Current Outbreak Research Articles

Perception of and Vaccine Readiness towards Mpox among Men Who Have Sex with Men Living with HIV in China: A Cross-Sectional Study.

Men who have sex with men (MSM) living with HIV make up the majority of cases in the current Mpox outbreak. We aimed to investigate the perception of and vaccine readiness towards Mpox among MSM living with HIV in China. This cross-sectional online study was conducted from 10 August to 9 September 2022. Participants responded to survey questions about their socio-demographic information, HIV status, sexual behaviors, knowledge of Mpox, and attitudes towards Mpox vaccines. A total of 577 MSM living with HIV participated in the study. A total of 37.6% expressed concerns about the Mpox epidemic in China, and 56.8% were willing to get the Mpox vaccine. Men who had > four sexual partners in the previous three months (aOR = 1.9 95% CI: 1.2-2.8 Ref: 0), had close contact with > four individuals in a day (3.1, 1.5-6.5 Ref: 0-3), were worried about the Mpox epidemic in China (1.6, 1.1-2.3 Ref: No), and believed that Mpox vaccines are safe (6.6, 2.7-16.4 Ref: No or not sure) and effective (1.9, 1.1-3.3 Ref: No) for people living with HIV were more likely to be willing to get the Mpox vaccine. MSM living with HIV with a high school education or below (0.5, 0.3-0.9 Ref: Postgraduate diploma), and sometimes (0.5, 0.3-0.8 Ref: Often), seldom, or never (0.5, 0.3-0.9 Ref: Often) followed news about Mpox were unwilling to get the Mpox vaccine. The ongoing Mpox pandemic has not attracted widespread concerns among MSM living with HIV in China. Having more sexual partners and close contacts, worrying about the Mpox epidemic, and believing in the vaccine's safety and efficacy were predictors of their willingness to get the Mpox vaccine. Efforts should be made to raise awareness of the potential risk of Mpox in this at-risk population. Public health strategies should fully address predictors of vaccination willingness.

Search of Novel Small Molecule Inhibitors for the Main Protease of SARS-CoV-2.

The current outbreak of coronavirus disease 2019 (COVID-19) has prompted the necessity of efficient treatment strategies. The COVID-19 pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Main protease (Mpro), also called 3-chymotrypsin-like protease (3CL protease), plays an essential role in cleaving virus polyproteins for the functional replication complex. Therefore, Mpro is a promising drug target for COVID-19 therapy. Through molecular modelling, docking and a protease activity assay, we found four novel inhibitors targeting Mpro with the half maximal inhibitory concentration (IC50) and their binding affinities shown by the dissociation constants (KDs). Our new inhibitors CB-21, CB-25, CP-1 and LC24-20 have IC50s at 14.88 µM (95% Confidence Interval (95% CI): 10.35 µM to 20.48 µM), 22.74 µM (95% CI: 13.01 µM to 38.16 µM), 18.54µM (95% CI: 6.54 µM to 36.30 µM) and 32.87µM (95% CI: 18.37 µM to 54.80 µM)), respectively. The evaluation of interactions suggested that each inhibitor has a hydrogen bond or hydrophobic interactions with important residues, including the most essential catalytic residues: His41 and Cys145. All the four inhibitors have a much higher 50% lethal dose (LD50) compared with the well-known Mpro inhibitor GC376, demonstrating its low toxicity. These four inhibitors can be potential drug candidates for further in vitro and in vivo studies against COVID-19.

Discussion on Whether the Wildlife Trade Should be Banned for a Long Time

Wildlife markets are the suspected source of the current outbreak and the 2002 SARS outbreak, and the consumption of wild meat is thought to be the source of the Ebola virus in Africa. After the new coronavirus outbreak, the trade regarding wildlife markets was once again thrust into the limelight. We need to analyze how trade in wildlife products should be regulated in the context of relevant realities and specific data to answer the six questions in this case.

Monkeypox: A review of data essential in primary care.

