Abstract
Introduction
Epidemiology







Year | Duration | Number of cases |
---|---|---|
1970-2000 | 30 y | <1000 |
2000-2009 | 10 y | >10,000 |
2010-2019 | 10 y | >8000 |
2020-April 2022 | 2 y 4 mo | 10,545 |
May 2022-July 2022 | 3 mo | >16,000 |
Mathieu E, Dattani S, Ritchie H, et al. Monkeypox. Available at: https://ourworldindata.org/monkeypox, accessed on 27 July 2022.
World Health Network. The World Health Network declares monkeypox a pandemic - press release. Available at: https://www.worldhealthnetwork.global/monkeypoxpressrelease, accessed on 27 July 2022.
The agent
Species | Infection |
---|---|
Variola-vaccinia viruses | Variola major (smallpox)Variola minorVacciniaCowpoxMonkeypoxRabbitpoxBuffalopox |
Orf-like viruses | Milker's nodulesContagious pustular dermatitis (Orf)Bovine papular stomatitis |
Avian poxviruses | Canarypox Fowlpox Pigeonpox Turkeypox |
Myxoma-fibroma viruses | Rabbit myxoma Rabbit fibroma Squirrel fibroma Hare fibroma |
Unclassified | Molluscum contagiosum Entomopox |
Strains | Virulence | Human case fatality |
---|---|---|
The Congo Basin clade (Central African) | High | 10.6% |
The West African clade | Low | 3.6% |
Clinical features
Bragazzi NL, Kong JD, Mahroum N, et al. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: a preliminary pooled data analysis and literature review. J Med Virol. doi:10.1002/jmv.27931, accessed on 27 July 2022.
Ministry of Health and Family Welfare. Guidelines for management of monkeypox disease. Available at:https://main.mohfw.gov.in/sites/default/files/Guidelines%20for%20Management%20of%20Monkeypox%20Disease.pdf. Accessed on 27 July 2022.


Stage | Infectivity | Clinical features | Duration |
---|---|---|---|
Incubation period | Noninfectious | Asymptomatic | 7-21 d(Mean: 13 d) |
Prodrome | Infectious | • Fever• Lymphadenopathy:Periauricular, cervical,axillary, and inguinal• Myalgia• Fatigue | 1-3 d |
Prodrome | Infectious | • Fever • Lymphadenopathy: Periauricular, cervical, axillary, and inguinal. • Myalgia • Fatigue | 1-3 d |
Infectious | |||
Infectious | |||
Non-infectious |
- Thornhill JP
- Barkati S
- Walmsley S
- et al.
Soucheray S. WHO: 14,000 monkeypox cases worldwide, 5 deaths. Available at: https://www.cidrap.umn.edu/news-perspective/2022/07/who-14000-monkeypox-cases-worldwide-5-deaths. Accessed on 30 July 2022.
- Thornhill JP
- Barkati S
- Walmsley S
- et al.
Parameter | Features |
---|---|
Sex | Exclusively men (men = 527, trans/nonbinary = 1) |
Sex orientation | Homosexual = 509 (96%), heterosexual = 9 (2%), bisexual = 10 (2%) |
HIV status | HIV positive = 218 (41%) |
Concomitant STI | Present in 109 (29%) patients among 377 (screened) |
Suspected route oftransmission | Sexual close contact = 504 (95%), nonsexual close contact = 4 (1%),household/unknown = 20 (4%) |
Clinical features | Dermatitis = 500 (95%), fever = 330 (62%), lymphadenopathy = 295 (56%), lethargy = 216 (41%), myalgia = 165 (31%), headache = 145 (27%), pharyngitis = 113 (21%), anorectal pain/proctitis = 75 (14%) |
Site of skin lesions | Anogenital region = 383 (73%), trunk and extremities = 292 (55%), face = 134 (25%), palm and soles = 51 (10%) |
Characters of skin lesions (n = 500) | Dermatitis (vesicular = 291, macular = 19) = 310 (62%), single ulcer = 54 (11%), multiple ulcers = 95 (19%) |
Mucosal lesions (n = 217) | Only anogenital regions = 148 (68%), only oropharyngeal region = 50(23%), both anogenital and oropharyngeal regions = 16 (7%), nasal/eyes = 3 |
Site of positive viralPCR | Anogenital region/skin = 512 (97%), nose/throat swab = 138 (26%),blood = 35 (7%), semen = 29 (5%), urine = 14 (3%) |
Centers for Disease Control and Prevention. CDC and health partners responding to Monkeypox Case in the U.S. Available at: https://www.cdc.gov/media/releases/2022/s0518-monkeypox-case.html. Accessed on 30 July 2022.
