Symptomatology, prognosis, and clinical findings of Monkeypox infected patients during COVID‐19 era: A systematic‐review

Monkeypox (MPX) is a zoonotic disease that is endemic to the western and central regions of Africa and it is caused by monkeypox virus (MPXV), which is classified as a member of the Poxviridae family, specifically the Chordopoxvirinae subfamily, and the Orthopoxvirus genus. The current multiregional outbreak of MPX, which started in May of 2022, has since swiftly spread across the globe and thus has been declared a global public health emergency by the World Health Organization (WHO). Protective immunity against MPXV can be achieved by administering a smallpox vaccination, as the two viruses share antigenic properties. Although smallpox was declared eradicated in 1980, the vaccine campaign was halted the following year, leaving the population with significantly less immunity than it had before. The potential for human-to-human transmission of MPXV has grown as a result. Due to the lack of a particular treatment for MPX infection, anti-viral medications initially designed for the smallpox virus are being employed. However, the prognosis for MPX may vary depending on factors like immunization history, pre-existing illnesses, and comorbidities, even though the majority of persons who develop MPX have a mild, self-limiting illness. Vaccines and antiviral drugs are being researched as potential responses to the latest 2022 MPX epidemic. The first-generation smallpox vaccinations maintained in national stockpiles of several countries are not recommended due to not meeting the current safety and manufacturing criteria, as stated by the WHO. Newer, safer (second- and third-generation) smallpox vaccines, such as JYNNEOSTM, which has been licensed for the prevention of MPX, are indicated as potentially useful in the interim guideline. Studies on vaccines and antiviral drugs are still being investigated as possible remedies to the recent MPX outbreak. This mini-review article serves as a retrospective look at the evolution of smallpox vaccines from their inception in the 1700s to the current trends up to the end of year 2022, specifically for developing monkeypox vaccines.

Section: Third-generation Mpx Vaccinesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Major Advances in Monkeypox Vaccine Research and Development – An Update

Chandran¹,

Nandanagopal²,

Gopan³

et al. 2022

“…38 It is also unknown if the MPXV may spread through semen, vaginal fluids, urine, or faeces, despite the fact that the virus has been found in semen. 39 When a woman is pregnant, transmission to the fetus may happen via the placenta. 40 It is uncertain if people without skin lesions can spread the virus or how frequently the virus is disseminated by respiratory secretions.…”

Section: Epidemiology Of Monkeypox and Underlying Etiological Factorsmentioning

confidence: 99%

“…To counter this, tecovirimat blocks a specific viral product to prevent intracellular viruses from escaping the cell. 39,66 Vaccinia immune globulin intravenous (VIGIV) has also been found useful in treating severe cases of MPX as well as prospective passive antibody-based therapies such as hyperimmune globulin (HIG), monoclonal antibodies (mAbs), and convalescent plasma (CP) have also been suggested to play useful role for treating MPX, particularly beneficial against severe cases. 72 The replicative cycle of MPOX virus in humans and the therapeutic interventions by the anti-MPX viral drugs have been elucidated in Figure . Tecovirimat, which is an orthopoxvirusspecific protein (VP37) inhibitor harbors the…”

Section: Anti-viral Drugs and Therapeutic Interventionsmentioning

confidence: 99%

An overview on Monkeypox, Current Paradigms and Advances in its Vaccination, Treatment and Clinical Management: Trends, Scope, Promise and Challenges

Sharma¹,

Aggarwal²,

Sharma³

et al. 2022

Monkeypox virus is an orthopoxvirus sharing the common genus with variola and vaccinia virus. Most of the monkeypox (MPX) cases had been reported from the central and west African region (the main endemic areas) prior to 2022 but there was a sudden outbreak in May, 2022 disseminating the infections to thousands of people even in non-endemic countries, posing a global public health emergency. MPX was considered a rae and neglected disease, however the 2022 MPX outbreaks in multiple countries attracted attention of worldwide researchers to pace up for carrying out researches on various aspects of MPXV including attempts to design and develop diagnostics, vaccines, drugs and therapeutics counteract MPX. Apart from being a zoonotic disease, the current outbreaks highlighted rapid human-to-human transmission of MPXV, besides the reverse zoonosis has also been documented with recent first report of human-to-dog transmission, urging a call for the importance of one health approach. Atypical and unusual disease manifestations as well asymptomatic MPXV infections have also been observed during 2022 MPX outbreak. The affected patients typically develop a rash resulting in a mild disease followed by recovery with some supportive care and use of antivirals such as tecovirimat, cidofovir and brincidofovir in severe disease cases. Modified vaccinia Ankara (MVA) vaccine with an excellent safety profile has been recommended to patients with higher risk exposure and immunocompromised individuals. Moreover, another vaccine the replication-competent vaccine (ACAM2000) could be a suitable alternative to MVA’s non-availability to some selective immunocompetent individuals. Current review highlights the salient aspects of management and treatment of monkeypox along with underlying promises in terms of therapeutics and a variety of challenges posed due to current global public health emergency situation to counteract MPX.

“…High viral loads have been detected in body fluids viz urine, saliva, semen, faeces and the swabs from oropharynx and rectum, suggesting that sexual transmission being greatly responsible for the transmission. 20,21 It is still unclear where in nature MPXV actually resides. 22 The current mini-review article presents a timeline of MPXV's epidemiology from its first identification until its present outbreaks in 2022.…”

Section: Introductionmentioning

confidence: 99%

Changing Patterns in the Spread of Human Monkeypox: A Dangerous New Development in Disease Epidemiology

Chandran¹,

Hridya²,

Prasanth³

et al. 2022

Recent cases of monkeypox (MPX), a zoonotic illness caused by monkeypox virus (MPXV), outside of Africa have prompted international public health concerns. The emergence, re-emergence, and global dispersion of zoonoses are profoundly impacted by a wide variety of causes, including but not limited to climate change, urbanization, animal migration, quick means of travel and tourism, vector biology, anthropogenic influences, and natural factors. Human MPX was first identified in the Democratic Republic of the Congo (DRC) in 1970, and since then it has spread throughout Africa, particularly to West and Central Africa, with some instances even emerging outside of Africa. Since the 1970s, there has been an increasing trend in the occurrence of human MPX, with the DRC seeing the largest increase. The median age at first presentation has increased from 4 years in the 1970s to 21 years in the current time. The total fatality rate was 8.7%, although there was a significant variation between clades: Central African (10.6%) and West African (3.6%). Since 2003, sporadic outbreaks have occurred outside of Africa due to imports and travel-related dissemination. Risky practices that could lead to contracting MPX include having contact with infected animals or people. There is still much to learn about MPXV, such as the reason for the sudden increase in cases while travel links from endemic countries have not yet been established profoundly, identity the natural reservoir animal(s), make advances in diagnostics, increase surveillance and monitoring, carry out in-depth epidemiological investigations, genome sequencing and phylogenetic analysis, explore the reasons for the changing epidemiology and evolving nature of the virus, its ecological niche, and the discovery of effective treatment and management of MPX. This l mini-review aims to reveal an increase in the number of reported cases of MPX worldwide, with the highest concentration in the DRC, as well as its spread to other countries and a shift in the median age of patients from infants to teenagers and young adults highlighting from older years to current 2022 MPX outbreaks. Some cross-protection against MPX was provided by smallpox vaccination, suggesting that its discontinuation may have contributed to an increase in human-to-human transmission. The disease’s worldwide significance is underscored by the fact that it has spread beyond Africa. As the epidemiology of this resurging disease is constantly shifting, surveillance and detection programs are crucial to keeping up with it.