The 2022 outbreak and the pathobiology of the monkeypox virus

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.

SARS-CoV-2 and monkeypox: what is common and what is not in a present pandemic versus a potential one-a neuropsychiatric narrative review

Pandemic represents challenging medical emergency as it is usually associated with high rates of mortalities and morbidities. Along the last 2 and half years the world has faced the emergence of severe acute respiratory syndrome corona virus 2 pandemic that caught medical agencies and health authorities by surprise and costed more than half billion morbidities and 6 million mortalities. Unfortunately, the way developed countries contained the novel corona virus was unsatisfactory in means of early quarantines as well as obtaining and distributing an effective vaccine. This failure in management might have been responsible for the emergence of a new potential pandemic caused by monkeypox virus. Along the current review article, a detailed comparison is presented between corona virus and monkeypox virus based on virological characteristics, role of corona virus in monkeypox spread, pathogenesis, neuropsychiatric manifestations, and treatment and management. It is obvious that both viruses have a major role in causing various neuropsychiatric manifestations. Neurological manifestations are either bound directly to the virus spread to central and peripheral nervous system or secondary to triggering an immune reaction. Psychiatric ones are mostly related to stigmatization, isolation as well as changes that takes place in neurotransmitters and their metabolites within the nervous system. Dealing properly with monkeypox virus spread through previously learned lessons from corona virus might protect the world from a new pandemic.

Modeling and Forecasting Monkeypox Cases Using Stochastic Models

BACKGROUND

Monkeypox virus is gaining attention due to its severity and spread among people. This study sheds light on the modeling and forecasting of new monkeypox cases. Knowledge about the future situation of the virus using a more accurate time series and stochastic models is required for future actions and plans to cope with the challenge.

METHODS

We conduct a side-by-side comparison of the machine learning approach with the traditional time series model. The multilayer perceptron model (MLP), a machine learning technique, and the Box-Jenkins methodology, also known as the ARIMA model, are used for classical modeling. Both methods are applied to the Monkeypox cumulative data set and compared using different model selection criteria such as root mean square error, mean square error, mean absolute error, and mean absolute percentage error.

RESULTS

With a root mean square error of 150.78, the monkeypox series follows the ARIMA (7,1,7) model among the other potential models. Comparatively, we use the multilayer perceptron (MLP) model, which employs the sigmoid activation function and has a different number of hidden neurons in a single hidden layer. The root mean square error of the MLP model, which uses a single input and ten hidden neurons, is 54.40, significantly lower than that of the ARIMA model. The actual confirmed cases versus estimated or fitted plots also demonstrate that the multilayer perceptron model has a better fit for the monkeypox data than the ARIMA model.

CONCLUSIONS AND RECOMMENDATION

When it comes to predicting monkeypox, the machine learning method outperforms the traditional time series. A better match can be achieved in future studies by applying the extreme learning machine model (ELM), support vector machine (SVM), and some other methods with various activation functions. It is thus concluded that the selected data provide a real picture of the virus. If the situations remain the same, governments and other stockholders should ensure the follow-up of Standard Operating Procedures (SOPs) among the masses, as the trends will continue rising in the upcoming 10 days. However, governments should take some serious interventions to cope with the virus.

LIMITATION

In the ARIMA models selected for forecasting, we did not incorporate the effect of covariates such as the effect of net migration of monkeypox virus patients, government interventions, etc.

