Monkeypox Cases Research Articles

Monkeypox: From Emerging Trends to Therapeutic Concerns.

Monkeypox is a zoonotic viral disease. Monkeypox was first reported in humans about 54 years ago. Prior to the global outbreak, monkeypox was endemic to the rainforests of central and western African countries. In the last three years, increasing numbers of human monkeypox have been reported from various countries. Responding to the severity, monkeypox was declared a Public Health Emergency of International Concern by the World Health Organization. In the absence of approved drugs or clinical studies, repurposed drugs and therapeutic medical countermeasures effective against other orthopoxviruses have been utilized to treat severe human monkeypox cases. Currently, clinical trials are underway exploring the potential therapeutic effectiveness of tecovirimate in human monkeypox cases. Monoclonal antibodies, IFN-β, resveratrol, and 15 triple-targeting FDA-approved drugs represent potential new drug targets for human monkeypox, necessitating further research.

Les défis de la prise en charge de la variole du singe dans un pays en voie de développement : cas du Cameroun

International interest has been focused on Monkeypox since July 2022, due to multiples cases reported outside Africa. We report a case that occurred in Cameroon during this period. A 40-year-old Patient, heterosexual, living in Tombel in the southwest of Cameroon, HIV positive, consulted on 02/10/2022 for umbilicated, confluent vesiculo-pustular lesions, confluent on the face and scalp with palmo-plantar involvement, without lymphadenopathy, febrile, and evolving for 2 weeks. The diagnosis of Monkeypox was made based on a positive PCR test from on a skin sample revealing the Monkeypox clade 2 virus. Under treatment, the evolution was favourable after 17 days. We report the first confirmed case of Monkeypox in the city of Douala. The major challenge for the government would be to develop diagnostic and response strategies, to contain and neutralize the disease.

Epidemiología, clínica y prevención de la Viruela Símica. Revisión bibliográfica

Introduction: Monkeypox, or monkeypox, is a zoonosis endemic in the rural jungle areas of central and western Africa, in humans the first occurrence was in 1970 in the Democratic Republic of Congo. It is caused by a virus belonging to the genus Orthopoxvirus of the Poxviridae family. Objective: To determine the causes and predisposing factors to the outbreak of monkeypox, transmission routes, clinical manifestations, evolution, complications, diagnosis, therapeutic management, prevention and control of infection.Material and methods: A systematic review was carried out in the Medscape, Pubmed, Science Direct and Scielo databases. Thirty-one papers were used.Results: Monkeypox was discovered in 1958 in the city of Copenhagen, capital of Denmark, in monkeys used for research. In 1970, the first case of monkeypox in humans was reported in a child in the Democratic Republic of Congo. Once the diagnostic suspicion is determined, sampling is indicated to confirm infection by nucleic acid amplification test (NAAT) or real-time PCR. PCR is the definitive diagnostic test, can be alone or followed by restriction fragment length polymorphism (RFLP) analysis or sequencing, has high sensitivity and specificity; and a rapid turnaround time of about one day or less. Monkeypox is usually mild and most people recover without treatment.Conclusions: So far in Ecuador 421 cases of monkeypox have been reported, so it is important that public health officials and health care personnel receive training on the risk of the disease, recognition, treatment and isolation of cases. It is important that the country has sufficient PCR tests in public facilities for the confirmation of cases and as a method of prevention, citizens should maintain the biosecurity measures announced by the MSP.

Current knowledge of human Mpox viral infection among healthcare workers in Cameroon calls for capacity-strengthening for pandemic preparedness.