Monkeypox is known to be endemic in Africa, but recently, the unusually increasing number of cases of monkeypox in non-endemic countries has caught the attention of the world. The World Health Organization has declared the monkeypox outbreak a public health emergency. The spread pattern is unlikely associated with the previous outbreak outside of Africa, which is related to travelling or contact with exotic animals. The current outbreak is linked to sexual history and presents with atypical localised genital eruptions with an unpredictable onset of viral prodromal symptoms. Although the monkeypox virus is not easily transmittable compared with severe acute respiratory syndrome coronavirus 2, anyone who has been in close contact with a patient with monkeypox is at risk. Most patients will present to a primary care centre for assessment and treatment; therefore, it is important to increase awareness of the infection among primary care providers for early recognition of monkeypox, containment of the outbreak and prevention of healthcare-associated infection. A physician who suspects any patient with monkeypox should notify local or state health authorities immediately.

Ebola and the Ravages of History in Paul Farmer: A Catholic Theological Ethical Response to Global Health Inequity in Africa

In this chapter, I explore with Paul Farmer why Ebola has persisted in Africa and why it continues to kill so many Africans as we see in the current outbreak in Uganda (September 2022) with the Sudanese strain. Farmer’s appeal to social medicine and social context in understanding the remote causes of the cause of Ebola offers an important corrective to the disease control and treatment paradigm approach in global health amidst the devastating impact of health inequity. I conclude my chapter by using Farmer’s analysis of the causes of global health inequity in Africa to propose how theological ethics can serve the mission of churches and African communities in designing healthcare systems for health improvement and health protection in solidarity with the poor and the most vulnerable. I will propose some effective strategies for global health partnerships in Africa against the current preoccupation with disease control and prevention, medical mission, and crisis intervention from outside Africa.

Characteristics and Management of Ocular Involvement in Individuals with Monkeypox Disease

Ocular complications of mpox infection have a prevalence of 1% in the current outbreak. Although conjunctivitis is the most common presentation, corneal involvement may occur. Tecovirimat is recommended for severe ocular mpox involvement.

Virulence differences of mpox (monkeypox) virus clades I, IIa, and IIb.1 in a small animal model

Human mpox (monkeypox), a disease with similarities to smallpox, is endemic in Africa where it has persisted as a zoonosis with limited human-to-human spread. Unexpectedly, the disease expanded globally in 2022 driven by human-to-human transmission outside of Africa. It is not yet known whether the latter is due solely to behavioral and environmental factors or whether the mpox virus is adapting to a new host. Genome sequencing has revealed differences between the current outbreak strains, classified as clade IIb, and the prior clade IIa and clade I viruses, but whether these differences contribute to virulence or transmission has not been determined. We demonstrate that the wild-derived inbred castaneous mouse provides an exceptional animal model for investigating clade differences in mpox virus virulence and show that the order is clade I > clade IIa > clade IIb.1. The greatly reduced replication of the clade IIb.1 major outbreak strain in mice and absence of lethality at 100 times the lethal dose of a closely related clade IIa virus, despite similar multiplication in cell culture, suggest that clade IIb is evolving diminished virulence or adapting to other species.

Automatic Classification of Bagworm, Metisa plana (Walker) Instar Stages Using a Transfer Learning-Based Framework

Bagworms, particularly Metisa plana Walker (Lepidoptera: Psychidae), are one of the most destructive leaf-eating pests, especially in oil palm plantations, causing severe defoliation which reduces yield. Due to the delayed control of the bagworm population, it was discovered to be the most widespread oil palm pest in Peninsular Malaysia. Identification and classification of bagworm instar stages are critical for determining the current outbreak and taking appropriate control measures in the infested area. Therefore, this work proposes an automatic classification of bagworm larval instar stage starting from the second (S2) to the fifth (S5) instar stage using a transfer learning-based framework. Five different deep CNN architectures were used i.e., VGG16, ResNet50, ResNet152, DenseNet121 and DenseNet201 to categorize the larval instar stages. All the models were fine-tuned using two different optimizers, i.e., stochastic gradient descent (SGD) with momentum and adaptive moment estimation (Adam). Among the five models used, the DenseNet121 model, which used SGD with momentum (0.9) had the best classification accuracy of 96.18% with a testing time of 0.048 s per sample. Besides, all the instar stages from S2 to S5 can be identified with high value accuracy (94.52–97.57%), precision (89.71–95.87%), sensitivity (87.67–96.65%), specificity (96.51–98.61%) and the F1-score (88.89–96.18%). The presented transfer learning approach yields promising results, demonstrating its ability to classify bagworm instar stages.

