Monkeypox virus: a re-emergent threat to humans

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

In addition to the COVID-19 waves, the globe is facing global monkeypox (MPX) outbreak. MPX is an uncommon zoonotic infection characterized by symptoms similar to smallpox. It is caused by the monkeypox virus (MPXV), a double-stranded DNA virus that belongs to the genus Orthopoxvirus (OPXV). MPXV, which causes human disease, has been confined to Africa for many years, with only a few isolated cases in other areas. Outside of Africa, the continuing MPXV outbreak in multiple countries in 2022 is the greatest in recorded history. The current outbreak, with over 10 000 confirmed cases in over 50 countries between May and July 2022, demonstrates that MPXV may travel rapidly among humans and pose a danger to human health worldwide. The rapid spread of such outbreaks in recent times has elevated MPX to the status of a rising zoonotic disease with significant epidemic potential. While the MPXV is not as deadly or contagious as the variola virus that causes smallpox, it poses a threat because it could evolve into a more potent human pathogen. This review assesses the potential threat to the human population and provides a brief overview of what is currently known about this reemerging virus. By analyzing the biological effects of MPXV on human health, its shifting epidemiological footprint, and currently available therapeutic options, this review has presented the most recent insights into the biology of the virus. This study also clarifies the key potential causes that could be to blame for the present MPX outbreak and draw attention to major research questions and promising new avenues for combating the current MPX epidemic.

[Mpox and pregnancy: A neglected disease and its impact on perinatal health]

Viral infections during pregnancy have been one of the leading causes associated with significant perinatal problems, such as congenital defects, fetal neurological syndromes, stillbirths, and adverse pregnancy outcomes. The mpox virus infection, caused by an Orthopoxvirus related to the human smallpox virus, was declared a global health emergency by the World Health Organization in July 2022 due to the large number of cases emerging outside the usual endemic area in Africa. There is little information on the impact of mpox virus infection during pregnancy, although the limited evidence available shows a high rate of fetal harm. This review addresses the problem of mpox virus infection in pregnant women and provides indications for its prevention, diagnosis, and treatment.

Protective immunity rate against monkeypox: expectation for present and future in case that there is no smallpox vaccine booster

OBJECTIVES

Monkeypox is now regarded as a major global public health concern. A common symptom of this disease is an acute febrile illness with skin sores. The likelihood of the virus spreading from person to person is increasing. The aim of the present study is to estimate the protective immunity rate against monkeypox.

METHODS

Based on the current situation in Africa, the authors forecast the protective immunity rate against monkeypox for the present and future if a smallpox vaccination booster is not available. The clinical mathematical model was used. The primary data for analysis include data on the current serological rate against smallpox and data on the declining rate of smallpox immunity after the last vaccination.

RESULTS

According to the current clinical modeling study, protective immunity to monkeypox is limited. The rate among people who have previously been immunized against smallpox is still higher than the general population rate. If the present monkeypox outbreak (2022) is not successfully controlled, there could be a severe public health danger, such as a pandemic. On a larger scale, in a few years, no immunity will be a concern.

CONCLUSIONS

To suppress the current monkeypox outbreak, it may be necessary to research the use of a novel monkeypox immunization or a traditional smallpox vaccine.

Mpox diagnostics: Review of current and emerging technologies

Mpox is a zoonotic disease caused by monkeypox virus (MPXV) from the Orthopoxvirus genus. Unprecedented transmission events have led to more than 70 000 cases reported worldwide by October 2022. The change in mpox epidemiology has raised concerns of its ability to establish endemicity beyond its traditional geographical locations. In this review, we discuss the current understanding of mpox virology and viral dynamics that are relevant to mpox diagnostics. A synopsis of the traditional and emerging laboratory technologies useful for MPXV detection and in guiding "elimination" strategies is outlined in this review. Importantly, development in MPXV genomics has rapidly advanced our understanding of the role of viral evolution and adaptation in the current outbreak.

