State-of-the-art on monkeypox virus: an emerging zoonotic disease

Abstract

The non-endemic monkeypox outbreak in 2022 is the largest outside of Africa in recorded history. The assumption is that monkeypox, an emerging zoonotic disease, has a high potential for epidemic spread with increased human outbreaks in recent years. The vaccinia-based smallpox vaccination has been discontinued globally for more than 40 years. Additionally, there are now more vulnerable populations. Populations who have not received the vaccine are more susceptible to monkeypox viral infection, while smallpox cannot spontaneously recur. As a member of the orthopoxvirus family and because of its potential for rapid adaptation in humans, the monkeypox virus (MPXV) has emerged as a pathogen that needs further study. Many non-endemic countries with no prior history of travel to an endemic region had increased global health concerns after the finding of MPXV cases in May 2022. Here, we summarize the clinical significance of MPXV and its unique infection characteristics. Finally, this review sheds light on worries regarding its resurgence in global health.

Clinical features of monkeypox in adults

“…(12,15,18,19,20) La mayor parte de los autores afirma que el período de incubación de MPXV va de 5 a 21 días. (3,8,20,23,24,25,26,27) Del total de los investigadores, solo 3 describen que la sintomatología dura de entre 2 y 5 semanas. (3,23,25) Y según cuatro autores, se inician con síntomas inespecíficos como la cefalea, fiebre, dolor de espalda, letargo, mialgia, escalofríos, fatiga, e incluso los ganglios linfáticos pueden estar inflamados; pero solo dos de estos agregan a estos síntomas la postración, náuseas, vómitos, miodinia, desmayos, y ganglios inflamados que son un signo que caracteriza a la MPV.…”

“…(3,19,23,28) Tres autores catalogan que la MPV se da en 2 fases: la primera es una fase prodrómica que va a durar aproximadamente de entre 0 a 5 días y consiste en la presentación de cefalea intensa, mialgias, fatiga, fiebre, y linfadenopatías; la segunda es una fase de erupción que va de 7 a 21 días y comienza de 1 a 3 días posteriormente de haberse presentado la fiebre. (24,26,29) Tabla 1. Características clínicas en pacientes con viruela del mono…”

Mechanisms of immune evasion of monkeypox virus

“…The discontinuation of the smallpox vaccination, which provides cross-protection against mpox, maybe a key determinant in the 2022 mpox outbreak. The mortality rate in the African clade was 10.6% versus 3.6% for the West African clade (Shafaati and Zandi, 2022b). Due to the current mpox outbreak outside of Africa, the World Health Organization (WHO) updated the names of the clades to I and II, respectively, and warned against stigmas because gay men (MSM) have a higher mortality rate.…”

“…Considering that the current human population has little or no immunity to smallpox, this is very problematic. Although the vaccinia virus (VACV; smallpox vaccine) is 85% effective in preventing disease, it is highly unlikely that it will be used as a pre-exposure vaccine because of the adverse side effects of vaccination ( Arndt et al, 2015 ; Shafaati and Zandi, 2022b ). For these reasons, there is an increasing need for evidence on how monkeypox virus might infiltrate the immune system and infect humans.…”

Cidofovir for treating complicated monkeypox in a man with acquired immune deficiency syndrome

“…Among cases with known HIV status, 49.6% were HIV positive, although with overall mild, self-limiting clinical manifestations [1][2][3]. Cidofovir is one of the recently approved therapeutic options for MPX, although data regarding its use in real-life settings are still scarce [4,5].…”