Centers for Disease Control and Prevention. What clinicians need to know about monkeypox in the United States and other countries. Available at: https://emergency.cdc.gov/coca/calls/2022/callinfo_052422.asp. Accessed on 30 July 2022.
Centers for Disease Control and Prevention. What clinicians need to know about monkeypox in the United States and other countries. Available at: https://emergency.cdc.gov/coca/calls/2022/callinfo_052422.asp. Accessed on 30 July 2022.
Crist C. Two children in U.S. diagnosed with monkeypox. Available at: https://www.webmd.com/a-to-z-guides/news/20220725/two-children-us-diagnosed-monkeypox. Accessed on 30 July 2022.
Diagnosis
Management
- 1.The first next-generation smallpox vaccine called ACAM-2000 is similar to the discontinued Dryvax vaccine, known to generate long-lasting immunity34,35and provides 85% protection against human monkeypox.36
- 2.The second next-generation smallpox vaccine is MVA-BN (JYNNEOS in the United States), manufactured with the Modified Vaccinia Ankara strain and administered by two subcutaneous injections, 4 weeks apart.37While the former vaccine is contraindicated in pregnancy, atopic dermatitis, and various immune deficiencies, the latter displayed no serious adverse events and no risk of inadvertent inoculation and auto-inoculation.
- Rao AK
- Petersen BW
- Whitehill F
- et al.
Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for pre-exposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the advisory committee on immunization practices - United States, 2022.MMWR Morb Mortal Wkly Rep. 2022; 71: 734-7426,18,37The MVA-BN vaccine is approved in the United States for use against both smallpox and monkeypox. Tt still requires clinical trials for human efficacy.- Rao AK
- Petersen BW
- Whitehill F
- et al.
Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for pre-exposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the advisory committee on immunization practices - United States, 2022.MMWR Morb Mortal Wkly Rep. 2022; 71: 734-74237- Rao AK
- Petersen BW
- Whitehill F
- et al.
Use of JYNNEOS (smallpox and monkeypox vaccine, live, nonreplicating) for pre-exposure vaccination of persons at risk for occupational exposure to orthopoxviruses: recommendations of the advisory committee on immunization practices - United States, 2022.MMWR Morb Mortal Wkly Rep. 2022; 71: 734-742
U.S. Food & Drug Administration. ACAM2000, (Smallpox (Vaccinia) Vaccine, Live)Lyophilized preparation for percutaneous scarification. Available at: https://www.fda.gov/media/75792/download.
U.S. Food & Drug Administration. TPOXX (tecovirimat) capsules for oral use. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/208627s000lbl.pdf.
Centers for Disease Control and Prevention. Smallpox vaccines. Available at: https://www.cdc.gov/smallpox/clinicians/vaccines.html. Accessed July 27, 2022.
Mode | Interventions |
---|---|
Prevention | By prior immunization with available smallpox vaccines |
1. JYNNEOS™ (MVA-BN, IMAVAMUNE, IMVANEX) | |
2. ACAM 2000® | |
3. Newer APSV (Avantis Pasteur Smallpox Vaccine) | |
Prophylaxis | 1. Pre-exposure: Vaccinating select people at risk for occupational exposure. |
2. Post-exposure: Vaccination within 4 d of exposure to the virus to prevent or minimize the development of the disease. | |
Antiviral therapy | 1. Tecovirimat: (oral or intravenous) Adults 600 mg, twice daily; children 13-25 kg 200 mg, twice daily; children 25-40 kg, 400 mg twice daily. The duration of treatment is 14 d. |
2. Brincidofovir: (Oral suspension) Adults (>48 kg) 200 mg, once weekly for two doses; children (>10 kg) 4 mg/kg, once weekly for two doses. | |
3. Cidofovir: (Intravenous) 5 mg/kg, once weekly for 2 wk, followed by 5 mg/kg, once every other week. | |
4. Vaccinia immune globulins (intravenous): 6000 U/kg as soon as Symptoms appear. Repeat dose required based on response to Treatment and severity of symptoms. |
- Rao AK
- Petersen BW
- Whitehill F
- et al.
Conclusions
Conflict of interest
References
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U.S. Food & Drug Administration. TPOXX (tecovirimat) capsules for oral use. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/208627s000lbl.pdf.
Centers for Disease Control and Prevention. Smallpox vaccines. Available at: https://www.cdc.gov/smallpox/clinicians/vaccines.html. Accessed July 27, 2022.
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