Outbreak of Lumpy skin disease in India 2022- an emerging threat to livestock & livelihoods

An ongoing outbreak of Lumpy skin disease (LSD) has affected many states in India since May 2022. The disease originated in Zambia in 1929. The disease first appeared in South Asia in July 2019, with Bangladesh reporting an outbreak. India reported its first ever Lumpy skin disease outbreak in August 2019. LSD is a contagious epizootic disease caused by the Capri pox virus, which spreads among cattle. The major mode of transmission is vector-borne. There is no specific treatment for LSD. The current preventive measure include vaccination, movement control of bovine animals and quarantining, implementing biosecurity through vector control. There is no evidence that it can affect humans. The current outbreak in India has a wide range of morbidity rates, and higher range of mortality rates among cattle, comparing to the previous outbreak. The outbreak has resulted in huge economic implications for dairy farmers, which is exacerbated by the spread of misinformation through social media.

Ocular manifestations: A novel association of Monkeypox virus outbreak in 2022

Monkeypox virus (MPXV) is a double-stranded DNA zoonotic virus of the Poxviridae family. Infected persons, animals, or inanimate items can all spread the virus to humans when they come into close contact. The first human-to-human transmission was reported in 1970 in the Democratic Republic of Congo. The outbreak emerged in May 2022 involved mostly men who had sex with men (MSM). Patients usually present with symptoms of rash along with fever, flu-like symptoms, and lesions in the genital and perineal region. A rising concern is ocular manifestations seen with MPVX like conjunctivitis, blepharitis, keratitis, and corneal lesions, especially in unvaccinated patients which might lead to blindness. Although it is self-limiting with supportive care, many patients benefited from tecovirimat. Combination therapy of brincidofovir and tecovirimat was also used for severe disease. Smallpox vaccinations will also play a vital role as unvaccinated patients had serious complications. Risk counseling should be carried out to prevent further spread amongst high-risk populations. Ophthalmologists should also remain aware of these ocular manifestations during the current outbreak and keep it as a differential diagnosis whenever they come across with aforementioned complaints that can be seen in MPVX illness.

A Comprehensive Review of the Current Monkeypox Outbreak.

Monkeypoxis a zoonotic disease caused by an orthopoxvirus named monkeypox virus. The virus was identified in 1958, while the first human monkeypox case was discovered in 1970. Monkeypox caused a wide outbreak that was considered a global health emergency in July 2022. Monkeypox is transmitted through direct or indirect contact with the lesions and respiratory droplets. Animals can also transmit the disease if contacted without protection or if their products are consumed without proper processing. The disease presents as a prodromal period followed by the appearance of a rash filled with exudate. The rash appears initially on the face and then spreads to involve the genital area and the anus. Typically, the disease is mild and resolves spontaneously, but antiviral therapy with tecovirimat might be required. Monkeypox can be controlled by avoiding contact with the cases and vaccinating those at high risk for acquiring the infection and those at high risk for developing severe illness (immune deficient individuals, pregnant women, and children). Our review aims to comprehensively review the current literature regarding Monkeypox, including modes of transmission, pathogenesis, clinical presentation, diagnosis, treatment, preventive measures, and epidemiology.

Safety and Efficacy of Post-Eradication Smallpox Vaccine as an Mpox Vaccine: A Systematic Review with Meta-Analysis.