Recent Advances in the Prevention and Management of Monkeypox Viral Infection in Humans

BACKGROUND

There have been several neglected infectious pathogens that have reemerged in the last few decades, including the monkeypox virus, a virus from the orthopoxviral genus that causes monkeypox and is transmitted between animals and humans. The human monkeypox outbreak has spread to several different countries. Because of the outbreak's unusually high case count and lack of connections to endemic nations, there are concerns that the monkeypox transmission pattern may have changed.

OBJECTIVE

The current study aimed to provide recent advancements in the prevention and management of the monkeypox virus in humans.

METHODOLOGY

We have highlighted recent advancements in the prevention and management of the monkeypox virus in humans in this work.

RESULTS

For the treatment and prevention of monkeypox, new medications and vaccinations are being used, and more study is needed to understand the epidemiology, biology, and ecology of the virus in endemic regions and stop future global outbreaks. Vaccines available in the market for the treatment of viruses are JYNEOS and ACAM2000. Some of the antiviral drugs, such as tecovirimat, brincidofovir, cidofovir, trifluridine, and vaccinia immune globulin, are used for the treatment of the monkeypox virus. Some of the vaccines, such as NIOCH-14, Cidofovir, CMX-001, and ST-246, are currently in clinical trials.

CONCLUSION

We have, herein, covered features of monkeypox viral biology that are important for risk assessment and getting ready for an outbreak of the monkeypox virus, with a focus on recent advances in knowledge of the virus's host range, evolutionary potential, and potential targets for neutralization.

In-depth review of delivery carriers associated with vaccine adjuvants: current status and future perspectives

INTRODUCTION

Vaccines are powerful tools for controlling microbial infections and preventing epidemics. To enhance the immune response to antigens, effective subunit vaccines or mRNA vaccines often require the combination of adjuvants or delivery carriers. In recent years, with the rapid development of immune mechanism research and nanotechnology, various studies based on the optimization of traditional adjuvants or various novel carriers have been intensified, and the construction of vaccine adjuvant delivery systems (VADS) with both adjuvant activity and antigen delivery has become more and more important in vaccine research.

AREAS COVERED

This paper reviews the common types of vaccine adjuvant delivery carriers, classifies the VADS according to their basic carrier types, introduces the current research status and future development trend, and emphasizes the important role of VADS in novel vaccine research.

EXPERT OPINION

As the number of vaccine types increases, conventional aluminum adjuvants show limitations in effectively stimulating cellular immune responses, limiting their use in therapeutic vaccines for intracellular infections or tumors. In contrast, the use of conventional adjuvants as VADS to carry immunostimulatory molecules or deliver antigens can greatly enhance the immune boosting effect of classical adjuvants. A comprehensive understanding of the various delivery vehicles will further facilitate the development of vaccine adjuvant research.

Monkeypox infection in pregnancy: a systematic review and metaanalysis

OBJECTIVE

The World Health Organization has recently declared a monkeypox outbreak as a public health emergency of global concern. The main aim of this systematic review was to ascertain the maternal and perinatal outcomes of pregnancies complicated by monkeypox infection.

DATA SOURCES

The Medline, Embase, and Cochrane databases were searched on June 25, 2022 utilizing combinations of the relevant medical subject heading terms, key words, and word variants for "monkeypox" and "pregnancy."

STUDY ELIGIBILITY CRITERIA

The search and selection criteria were restricted to the English language.

METHODS

The outcomes observed were miscarriage; intrauterine, neonatal, and perinatal death; preterm birth, vertical transmission, and maternal symptoms. A metaanalysis of proportions was used to analyze the data.

RESULTS

Four studies were included. All the cases in the present systematic review presented with symptoms and signs of monkeypox infection. There was no case of maternal death. Miscarriage occurred in 39% of cases (95% confidence interval, 0-89.0), whereas intrauterine fetal death occurred in 23.0% (95% confidence interval, 0-74.0) of cases. The overall incidence of late fetal and perinatal loss was 77.0% (95% confidence interval, 26.0-100), whereas only 23% (95% confidence interval, 0-74.0) of the included fetuses survived to birth. The incidence of preterm birth before 37 weeks of gestation was 8.0% (95% confidence interval, 0-62.0). Vertical transmission occurred in 62.0% (95% confidence interval, 3.0-100) of cases. When stratifying the analysis according to gestational age at infection, fetal loss was found to occur in 67.0% (95% confidence interval, 9.0-99.0) of cases with first-trimester infection and in 82.0% (95% confidence interval, 17.0-100) of those with second-trimester infection.

