Monkeypox: A Re-emerging Viral Zoonotic Infection

Abstract

Context: Monkeypox virus (MPXV) infection is a zoonotic disease, endemic in sub-Saharan Africa, but recently has re-emerged outside Africa and caused some concerns. Evidence Acquisition: The current study aimed to briefly present a narrative mini-review on different features of MPXV. Data were gathered from Google Scholar, ScienceDirect, and PubMed databases and also WHO and CDC websites, using ''Monkeypox'', ''Variola'', ''Bioterrorism'', and ''Bioweapon'' keywords. Results: Monkeypox virus (MPXV) is categorized into two genetic clades with different outcomes. The incubation period of infection is 5 - 21 days, and infection by Central African clade may lead to a clinical representation similar to smallpox with about 10% mortality rate. Monkeypox virus (MPXV) can infect a wide range of mammals, and its natural reservoir is almost unknown. It is endemic in sub-Saharan Africa and is rarely seen outside Africa. Its most reliable detection is based on nucleic acid amplification tests (NAATs). Treatment is mainly supportive, and some selective drugs are developed for severe cases. Avoiding close contact with wild animals and infected patients is the first line of prevention. Prior vaccination with smallpox or MPX vaccines is also protective. Due to similar symptoms of human monkeypox and smallpox, it may be a candidate for bioterrorism. However, there is no evidence of recent intentional spread of MPXV. Conclusions: This study has tried to provide a summary of MPXV infection. Despite recent concerns, there is still a very low risk of the MPXV pandemic. However, it is recommended to be alert for such infection and provide essential readiness against it.

A comprehensive review of monkeypox virus and mpox characteristics

“…Although there is insufficient evidence of MPXV being used for bioterrorism at the moment ( Hosseini-Shokouh et al., 2022 ), many scientists have expressed concerns over its potential use for bioterrorism because there is a report that there was an attempt by the former Soviet Union to use MPXV as a bioweapon ( Nalca et al., 2005 ; Duraffour et al., 2007 ; Kindrachuk et al., 2012 ; Hosseini-Shokouh et al., 2022 ; Makkar, 2022 ). The possibility of MPXV as a potential bioweapon due to its global reemergence and its clinical similarities with VARV has placed the virus on the global public health agenda ( Ellis et al., 2012 ; Ihekweazu et al., 2020 ).…”

“…For example, the USA has made preparation for the possibility of smallpox virus as a potential bioterror biological by storing smallpox vaccines and antivirals after the 9/11 attack ( Franz, 2004 ; Xiang and White, 2022 ). Smallpox virus is in category A of the CDC list of bioterrorism agents ( Hosseini-Shokouh et al., 2022 ). The risk of bioterrorism is heightened knowing that MPXV genomes can be synthesized from publicly available sequence data and life viruses (with or without further genetic modification) can be re-constituted.…”