Human Monkeypox: Current State of Knowledge and Implications for the Future

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.

Buffalopox Virus: An Emerging Virus in Livestock and Humans

“…Increasing incidences of OPXV infections are being reported across the world: BPXV in Asia, VACV and VACV-like viruses (VLVs) in Brazil [66], MPXV in East and Central Africa and the USA [67] and novel OXPVs (AKMV [68], AKPV [66], ECTV-like OPXV [69,70])-which are being described at an increasing rate. Emergence and re-emergence of these OPXVs are alarming in view that about 50% of the world population >30 years are not vaccinated against smallpox and are most vulnerable in the event re-emergence of this disease [33].…”

A game-theoretic model of Monkeypox to assess vaccination strategies

“…The majority of reported human cases originate from an interaction with an infected animal (Arita et al, 1985). The transmission of MPX among animals can be affected by environmental conditions (Brown & Leggat, 2016). Deforestation and flooding could potentially increase or decrease the MPX reservoirs, depending on how the animal population is affected by these conditions (Brown & Leggat, 2016).…”

Imported Monkeypox, Singapore

“…The patient's clinical manifestations of a vesiculopustular rash and uncomplicated illness was similar to monkeypox cases in the United Kingdom and Israel, which were also linked to travel from Nigeria (3,4,12). All exported cases were of the West African clade, which is thought to be milder and less transmissible than the Congo Basin clade (13). Nevertheless, human-to-human transmission had been also demonstrated in Nigeria and the United Kingdom.…”