Our main result is that, had the DRC population been fully susceptible to monkeypox, monkeypox would have triggered an epidemic where the average number of cases per infectious individual would have been 1.46-2.67. “We reanalyzed monkeypox historical data to assess its epidemic potential, explain Institut Pasteur researchers. However, a complete analysis should have taken into account that, at that time, nearly all DRC population was vaccinated against smallpox and the vaccine was 85% effective against monkeypox. Retrospective analysis confirms protection from smallpox vaccination Indeed, subsequent studies showed that the average number of cases caused by an infected individual was less than 1, which is the epidemic threshold. Monkeypox was thus regarded as a limited risk for public health. It was found that the new cases were monkeypox cases, where transmission was limited to small outbreaks, not reaching the entire population. In the early 1980s, after the worldwide eradication of smallpox and cessation of smallpox vaccination, epidemiologists were called to assess hundreds of cases of pox disease in the Democratic Republic of Congo (DRC). Monkeypox is caused by the monkeypox virus, member of the orthopoxvirus genus. We use mathematical modelling to argue that, in a population with diminishing herd immunity against orthopoxvirusspecies, the epidemic potential of monkeypox will continue increasing. Monkeypox could therefore emerge as the most important orthopoxvirus infection in humans. This transmission pattern is likely due to the worldwide decline in orthopoxvirus immunity (monkeypox virus), following cessation of smallpox vaccination, once smallpox was declared eradicated in 1980. The geographic spread of monkeypox cases has expanded beyond the forests of central Africa, where cases were initially found, to other parts of the world, where cases have been imported. Monkeypox is an emerging infectious disease for which outbreak frequency and expected outbreak size in human populations have steadily increased.
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