CONCLUSION

Monkeypox infection in pregnancy is associated with a high risk of perinatal loss and vertical transmission. The preliminary results from this systematic review affected by a very small number of included cases highlight the need for thorough maternal and fetal surveillance in pregnancies complicated by monkeypox infection.

Knowledge and Attitude Regarding Monkeypox Virus among Physicians in Saudi Arabia: A Cross-Sectional Study

The growing incidence of human monkeypox cases emphasizes the significance of prevention, early detection, and prompt responses for healthcare providers. The aim of this study was to assess the knowledge and attitudes toward monkeypox infection among physicians, a frontline healthcare worker group, in Saudi Arabia. A cross-sectional survey assessing knowledge and attitudes towards monkeypox infection on multiple-item scales was sent to physicians in Saudi Arabia. The associations between independent factors and either knowledge or attitude were assessed. The final analysis included 398 participants. Approximately 55% of the surveyed participants had a "good knowledge" score about human monkeypox. The adjusted logistic regression analysis showed that being a female physician, working in the private sector, and having information on human monkeypox during medical school or residency years were the only factors associated with a good level of knowledge about human monkeypox. However, physicians' knowledge and attitudes regarding monkeypox infection are inadequate and influenced by various factors. There is a significant knowledge gap between the therapeutic management of monkeypox and its vaccination. Training and knowledge assessments are important, especially when studies show significant improvement in related and specific knowledge.

The Global Human Monkeypox Outbreak and Management: A Comprehensive Literature Review

Monkeypox (MPX) belongs to the genus Orthopoxvirus (OPV), family Poxviridae, and sub-family Chordopoxvirinae. Human monkeypox (HMPX) is a viral zoonotic illness caused by the monkeypox virus (MPXV). Several non-endemic countries have confirmed MPX cases across the globe. Therefore, consider an outbreak to be a global health emergency. MPXV transmits from animals to humans via infected animals, and there is currently human-to-human transmission, notably among guys who have sexual relations with males. Healthcare interventions are required to stop outbreaks. These include strict isolation and care for MPX patients while they are still contagious or until the skin lesions dry out and crust over. JYNNEOS was approved as a vaccine for the prevention of MPXV. Tecovirimat is licensed to treat severe MPX or risk developing a serious disease. We should encourage international cooperation to conduct clinical trials investigating the effectiveness and safety of MPXV vaccines and antiviral medications. Precautions must be taken at the global level to prevent an MPXV outbreak.

The evolving epidemiology of monkeypox virus

Monkeypox, caused by the monkeypox virus (MPXV), is a zoonotic disease endemic mainly in West and Central Africa. As of 27 September 2022, human monkeypox has occurred in more than 100 countries (mostly in non-endemic regions) and caused over 66,000 confirmed cases, which differs from previous epidemics that mainly affected African countries. Due to the increasing number of confirmed cases worldwide, the World Health Organization (WHO) has declared the monkeypox outbreak as a Public Health Emergency of International Concern on July 23, 2022. The international outbreak of human monkeypox represents a novel route of transmission for MPXV, with genital lesions as the primary infection, and the emergence of monkeypox in the current outbreak is also new, as novel variants emerge. Clinical physicians and scientists should be aware of this emerging situation, which presents a different scenario from previous outbreaks. In this review, we will discuss the molecular virology, evasion of antiviral immunity, epidemiology, evolution, and detection of MPXV, as well as prophylaxis and treatment strategies for monkeypox. This review also emphasizes the integration of relevant epidemiological data with genomic surveillance data to obtain real-time data, which could formulate prevention and control measures to curb this outbreak.