Monkeypox: epidemiology, pathogenesis, treatment and prevention

Monkeypox is a zoonotic disease that was once endemic in west and central Africa caused by monkeypox virus. However, cases recently have been confirmed in many nonendemic countries outside of Africa. WHO declared the ongoing monkeypox outbreak to be a public health emergency of international concern on July 23, 2022, in the context of the COVID-19 pandemic. The rapidly increasing number of confirmed cases could pose a threat to the international community. Here, we review the epidemiology of monkeypox, monkeypox virus reservoirs, novel transmission patterns, mutations and mechanisms of viral infection, clinical characteristics, laboratory diagnosis and treatment measures. In addition, strategies for the prevention, such as vaccination of smallpox vaccine, is also included. Current epidemiological data indicate that high frequency of human-to-human transmission could lead to further outbreaks, especially among men who have sex with men. The development of antiviral drugs and vaccines against monkeypox virus is urgently needed, despite some therapeutic effects of currently used drugs in the clinic. We provide useful information to improve the understanding of monkeypox virus and give guidance for the government and relative agency to prevent and control the further spread of monkeypox virus.

Designing, characterization, and immune stimulation of a novel multi-epitopic peptide-based potential vaccine candidate against monkeypox virus through screening its whole genome encoded proteins: An immunoinformatics approach

BACKGROUND

The current monkeypox virus (MPXV) spread in the non-epidemic regions raises global concern. Presently, the smallpox vaccine is used against monkeypox with several difficulties. Conversely, no next-generation vaccine is available against MPXV. Here, we proposed a novel multi-epitopic peptide-based in-silico potential vaccine candidate against the monkeypox virus.

METHODS

The multi-epitopic potential vaccine construct was developed from antigen screening through whole genome-encoded 176 proteins of MPXV. Afterward, ten common B and T cell epitopes (9-mer) having the highest antigenicity and high population coverage were chosen, and a vaccine construct was developed using peptide linkers. The vaccine was characterized through bioinformatics to understand antigenicity, non-allergenicity, physicochemical properties, and binding affinity to immune receptors (TLR4/MD2-complex). Finally, the immune system simulation of the vaccine was performed through immunoinformatics and machine learning approaches.

RESULTS

The highest antigenic epitopes were used to design the vaccine. The docked complex of the vaccine and TLR4/MD2 had shown significant free binding energy (-98.37 kcal/mol) with a definite binding affinity. Likewise, the eigenvalue (2.428517e-05) from NMA analysis of this docked complex reflects greater flexibility, adequate molecular motion, and reduced protein deformability, and it can provoke a robust immune response.

CONCLUSIONS

The designed vaccine has shown the required effectiveness against MPXV without any side effects, a significant milestone against the neglected disease.

Human Monkeypox: An Emerging Zoonosis

Human monkeypox is caused by a zoonotic Orthopoxvirus that resembles smallpox. It is challenging to identify the illness from varicella and smallpox. The rapid spread of cases across countries has raised serious concerns among public health officials around the world, prompting accelerated investigations to identify the origins and causes of the rapid expansion of cases. When people come into contact with infected animals, they may unintentionally contract monkeypox. The monkeypox virus is transferred by direct exposure to lesions, respiratory droplets, body fluids, and contaminated objects like blood. Fever, rash, and lymph nodes frequent swelling are clinical signs of monkeypox, which can cause a multitude of health problems. The disease's worldwide significance is shown by the advent of outbreaks outside of Africa. To understand the constantly shifting epidemiology of this disease that is reemerging, monkeypox cases require improved monitoring and case identification. Before smallpox's eradication and the consequent absence of immunization attempts, vaccinia vaccination provided coincidental protection to the monkeypox virus; however, monkeypox gained therapeutic relevance. Additionally, given that rural Africa is where monkeypox cases are most common, it is possible that underreporting could result in an underestimate of the pathogen's potential impact. In recent months, cases of human monkeypox have alarmingly increased in nations where the illness is not prevalent. The current monkeypox outbreak, in light of the COVID-19 pandemic, represents a fresh threat. Clinicians need to be aware of this novel scenario, which differs from previous epidemics' scenarios. The transmission of monkeypox should be reduced by the development of efficient solutions by global health systems.

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.

