In the Kole hospital, “the walls are crumbling and the glass panes are falling out–and it’s one of the best-maintained hospitals in that part of that country,” notes Kate Rubins. The central African country is plagued by violence. Photos: Kate Rubins

Some patients walk dozens of miles to be admitted to the hospital, which treats an increasing number of monkeypox patients every year.

An expert on dangerous viruses, Rubins is no stranger to Biosafety Level 4 laboratories. The lab at the Kole hospital was at the opposite extreme, like “a microbiology lab from 1910.”

The only lights in the lab came from the scientific equipment, notably this portable lab isolation hood. Power came from solar power or generators, but half the time there was none.

Monkeypox lesions break out on the face, limbs and hands, and last about three weeks. Medical staff drew the lines on this boy’s face to help track the lesions. There is no drug regimen for the disease, but patients generally do better in the hospital.

Patients go to the monkeypox isolation ward when they develop lesions. Often patients have great difficulty swallowing and become dehydrated.

The human side of monkeypox

In the Congo, Kate Rubins and colleagues study the smallpox-like disease

The single-engine plane lifted off the runway and up through the smog over Kinshasa, loaded near its maximum weight with five people, a portable lab isolation hood and related gear. In mid-July, Kate Rubins and her colleagues were headed for Kole, a remote and poverty-stricken village five hours by air from the Democratic Republic of Congo’s capital.

There, in a mission hospital, they would spend several weeks gathering blood samples from patients with monkeypox.

Like smallpox, monkeypox is a poxvirus, equipped with only about 200 genes but cunningly crafted for attack. “It’s a tiny bit of nucleic acid and a few proteins all wrapped up, and it can kill you,” says Rubins, a Whitehead Fellow.

While episodes of monkeypox are reported sporadically, Rubins and her colleagues believe it is endemic in this isolated area of Africa. Villagers most likely get the disease by eating or being bitten by infected monkeys or rodents. Monkeypox is less dangerous to humans than smallpox and less easily transmitted, but it kills about 10 percent of its victims, and may leave others blind or permanently disfigured. The hospital treats patients with intravenous fluids and antibiotics for secondary infections.

Monkeypox first appeared in the medical literature several decades ago, but “it’s like a new disease because it’s so understudied,” says Rubins, whose team collaborated with the Congolese Ministry of Health.

Other collaborators include Emile Okitolonda Wemakoy of the Kinshasa School of Public Health, Jean Jacques Muyembe–Tamfum of the National Institute of Biomedical Research in Kinshasa, Anne Rimoin of the University of California/Los Angeles School of Public Health, David Relman of Stanford University and Lisa Hensley and John Huggins of the U.S. Army Medical Research Institute of Infectious Diseases. Funding came from USAMRIID, the Pacific Southwest Regional Center of Excellence for Biodefense and Emerging Infectious Disease, and the National Academies Keck Futures Initiative.

While the team was in Kole, the researchers separated patient blood samples into many different components. This work was done in the field because the samples had to be processed fresh and then stored in liquid nitrogen.

The scientists are now examining how monkeypox affects various components of the human immune system, including innate immunity (the first line of defense against invaders), cytokines (which aid in many immune cell processes, such as helping to tailor T-cells to handle a given pathogen), and antibodies, which recognize and destroy infectious organisms.

“People in the village were fantastic,” says Rubins. About half the village’s population greeted the research team’s plane, and the team’s work drew a constant stream of onlookers.