Monkeypox (mpox) is a new problem on a global scale for humanity

Authors

DOI:

https://doi.org/10.15574/SP.2023.129.7

Keywords:

monkeypox, infection, zoonosis, orthopoxvirus, antiviral drugs, vaccine

Abstract

Purpose - to draw attention to an infection that was little known, but has now become a global problem for society; to familiarize readers with the peculiarities of the 2022 monkeypox outbreak and to increase the level of alertness of doctors to this disease.

Monkeypox is a global problem because the disease is spreading rapidly, covering 111 countries. Three cases were diagnosed in Ukraine. It is predominantly a self-limited infection, but there are severe and deadly complications. The lethality of this disease ranges from 0% to 11%. The course of the disease is more severe in children and people with reduced immunity. Vertical transmission of the virus from mother to child is possible, resulting in congenital monkeypox. Monkeypox is a zoonotic disease and its natural reservoir is not exactly known, but rodents are most likely to act. In most cases, person-to-person transmission of the virus occurs through close skin to skin contact, often during sexual intercourse. At the beginning of the outbreak 98% of cases of disease were was diagnosed in homo- and bisexuals. Airborne transmission is also possible. Infection is possible through close contact with infectious skin lesions. Clinically, the initial period resembles influenza, but lymphadenopathy is characteristic, which is considered a pathognomonic symptom of mpox. The rash is similar to that of chickenpox, but with more prevalent location on palms and soles than in chickenpox. In the presence of a vesicular rash in a patient, it is necessary to exclude monkeypox. PCR diagnostics of the virus in samples of vesicles or crusts has the greatest diagnostic value. Hygienic skin care is important. Antiviral drugs (tecovirimat, brincidofovir) are recommended only in severe cases. To reduce the spread of infection, international rules apply as for other infections, such as COVID-19. The monkeypox virus vaccine is recommended primarily for groups at risk of infection, including medical personnel who may come into contact with the patient or samples for laboratory testing.

Being aware for this infection, following international health regulations, it is possible to prevent the further spread of monkeypox.

No conflict of interests was declared by the authors.

References

Aldhaeefi M, Rungkitwattanakul D, Unonu J, Franklin CJ, Lyons J, Hager K, Daftary MN. (2023, Jan 5). The 2022 human monkeypox outbreak: Clinical review and management guidance. Am J Health Syst Pharm. 80(2): 44-52. https://doi.org/10.1093/ajhp/zxac300; PMid:36259674

Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE et al. (2022). Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Euro Surveill. 27: 2200421. https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200421

Berthet N, Descorps-Declère S, Besombes C, Curaudeau M, Nkili Meyong AA, Selekon B et al. (2021). Genomic history of human monkey pox infections in the Central African Republic between 2001 and 2018. Sci Rep. 11: 13085. https://doi.org/10.1038/s41598-021-92315-8; PMid:34158533 PMCid:PMC8219716

BMJ Best Practice. (2022). Poxvirus infection (monkeypox and smallpox) - Treatment algorithm. Retrieved 20 May 2022. URL: https://bestpractice.bmj.com/topics/en-us/1611/treatment-algorithm

Cann JA, Jahrling PB, Hensley LE, Wahl-Jensen V. (2013). Comparative pathology of smallpox and monkeypox in man and macaques. Journal of comparative pathology. 148(1): 6-21. https://doi.org/10.1016/j.jcpa.2012.06.007; PMid:22884034 PMCid:PMC3498598

CDC. (2007). Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html.

CDC. (2022). Considerations for Monkeypox Vaccination. www.cdc.gov. Retrieved 9 July 2022.

CDC. (2022). Epidemiological update: Monkeypox outbreak. European Centre for Disease Prevention and Control. 20 May 2022. Archived from the original on 23 May 2022. Retrieved 23 May 2022.

CDC. (2022). Isolation and Prevention Practices for People with Mpox. URL: https://www.cdc.gov/poxvirus/monkeypox/clinicians/isolation-procedures.html.

CDC. (2022). JYNNEOS Vaccine. URL: https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/jynneos-vaccine.html#interim

CDC. (2022, Sep 28). About Mpox. URL: https://www.cdc.gov/poxvirus/monkeypox/about/index.html.

Di Giulio DB, Eckburg PB. (2004). Human monkeypox: An emerging zoonosis. Lancet Infect. Dis. 4: 15-25. https://doi.org/10.1016/S1473-3099(03)00856-9; PMid:14720564

European Centre for Diseases Prevention and Control. (2022). Monkeypox Situation Update, as of 18 October 2022. URL: https://www.ecdc.europa.eu/en/news-events/monkeypox-situation-update (accessed on 21 October 2022).