According to the World Health Organization, 83,339 laboratory-confirmed cases, including 72 deaths, of mpox (formerly known as monkeypox), have been reported from 110 locations globally as of 20 December 2022, making the disease a public health concern. Most of the cases (56,171, 67.4%) were reported from countries in North America. Limited data on vaccine effectiveness in the current mpox outbreak are available. However, the modified vaccinia virus (smallpox vaccine) has been predicted to prevent or reduce the severity of the mpox infection. The present study of systematic review and meta-analysis aimed to evaluate the modified vaccinia vaccine's safety and efficacy on mpox by using reported randomized clinical trials. Following guidelines from the Cochrane Collaboration and PRISMA, multiple databases including PubMed, PLOS ONE, Google Scholar, British Medical Journal, and the U. S. National Library of Medicine were searched. Out of 13,294 research articles initially identified, 187 were screened after removing duplicates. Following the inclusion and exclusion criteria, the meta-analysis included ten studies with 7430 patients. Three researchers independently assessed the risk of bias in the included study. The pooled results suggest that the vaccinia-exposed group had fewer side effects when compared to the vaccinia naïve group (odds ratio: 1.66; 95% CI: 1.07-2.57; p = 0.03). Overall, the modified vaccinia has proven safe and effective in both vaccinia naïve and previously exposed groups, with higher efficacy in the previously exposed groups.

Pediatric Hepatitis and Respiratory Viruses: A Spatiotemporal Ecologic Analysis.

Beginning in early 2022, clusters of severe pediatric hepatitis were reported in Europe and the United States. To date, no cause has been identified although human adenovirus 41 has been proposed in a proportion of cases. We examined population data >11 years for hepatitis clusters in Victoria, Australia, and whether any were spatiotemporally associated with community transmission of common respiratory viruses. We used SaTScan to analyze for clusters of pediatric hepatitis and respiratory adenoviruses in Victoria. Negative binomial regression analysis was performed to determine any associations between hepatitis and respiratory viruses across Victoria between July 1, 2011, and June 30, 2022. A number of positive associations were observed in Victoria between pediatric hepatitis clusters and respiratory viruses in our spatiotemporal analysis. A positive association was not found with respiratory adenoviruses or SARS-CoV-2. Increased hepatitis clusters were observed in 2021 and 2022 as noted internationally. The current hepatitis outbreak is novel and, although respiratory viruses are broadly associated with hepatitis, SARS-CoV-2 and respiratory adenoviruses are unlikely to be related.

Pain Associated With Monkeypox Virus: A Rapid Review.

International concerns for another pandemic arose after emerging reports of an ongoing outbreak of the monkeypox virus (MPXV) in Europe and the United States in 2022. Severe pain is one of the most distressing complications for patients in the current outbreak, but there is a general paucity of relevant peer-reviewed medical literature from which to draw clear recommendations on appropriate pain therapies. The Centers for Disease Control recently published a letter in July 2022 urging providers to conduct further studies concerning pain management. Thus, a rapid literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of several databases from inception until August 19, 2022, was conducted. All published studies describing pain in patients who tested positive for MPXV with original data and written in English were included. Sixty-nine studies were initially identified for screening. After initial screening, 27 papers were considered for full-text review, and 15 papers met the inclusion criteria. A total of 1043 positive cases were included in this study. Most patients were men. Treatment options proposed by the authors include acetaminophen, ibuprofen, opioids, lidocaine gel, metamizole, and rectal suppositories containing emollients or steroids with oral laxatives for severe anal pain. Although most cases were mild requiring outpatient treatment, a considerable number of patients were admitted due to serious complications. Severe pain was often the reason to seek medical attention and hospital admission for pain control. Analgesic plans included oral and topical analgesia. In severe cases, pain was managed with opioids.To our knowledge, this rapid review is the first study to comprehensively summarize proposed treatments for pain associated with MPXV. Guidelines may be needed to help direct the best management to avoid morbidity in patients, particularly as adjuvants may play a key role but are not commonly utilized in published reports.

New nomenclature for mpox (monkeypox) and monkeypox virus clades

New nomenclature for mpox (monkeypox) and monkeypox virus clades

First case of mpox diagnosed in Queensland, Australia: clinical and molecular aspects.

First case of mpox diagnosed in Queensland, Australia: clinical and molecular aspects.

Cardiac Involvement in Monkeypox Outbreak.