An increased incidence of human Monkeypox (Mpox) cases was recently observed worldwide, including in Cameroon. To ensure efficient preparedness and interventions in the health system, we sought to assess the knowledge of Mpox's transmission, prevention, and response among healthcare workers (HCWs) in Cameroon. A cross-sectional online survey was conducted among HCWs in Cameroon using 21-item questions adapted from the United States Centers for Disease Control and Prevention (US-CDC) standard questionnaire on Mpox. The overall knowledge of Mpox was assessed by cumulative score and categorized as excellent (≥80%, 17/21) or good (≥70%, ≥15/21) knowledge. The regression analysis was used to identify the predictors of Mpox knowledge. The survey enrolled 377 participants, but only responses from 342 participants were analyzed. Overall, 50.6% were female participants, and 59.6% aged 30 years or younger. The majority of the participants were medical doctors (50.3%); most worked in central-level hospitals (25.1%) and had 1-5 years of experience (70.7%). A total of up to 92.7% were aware of Mpox, with social media (58.7%) and radio/television (49.2%) as the main sources. The mean knowledge score was 14.0 ± 3.0 (4 to 20), with only 12.9% having excellent knowledge (≥80%) and 42.1% having good knowledge of Mpox. Younger age (26-30 years old) was associated with good knowledge, while workplace type was associated with excellent knowledge of Mpox (aOR [95% CI]: 4.01 [1.43-11.24]). Knowledge of treatment/management of Mpox was generally poor across the different professional categories. Knowledge of Mpox among HCWs is substandard across different professionals. Thus, for optimal preparedness and immediate interventions for Mpox and similar emerging pathogens, capacity-strengthening programs should be organized for HCWs while encouraging scientific literature and organizational social media websites.

Implantación y uso de la telemedicina en la asistencia sanitaria del brote de viruela símica en el Área de Salud de Ibiza y Formentera

ObjectiveThe objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area. Design and siteA descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care. Participants and methodsAll patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves. Results and conclusionsThe adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring.

Successful treatment of severe monkeypox case with advanced HIV infection using plasma from smallpox‐vaccinated healthy population: A case report

AbstractSince the first reported case of monkeypox in the UK in May 2022, there has been an upward trend in monkeypox cases and a global outbreak. However, reports of severe cases are relatively limited. In this study, we report a case of severe monkeypox in a patient with HIV. The patient presented with skin lesions that started on his face and around the penis and persisted for several months. Throughout the course of the disease, he received systematic symptomatic supportive treatment, topical remedies, and special care for the rash. He also underwent cidofovir antiviral therapy and smallpox‐vaccinated healthy population‐derived plasma therapy in succession, with the condition ultimately showing improvement after plasma treatment. After more than 3 months of hospitalization, he fully recovered. To the best of our knowledge, this is the first reported use of smallpox‐vaccinated healthy population‐derived plasma in the treatment of severe monkeypox cases.

Monkeypox: A re-emerging disease.

The virus known as monkeypox is the source of the zoonotic disease monkeypox, which was historically widespread in Central Africa and West Africa. The cases of monkeypox in humans are uncommon outside of West and Central Africa, but copious nonendemic nations outside of Africa have recently confirmed cases. People when interact with diseased animals, then, they may inadvertently contact monkeypox. There are two drugs in the market: brincidofovir and tecovirimat and both of these drugs are permitted for the cure of monkeypox by the US Food and Drug Administration. The present review summarizes the various parameters of monkeypox in context with transmission, signs and symptoms, histopathological and etiological changes, and possible treatment. Monkeypox is clinically similar to that of smallpox infection but epidemiologically, these two are different, the present study also signifies the main differences and similarities of monkeypox to that of other infectious diseases. As it is an emerging disease, it is important to know about the various factors related to monkeypox so as to control it on a very early stage of transmission.

Monkeypox and oral lesions associated with its occurrence: a systematic review and meta-analysis

Background A zoonotic, double-stranded DNA virus belonging to the genus Orthopoxvirus, the mpox virus (MPXV) is most common in tropical regions of Central and West Africa. The frequency of monkeypox (mpox) cases, however, has sharply climbed globally since May 2022. Objectives To establish the threat of mpox in terms of the oral lesions caused in sufferers. Materials and methods After a thorough study of the literature identified in the PubMed, Web of Science, and Cochrane library databases using the PRISMA framework, 103 papers were found. Using inclusion and exclusion criteria, we chose research that was relevant for our review before shortlisting 14 papers that conformed to the review's guidelines. Results In the 14 selected studies, it was found that oral lesions were among the first clinical signs of a mpox affliction, with ulcers on the dorsal surface of tongue lips being the most common areas affected. Conclusion The rarely observed oral lesions of mpox infection may help in the diagnosis and management of this condition. It is critical to keep in mind that recognising and detecting oral lesions in mpox patients opens the door to more research and efficient patient management.