A growth-based platform for detecting domain-peptide interactions in the cytoplasm of mammalian cells

Development of a method for detecting protein-protein interactions (PPIs) in living cells is important for therapeutic drug screening against various diseases including infectious diseases. We have recently developed a method named SOS localization-based interaction screening (SOLIS), in which we designed membrane-anchored and SOS-fused chimeric proteins, whose PPI-dependent association triggers membrane localization of the SOS-fused chimeric protein, activates the Ras/MAPK pathway, and induces cell growth. While SOLIS was able to detect relatively strong PPIs, further sensitivity was required for detecting intracellular endogenous PPIs typically having a micromolar order of dissociation constant (K_d). Here we develop high-sensitive SOLIS (H-SOLIS) that could universally detect PPIs with lower affinities. In order to improve the sensitivity, H-SOLIS introduces a heterodimeric helper interaction, in which addition of a small-molecule helper ligand could accommodate association of the two chimeric proteins and regulate the sensitivity. Four types of domain-peptide interactions having known K_d values are employed to examine the versatility and detection limit of H-SOLIS. Consequently, the heterodimer-inducible helper ligand dramatically enhances detection sensitivity, lowering the detection limit to a ten-micromolar order of K_d. Thus, H-SOLIS could be a platform to detect disease-related domain-peptide interactions for drug discovery screening.

A Brief Report on Monkeypox Outbreak 2022: Historical Perspective and Disease Pathogenesis

Monkeypox is a zoonotic disease caused by the monkeypox virus (MPXV). It was an epidemic infection among African countries over the last few decades. In 2022, MPXV has been broke through in Africa, America, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific region. This widespread infection of MPXV has created panic across the nations, and the WHO has declared a global public health emergency due to the multi-country MPX outbreak. We prepared this brief report on the MPX outbreak 2022 by extracting data from Scopus, PubMed, and website databases. We manually read all the relevant articles from our target databases. The rapid spread of MPX infection in around a 100 countries has threatened the global healthcare systems. The available epidemiological data revealed that sexual orientations and encounters are potential contributing factors for monkeypox infections. However, it has not been categorized as a sexually transmitted infection. Also, MPXV can transfer from 1 individual to others in many ways. The empowerment of this old foe has created additional pressure and threat on the healthcare authorities during the ongoing Covid-19 pandemic. Effective preventive measures, social awareness, and therapeutic approaches can reduce this extra burden on the healthcare system across the countries. Focusing only on sexual orientations and encounters as risk factors for MPX infection might increase stigma that will be another barrier to controlling and preventing MPXV spread. Therefore, we should be careful in delivering messages about MPX infection to the general population. Also, we recommend repositioning the existing smallpox vaccines and antivirals in MPX infection until the development of specific antiviral agents against this infection.

Promising strategy for developing mRNA-based universal influenza virus vaccine for human population, poultry, and pigs- focus on the bigger picture

Since the first outbreak in the 19th century influenza virus has remained emergent owing to the huge pandemic potential. Only the pandemic of 1918 caused more deaths than any war in world history. Although two types of influenza- A (IAV) and B (IBV) cause epidemics annually, influenza A deserves more attention as its nature is much wilier. IAVs have a large animal reservoir and cause the infection manifestation not only in the human population but in poultry and domestic pigs as well. This many-sided characteristic of IAV along with the segmented genome gives rise to the antigenic drift and shift that allows evolving the new strains and new subtypes, respectively. As a result, the immune system of the body is unable to recognize them. Importantly, several highly pathogenic avian IAVs have already caused sporadic human infections with a high fatality rate (~60%). The current review discusses the promising strategy of using a potentially universal IAV mRNA vaccine based on conserved elements for humans, poultry, and pigs. This will better aid in averting the outbreaks in different susceptible species, thus, reduce the adverse impact on agriculture, and economics, and ultimately, prevent deadly pandemics in the human population.

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.

Concurrent monkeypox and COVID-19: role of interleukin-1 receptor antagonist-like protein mechanism

OBJECTIVE

In 2022, monkeypox becomes a new global public health threat. Monkeypox has been present in Africa for a very long time. The COVID-19 epidemic has been affecting this region for some years. The outbreak state persists. The coexistence of the two diseases is an intriguing discovery. There is no documentation of the co-occurrence.

