Abstract
Monkeypox virus (MPXV) is another zoonotic virus spilled over to the man and resulted in pandemic. World Health Organization declared it as a ‘Public Health Emergency of International Concern (PHEIC) on July 22, 2022. Mpox affected over 95226 individuals among them claimed the lives of 185. Despite the fact that Mpox is generally mild and self-limited, immunocompromised people with low CD4 counts may experience severe disease course. Management of Mpox patients has three pillars. First symptomatic approach includes pain management, prophylaxis for secondary infections and when needed effective treatment of superinfections. Second, vaccines developed against smallpox can be used in preexposure or postexposure prophylaxis strategies against Mpox. Third, current antiviral options include tecovirimat, cidofovir and birincidofovir all of which have been recommended relying on experience from animal studies, clinical case reports or case series. Results of well-planned randomized control trials are not available. Occupational exposure to MPXV is especially a manageable risk for health care workers. Prevention of Mpox also requires risk communication with vulnerable population and their involvement in mitigation efforts.
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References
Ladnyj ID, Ziegler P, Kima E. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bull World Health Organ. 1972;46:593–7.
von Magnus P, Andersen EA, Petersen KB, Birch-Andersen A. A pox-like disease in cynomolgus monkeys. Acta Path Microbiol Scand. 1959;46:156–76.
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16:e0010141.
Centers for Disease Control and Prevention. Monkeypox. 2024. https://www.cdc.gov/poxvirus/monkeypox/index.html.
Public Health England. Monkeypox case confirmed in England 2019. 2019. https://www.gov.uk/government/news/monkeypox-case-confirmed-in-england.
Yong SEF, Ng OT, Ho ZJM, Mak TM, Marimuthu K, Vasoo S, et al. Imported monkeypox, Singapore. Emerg Infect Dis. 2020;26:1826–30.
2022-23 Mpox Outbreak: Global Trends. Geneva: World Health Organization. 2024. https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report-32--30-april-2024.
ECDC. Epidemiological update: monkeypox outbreak. 2022. https://www.ecdc.europa.eu/en/newsevents/epidemiological-updatemonkeypox-outbreak.
Smith GL, Vanderplasschen A, Law M. The formation and function of extracellular enveloped vaccinia virus. J Gen Virol. 2002;83:2915–31.
Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, et al. Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Infect Dis Clin North Am. 2019;33:1027–43.
Yu X, Shi H, Cheng G. Mpox Virus: Its Molecular Evolution and Potential Impact on Viral Epidemiology. Viruses. 2023;15:995.
Zhang F, Meng X, Townsend MB, Satheshkumar PS, Xiang Y. Identification of CP77 as the Third Orthopoxvirus SAMD9 and SAMD9L Inhibitor with Unique Specificity for a Rodent SAMD9L. J Virol. 2019;93:e00225-19.
Petersen BW, Damon IK. Orthopoxviruses: vaccinia (smallpox vaccine), variola (smallpox), monkeypox, and cowpox. In: Bennett JE, Dolin R, Blaser MJ (eds). Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 9th ed. pp 1809–17, (Elsevier, Philedphia, 2020).
Hammarlund E, Lewis MW, Hansen SG, Strelow LI, Nelson JA, Sexton GJ, et al. Duration of antiviral immunity after smallpox vaccination. Nat Med. 2003;9:1131–7.
Hammarlund E, Lewis MW, Carter SV, Amanna I, Hansen SG, Strelow LI, et al. Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox. Nat Med. 2005;11:1005–11.
Reynolds MG, Doty JB, McCollum AM, Olson VA, Nakazawa Y. Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health. Expert Rev Anti Infect Ther. 2019;17:129–39.
Titanji BK, Tegomoh B, Nematollahi S, Konomos M, Kulkarni PA. Monkeypox: A Contemporary Review for Healthcare Professionals. Open Forum Infect Dis. 2022;9:ofac310.
Nakoune E, Lampaert E, Ndjapou SG, Janssens C, Zuniga I, Van Herp M, et al. A Nosocomial Outbreak of Human Monkeypox in the Central African Republic. Open Forum Infect Dis. 2017;4:ofx168.
Beeson A, Styczynski A, Hutson CL, Whitehill F, Angelo KM, Minhaj FS, et al. Mpox respiratory transmission: the state of the evidence. Lancet Microbe. 2023;4:e277–e283.
Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387:679–91.
Patel A, Bilinska J, Tam JCH, Da Silva Fontoura D, Mason CY, Daunt A, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022;378:e072410.
Lapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S, et al. Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. Lancet Infect Dis. 2022;22:1267–9.
Jacobs JW, Filkins L, Booth GS, Adkins BD. The potential impact of monkeypox infection and vaccination on blood donor deferrals and the blood supply. Br J Haematol. 2022;199:443–6.
Reynolds MG, Yorita KL, Kuehnert MJ, Davidson WB, Huhn GD, Holman RC, et al. Clinical manifestations of human monkeypox influenced by route of infection. J Infect Dis. 2006;194:773–80.
Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023;401:939–49.
Saldana CS, Kelley CF, Aldred BM, Cantos VD. Mpox and HIV: a Narrative Review. Curr HIV/AIDS Rep. 2023;13:1–9.
American Academy of Dermatology. Monkeypox: Caring for skin. 2022. https://www.aad.org/member/clinical-quality/clinical-care/mpox/treatment.
CDC. Clinical Considerations for Pain Management of Mpox. 2023. https://www.cdc.gov/poxvirus/mpox/clinicians/pain-management.html.
DeLaurentis CE, Kiser J, Zucker J. New Perspectives on Antimicrobial Agents: Tecovirimat for Treatment of Human Monkeypox Virus. Antimicrob Agents Chemother. 2022;66:e0122622.