In silico development of a novel anti-mutation, multi-epitope mRNA vaccine against MPXV variants of emerging lineage and sub-lineages by using immunoinformatics approaches

Over the past year, an unexpected surge in human monkeypox (hMPX) cases has been observed. This outbreak differs from previous ones, displaying distinct epidemiological characteristics and transmission patterns, believed to be influenced by a newly emerging monkeypox virus (MPXV) lineage. Notably, this emerging MPXV lineage has exhibited several non-synonymous mutations, some of which are linked to immunomodulatory activities and antigenic characteristics that aid in host detection. However, specific treatments or vaccines for human monkeypox are currently lacking. Hence, we aim to develop a multi-epitope mRNA vaccine by using immunoinformatics approaches against the MPXV, particularly its emerging variants. Six proteins (A29L, A35R, B6R, M1R, H3L, and E8L) were chosen for epitope and mutation site identification. Seventeen top-performing epitopes and eight epitopes containing mutation sites were selected and combined with adjuvants, the PADRE sequence, and linkers for vaccine development. The molecular and physical properties of the designed vaccine (WLmpx) were favorable. Immunological characteristics of WLmpx were assessed through molecular docking, molecular dynamics (MD) simulations, and immune simulations. Finally, the vaccine sequence was utilized to formulate an mRNA-based vaccine. The informatics-based predicted results indicated that the designed vaccine exhibits significant potential in eliciting high-level humoral and cellular immune responses, but further validation through in vivo and vitro studies is warranted. Communicated by Ramaswamy H. Sarma

Pityriasis Lichenoides ET Varioliformis Acuta (PLEVA) As a Possible Differential Diagnosis for Monkeypox during the 2022 Outbreak in Non-Endemic Countries

In May 2022 several cases of monkeypox transmitted among humans in the UK, the USA and Europe were detected. The images of monkeypox skin lesions that were widely published in the media consisted exclusively of deeply seated vesicles and pustules on brown and black skin from endemic outbreaks in Africa. However, as cases accumulated in non-endemic countries, it has become clear that the clinical presentation of the current outbreak outside of Africa shows a very different picture, and that at least some of these cases might mimic pityriasis lichenoides et varioliformis acuta (PLEVA). It is a rare dermatologic condition of unknown aetiology, which has been described also as a reaction to vaccines. Currently, the World Health Organisation recommended laboratory tool for diagnosing monkeypox is the real time polymerase chain reaction test. Antigen and antibodies detection methods are not considered useful due to cross-reactivity between different orthopoxviruses. In this paper, I present the classic dermatologic criteria used for distinguishing between monkeypox and pityriasis lichenoides et varioliformis acuta as described in the literature. Further, as a hypothesis, I suggest considering pityriasis lichenoides et varioliformis acuta, a non- infectious skin reaction associated with extrinsic factors, including vaccines (also Covid-19 vaccines) as a possible differential diagnosis for monkeypox cases in the non-endemic countries.

Tracing the journey of poxviruses: insights from history.

The historical significance of the poxviruses is profound, largely due to the enduring impact left by smallpox virus across many centuries. The elimination of smallpox is a remarkable accomplishment in the history of science and medicine, with centuries of devoted efforts resulting in the development and widespread administration of smallpox vaccines. This review provides insight into the pivotal historical events involving medically significant poxviruses. Understanding the remarkable saga of combatting smallpox is crucial, serving as a guidepost for potential future encounters with poxvirus infections. There is a continual need for vigilant observation of poxvirus evolution and spillover from animals to humans, considering the expansive range of susceptible hosts. The recent occurrence of monkeypox cases in non-endemic countries stands as a stark reminder of the ease with which infections can be disseminated through international travel and trade. This backdrop encourages introspection about our journey and the current status of poxvirus research.