METHODS

The possibility of coexisting of the two lethal illnesses, monkeypox and COVID-19, is an intriguing scientific subject. Using bioinformatic pathophysiological pathway analysis, the authors investigated the pathophysiological pathways of COVID-19 and monkeypox.

RESULTS

The most common pathway was identified. An interleukin-1 receptor antagonist-like protein has been identified as a common pathway between the pathogenic processes of monkeypox and COVID-19.

CONCLUSION

The findings could explain why severe COVID-19 and monkeypox do not coexist.

Combating Stigma and Health Inequality of Monkeypox: Experience from HIV

With Western Pacific Region reporting more imported cases, the World Health Organization (WHO) declared monkeypox a public health emergency of international concern in July. Currently, we are now at the beginning of forming stigmatization toward monkeypox. Based on the experience of combating HIV stigmatization for over 30 years, in this comment, we proposed measures based on the three stages of the stigma formation process. We believe the paper may be of particular interest to the readers of your journal as it offered implications for both healthcare professionals and researchers in Western Pacific Region.

Monkeypox: An Emerging Global Public Health Emergency

The virus causing monkeypox, a rare zoonotic viral disease, belongs to the Poxviridae family and the Orthopoxvirus genus. On 23 July 2022, the World Health Organization (WHO) declared the monkeypox outbreak as a Public Health Emergency of International Concern (PHEIC). From May to July 2022, a multi-country outbreak of monkeypox was reported in both endemic and non-endemic regions. Major goals of managing monkeypox are to identify the suspected cases, detect generic orthopoxvirus DNA at a state or commercial laboratory, and establish the Centers for Disease Control and Prevention real-time polymerase chain reaction testing. Currently, there are no approved treatments for monkeypox virus infection. However, a variety of antiviral medications originally designed for the treatment of smallpox and other viral infections could be considered. Pre-exposure prophylaxis for laboratory and health care employees and post-exposure prophylaxis for individuals with high-risk or intermediate-risk exposures are to be considered. The CDC Emergency Operations Center is available for advice on the appropriate use of medical countermeasures, and can help in obtaining antiviral drugs and vaccines from the National Strategic Stockpile. This review gives an overview of the global scenario, clinical presentation, and management of monkeypox in the light of a global public health emergency.

Monkeypox outbreak amidst COVID-19 reemergence in the European Region: Challenges, efforts, and recommendations

Monkeypox (MPX), caused by the Monkeypox virus (MPXV), is an endemic disease in African countries and is currently causing outbreaks in several European regions, amidst a recent surge in new COVID-19 cases. This can significantly impact already exhausted healthcare services, adding on to the economic and social burdens in the region. A lack of sufficient laboratory diagnostics, antivirals, vaccines may hinder effective clinical management of affected patients. Therefore, it is essential to increase awareness about MPX and its transmission among the general population, to ensure necessary precautions are taken and new cases are reported swiftly. This article discusses the impact of MPXV on the current reemergence of COVID-19 in Europe, lessons learnt during the COVID-19 pandemic and recommendations to address potential challenges.

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.

Kinetic and Structural Aspects of Glycosaminoglycan-Monkeypox Virus Protein A29 Interactions Using Surface Plasmon Resonance

Monkeypox virus (MPXV), a member of the Orthopoxvirus genus, has begun to spread into many countries worldwide. While the prevalence of monkeypox in Central and Western Africa is well-known, the recent rise in the number of cases spread through intimate personal contact, particularly in the United States, poses a grave international threat. Previous studies have shown that cell-surface heparan sulfate (HS) is important for vaccinia virus (VACV) infection, particularly the binding of VACV A27, which appears to mediate the binding of virus to cellular HS. Some other glycosaminoglycans (GAGs) also bind to proteins on Orthopoxviruses. In this study, by using surface plasmon resonance, we demonstrated that MPXV A29 protein (a homolog of VACV A27) binds to GAGs including heparin and chondroitin sulfate/dermatan sulfate. The negative charges on GAGs are important for GAG-MPXV A29 interaction. GAG analogs, pentosan polysulfate and mucopolysaccharide polysulfate, show strong inhibition of MPXV A29-heparin interaction. A detailed understanding on the molecular interactions involved in this disease should accelerate the development of therapeutics and drugs for the treatment of MPXV.

