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Trends Microbiol. 2012 Feb;20(2):80-7. doi: 10.1016/j.tim.2011.12.001. Epub 2012 Jan 10.

Outbreaks of human monkeypox after cessation of smallpox vaccination.

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Division of High-consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop G-43, Atlanta, GA 30333, USA.


The recent observation of a surge in human monkeypox in the Democratic Republic of the Congo (DRC) prompts the question of whether cessation of smallpox vaccination is driving the phenomenon, and if so, why is re-emergence not universal throughout the historic geographic range of the virus? Research addressing the virus's mechanisms for immune evasion and induction, as well as that directed at elucidating the genes involved in pathogenesis in different viral lineages (West African vs Congo Basin), provide insights to help explain why emergence appears to be geographically limited. Novel vaccines offer one solution to curtail the spread of this disease.

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