Last month scientists detailed how monkeypox has rushed to fill the niche left vacant in certain parts of Africa by the human eradication of smallpox. Now, a new report from Emerging Infectious Diseases documents a 2005 outbreak of monkeypox in the Sudanese state of Unity that hints at possible human-to-human transmission. There were ten confirmed cases and nine probable cases of monkeypox between September and December of 2005. No deaths occurred.

The disease presents symptoms similar to smallpox, causing swelling of the lymph nodes, fever, and a raised, bumpy rash. It has a mortality rate of 1-10% in Africa.

The particularly intriguing aspect of this outbreak is the evidence of possible human-to-human transmission. In this case, a traditional healer was linked to three of the four transmission chains in the outbreak. The healer had a confirmed case of monkeypox, and a number of the monkeypox patients were either children whom the healer had recently treated for illnesses or young adults who had gone to him for a tooth extraction procedure (removal of the incisors to signify passage into adulthood is a cultural tradition in this part of Sudan).

Usually most cases of monkeypox originate in rural areas, where the virus is spread through contact with infected animals (usually rodents, domestic animals, and, yes, monkeys). Though it is not unheard of, another instance of human-to-human transmission—if it proves to have indeed happened in this case—would heighten concerns about possible monkeypox outbreaks in urban areas.

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