Monkeypox Vaccines: Current Update

Monkeypox belonging to the genus Orthopoxvirus (OPV) of the family poxviridiae poses a major human threat even after 30 years after eradicating smallpox. OPV family includes other viruses like vaccinia virus (VACV), variola virus and cowpox virus. VACV smallpox vaccine provided cross protective antibody response against other orthopox viruses.1 The ongoing monkeypox outbreak has affected 31,800 people in more than 89 different countries. India has documented 9 confirmed cases with one death reported.2 Stockpile of smallpox vaccines that contain live vaccinia virus is maintained at two locations, one at Centre for Disease Control laboratory at Atlanta, Georgia and the other at VECTOR institute, Koltsovo, Russia. Data shows effectiveness of Smallpox vaccines against monkeypox to be 85%.3 Vaccine used in smallpox eradication were first generation vaccines which produced multiple side effects like eczema, progressive vaccinia and myopericarditis. This fear of adverse effects and safety concerns had led to the production of second and third generation vaccines like imvanex or ACAM2000.4 The interim guidelines for monkeypox vaccination does not urge the need for mass vaccination considering the side effects and the vaccine production. Countries like Canada, United Kingdom and USA are using ring vaccination to prevent monkeypox. The two vaccines currently being used against monkeypox are Jynneos vaccine and ACAM2000.5 JYNNEOS vaccine (Imvamune in Canada /Imvanex in Europe developed by Bavarian Nordiac) for adults aged 18 years and older was approved in Europe and U.S. The vaccine contains a replication deficient live vaccinia virus (Modified vaccinia Ankara-MVA BN) that is given as subcutaneous injection of 0.5 ml, two doses four weeks apart. The vaccine is used for post exposure prophylaxis against monkeypox virus. CDC recommends the intermediate or high risk group as potential group to receive post exposure propylaxis of the vaccine (Unprotected contact with the body fluid of infected person or contact with less 6 meter distance with the infected person). Vaccine is available in countries like Canada, Europe and Britain.6 ACAM2OOO, containing live replicating vaccinia virus that can replicate as compared to jynneos vaccine. Owning to the side effects associated with the vaccine its only used for laboratory workers handling pox viruses or for military personnel.4,7,8 WHO has stated there is no need for mass vaccination and decision regarding vaccination should be based on the individual case accessing the risk and benefits.5 In India, the Serum Institute of India has confirmed its ongoing research to find vaccine against monkeypox. Monkeypox vaccine pipelines include 1. Tonix Pharmaceuticals Holding Corp TNX-8011, a preclinical live virus, which uses horsepox virus 2. EpiVax, Inc’s-Epitome driven vaccine 3. VennVax, DNA prime peptide boost multi-T cell epitome Pox virus vaccine.9

Comparison of Transcriptomic Signatures between Monkeypox-Infected Monkey and Human Cell Lines

