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Li D, Wang H, Sun L, Feng J, Li W, Cheng L, Liao X, Zhang Y, Xu Z, Ge X, Zhou B, Zhao J, Ju B, Lu H, Zhang Z. Levels of antibodies against the monkeypox virus compared by HIV status and historical smallpox vaccinations: a serological study. Emerg Microbes Infect 2024; 13:2356153. [PMID: 38767199 PMCID: PMC11138228 DOI: 10.1080/22221751.2024.2356153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
Men who have sex with men and people living with HIV are disproportionately affected in the 2022 multi-country monkeypox epidemic. The smallpox vaccine can induce cross-reactive antibodies against the monkeypox virus (MPXV) and reduce the risk of infection. Data on antibodies against MPXV induced by historic smallpox vaccination in people with HIV are scarce. In this observational study, plasma samples were collected from people living with and without HIV in Shenzhen, China. We measured antibodies binding to two representative proteins of vaccinia virus (VACV; A27L and A33R) and homologous proteins of MPXV (A29L and A35R) using an enzyme-linked immunosorbent assay. We compared the levels of these antibodies between people living with and without HIV. Stratified analyses were performed based on the year of birth of 1981 when the smallpox vaccination was stopped in China. Plasma samples from 677 people living with HIV and 746 people without HIV were tested. A consistent pattern was identified among the four antibodies, regardless of HIV status. VACV antigen-reactive and MPXV antigen-reactive antibodies induced by historic smallpox vaccination were detectable in the people born before 1981, and antibody levels reached a nadir during or after 1981. The levels of smallpox vaccine-induced antibodies were comparable between people living with HIV and those without HIV. Our findings suggest that the antibody levels against MPXV decreased in both people living with and without HIV due to the cessation of smallpox vaccination.
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Affiliation(s)
- Dapeng Li
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Haiyan Wang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Liqin Sun
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Department of Infection & Immunity, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
| | - Jiamin Feng
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Wenting Li
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Lin Cheng
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Xuejiao Liao
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Yangzhen Zhang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Zhongxian Xu
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Xiangyang Ge
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Bing Zhou
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Juanjuan Zhao
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
| | - Bin Ju
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Guangdong Key Laboratory for Anti-infection Drug Quality Evaluation, Shenzhen, People’s Republic of China
| | - Hongzhou Lu
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Department of Infection & Immunity, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
| | - Zheng Zhang
- Institute for Hepatology, National Clinical Research Center for Infectious Disease, Shenzhen Third People’s Hospital, Shenzhen, People’s Republic of China
- The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, People’s Republic of China
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Guangdong Key Laboratory for Anti-infection Drug Quality Evaluation, Shenzhen, People’s Republic of China
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2
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Hemati S, Mohammadi-Moghadam F. A systematic review on environmental perspectives of monkeypox virus. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:363-370. [PMID: 36593124 DOI: 10.1515/reveh-2022-0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Monkeypox (MPX) is one of the common infections between humans and animals that caused by a virus belonging to the Orthopoxvirus genus. The Monkeypox virus (MPXV) outbreak is a global crisis triggered by environmental factors (virus, wastewater, surface, air) and amplified by the decisions of government officials and communities. The aim of this systematic review is to describe the environmental perspectives of MPXV with emphasis on risk assessment to prevent and control a new pandemic. Five online databases including Web of Science, PubMed, Scopus, Science Direct and Google Scholar were searched from 1990 to October 2022. Among 120 records, after the screening, four studies were included in the systematic review. The systematic review revealed that the possibility of MPXV transmission through wastewater, air, and the contaminated surfaces is a significant concern and its detection and destroying will play a major role in controlling the spread of the virus. Poxviruses have a high environmental stability, but are sensitive to all common chemical disinfectants. In conclusion, this study revealed that the environmental surveillance can be used as a complementary tool for detecting pathogens circulation in communities. This implies that the monitoring of environmental perspectives of MPXV can provide new awareness into virus transmission routes as well as the role of stakeholders and public health policies in MPXV risk management.