Monkeypox: An emerging zoonotic pathogen

Monkeypox virus (MPXV), which belongs to the orthopoxvirus genus, causes zoonotic viral disease. This review discusses the biology, epidemiology, and evolution of MPXV infection, particularly cellular, human, and viral factors, virus transmission dynamics, infection, and persistence in nature. This review also describes the role of recombination, gene loss, and gene gain in MPXV evol-vement and the role of signal transduction in MPXV infection and provides an overview of the current access to therapeutic options for the treatment and prevention of MPXV. Finally, this review highlighted gaps in knowledge and proposed future research endeavors to address the unresolved questions.

An Al-Biruni Earth Radius Optimization-Based Deep Convolutional Neural Network for Classifying Monkeypox Disease

Human skin diseases have become increasingly prevalent in recent decades, with millions of individuals in developed countries experiencing monkeypox. Such conditions often carry less obvious but no less devastating risks, including increased vulnerability to monkeypox, cancer, and low self-esteem. Due to the low visual resolution of monkeypox disease images, medical specialists with high-level tools are typically required for a proper diagnosis. The manual diagnosis of monkeypox disease is subjective, time-consuming, and labor-intensive. Therefore, it is necessary to create a computer-aided approach for the automated diagnosis of monkeypox disease. Most research articles on monkeypox disease relied on convolutional neural networks (CNNs) and using classical loss functions, allowing them to pick up discriminative elements in monkeypox images. To enhance this, a novel framework using Al-Biruni Earth radius (BER) optimization-based stochastic fractal search (BERSFS) is proposed to fine-tune the deep CNN layers for classifying monkeypox disease from images. As a first step in the proposed approach, we use deep CNN-based models to learn the embedding of input images in Euclidean space. In the second step, we use an optimized classification model based on the triplet loss function to calculate the distance between pairs of images in Euclidean space and learn features that may be used to distinguish between different cases, including monkeypox cases. The proposed approach uses images of human skin diseases obtained from an African hospital. The experimental results of the study demonstrate the proposed framework's efficacy, as it outperforms numerous examples of prior research on skin disease problems. On the other hand, statistical experiments with Wilcoxon and analysis of variance (ANOVA) tests are conducted to evaluate the proposed approach in terms of effectiveness and stability. The recorded results confirm the superiority of the proposed method when compared with other optimization algorithms and machine learning models.

Affenpocken – eine neue Geschlechtskrankheit

Aktuell steht zur Diskussion, wie und über welchen Verbreitungsweg es zu der deutlichen Zunahme von Affenpocken-Infektionen in Europa gekommen ist. Anhand unserer zweier Fallbeispiele möchten wir die histopathologischen Charakteristika und Unterschiede zu anderen viralen Infektionen wie etwa Schafpocken- oder Herpes simplex-Infektionen zeigen. Zudem möchten wir aufgrund der klinisch ähnlichen Präsentation von Affenpocken zu anderen STDs (sexual transmitted diseases) bezüglich genitaler Ulzerationen und Lymphadenopathien sowie der häufigen Koinfektionen mit weiteren STDs die differenzialdiagnostische Inkludierung in die gängige STD-Routinediagnostik vorschlagen.

Identification of Antiviral Compounds against Monkeypox Virus Profilin-like Protein A42R from Plantago lanceolata

Infections caused by the monkeypox virus (MPXV) have continued to be transmitted significantly in recent years. However, understanding the transmission mechanism, risk factors, and consequences of infection are still limited. Structure-based drug design for MPXV is at an early stage due to the availability of protein structures that have been determined experimentally. However, the structure of the A42R profilin-like protein of MPXV has been solved and submitted to the structure database. This study illustrated an in silico structure-based approach to identify the potential hit compound against A42R of MPXV. Here, 65 Plantago lanceolata compounds were computationally screened against A42R of MPXV. Virtual screening identified top five hits (i) Luteolin 7,3′-Diglucuronide (PubChem ID: 44258091), (ii) Luteolin 7-Glucuronide-3′-Glucoside (PubChem ID: 44258090), (iii) Plantagoside (PubChem ID: 174157), (iv) Narcissoside (PubChem ID: 5481663), and (v) (AlphaE,8S,9R)-N-(3,4-Dihydroxyphenethyl)-8-[(3,4-Dihydroxyphenethyl)Carbamoyl]-9-(1,3-Benzodioxole-5-Yl)-3aalpha,7aalpha-Ethano-1,3-Benzodioxole-5-Acrylamide (PubChem ID: 101131595), with binding energy <−9.0 kcal/mol that was further validated by re-docking and molecular dynamic (MD) simulation. Interaction analysis of re-docked poses confirmed the binding of these top hits to the A42R protein as reported in the reference compound, including active residues ARG114, ARG115, and ARG119. Further, MD simulation and post-simulation analysis support Plantagoside and Narcissoside for substantial stability in the binding pocket of viral protein contributed by hydrogen and hydrophobic interactions. The compounds can be considered for further optimisation and in vitro experimental validation for anti-monkeypox drug development.

