Abstract
Identification of human monkeypox cases during 2005 in southern Sudan (now South Sudan) raised several questions about the natural history of monkeypox virus (MPXV) in Africa. The outbreak area, characterized by seasonally dry riverine grasslands, is not identified as environmentally suitable for MPXV transmission. We examined possible origins of this outbreak by performing phylogenetic analysis of genome sequences of MPXV isolates from the outbreak in Sudan and from differing localities. We also compared the environmental suitability of study localities for monkeypox transmission. Phylogenetically, the viruses isolated from Sudan outbreak specimens belong to a clade identified in the Congo Basin. This finding, added to the political instability of the area during the time of the outbreak, supports the hypothesis of importation by infected animals or humans entering Sudan from the Congo Basin, and person-to-person transmission of virus, rather than transmission of indigenous virus from infected animals to humans.
Highlights
Identification of human monkeypox cases during 2005 in southern Sudan ( South Sudan) raised several questions about the natural history of monkeypox virus (MPXV) in Africa
We used 2 independent lines of investigation: 1) the genetic characterization of the virus isolates from Sudan (Sudan isolates 1 and 2) and their comparison with previous isolates of MPXV from various regions of Africa by using phylogenetic analysis and 2) the generation of ecological niche models and characterization of ecological factors associated with monkeypox virus transmission on the basis of reported human cases in central and western Africa, including the assessment of environmental suitability for MPXV transmission among the Sudan localities
The remaining 5 isolates were grouped within the Congo Basin clade, including the 2 isolates obtained during the Sudan outbreak in 2005 that were processed and combined for analysis
Summary
Identification of human monkeypox cases during 2005 in southern Sudan ( South Sudan) raised several questions about the natural history of monkeypox virus (MPXV) in Africa. Monkeypox cases among humans derived from contact with native animals have been reported in central and western Africa only; this outbreak in Sudan could represent, if zoonotic transmission is confirmed, endemic transmission of monkeypox outside the recognized geographic range of the disease [7,11]. We used 2 independent lines of investigation: 1) the genetic characterization of the virus isolates from Sudan (Sudan isolates 1 and 2) and their comparison with previous isolates of MPXV from various regions of Africa by using phylogenetic analysis and 2) the generation of ecological niche models and characterization of ecological factors associated with monkeypox virus transmission on the basis of reported human cases in central and western Africa, including the assessment of environmental suitability for MPXV transmission among the Sudan localities
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