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Affiliation(s)
- Sara Hemati
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fazel Mohammadi-Moghadam
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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3
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Moss B. Understanding the biology of monkeypox virus to prevent future outbreaks. Nat Microbiol 2024; 9:1408-1416. [PMID: 38724757 DOI: 10.1038/s41564-024-01690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/26/2024] [Indexed: 06/07/2024]
Abstract
Historically, monkeypox (mpox) was a zoonotic disease endemic in Africa. However, in 2022, a global outbreak occurred following a substantial increase in cases in Africa, coupled with spread by international travellers to other continents. Between January 2022 and October 2023, about 91,000 confirmed cases from 115 countries were reported, leading the World Health Organization to declare a public health emergency. The basic biology of monkeypox virus (MPXV) can be inferred from other poxviruses, such as vaccinia virus, and confirmed by genome sequencing. Here the biology of MPXV is reviewed, together with a discussion of adaptive changes during MPXV evolution and implications for transmission. Studying MPXV biology is important to inform specific host interactions, to aid in ongoing outbreaks and to predict those in the future.
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Affiliation(s)
- Bernard Moss
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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4
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Araf Y, Nipa JF, Naher S, Maliha ST, Rahman H, Arafat KI, Munif MR, Uddin MJ, Jeba N, Saha S, Zhai J, Hasan SMN, Xue M, Hossain MG, Zheng C. Insights into the Transmission, Host Range, Genomics, Vaccination, and Current Epidemiology of the Monkeypox Virus. Vet Med Int 2024; 2024:8839830. [PMID: 38836166 PMCID: PMC11150048 DOI: 10.1155/2024/8839830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 06/06/2024] Open
Abstract
This review delves into the historical context, current epidemiological landscape, genomics, and pathobiology of monkeypox virus (MPXV). Furthermore, it elucidates the present vaccination status and strategies to curb the spread of monkeypox. Monkeypox, caused by the Orthopoxvirus known as MPXV, is a zoonotic ailment. MPXV can be transmitted from person to person through respiratory droplets during prolonged face-to-face interactions. While many cases of monkeypox are self-limiting, vulnerable groups such as young children, pregnant women, and immunocompromised individuals may experience severe manifestations. Diagnosis predominantly relies on clinical presentations, complemented by laboratory techniques like RT-PCR. Although treatment is often not required, severe cases necessitate antiviral medications like tecovirimat, cidofovir, and brincidofovir. Vaccination, particularly using the smallpox vaccine, has proven instrumental in outbreak control, exhibiting an efficacy of at least 85% against mpox as evidenced by data from Africa. Mitigating transmission requires measures like wearing surgical masks, adequately covering skin lesions, and avoiding handling wild animals.