Cases of Monkeypox show highly-overlapping co-infection with HIV and syphilis.

Ongoing Monkeypox (MPX) outbreaks in countries outside Africa have unique characteristics. However, data on cohorts of confirmed cases in China is limited. The study provides important epidemiological, diagnostic, and clinical information about this disease in China. We report a series of Chinese individuals with confirmed MPX infections identified at Beijing Youan Hospital (China) from June 10 to July 15, 2023. Samples were taken from the skin, anus, throat, and blood. An epidemiological questionnaire was used to collect demographic and clinical data. Further, we compared the MPX viral (MPXV) loads across different anatomical sites. 66 samples were collected from 20 patients, all of whom were cisgender men. Median patient age was 29 years. Notably, 19 (95%) patients reported unprotected sexual encounters with men in the preceding month, and 13 (65%) were human immunodeficiency virus (HIV)-positive. Among those with HIV, 12 (92%) were receiving antiretroviral therapy, and 11 (85%) had well-controlled infections (HIV viral load <40/mL). The median CD4+ T cell count was 667 cells/mm3. In the HIV-negative group, three (43%) patients were taking preexposure prophylaxis. Fifteen patients (75%) had concurrent sexually transmitted infections (50% had syphilis and 65% had HIV) and eight (40%) had HIV and syphilis co-infection. MPXV loads were significantly higher in samples from the skin (cycle threshold value [Ct value]: 19·0) and anus (Ct value: 23.0) compared to samples from the throat (Ct value: 31.0) or blood (Ct value: 34.5). All patients had skin lesions (85% of whom presented with anogenital lesions). Common systemic symptoms included fever (85%) and lymphadenopathy (55%). The median incubation period was 8 d [interquartile range (IQR): 6-16 d]. The median time from the onset of skin lesions to scab removal was 14 d (IQR: 10-16 d). No deaths or severe cases were reported. MPXV primarily affects young homosexual men. The high MPXV viral loads in skin and anal lesions indicate that transmission most likely occurs through direct and close body contact. This study also reports high rates of HIV and syphilis co-infection. Therefore, preventive efforts should focus on homosexual men.

Count Data Regression Modelling: An Application to Monkeypox Confirmed Cases

Introduction: With the presence of COVID 19, some countries also faced an increase in number of cases due to Monkeypox virus. The main aim of this research was to investigate whether it is possible to fit count data regression models to predict the daily incidence of Monkeypox confirmed cases.&#x0D; Methods: In this study we have used two types of traditional count regression models like Poisson regression model and Negative binomial regression model using identity and logarithmic link function. Since our data was overdispersed, Negative binomial regression model with logarithmic link function fitted well as compared to other models. The parameters were estimated using SPSS, version 23.0.&#x0D; Results: The Negative Binomial Regression model with logarithm function fits well to the data related to Monkeypox cases. Therefore, the model shows that majority of the countries like Brazil, Canada, France, Germany, Peru, Spain, United Kingdom and United States of America shows significant decrease in number of cases with respect to time. The prediction line was plotted using this model where the line predicts well about the daily Monkeypox cases reported by different countries.&#x0D; Conclusion: From our study, we concluded that the count data regression model can be used widely to predict the incidence of any disease. The countries like Canada and Brazil have largest and smallest slope coefficient which shows maximum and minimum decrease in expected number of cases confirmed each day respectively.

Knowledge and attitude regarding monkeypox among Saudi MOH primary healthcare nurses in Jeddah: A cross-sectional study.

