, VZV and MPXV-VZV co-infections occurred predominantly among males and children in Adamawa state, Nigeria. Given the patient contact with rodents and livestock, further research on the animal reservoir is needed to highlight the transmission of MPXV in Adamawa.

Surveillance of Nigerian children suggests that varicella may be a risk factor for acquisition of monkeypox

“…For all the above reasons, the simplest explanation for the Nigerian outbreaks is that varicella occurred first, followed rapidly by a second infection with mpox. The clustering of cases suggests that there were outbreaks of varicella in the villages where mpox was found ( 2 ). Since there were far more cases of varicella than mpox, the data further suggest that a subgroup of children with varicella contracted mpox.…”

“…In their Discussion, the authors propose that it may be worthwhile for the varicella vaccine to be added to the routine vaccination schedule for children in Nigeria ( 2 ). The rationale was to eliminate the confusion over diagnosis of varicella vs. mpox in children.…”

“…In one study in Nigerian school children, around 50% of children aged 4–6 years were seropositive for varicella antibody; this percentage rose to 70% by ages 13–15 years ( 5 ). The authors in the current study enrolled 33 patients with fever and rashes, but they eliminated 9 patients because their diagnoses could not be confirmed ( 2 ). Of the remaining 24 patients, 18 were children (up to age 19 years) and 6 were adults.…”

“…An intersection between the epidemiology profiles of varicella and monkeypox was not reported in a recent state-of-the-art review on monkeypox in children ( 1 ). Yet, Stephen et al ( 2 ) have described several cases of coinfection with monkeypox and varicella during outbreaks of fever with rash in children and adults living in Northeastern Nigeria. In their Discussion, the authors speculate about the sequence of events during a coinfection with monkeypox and varicella.…”

Epidemiological and clinical characteristics of mpox cases: correspondence

“…We would like to share ideas on the publication Epidemiological and clinical characteristics of monkeypox cases in Brazil in 2022: a cross-sectional study 1 The epidemiological and clinical characteristics of mpox documented by Pascom et al., in Brazil, were comparable to those of other nations, such as México and Nigéria. 1 , 2 , 3 An epidemiological characteristic that has been common is the highest occurrence of the disease among males, especially homosexual men. 2 , 3 …”