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Affiliation(s)
- Yusha Araf
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Biotechnology, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Jannatul Ferdous Nipa
- Department of Genetic Engineering and Biotechnology, East West University, Dhaka 1212, Bangladesh
| | - Sabekun Naher
- Department of Microbiology, Faculty of Biological Sciences, University of Chittagong, Chittagong 4331, Bangladesh
| | - Sumaiya Tasnim Maliha
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, BRAC University, Dhaka, Bangladesh
| | - Hasanur Rahman
- Department of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Faculty of Life Sciences, Gopalganj, Bangladesh
| | - Kazi Ifthi Arafat
- Department of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Faculty of Life Sciences, Gopalganj, Bangladesh
| | - Mohammad Raguib Munif
- Department of Surgery and Obstetrics, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Md Jamal Uddin
- ABEx Bio-Research Center, East Azampur, Dhaka 1230, Bangladesh
| | - Nurejunnati Jeba
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Sukumar Saha
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Jingbo Zhai
- Key Laboratory of Zoonose Prevention and Control at Universities of Inner Mongolia Autonomous Region, Medical College, Inner Mongolia Minzu University, Tongliao 028000, China
| | - S M Nazmul Hasan
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, 2 Jingba Road, Zhengzhou, Henan 450001, China
| | - Md Golzar Hossain
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh
| | - Chunfu Zheng
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, AB, Canada
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Griffin I, Berry I, Navarra T, Priyamvada L, Carson WC, Noiman A, Jackson DA, Waltenburg MA, Still W, Lujan L, Beverly J, Willut C, Lee M, Mangla A, Shelus V, Hutson CL, Townsend MB, Satheshkumar PS. Serologic responses to the MVA-based JYNNEOS mpox vaccine in a cohort of participants from the District of Columbia (D.C.). Vaccine 2024:S0264-410X(24)00563-2. [PMID: 38762357 DOI: 10.1016/j.vaccine.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
We assessed early antibody responses after two doses of JYNNEOS (IMVANEX) mpox vaccine in the District of Columbia (D.C.) in persons at high risk for mpox without characteristic lesions or rash. Participants with PCR mpox negative specimens (oral swab, blood, and/or rectal swab) on the day of receipt of the first vaccine dose and who provided a baseline (day 0) serum sample and at least one serum sample at ∼28, ∼42-56 days, or 180 days post vaccination were included in this analysis. Orthopoxvirus (OPXV)-specific IgG and IgM ELISAs and neutralizing antibody titers were performed, and longitudinal serologic responses were examined. Based on participants' IgG and IgM antibody levels at baseline, they were categorized as naïve or non-naïve. Linear mixed effects regression models were conducted to determine if IgG antibody response over time varied by age, sex, HIV status, and route of administration for both naïve and non-naïve participants. Among both naïve and non-naïve participants IgG seropositivity rates increased until day 42-56, with 89.4 % of naïve and 92.1 % of non-naïve participants having detectable IgG antibodies. The proportion of naive participants with detectable IgG antibodies declined by day 180 (67.7 %) but remained high among non-naïve participants (94.4 %). Neutralizing antibody titers displayed a similar pattern, increasing initially post vaccination but declining by day 180 among naïve participants. There were no significant serologic response differences by age, sex, or HIV status. Serologic response did vary by route of vaccine administration, with those receiving a combination of intradermal and subcutaneous doses displaying significantly higher IgG values than those receiving both doses intradermally. These analyses provide initial insights into the immunogenicity of a two-dose JYNNEOS PEP regimen in individuals at high risk of mpox exposure in the United States.
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Affiliation(s)
- Isabel Griffin
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isha Berry
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terese Navarra
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lalita Priyamvada
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William C Carson
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adi Noiman
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David A Jackson
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA
| | - Michelle A Waltenburg
- Centers for Disease Control and Prevention Multinational Monkeypox Response, Atlanta, GA, USA
| | | | | | | | | | | | | | - Victoria Shelus
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L Hutson
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael B Townsend
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Panayampalli S Satheshkumar
- CDC Monkeypox Laboratory Task Force, USA; Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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6
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Acharya A, Kumar N, Singh K, Byrareddy SN. "Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches". Biomed J 2024:100746. [PMID: 38734408 DOI: 10.1016/j.bj.2024.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/07/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024] Open
Abstract
Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission, this review discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.