ABA supports AMA regarding monkeypox name change: A satire

The names of organizations, teams, and medical conditions can elicit controversy when presumedly unintentional defamation of a subset of individuals is perceived. Indeed, this has recently resulted in changing the names of sports teams and diseases. Previously, the ABA (American Baboon Association) solicited the other ABA (American Bar Association), and the drug reaction initially described to as baboon syndrome is now appropriately referred to as symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). Currently, the AMA (American Monkey Association)-with the support of the ABA (American Baboon Association) -has notified the other AMA (American Medical Association) that they consider the name monkeypox unacceptable for this viral infection. The ABA (American Baboon Association) and the AMA (American Monkey Association) are fictional organizations created by the author for the purpose of this satire.

A review on insights and lessons from COVID-19 to the prevent of monkeypox pandemic

Re-emerging of monkeypox virus (MPXV), a neglected viral zoonotic disease, is a potential global threat. In the current COVID-19 pandemic status, the increasing reporting of positive cases of human MPXV in most countries of the world is a major reason for concern. This paper aims to describe the insights and lessons from COVID-19 pandemic in preventing the impending danger MPXV. In order to prevent further outbreak of disease, identify and control of MPXV transmission routes is necessary. Public health authorities should be vigilant and applied of effective strategies to mitigate the potential spread of MPXV. To address research gaps related to MPX outbreaks, national, regional, and international collaborations are required in time. Finally, the lessons and insights put forward point to the fact that, like the COVID-19 pandemic, people's health by and large depends on the decisions of government officials and people must continue to adhere to health principles. Hence, governments and policymakers must take appropriate precautionary measures to prevent similar crises like COVID-19 in the world.

Strategy of developing nucleic acid-based universal monkeypox vaccine candidates

Until May 2022, zoonotic infectious disease monkeypox (MPX) caused by the monkeypox virus (MPXV) was one of the forgotten viruses considered to be geographically limited in African countries even though few cases outside of Africa were identified. Central and West African countries are known to be endemic for MPXV. However, since the number of human MPX cases has rapidly increased outside of Africa the global interest in this virus has markedly grown. The majority of infected people with MPXV have never been vaccinated against smallpox virus. Noteworthily, the MPXV spreads fast in men who have sex with men (MSM). Preventive measures against MPXV are essential to be taken, indeed, vaccination is the key. Due to the antigenic similarities, the smallpox vaccine is efficient against MPXV. Nevertheless, there is no specific MPXV vaccine until now. Nucleic acid vaccines deserve special attention since the emergency approval of two messenger RNA (mRNA)-based coronavirus disease 2019 (COVID-19) vaccines in 2020. This milestone in vaccinology has opened a new platform for developing more mRNA- or DNA-based vaccines. Certainly, this type of vaccine has a number of advantages including time- and cost-effectiveness over conventional vaccines. The platform of nucleic acid-based vaccines gives humankind a huge opportunity. Ultimately, there is a strong need for developing a universal vaccine against MPXV. This review will shed the light on the strategies for developing nucleic acid vaccines against MPXV in a timely manner. Consequently, developing nucleic acid-based vaccines may alleviate the global threat against MPXV.

