First reports of monkeypox and varicella-zoster virus coinfection in the global human monkeypox outbreak in 2022

Most cases of disease in the current multi-country outbreak have been associated with sexual risk behaviors among men who have sex with men, with a higher prevalence of lesions in the anogenital region and oral mucosa due to skin-to-skin contact during unprotected sexual intercourse. In Brazil, the varicella vaccine has been made available free of charge by the National Immunization Program since 2013 [6], but herpes zoster vaccine is only offered in private clinics at a high cost. [...]the co-occurrence of MPX and VZV infections in Brazil should not be overlooked. Variables Case 1 Case 2 Case 3 Case 4 Case 5 Sex Male Male Male Female Male Sexual orientation Heterosexual Heterosexual Heterosexual Heterosexual Heterosexual Age 44 years 20 years 21 years 13 years 46 years MPX Diagnosis Method RT-PCR RT-PCR RT-PCR RT-PCR RT-PCR Sample Skin swab Skin swab Skin swab Skin swab Skin swab Days between the onset of lesions and testing 4 8 5 4 1 Ct values 29.8 34.4 33.5 35.0 36.0 Systemic symptoms Lymphadenopathy Yes No No No No Fever Yes No Yes Yes Yes Asthenia No No No No No Headache Yes Yes No Yes No Myalgia No No No No Yes Sore throat No No No No No Cutaneous lesions Yes Yes Yes Yes Yes Location Hands/feet Yes Yes Yes No No Arms/legs Yes Yes Yes No No Trunk No No Yes Yes Yes Face No No No No No Genital No No No No No Anal/perianal No No No No No Oropharynx/oral mucosa/lips No No No No No Hospitalization No No No No No Prior vaccination against varicella NR NR Yes Yes Yes Prior vaccination against shingles No No No No No Known contact with a confirmed case No No No No No Travel abroad No No No No No Sexual exposure before onset of symptoms No No No No No Concomitant sexually transmitted infection Syphilis and herpes simplex virus infection No No No No No HIV No No No No No Concomitant varicella zoster virus infection Yes Yes Yes Yes Yes Ct values 20.6 22.3 17.6 14.0 21.0 Table 1 Clinical and epidemiological characteristics of patients with monkeypox and varicella-zoster virus coinfection.