Monkeypox virus (MPV) is a smallpox-like virus belonging to the genus Orthopoxvirus of the family Poxviridae. Unlike smallpox with no animal reservoir identified and patients suffering from milder symptoms with less mortality, several animals were confirmed to serve as natural hosts of MPV. The reemergence of a recently reported monkeypox epidemic outbreak in nonendemic countries has raised concerns about a global outburst. Since the underlying mechanism of animal-to-human transmission remains largely unknown, comprehensive analyses to discover principal differences in gene signatures during disease progression have become ever more critical. In this study, two MPV-infected in vitro models, including human immortal epithelial cancer (HeLa) cells and rhesus monkey (Macaca mulatta) kidney epithelial (MK2) cells, were chosen as the two subjects to identify alterations in gene expression profiles, together with co-regulated genes and pathways that are affected during monkeypox disease progression. Using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and MetaCore analyses, we discovered that elevated expression of genes associated with interleukins (ILs), G protein-coupled receptors (GPCRs), heat shock proteins (HSPs), Toll-like receptors (TLRs), and metabolic-related pathways play major roles in disease progression of both monkeypox-infected monkey MK2 and human HeLa cell lines. Interestingly, our analytical results also revealed that a cluster of differentiation 40 (CD40), plasmin, and histamine served as major regulators in the monkeypox-infected monkey MK2 cell line model, while interferons (IFNs), macrophages, and neutrophil-related signaling pathways dominated the monkeypox-infected human HeLa cell line model. Among immune pathways of interest, apart from traditional monkeypox-regulated signaling pathways such as nuclear factor- (NF-κB), mitogen-activated protein kinases (MAPKs), and tumor necrosis factors (TNFs), we also identified highly significantly expressed genes in both monkey and human models that played pivotal roles during the progression of monkeypox infection, including CXCL1, TNFAIP3, BIRC3, IL6, CCL2, ZC3H12A, IL11, CSF2, LIF, PTX3, IER3, EGR1, ADORA2A, and DUOX1, together with several epigenetic regulators, such as histone cluster family gene members, HIST1H3D, HIST1H2BJ, etc. These findings might contribute to specific underlying mechanisms related to the pathophysiology and provide suggestions regarding modes of transmission, post-infectious sequelae, and vaccine development for monkeypox in the future.

A brief on new waves of monkeypox and vaccines and antiviral drugs for monkeypox

Monkeypox virus (MPXV), genetic closely linked to the notorious variola (smallpox) virus, currently causes several clusters and outbreaks in the areas outside Africa and is noted to be phylogenetically related to the West African clade. To prepare for the upsurge of the cases of monkeypox in the Europe and North America, two vaccines, Jynneos® in the U.S. (Imvamune® in Canada or Imvanex® in the Europe) and ACAM2000® (Acambis, Inc.) initially developed in the smallpox eradication program, can provide protective immunity to monkeypox, and their production and availability are rapidly scaled up in the response to the emerging threat. So far, these two vaccines are recommended for people at a high risk for monkeypox, instead of universal vaccination. Tecovirimat, an inhibitor of extracellular virus formation, and brincidofovir, a lipid conjugate of cidofovir, both are in vitro and in vivo active against MPXV, and are suggested for immunocompromised persons, who are at risk to develop severe diseases. However, current general consensus in the response to the monkeypox outbreak among public health systems is early identification and isolation of infected patients to prevent its spread.

Monkeypox virus neurological manifestations in comparison to other orthopoxviruses

Viral infectious diseases have various neurological manifestations, whether they are epidemic or pandemic in nature. Nonspecific encephalopathy is the most common central nervous system (CNS) manifestation. The spectrum of nervous evidence varies for viral pathogens. Some infectious viruses, such as the Ebola virus, exhibit direct neurotropism. Others, such as the Rift Valley fever virus, have the potential for neurotropism. Direct neurotropism is unknown in monkeypox virus, SARS-CoV-2, MERS-CoV, and even smallpox. As seen in the COVID-19, there may be evidence of para-infectious neurological syndrome. There have only been a few reports of neurological diseases caused by monkeypox infection. Future efforts to prevent the spread of infectious disease surges can reduce mortality complications, the therapeutic burden on the health-care system, and prevent further spread. This study describes the clinical and neurological complications of monkeypox infection, particularly encephalitis, as well as the laboratory diagnosis of these cases.