Smallpox vaccination discontinuation and monkeypox incidence in an African endemic region: a reanalysis on the relationship between the withdrawal of smallpox vaccine and subsequent morbidity

BACKGROUND

Monkey pox has expanded across Europe as a result of the widespread outbreak, creating a severe public health risk. Monkey pox is an uncommon pox infection that has reappeared due to zoonosis. Monkey pox has spread over Europe and North America, posing a serious public health risk. The regular smallpox vaccine has been shown to be effective against monkeypox. The suspension of smallpox immunization is currently being debated due to the possibility of a connection with the current monkeypox outbreak. In clinical immunology, the link between a desire for smallpox vaccination, low population immunity, and a higher incidence of monkeypox is an intriguing topic.

METHODS

This is a descriptive analysis done in the past. The writers investigate the situation in West Africa in this research. The available data on monkeypox incidence in an African endemic area was reassessed.

RESULTS

Based on a recent analysis of epidemiological data from an endemic area, there is no indication of a yearly ongoing increase in monkeypox incidence following the discontinuation of the smallpox vaccine, and incidence varies.

CONCLUSION

There is no evidence of an annual increase in monkeypox incidence following the withdrawal of smallpox immunization.

Monkeypox Disease: An Emerging Public Health Concern in the Shadow of COVID-19 Pandemic: An Update

The last few decades have witnessed an appalling rise in several emerging and re-emerging viral and zoonotic outbreaks. Such outbreaks are a lesson to learn from and seek insight into better disease monitoring and surveillance, thus preventing future outbreaks. Monkeypox, a viral zoonotic illness caused by the monkeypox virus, may no longer be endemic to the tropical rainforests of Central and West Africa. However, the current monkeypox outbreak in nonendemic countries is most likely due to failure to curb the disease dissemination in endemic African regions despite decades of constant outbreaks. The clinical manifestations are typified by a prodromal phase (fever, myalgia, malaise, and lymphadenopathy) followed by maculopapular or vesicular, or pustular cutaneous eruptions that eventually form encrustations and peel off. Children and the elderly, pregnant females, and individuals living with comorbidities (diabetes, HIV/AIDS, and lymphoproliferative ailments) are at a high risk of severe disease. Monkeypox is a self-limiting disorder, but its complications and pandemic potential signify its immense public health relevance. The recent ongoing monkeypox outbreak in nonendemic nations areas was identified with increased propensity in men who have sex with men (MSMs) with no travel history to endemic regions, emphasizing the changing trends in disease transmission. This review article provides an updated overview of the monkeypox disease taxonomy, pathogenesis, transmission, epidemiology, clinical and oral features, diagnostic aids, differential diagnosis, preventive aspects, and treatment protocol.

Identification of Diosmin and Flavin Adenine Dinucleotide as Repurposing Treatments for Monkeypox Virus: A Computational Study

The World Health Organization declared monkeypox a global public health emergency on 23 July 2022. This disease was caused by the monkeypox virus (MPXV), which was first identified in 1958 in Denmark. The MPXV is a member of the Poxviridae family, the Chordopoxvirinae subfamily, and the genus Orthopoxvirus, which share high similarities with the vaccinia virus (the virus used to produce the smallpox vaccine). For the initial stage of infection, the MPXV needs to attach to the human cell surface glycosaminoglycan (GAG) adhesion molecules using its E8 protein. However, up until now, neither a structure for the MPXV E8 protein nor a specific cure for the MPXV exists. This study aimed to search for small molecules that inhibit the MPXV E8 protein, using computational approaches. In this study, a high-quality three-dimensional structure of the MPXV E8 protein was retrieved by homology modeling using the AlphaFold deep learning server. Subsequent molecular docking and molecular dynamics simulations (MDs) for a cumulative duration of 2.1 microseconds revealed that ZINC003977803 (Diosmin) and ZINC008215434 (Flavin adenine dinucleotide-FAD) could be potential inhibitors against the E8 protein with the MM/GBSA binding free energies of −38.19 ± 9.69 and −35.59 ± 7.65 kcal·mol⁻¹, respectively.

