Enhancing case definitions for surveillance of human monkeypox in the Democratic Republic of Congo,PLOS Neglected Tropical Diseases

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Enhancing case definitions for surveillance of human monkeypox in the Democratic Republic of Congo
PLOS Neglected Tropical Diseases ( IF 3.4 ) Pub Date : 2017-09-11 , DOI: 10.1371/journal.pntd.0005857
Lynda Osadebe _{1,

2} , Christine M Hughes ₂ , Robert Shongo Lushima ₃ , Joelle Kabamba ₄ , Beatrice Nguete ₅ , Jean Malekani ₆ , Elisabeth Pukuta ₇ , Stomy Karhemere ₇ , Jean-Jacques Muyembe Tamfum ₇ , Emile Wemakoy Okitolonda ₅ , Mary G Reynolds ₂ , Andrea M McCollum ₂

Affiliation

Background

Human monkeypox (MPX) occurs at appreciable rates in the Democratic Republic of Congo (DRC). Infection with varicella zoster virus (VZV) has a similar presentation to that of MPX, and in areas where MPX is endemic these two illnesses are commonly mistaken. This study evaluated the diagnostic utility of two surveillance case definitions for MPX and specific clinical characteristics associated with laboratory-confirmed MPX cases.

Methodology/Principal findings

Data from a cohort of suspect MPX cases (identified by surveillance over the course of a 42 month period during 2009–2014) from DRC were used; real-time PCR diagnostic test results were used to establish MPX and VZV diagnoses. A total of 333 laboratory-confirmed MPX cases, 383 laboratory-confirmed VZV cases, and 36 cases that were determined to not be either MPX or VZV were included in the analyses. Significant (p<0.05) differences between laboratory-confirmed MPX and VZV cases were noted for several signs/symptoms including key rash characteristics. Both surveillance case definitions had high sensitivity and low specificities for individuals that had suspected MPX virus infections. Using 12 signs/symptoms with high sensitivity and/or specificity values, a receiver operator characteristic analysis showed that models for MPX cases that had the presence of ‘fever before rash’ plus at least 7 or 8 of the 12 signs/symptoms demonstrated a more balanced performance between sensitivity and specificity.

Conclusions

Laboratory-confirmed MPX and VZV cases presented with many of the same signs and symptoms, and the analysis here emphasized the utility of including 12 specific signs/symptoms when investigating MPX cases. In order to document and detect endemic human MPX cases, a surveillance case definition with more specificity is needed for accurate case detection. In the absence of a more specific case definition, continued emphasis on confirmatory laboratory-based diagnostics is warranted.

中文翻译：

加强刚果民主共和国人类猴痘监测的病例定义

背景

人类猴痘 (MPX) 在刚果民主共和国 (DRC) 的发病率相当高。水痘带状疱疹病毒 (VZV) 感染与 MPX 感染具有相似的表现，在 MPX 流行的地区，这两种疾病经常被误诊。本研究评估了两个 MPX 监测病例定义的诊断效用以及与实验室确诊的 MPX 病例相关的具体临床特征。

方法/主要发现

使用来自刚果民主共和国的一组疑似 MPX 病例（通过 2009 年至 2014 年 42 个月期间的监测确定）的数据；实时 PCR 诊断测试结果用于建立 MPX 和 VZV 诊断。分析中总共纳入了 333 例实验室确诊的 MPX 病例、383 例实验室确诊的 VZV 病例以及 36 例确定既不是 MPX 也不是 VZV 的病例。实验室确诊的 MPX 和 VZV 病例之间的多种体征/症状（包括关键皮疹特征）存在显着差异（p<0.05）。对于疑似 MPX 病毒感染的个体，这两种监测病例定义的敏感性均较高，特异性较低。使用具有高敏感性和/或特异性值的 12 种体征/症状，接受者操作员特征分析表明，存在“皮疹前发烧”的 MPX 病例模型加上 12 种体征/症状中的至少 7 或 8 种表现出更多的症状。灵敏度和特异性之间的平衡性能。