Shulman Stanford T
Division of Pediatric Infectious Diseases, Children's Memorial Hospital, Chicago, Illinois, USA.
J Pediatric Infect Dis Soc. 2023 Feb 27;12(2):73-75. doi: 10.1093/jpids/piac120.
Human monkeypox infection was first identified in 1970 in African. Small rodents were the natural reservoir of this orthopoxvirus, with humans and primates as incidental hosts. Smallpox vaccination induces cross protection against monkeypox. In Africa monkeypox overlapped with the Global Smallpox Eradication Program (GSEP) six decades ago. The 2022 human monkeypox epidemic prompted literature review re potential impact of monkeypox upon GSEP efforts.
Literature review from 1960 to present related to GSEP launched in 1969 with particular focus on monkeypox epidemiology during planning of GSEP in the 1960's through 1989 including surveillance years later.
Establishing the lack of a non-human reservoir of smallpox was essential to assessing the GSEP because of the similarity of the two orthopoxviruses. It was found that a non-human smallpox reservoir was highly remote. Human monkeypox did not occur in smallpox-vaccinated humans and was limited to non-vaccinees. Surveillance in Democratic Republic of the Congo (DRC) until 1989 found monkeypox was very unlikely to persist in humans and unlikely to become a major public health problem. From 2005-2007, decades after cessation of smallpox vaccination, monkeypox surveillance in DRC revealed 20-fold higher incidence of human monkeypox correlated with much lower rates of prior smallpox vaccination.
Human monkeypox rates in DRC were 20-fold higher decades after cessation of smallpox vaccination compared to when smallpox vaccination was still used. The resultant decreased cross-protection against monkeypox contributed to the 2022 multinational outbreak of human monkeypox.
人类猴痘感染于1970年在非洲首次被发现。小型啮齿动物是这种正痘病毒的天然宿主，人类和灵长类动物为偶然宿主。天花疫苗接种可诱导对猴痘的交叉保护。六十年前，在非洲，猴痘与全球天花根除计划（GSEP）重叠。2022年的人类猴痘疫情促使对猴痘对GSEP工作的潜在影响进行文献综述。
对1960年至今与1969年启动的GSEP相关的文献进行综述，特别关注20世纪60年代至1989年GSEP规划期间的猴痘流行病学，包括之后的监测年份。
由于两种正痘病毒的相似性，确定不存在天花的非人类宿主对于评估GSEP至关重要。研究发现，天花的非人类宿主可能性极小。人类猴痘并未出现在接种天花疫苗的人群中，而是局限于未接种疫苗者。直到1989年在刚果民主共和国（DRC）进行的监测发现，猴痘在人类中极不可能持续存在，也不太可能成为主要的公共卫生问题。在天花疫苗接种停止数十年后的2005 - 2007年，刚果民主共和国的猴痘监测显示，人类猴痘发病率高出20倍，且与之前天花疫苗接种率低得多相关。
与仍使用天花疫苗接种时相比，刚果民主共和国在天花疫苗接种停止数十年后的人类猴痘发病率高出20倍。由此导致的对猴痘交叉保护的降低促成了2022年多国人类猴痘疫情的爆发。