Monkeypox: Emerging virus of concern; antivirals and vaccines therapeutic options

The detection of >400 Monkeypox virus cases in the month of May 2022 and increase to 57,527.

confirmed cases by September 9th^, 2022, across the world, emphasizes the need of new therapeutics for this emerging viral epidemic in humans. Largely the cases seen in Europe, Australia and America are among men who have sex with men making transmission through intimate contact with infectious skin lesions the likely mode of transmission. This implies that this high human-to-human transmission observed in the young Caucasian clusters, and the probable community transmission without any history of travelling to endemic areas would suggest that the epidemic is likely to be sustained human-to-human transmission and unlikely one that would be a short-lasting epidemic. This might necessitate the need for new therapeutic approaches and agents for prophylaxis and treatment of acute infections which is the focus of this review article.

Epidemiological Situation of Monkeypox Transmission by Possible Sexual Contact: A Systematic Review

Monkeypox (MPX), a zoonotic infection caused by the monkeypox virus (MPXV), has re-emerged worldwide with numerous confirmed cases with person-to-person transmission through close contacts, including in sexual networks. Therefore, this study aimed to determine the epidemiological situation of monkeypox transmission by possible sexual contact. A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Embase databases until 18 August 2022. The key search terms used were "monkeypox", "sexual contact", "sexual intercourse" and "sexual transmission". A total of 1291 articles were retrieved using the search strategy. After eliminating duplicates (n = 738) and examining by title, abstract, and full text, 28 studies reporting case reports of monkeypox with a detailed description of clinical features, sexually transmitted diseases, method of diagnosis, location and course of skin lesions, and treatment were included. A total of 4222 confirmed cases of monkeypox have been reported, of which 3876 monkeypox cases are the result of transmission by sexual contact distributed in twelve countries: 4152 cases were male with a mean age of 36 years. All confirmed cases of monkeypox were diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR). The most frequent clinical manifestations were fever, lymphadenopathy, headache, malaise, and painful perianal and genital lesions. The most frequent locations of the lesions were perianal, genital, oral, trunk, upper and lower extremities. Patients were in good clinical condition, with treatment based on analgesics and antipyretics to relieve some symptoms of monkeypox. A high proportion of STIs and frequent anogenital symptoms were found, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact during sexual activity. The highest risk of monkeypox transmission occurs in men who have sex with men, and MPXV DNA could be recovered in seminal fluid. It is essential to establish health policies for the early detection and management of patients with monkeypox.

Monkeypox viral disease outbreak in non-endemic countries in 2022: What clinicians and healthcare professionals need to know

An outbreak of monkeypox Viral Disease in non-endemic countries in May 2022 is increasingly spreading. Clinicians and other healthcare professionals need to understand the aetiology and characteristics of the monkeypox pathogen and illness. By familializing themselves with these characteristics, they can map out the outbreak and roll out necessary public health mitigation measures to curb the spread. This short communication presents a summarized message regarding the aetiology, mode of transmission, clinical features, risk factors, diagnosis, treatment, and prevention of monkeypox viral disease. Considerations for surveillance and reporting have also been highlighted.

Monkeypox, a Literature Review: What Is New and Where Does This concerning Virus Come From?

Among the Poxviridae family, orthopoxvirus is the most notorious genus. Several DNA viruses belonging to this group are known to produce human disease from the life-threatening variola virus (VARV) (the causative agent of smallpox), monkeypox virus (MPXV), cowpox virus (CPXV), and vaccinia virus (VACV). These orthopoxviruses still remain a public health concern as VACV or CPXV still cause emerging endemic threads, especially in developing countries. MPXV is able to cause sporadic human outbreaks of a smallpox-like zoonotic disease and, in May 2022, hundreds of cases related to MPXV have been reported from more than 30 countries around the globe. At the end of July, monkeypox (MPX) outbreak was even declared a global health emergency by the World Health Organization (WHO). Many aspects remain unclear regarding this outbreak and a deep understanding of orthopoxvirus might have crucial and evident implications. During the era in which people under 45 years old are not protected against VACV, the potential use of orthopoxviruses as a biological weapon raises global concern considering the rapid spreading of the current MPX outbreak in vulnerable populations. Hence, we review the most recent evidence about phylogenesis, pathogenesis, prevention, and treatment for this concerning disease.