Knowledge of monkeypox can be utilized to prevent and control possible new cases of monkeypox. Access to knowledge regarding monkeypox can help the health worker to determine the suspected cases of monkeypox and enhance Ministry of Health (MOH) efforts for good prevention and control of the disease that leads to reduced incidences. The aim of this study is to assess the knowledge of and attitude toward monkeypox disease among nurses. A cross-sectional survey was conducted among nurses working at MOH primary health care centers in Jeddah city, Kingdom of Saudi Arabia, between November 1 and December 31, 2022. A structured self-administered questionnaire was utilized in data collection including sections, the demographic information, work experience, respondent's knowledge of monkeypox, and nurses' attitude toward monkeypox. A total of 195 nurses were included in the study. Females represented 56.4% of them, and almost half (50.3%) aged between 35 and 44 years. The history of hearing about monkeypox was reported by the majority (88.2%) of the participated nurses. Overall, a good level of knowledge regarding monkeypox disease was observed among 16.9% of the nurses, whereas 30.8% of them had a poor level of knowledge. Nurses in the age group of 45-54 years, non-Saudis, and technicians/specialists were more knowledgeable about monkeypox disease compared to their peers. More than half of the nurses (57.9%) expressed positive attitude toward monkeypox disease, particularly more experienced nurses (>5 years) and those with good knowledge about the disease. Although the majority of nurses were aware of monkeypox disease, their knowledge about the disease was mostly poor to fair. However, they expressed positive attitude toward the disease. There is a need to organize educational programs for them about the disease, and this may assist the higher authorities to improve monkeypox prevention and control.

A Multi-pronged Approach to Addressing Global Poxviruses Vaccine Inequity: A Case of Monkeypox.

Monkeypox has been endemic in Congo and Nigeria for at least five decades. Since early May 2022, there have been numerous unprecedented outbreaks throughout the world in places without any previously reported cases. While a majority of the diagnosed cases have been within Europe and the Americas, several cases have occurred in non-endemic African countries. As of December 2022, 82,999 cases had been reported globally, prompting concern among the World Health Organization (WHO) members. While the WHO has not labeled this epidemic a Global Health Emergency, member states have begun to put forward plans to consolidate their emergency vaccine stockpiles and share the limited number of vaccines made by the single FDA-approved manufacturer, Bavarian Nordic. Many countries are concerned about how vaccines will be shared. Some of the larger donor States are positioned to be the biggest beneficiaries of vaccine sharing, while States from areas that have been suffering from the virus since the 1970s have not been allocated any. This pattern of vaccine distribution echoes that seen during the early part of the COVID-19 pandemic. Due to the similarities between Monkeypox and Smallpox, contact precautions and vaccination seem to be effective strategies to combat its rapid spread. We aim to evaluate how an eradication program model similar to that used for Smallpox can be applied to Monkeypox, and whether it can address vaccine inequity. To do this, we use a multi-pronged approach targeting disease surveillance, vaccine awareness, manufacturing, cost, and distribution strategies.

First case of monkeypox in Pakistan: WHO’s response and steps to prevent an outbreak

First case of monkeypox in Pakistan: WHO’s response and steps to prevent an outbreak

Demographic and clinical characteristics of people diagnosed with active sexually transmitted infections among monkeypox cases in Brazil: the 2022 outbreak.

The worldwide monkeypox (mpox) outbreak in 2022 showed a high frequency of sexually transmitted infections (STI). A cross-sectional study was carried out using secondary data from the Brazilian official mpox surveillance systems. A total of 10,169 mpox cases were identified, with a median age of 32 years. Among them, 92.3% were male at birth and 57.5% were men who have sex with other men (MSM). Approximately 11% were diagnosed with STI, including 5.8% with syphilis and 2.5% with genital herpes. Individuals aged from 25 to 34 years, MSM, individuals with HIV-positive status, and those manifesting skin eruptions or penile edema were associated with STI. Laboratory investigation for mpox must be implemented as a priority in STI clinics (especially for MSM) to mitigate neglected cases, ensure appropriate treatments, and prevent misdiagnoses.

