Monkeypox: Virology, Pathophysiology, Clinical Characteristics, Epidemiology, Vaccines, Diagnosis, and Treatments

Abstract

The World Health Organization, has declared the recent multiregional outbreak of monkeypox, a global public health emergency. Monkeypox is a zoonotic viral infection endemic to the west and central Africa. It belongs to the Poxviridae family, the Chordopoxvirinae subfamily, and the Orthopoxvirus genus. The Poxviridae family generally consists of complex, large, enveloped, and linear double-stranded DNA viruses. The initial clinical symptoms of monkeypox are often fever, severe headache, lymphadenopathy, myalgia, and fatigue. The skin lesions typically erupt within 1–3 days of the onset of fever. The rash tends to be more localized on the face and extremities than on the trunk. Monkeypox is often a self-limiting infection, and symptoms last from 2 to 4 weeks. It is isolated from various species, but the exact natural host is uncertain. Monkeypox is transmitted by close contact with infected humans or animals. Currently, no specific medication is available for monkeypox, and the existing therapeutics are the anti-viral agents approved for smallpox infection, including tecovirimat, cidofovir, and brincidofovir. Additionally, the U.S. Food and Drug Administration has approved Vaccinia Immune Globulin Intravenous for treating vaccination complications. It is diagnosed by PCR. There are currently two vaccines licensed by the U.S. Food and Drug Administration. According to the WHO guidance, the first-generation smallpox vaccines held in national reserves of some countries are not recommended as they do not meet the current safety and manufacturing standards. The interim guidance indicates that new and safer (second- and third generation) vaccines for smallpox, may be beneficial for monkeypox prevention, including JYNNEOS, which has been approved for the prevention of monkeypox. Human monkeypox was first reported in 1970. Since then, it has caused several outbreaks, mainly in central and west Africa. The first monkeypox outbreak outside of Africa occurred in the United States in 2003, linked to contact with infected pet prairie dogs. More recently (2018-2021), monkeypox cases have been reported in travelers from Nigeria to the United Kingdom, Israel, Singapore, and the US. Since May 2022, multiple monkeypox cases have been confirmed in several non-endemic countries, raising the concern of an emerging global pandemic. This review is an updated overview of our current state of knowledge regarding monkeypox virology, pathophysiology, clinical characteristics, epidemiology, vaccines, diagnosis, and treatment options.

Knowledge and vaccination intention of monkeypox in China's general population: A cross-sectional online survey

“…The Democratic Republic of Congo reported its first patient infected with the monkeypox virus in 1971 [ 3 ]. Since then, monkeypox has only been regionally endemic in western and central Africa [ 4 ]. In 2022, a widespread outbreak of monkeypox occurred worldwide.…”

Factors associated with geographic variations in the 2022 monkeypox outbreak; A systematic review

“…During the 21st century, cases occurred elsewhere, however, they did not attract much epidemiological attention because they were sporadic and small in numbers. This disease has attracted attention in the year 2003 when a cluster of 53 patients were affected in the USA, however, the source of infection was identified to be animals imported to the country [ 40 ]. In the last few years [2018-2021], only four cases were reported, all of them affecting men who travelled from Nigeria to areas outside Africa [ 40 ].…”

“…This disease has attracted attention in the year 2003 when a cluster of 53 patients were affected in the USA, however, the source of infection was identified to be animals imported to the country [ 40 ]. In the last few years [2018-2021], only four cases were reported, all of them affecting men who travelled from Nigeria to areas outside Africa [ 40 ]. Reports that documented these cases did not identify the source of infection or highlight the sexual orientation of patients [ 41 ], even in cases where genital areas were affected by the characteristic rash [ 42 ].…”

Monkeypox Viruses: Resurgence of Global Threat to Mankind

“…Jynneos was previously approved by European Medicine Agency in 2013 against smallpox for the age of 18 and older with the name MVANEX. [87][88][89][90][91] IMVAMUNE is the trade name by Public Health Agency of Canada (PHAC) in 2013. In 2020 PHAC added monkeypox and other orthopoxvirus infection to their previous indications, and EMA did the same in 2022 when it extended its indication of IMVANEX by adding monkeypox and vaccinia virus-causing diseases.…”

“…In 1975 researchers in Japan developed a live, replicating attenuated vaccine derived from the Lister strain of vaccinia which was said to be the third generation and was licensed. [86][87][88][89][90][91][92][93] In 2022 added the monkeypox to their existing indication of the vaccine. These above vaccines have a safety profile because these vaccines are attenuated phenotype and can be administrated to immunosuppressed patients.…”