Monkeypox: Some Keys to Understand This Emerging Disease

In 1958, several monkeys in a Copenhagen laboratory developed a skin rash from which an orthopoxvirus could be isolated, which was named monkeypox virus (MPXV). However, the natural animal reservoir for MPXV is thought to be a rodent. The first human case occurred in 1970, and the incidence has increased progressively throughout the years. Starting May 2022, the number of cases outside Africa has soared, especially in Western Europe. There are two clades of MPXV, Congo Basin, with higher virulence and mortality, and Western Africa (WA). MPXV from the present outbreak has been proposed to be classified as Clade 3, distinct from the WA clade by at least 50 substitutions, which may increase human-to-human transmissibility. Most cases correspond to men in their 30s who have sex with men, and the possibility of sexual transmission is under investigation. Though there is no evidence of human-to-animal transmission, pets of positive human cases may be classified as low risk, including dogs, cats, and birds, who can be quarantined at home, and high risk, such as pet rabbits or mice, who should be isolated in official laboratories for observation. The current epidemiological data do not support the risk of a pandemic.

Recent advances in the diagnosis monkeypox: implications for public health

Introduction

Monkeypox virus is a zoonotic double-stranded DNA poxvirus in the genus Orthopoxvirus, family Poxviridae. Until recently, monkeypox was found primarily in Central and West Africa, where the virus had split into Congo Basin and West African clades.

Areas Covered

On 6 May 2022, monkeypox was detected in the United Kingdom and the virus has now been detected in every continent except Antarctica. The current outbreak represents the first documentation of widespread community transmission outside of Africa.

Expert Opinion

On 23 July 2022, the World Health Organization declared monkeypox a public health emergency of international concern and issued a series of guidance and recommendations for governments, health professionals and the public. This manuscript reviews what is known about monkeypox virus, with a focus on recent diagnostics and epidemiologic advances, and explores how recent advances in our understanding of the virus will be used to combat the expanding outbreak.

Prevention and Treatment of Monkeypox: A Step-by-Step Guide for Healthcare Professionals and General Population

The World Health Organization (WHO) recently declared the monkeypox virus a Public Health Emergency of International Concern (PHEIC). As the cases of the COVID-19 pandemic start to get under control, we have seen the monkeypox virus, found predominantly in Africa, spread in non-endemic countries worldwide. In the 1970s, after the smallpox virus eradication and the vaccine's discontinuation, the monkeypox virus infection started to gain attention. The first United States outbreak happened in 2003; since then, more sporadic cases of monkeypox have gained media attention. With cases spreading worldwide, without epidemiological links with outbreaks among men who have sex with men (MSM), it warrants urgent public health control measures to contain the spread of the monkeypox virus and investigate the underlying pathophysiology, including genetic modification of the virus. This review highlights the epidemiology, transmission, pathogenesis, clinical manifestation, diagnosis, prevention, and management of the current human monkeypox virus infection.

Insights into the Monkeypox virus: making of another pandemic within the pandemic?

Just when the world started to adapt to the 'new normal' amid the coronavirus disease 19 (COVID-19) pandemic, the world is witnessing the wrath of another viral disease, the monkeypox virus (MPXV). The virus is endemic to African countries, where several outbreaks have been reported in the past. However, the present cases have been reported in non-endemic countries worldwide. Although MPX is considered to be a self-limiting disease, recent reports on its incidence have proved otherwise. The 2022 multi-country MPX outbreak has drawn the attention of global surveillance organizations and epidemiologists to trace its origin, however, there are existing gaps regarding the animal reservoirs, biological implications, and management of MPX. In view of the recent events, the World Health Organization (WHO) has also declared the ongoing MPX outbreak a global health emergency. Hence, the geographically expanding MPXV poses a significant threat to human health and public safety. In this review, the latest insights into the biology of MPXV have been provided by discussing its biological implications on human health, changing epidemiological footprint, and presently available intervention strategies. This review also sheds light on the existing lacunas and possible reasons that may have been responsible for the ongoing MPX outbreak. This article is protected by copyright. All rights reserved.