Frey SE, Wald A, Edupuganti S, Jackson LA, Stapleton JT, El Sahly H et al. (2015, Sep 22). Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects. Vaccine. 33(39): 5225-5234. Epub 2015 Jul 2. https://doi.org/10.1016/j.vaccine.2015.06.075; PMid:26143613 PMCid:PMC9533873

Gould S, Atkinson B, Okechukwu O, Spencer A, Furneaux J, Dunning J. (2022). Air and surface sampling for monkeypox virus in UK hospitals. medrxiv.org. Retrieved 7 August 2022. S2CID 250727253. https://doi.org/10.1101/2022.07.21.22277864

Harrison C. (2022). Monkeypox response relies on three vaccine suppliers. Nat Biotechnol. 40: 1306-1307. https://www.nature.com/articles/s41587-022-01463-3. https://doi.org/10.1038/s41587-022-01463-3; PMid:36085508

Isidro J, Borges V, Pinto M, Ferreira R, Sobral D, Nunes A et al. (2022). First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal). URL: https://virological.org/t/first-draft-genome-sequence-of-monkeypox-virus-associated-with-the-suspected-multi-country-outbreak-may-2022-confirmed-case-in-portugal/799

Jezek Z, Szczeniowski M, Paluku KM, Mutombo M, Grab B. (1988). Human monkeypox: Confusion with chickenpox. Acta Trop. 45: 297-307.

Kozlov M. (2022, Jul 25). Monkeypox declared a global emergency: will it help contain the outbreak?. Nature. PMID 35879614. S2CID 251067503. https://doi.org/10.1038/d41586-022-02054-7

Kunkalikar B, Ellis D. (2022, Jul 6). The contamination of surfaces in hospital rooms housing monkeypox patients. News article. News-Medical.net. URL: https://www.news-medical.net/news/20220706/The-contamination-of-surfaces-in-hospital-rooms-housing-monkeypox-patients.aspx.

Ladnyj ID, Ziegler P, Kima E. (1972). A human infection caused by monkeypox virus in Basankusu territory, Democratic Republic of the Congo. Bull World Health Organ. 46: 593-597.

Lapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S et al. (2022, Aug 2). Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. Lancet Infectious Diseases. 22(9): 1267-1269. PMC 9629691. S2CID 251289584. https://doi.org/10.1016/S1473-3099(22)00513-8; PMid:35931095

Mbala PK, Huggins JW, Riu-Rovira T, Ahuka SM, Mulembakani P, Rimoin AW et al. (2017). Maternal and fetal outcomes among pregnant women with human monkeypox infection in the Democratic Republic of Congo. J Infect Dis. 216(7): 824-828. https://doi.org/10.1093/infdis/jix260; PMid:29029147

McCollum AM, Damon IK. (2014, Jan). Human monkeypox. Clinical Infectious Diseases. 58(2): 260-267. https://doi.org/10.1093/cid/cit703; PMid:24158414

Nguyen P-Y, Ajisegiri WS, Costantino V, Chughtai AA, MacIntyre CR. (2021). Reemergence of human monkeypox and declining population Immunity in the context of urbanization, Nigeria, 2017-2020. Emerg Infect Dis. 27(4): 1007. https://doi.org/10.3201/eid2704.203569

Nörz D, Pfefferle S, Brehm ThT, Franke G, Grewe I, Knobling B et al. (2022, Jun 30). Evidence of surface contamination in hospital rooms occupied by patients infected with monkeypox, Germany, June 2022. Eurosurveillance. 27(26): 2200477. ISSN 1560-7917. S2CID 250356219. https://doi.org/10.2807/1560-7917.ES.2022.27.26.2200477; PMid:35775427 PMCid:PMC9248266

NYC Health. (2022). Monkeypox Vaccine Clinic for People Who May Have Been Exposed to Monkeypox. Health Department Launches. Archived from the original on 27 June 2022. Retrieved 23 June 2022. URL: https://www.nyc.gov/site/doh/about/press/pr2022/monkeypox-vaccine-clinic.page

Patel A, Bilinska Ju, Tam JCH, Da Silva Fontoura D, Mason CY, Daunt A et al. (2022, Jul 28). Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 378: e072410. ISSN 1756-1833. https://doi.org/10.1136/bmj-2022-072410; PMid:35902115 PMCid:PMC9331915

Petersen BW, Damon IK. (2020). Smallpox, monkeypox and other poxvirus infections. In Goldman-Cecil Medicine, 26th ed. Goldman, L., Schafer, A.I., Eds. Volume 2. Elsevier: Philadelphia, PA, USA: 2180-2183. ISBN 978-0-323-53266-2.

Prevention CfDCa. (2022, Oct 23). Monkeypox in multiple countries 2022. URL: https://wwwnc.cdc.gov/travel/notices/alert/monkeypox.

Proietti I, Santoro PE, Skroza N, Tieghi T, Bernardini N, Tolino E et al. (2022). A Case Report of Monkeypox in an Adult Patient from Italy: Clinical and Dermoscopic Manifestations, Diagnosis and Management. Vaccines. 10: 1903. URL: https://doi.org/10.3390/vaccines10111903; PMid:36366410 PMCid:PMC9694441

Soheili M, Nasseri Sh, Afraie M, Khateri S, Moradi Yo, Mortazavi SMM, Kohan HG. (2022). Monkeypox: Virology, Pathophysiology, Clinical Characteristics, Epidemiology, Vaccines, Diagnosis, and Treatments. J Pharm Pharm Sci. 25: 297-322. https://journals.library.ualberta.ca/jpps/index.php/JPPS/article/view/33138/21695. https://pubmed.ncbi.nlm.nih.gov/36130588/. https://doi.org/10.18433/jpps33138; PMid:36130588

Rao AK, Petersen BW, Whitehill F, Razeq JH, Isaacs SN, Merchlinsky MJ et al. (2022). Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for preexposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the advisory committee on immunization practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 71: 734-742. https://doi.org/10.15585/mmwr.mm7122e1; PMid:35653347 PMCid:PMC9169520

Rigby J. (2022, May 19). Britain offers smallpox shot as monkeypox cases spread in Europe. Reuters. Archived from the original on 20 May 2022. Retrieved 23 May 2022.

Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. (2022). Prevention and treatment of monkeypox. Drugs. 82: 957-963. https://doi.org/10.1007/s40265-022-01742-y; PMid:35763248 PMCid:PMC9244487

The U.S. Food and Drug Administration (2022). Medication Guide Smallpox (Vaccinia) Vaccine, Live ACAM2000®. https://www.fda.gov/media/75800/download.

Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. (2022, Jul 21). Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. New England Journal of Medicine. 387(8): 679-691. ISSN 0028-4793. S2CID 250953579. https://doi.org/10.1056/NEJMoa2207323; PMid:35866746

Ukrinform. (2022). SSA zbilsat postavki vakcini vid mavpacoi vispi. URL: https://www.ukrinform.ua/rubric-world/3553551-ssa-zbilsat-postavki-vakcini-vid-mavpacoi-vispi.html.

Ukrinform. (2022). V ukraini zafiksuvali tretij vipadok mavpacoi vispi. URL: https://www.ukrinform.ua/rubric-society/3577417-v-ukraini-zafiksuvali-tretij-vipadok-mavpacoi-vispi.html.

Whitehouse ER, Bonwitt J, Hughes CM, Lushima RS, Likafi T, Nguete B et al. (2021). Clinical and Epidemiological Findings from Enhanced Monkeypox Surveillance in Tshuapa Province, Democratic Republic of the Congo during 2011-2015. The Journal of infectious diseases. 223(11): 1870-1878. https://doi.org/10.1093/infdis/jiab133; PMid:33728469

WHO (2022). Factsheet - Monkeypox. World Health Organization (WHO). 19 May 2022. Retrieved 28 May 2022. URL: https://www.who.int/news-room/fact-sheets/detail/monkeypox.

WHO. (2022). Monkeypox. URL: https://www.who.int/news-room/fact-sheets/detail/monkeypox.

WHO. (2022). Monkeypox - United Kingdom of Great Britain and Northern Ireland. Press release. World Health Organization. Retrieved 28 May 2022. URL: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON383.

WHO. (2022, Jun 4). Multi-country monkeypox outbreak: situation update. World Health Organization. Archived from the original on 6 June 2022. Retrieved 7 June 2022. URL: www.who.int.

WHO. (2022). WHO Director-General declares the ongoing monkeypox outbreak a Public Health Emergency of International Concern. World Health Organization (WHO). 23 July 2022. Retrieved 4 August 2022. URL: https://www.who.int/europe/news/item/23-07-2022-who-director-general-declares-the-ongoing-monkeypox-outbreak-a-public-health-event-of-international-concern.

WHO. (2022). WHO recommends new name for monkeypox disease. URL: https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease.

WHO. (2022). Questions and answers. Monkeypox. URL: https://www.who.int/news-room/questions-and-answers/item/monkeypox?gclid=EAIaIQobChMIovjFy4Ok_QIVMwqiAx0OKAwMEAAYASAAEgLYt_D_BwE.

Yan K, Tang LK, Xiao FF, Zhang P, Lu CM, Hu LY, Wang LS, Cheng GQ, Zhou WH. (2022, Nov). Monkeypox and the perinatal period: what does maternal-fetal medicine need to know? World J Pediatr. 15: 1-11. doi: 10.1007/s12519-022-00630-5. Epub ahead of print. PMID: 36378482; PMCID: PMC9665008.

Yang Z, Martens CA, Bruno DP, Porcella SF, Moss B. (2012). Pervasive Initiation and 3′-End Formation of Poxvirus Postreplicative RNAs*. Journal of Biological Chemistry. 287(37): 31050-31060. https://doi.org/10.1074/jbc.M112.390054; PMid:22829601 PMCid:PMC3438937

Yang Z, Reynolds SE, Martens CA, Bruno DP, Porcella SF, Moss B. (2011). Expression profiling of the intermediate and late stages of poxvirus replication. Journal of virology. 85(19): 9899-9908. https://doi.org/10.1128/JVI.05446-11; PMid:21795349 PMCid:PMC3196450

Yinka-Ogunleye A, Aruna O, Dalhat M, Ogoina D, McCollum A, DisuY et al. (2019). Outbreak of human monkeypox in Nigeria in 2017-18: a clinical and epidemiological report. The Lancet Infectious diseases. 19(8): 872-879. https://doi.org/10.1016/S1473-3099(19)30294-4; PMid:31285143

Published

2023-02-27