Unusual presentations and uncommon clinical manifestations of Monkeypox (Mpox) in the current outbreak highlight the need to focus on cardiac symptoms of the virus. Owing to limited discussion regarding cardiac involvement in recent cases of Mpox, we conducted a scoping review to determine the range of existing research and provide a descriptive overview of the current literature on these manifestations. This review was conducted using a previously developed six-stage methodological approach and keeping in view the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Records retrieved from PubMed, ScienceDirect and Google Scholar, using a two-step search strategy, were subjected to title and abstract screening, followed by full text screening of remaining articles against specified eligibility criteria. Relevant information was extracted and summarized. Our search yielded 707 records. Following title and abstract screening, 23 articles were retrieved for full text screening. Finally, a total of nine articles were included in this review (three case series and six case reports discussing a total of 13 patients). Myocarditis was identified as the most frequently reported cardiac manifestation of Mpox. Novel clinical presentations included pharyngitis, sore throat, proctalgia, and perianal irritation. Most patients reported chest pain as the primary symptom of cardiac system involvement. Elevated troponin was the most commonly reported investigation finding followed by an elevated C- Reactive Protein. There exists a lack of high-quality studies investigating cardiac system involvement in the current outbreak of Mpox. More information is needed regarding risk factors for cardiac complications, disease progression, and cardio tropism and immunological response to improve preventive/therapeutic strategies. We highlight the paucity of relevant data and call for further discussion to improve the understanding of cardiac manifestations of Mpox. This scoping review sheds light on the underexplored cardiac manifestations of Mpox and highlights the need for heightened awareness of cardiac symptoms in the current outbreak.

Painful facial, oral, and genital ulcers

Painful facial, oral, and genital ulcers

Characterisation of SARS-CoV-2 variants in Beijing during 2022: an epidemiological and phylogenetic analysis

Due to the national dynamic zero-COVID strategy in China, there were no persistent local transmissions of SARS-CoV-2 in Beijing before December, 2022. However, imported cases have been frequently detected over the past 3 years. With soaring growth in the number of COVID-19 cases in China recently, there are concerns that there might be an emergence of novel SARS-CoV-2 variants. Routine surveillance of viral genomes has been carried out in Beijing over the last 3 years. Spatiotemporal analyses of recent viral genome sequences compared with that of global pooled and local data are crucial for the global response to the ongoing COVID-19 pandemic. We routinely collected respiratory samples covering both imported and local cases in Beijing for the last 3 years (of which the present study pertains to samples collected between January and December, 2022), and then randomly selected samples for analysis. Next-generation sequencing was used to generate the SARS-CoV-2 genomes. Phylogenetic and population dynamic analyses were performed using high-quality complete sequences in this study. We obtained a total of 2994 complete SARS-CoV-2 genome sequences in this study, among which 2881 were high quality and were used for further analysis. From Nov 14 to Dec 20, we sequenced 413 new samples, including 350 local cases and 63 imported cases. All of these genomes belong to the existing 123 Pango lineages, showing there are no persistently dominant variants or novel lineages. Nevertheless, BA.5.2 and BF.7 are currently dominant in Beijing, accounting for 90% of local cases since Nov 14 (315 of 350 local cases sequenced in this study). The effective population size for both BA.5.2 and BF.7 in Beijing increased after Nov 14, 2022. The co-circulation of BF.7 and BA.5.2 has been present in the current outbreak since Nov 14, 2022 in Beijing, and there is no evidence that novel variants emerged. Although our data were only from Beijing, the results could be considered a snapshot of China, due to the frequent population exchange and the presence of circulating strains with high transmissibility. National Key Research and Development Program of China and Strategic Priority Research Program of the Chinese Academy of Sciences. For the Chinese translation of the abstract see Supplementary Materials section.

Severe Mpox Infections in People With Uncontrolled Human Immunodeficiency Virus.

In the current mpox outbreak, infections are usually self-limited. We describe 3 patients with uncontrolled HIV and mpox infections lasting months, causing debilitating lesions, complications, and death, despite initiating anti-mpox and antiretroviral therapy. Delayed treatment of mpox with antiviral agents may contribute to poor outcomes in severely immunocompromised patients.