Abstract
The zoonosis human monkeypox (MPX) was discovered in 1970, twelve years after the discovery of monkeypox virus (MPXV) in a Danish laboratory in 1958. Historically confined to West Africa (WA) and the Congo basin (CB), new epidemics in Sudan and the United States of America (USA) have fuelled new research highlighting environmental factors contributing to the expanded geographical spread of monkeypox virus (MPXV). A systematic literature review was conducted in MEDLINE® (Ovid), MEDLINE® (PubMed) and Google Scholar databases using the search terms: monkeypox, MPXV and “human monkeypox”. The literature revealed MPX has classic prodromal symptoms followed by a total body rash. The sole distinguishing clinical characteristic from other pox-like illnesses is the profound lymphadenopathy. Laboratory diagnosis of MPX is essential, a suitable test for endemic areas is under development but not yet available. For the time being anti-poxvirus antibodies in an unvaccinated individual with a history of severe illness and rash can suggest MPX infection. The reservoir host remains elusive yet the rope squirrel and Gambian pouched rat appear to be the most likely candidates. Transmission includes fomite, droplet, direct contact with infected humans or animals and consumption of infected meat. Though smallpox vaccination is protective against MPXV, new non-immune generations contribute to increasing incidence. Environmental factors are increasing the frequency of contact with potential hosts, thus increasing the risk of animal-to-human transmission. Increased risk of transmission through globalisation, conflict and environmental influences makes MPX a more realistic threat to previously unaffected countries. Health worker training and further development and accessibility of suitable diagnostic tests, vaccinations and anti-viral treatment is becoming increasingly necessary.
Highlights
Following the eradication of smallpox in 1980, human monkeypox (MPX) was described in 1987 as the most important orthopoxvirus (OPXV) occurring in humans at the time [1]
monkeypox virus (MPXV) was first discovered during an outbreak amongst monkeys at a Danish laboratory in
If the CD4 count is above 200 cells/mm3 ACAM2000TM is recommended, as it is currently believed to be more effective [56]
Summary
Following the eradication of smallpox in 1980, human monkeypox (MPX) was described in 1987 as the most important orthopoxvirus (OPXV) occurring in humans at the time [1]. There are currently 10 species known in the genus OPXV, including variola (smallpox) [1]. With a 30% case fatality rate (CFR) and high virulence, smallpox is described as one of the most feared diseases known to humanity [2]. Monkeypox virus (MPXV) is highly pathogenic [3,4], causing similar clinical manifestations to smallpox. Smallpox vaccination is known to provide cross-immunity with up to 85%. Protection against infection [5,6] or reduction in severity of disease [7,8,9,10]. MPXV was first discovered during an outbreak amongst monkeys at a Danish laboratory in
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