TPOXX full prescribing information. 2021. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/208627s006lbl.pdf.
Jordan R, Chinsangaram J, Bolken TC, Tyavanagimatt SR, Tien D, Jones KF, et al. Safety and pharmacokinetics of the antiorthopoxvirus compound ST-246 following repeat oral dosing in healthy adult subjects. Antimicrob Agents Chemother. 2010;54:2560–6.
Chinsangaram J, Honeychurch KM, Tyavanagimatt SR, Leeds JM, Bolken TC, Jones KF, et al. Safety and pharmacokinetics of the anti-orthopoxvirus compound ST-246 following a single daily oral dose for 14 days in human volunteers. Antimicrob Agents Chemother. 2012;56:4900–5.
Alarcón J, Kim M, Terashita D, Davar K, Garrigues JM, Guccione JP, et al. An Mpox-Related Death in the United States. N Engl J Med. 2023;388:1246–7.
McLean J, Stoeckle K, Huang S, Berardi J, Gray B, Glesby MJ, et al. Tecovirimat Treatment of People with HIV During the 2022 Mpox Outbreak: A Retrospective Cohort Study. Ann Intern Med. 2023;176:642–8.
Hermanussen L, Brehm TT, Wolf T, Boesecke C, Schlabe S, Borgans F, et al. Tecovirimat for the treatment of severe Mpox in Germany. Infection. 2023;51:1563–8.
O’Laughlin K, Tobolowsky FA, Elmor R, Overton R, O’Connor SM, Damon IK, et al. Clinical Use of Tecovirimat (Tpoxx) for Treatment of Monkeypox Under an Investigational New Drug Protocol - United States, May-August 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1190–5.
Hutson CL, Kondas AV, Mauldin MR, Doty JB, Grossi IM, Morgan CN, et al. Pharmacokinetics and Efficacy of a Potential Smallpox Therapeutic, Brincidofovir, in a Lethal Monkeypox Virus Animal Model. mSphere. 2021;6:e00927–20.
Raccagni AR, Candela C, Bruzzesi E, Mileto D, Canetti D, Rizzo A, et al. Real-life use of cidofovir for the treatment of severe monkeypox cases. J Med Virol. 2023;95:e28218.
Moschese D, Giacomelli A, Beltrami M, Pozza G, Mileto D, Reato S, et al. Hospitalisation for monkeypox in Milan, Italy. Travel Med Infect Dis. 2022;49:102417.
Stafford A, Rimmer S, Gilchrist M, Sun K, Davies EP, Waddington CS, et al. Use of cidofovir in a patient with severe mpox and uncontrolled HIV infection. Lancet Infect Dis. 2023;23:e218–e226.
Sobral-Costas TG, Escudero-Tornero R, Servera-Negre G, Bernardino JI, Gutiérrez Arroyo A, Díaz-Menéndez M, et al. Human monkeypox outbreak: Epidemiological data and therapeutic potential of topical cidofovir in a prospective cohort study. J Am Acad Dermatol. 2023;88:1074–82.
Rao AK, Schrodt CA, Minhaj FS, Waltenburg MA, Cash-Goldwasser S, Yu Y, et al. Interim Clinical Treatment Considerations for Severe Manifestations of Mpox - United States, February 2023. MMWR Morb Mortal Wkly Rep. 2023;72:232–43.
Poland GA, Kennedy RB, Tosh PK. Prevention of monkeypox with vaccines: a rapid review. Lancet Infect Dis. 2022;22:e349–e358.
Frey SE, Wald A, Edupuganti S, Jackson LA, Stapleton JT, El Sahly H, et al. Comparison of lyophilized versus liquid modified vaccinia Ankara (MVA) formulations and subcutaneous versus intradermal routes of administration in healthy vaccinia-naïve subjects. Vaccine. 2015;33:5225–34.
Agunbiade S, Burton F, Muirhead J, Whitlock GG, Girometti N. Clinical characteristics of mpox infection in individuals who received a first dose of modified vaccinia Ankara immunisation. Sex Transm Infect. 2023;99:198–9.
Farrar JL, Lewis NM, Houck K, Canning M, Fothergill A, Payne AB, et al. Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:1610–5.
Wolff Sagy Y, Zucker R, Hammerman A, Markovits H, Arieh NG, Abu Ahmad W, et al. Real-world effectiveness of a single dose of mpox vaccine in males. Nat Med. 2023;29:748–52.
Szkiela M, Wiszniewska M, Lipińska-Ojrzanowska A. Monkeypox (Mpox) and Occupational Exposure. Int J Environ Res Public Health. 2023;20:5087.
Meister TL, Tao R, Brüggemann Y, Todt D, Steinmann J, Timm J, et al. Efficient Inactivation of Monkeypox Virus by World Health Organization‒Recommended Hand Rub Formulations and Alcohols. Emerg Infect Dis. 2023;29:189–92.
Meister TL, Brüggemann Y, Todt D, Tao R, Müller L, Steinmann J, et al. Stability and inactivation of monkeypox virus on inanimate surfaces. J Infect Dis. 2023;228:1227–30.
Kapmaz M, Uymaz DS, Ozcan G, Barlas T, Guney-Esken G, Manici M, et al. A complicated case of monkeypox and viral shedding characteristics. J Infect. 2023;86:66–117.
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This manuscript is reviewing the current understanding on Mpox infection and thus no IRB approval is needed. There is no funding for this study.
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İnkaya, A.Ç. Mpox: what sexual health physicians need to know?. Int J Impot Res 36, 556–561 (2024). https://doi.org/10.1038/s41443-024-00964-w
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DOI: https://doi.org/10.1038/s41443-024-00964-w