Novel point-of-care rapid detection of monkeypox virus.

Monkeypox, a viral zoonotic disease caused by MPXV, has emerged as a significant global health concern since the first outbreak outside Africa in 2003. As of the current data, there have been 30 189 confirmed cases of monkeypox in 88 countries, with 29 844 cases reported in 81 countries. Given the absence of prior documented instances of the disease, swift and accurate testing is imperative to contain the spread of monkeypox. In this study, we developed a LAMP detection reagent for monkeypox and evaluated its performance in terms of sensitivity, specificity, repeatability, stability, linear range, and linearity, utilizing a commercial magnetic bead-based nucleic acid extraction system. This has led to the establishment of an integrated on-site detection platform for the monkeypox virus, utilizing a closed cartridge. The sensitivity was found to be 100 copies per μL, with no cross-reactivity observed with three other viruses, indicating robust performance. The parameters of repeatability, stability, linear range, and linearity were also assessed. For 28 simulated samples, the detection results obtained from the integrated system were consistent with those from conventional laboratory methods, specifically qPCR and LAMP detection following nucleic acid extraction. The entire process can be completed in approximately one hour, making it highly suitable for immediate rapid testing.

Monkeypox spread among men who have sex with men: how do people explain this relationship? A quali-quantitative study of beliefs among heterosexual and non-heterosexual Italian individuals

ABSTRACT The majority of monkeypox (Mpox) cases in the 2022 outbreak have been traced back to mass gathering events in May, primarily among men who have sex with men (MSM). While some quantitative studies exist in the literature, focusing mainly on the link between Mpox knowledge, conspiracy theories, and vaccination hesitancy, there is a dearth of qualitative or mixed-method research that examines the beliefs surrounding this phenomenon, particularly including LGBTQIA+ groups. This study’s primary objective is to delve into the beliefs associated with the media’s portrayal of a connection between Mpox and MSM during the initial outbreak period. A total of 333 participants, including 212 cisgender women, 110 cisgender men, and 11 individuals identifying with other genders, took part in an online quali-quantitative survey conducted in June 2022 in Italy. This survey aimed to explore participants’ perceptions of Mpox, their knowledge about it, and their attitudes towards LGBTQIA+ individuals and sexuality. The final thematic structure revealed a hierarchical arrangement of themes, encompassing: (1) The linkage between Mpox and MSM, elucidated through risky sexual behaviours or contextual factors; (2)The absence of any connection, explained through causal effects and a general mistrust of society. Individuals identified as male at birth and cisgender men tended to attribute the primary reason behind Mpox contagion to sexual promiscuity. Conversely, non-heterosexual participants were more inclined to consider both sexual promiscuity and the presence of stigma. The results demonstrated a diverse range of opinions concerning Mpox, spanning from objective behavioural risks to the stigmatising notion that MSM constitute a socially hazardous group. It is incumbent upon researchers and scientific organisations to disseminate lucid, non-alarmist, and destigmatizing information aimed at curbing risky behaviours.

A study on the recognition of monkeypox infection based on deep convolutional neural networks.

The World Health Organization (WHO) has assessed the global public risk of monkeypox as moderate, and 71 WHO member countries have reported more than 14,000 cases of monkeypox infection. At present, the identification of clinical symptoms of monkeypox mainly depends on traditional medical means, which has the problems of low detection efficiency and high detection cost. The deep learning algorithm is excellent in image recognition and can extract and recognize image features quickly and reliably. Therefore, this paper proposes a residual convolutional neural network based on the λ function and contextual transformer (LaCTResNet) for the image recognition of monkeypox cases. The average recognition accuracy of the neural network model is 91.85%, which is 15.82% higher than that of the baseline model ResNet50 and better than the classical convolutional neural networks models such as AlexNet, VGG16, Inception-V3, and EfficientNet-B5. This method realizes high-precision identification of skin symptoms of the monkeypox virus to provide a fast and reliable auxiliary diagnosis method for monkeypox cases for front-line medical staff.