Monkeypox in the COVID-19 era

Abstract

Currently, in addition to the COVID-19 waves, the world is confronting an additional threat: the global monkeypox infection outbreak, already regarded as a “public health emergency of international concern” by the World Health Organization. According to the most recently published reports, more than 21000 monkeypox infection cases have been confirmed in 78 countries, with 5 African deaths and more than three deaths outside endemic Africa while the numbers are still increasing. Too little is currently known about the monkeypox virus, although it does not appear as a recently emerged pathogen, being probably as ancient as the smallpox virus. The major fear in regards to the current international monkeypox infection spread has multiple causes: monkeypox's similarity to smallpox, the deadliest pathogen in the history of humanity; lack of knowledge of the virus's natural occurrence, animal reservoir, mechanisms of transmission, pathogenicity, host immune response; lack of effective specific treatment and vaccine; unusually rapid geographic spread and atypical clinical presentation; increase in the mutation rate outside the standard, mathematically anticipated rates; putative complications and sequelae of the infection; potential use as a biological weapon. Actually, with such characteristics, the monkeypox virus has the potential to occupy/replicate the place of the much-feared smallpox virus. In the near future, due to the high registry of viral mutagenesis, limitations in the preventive strategies, and lack of an efficient vaccine, several viruses, including SARS-CoV-2 and monkeypox, could continue their worldwide spread and generate flu-like subsequent infective bursts. Therefore, dedicated research and detailed knowledge of the viral pathogenic mechanisms and transmission routes are required to design efficient therapies and limit/stop future pandemics: until the emergence of a new virus.

Expression of Concern: The pathophysiological and immunological background of the monkeypox virus infection: An update

“…While it is true that MPXV and other sexually transmitted diseases can be found in the sperm, some researchers still question whether or not the virus can be transferred in this way. Due to the porous blood‐testis barrier and viral immune evasion at that level, they believe that the high titers of MPXV in the semen are only secondary via the systemic viral transmission during the infection, particularly in immunocompromised individuals 41 …”

“…8,[47][48][49] The placental transfer is a different possible pathway. 41,50 The MPXV has been isolated in large titers comparable to nasal/throat swab titers. 47,[51][52][53] It suggests that the virus could be communicated sexually by intimate contact with the skin lesions of the partner, through respiratory droplets, or seminal/sexual fluids.…”

“…The placental transfer is a different possible pathway 41,50 . The MPXV has been isolated in large titers comparable to nasal/throat swab titers 47,51–53 .…”

“…It seems, however, that transmission from human to human is feasible through close (and usually prolonged) contact with body fluids and skin lesions, such as through large respiratory droplets during sneezing and coughing; through direct contact with the MPX skin lesions of an infected patient, or indirect contact with skin lesions material via bed linens, towels, contaminated clothes, various surfaces touched by an infected case and contaminated; putative contact with infected blood, urine, other body fluids, or even feces. 17,[40][41][42][43][44][45][46] Though this is not yet a recognized transmission mode and is still being researched, it is interesting that the WHO claimed that close physical contact between males was the predominant mode of transmission, which caused the most recent rise. 8,[47][48][49] The placental transfer is a different possible pathway.…”

The Monkeypox Fear Scale: development and initial validation in a Peruvian sample

“…Previous outbreaks of monkeypox were accompanied by fear and concerns about stigmatization and social exclusion of infected patients, survivors and family members [ 12 ]. It has been suggested that the current fear of monkeypox may be due to its similarity to the dreaded and eradicated smallpox virus, case fatality rates of up to 11%; more frequent person-to-person transmission; lack of clarity about the source and mode of transmission of the virus; faster geographic spread; lack of data on the efficacy of available antivirals in treatment, among other factors [ 13 , 14 ]. It should be noted that fear is associated with the speed, means of transmission, morbidity and mortality of a disease [ 15 ].…”