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Affiliation(s)
- Arpan Acharya
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Narendra Kumar
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kamal Singh
- Department of Veterinary Pathobiology, College of Veterinary Medicine, and Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
| | - Siddappa N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Genetics, Cell Biology and Anatomy, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Biochemistry and Molecular Biology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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7
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Shan KJ, Wu C, Tang X, Lu R, Hu Y, Tan W, Lu J. Molecular Evolution of Protein Sequences and Codon Usage in Monkeypox Viruses. GENOMICS, PROTEOMICS & BIOINFORMATICS 2024; 22:qzad003. [PMID: 38862422 DOI: 10.1093/gpbjnl/qzad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 06/13/2024]
Abstract
The monkeypox virus (mpox virus, MPXV) epidemic in 2022 has posed a significant public health risk. Yet, the evolutionary principles of MPXV remain largely unknown. Here, we examined the evolutionary patterns of protein sequences and codon usage in MPXV. We first demonstrated the signal of positive selection in OPG027, specifically in the Clade I lineage of MPXV. Subsequently, we discovered accelerated protein sequence evolution over time in the variants responsible for the 2022 outbreak. Furthermore, we showed strong epistasis between amino acid substitutions located in different genes. The codon adaptation index (CAI) analysis revealed that MPXV genes tended to use more non-preferred codons compared to human genes, and the CAI decreased over time and diverged between clades, with Clade I > IIa and IIb-A > IIb-B. While the decrease in fatality rate among the three groups aligned with the CAI pattern, it remains unclear whether this correlation was coincidental or if the deoptimization of codon usage in MPXV led to a reduction in fatality rates. This study sheds new light on the mechanisms that govern the evolution of MPXV in human populations.
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Affiliation(s)
- Ke-Jia Shan
- State Key Laboratory of Protein and Plant Gene Research, Center for Bioinformatics, School of Life Sciences, Peking University, Beijing 100871, China
- Sinovac Biotech Ltd., Beijing 100085, China
| | - Changcheng Wu
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China
| | - Xiaolu Tang
- State Key Laboratory of Protein and Plant Gene Research, Center for Bioinformatics, School of Life Sciences, Peking University, Beijing 100871, China
| | - Roujian Lu
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China
| | - Yaling Hu
- Sinovac Biotech Ltd., Beijing 100085, China
| | - Wenjie Tan
- NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China
| | - Jian Lu
- State Key Laboratory of Protein and Plant Gene Research, Center for Bioinformatics, School of Life Sciences, Peking University, Beijing 100871, China
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Mercy K, Tibebu B, Fallah M, Faria NR, Ndembi N, Tebeje YK. Mpox continues to spread in Africa and threatens global health security. Nat Med 2024; 30:1225-1226. [PMID: 38472296 DOI: 10.1038/s41591-024-02862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- Kyeng Mercy
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bethelhem Tibebu
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mosoka Fallah
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Nuno R Faria
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nicaise Ndembi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
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9
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Tan RKJ, Perera D, Arasaratnam S, Kularathne Y. Adapting an artificial intelligence sexually transmitted diseases symptom checker tool for Mpox detection: the HeHealth experience. Sex Health 2024; 21:SH23197. [PMID: 38743839 DOI: 10.1071/sh23197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
Artificial Intelligence (AI) applications have shown promise in the management of pandemics. In response to the global Monkeypox (Mpox) outbreak, the HeHealth.ai team leveraged an existing tool to screen for sexually transmitted diseases (STD) to develop a digital screening test for symptomatic Mpox using AI. Before the global Mpox outbreak, the team developed a smartphone app (HeHealth) where app users can use a smartphone to photograph their own penises to screen for symptomatic STD. The AI model initially used 5000 cases and a modified convolutional neural network to output prediction scores across visually diagnosable penis pathologies including syphilis, herpes simplex virus, and human papillomavirus. A total of about 22,000 users had downloaded the HeHealth app, and ~21,000 images were analysed using HeHealth AI technology. We then used formative research, stakeholder engagement, rapid consolidation images, a validation study, and implementation of the tool. A total of 1000 Mpox-related images had been used to train the Mpox symptom checker tool. Based on an internal validation, our digital symptom checker tool showed specificity of 87% and sensitivity of 90% for symptomatic Mpox. Several hurdles identified included issues of data privacy and security for app users, initial lack of data to train the AI tool, and the potential generalisability of input data. We offer several suggestions to help others get started on similar projects in emergency situations, including engaging a wide range of stakeholders, having a multidisciplinary team, prioritising pragmatism, as well as the concept that 'big data' in fact is made up of 'small data'.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; and HeHealth.ai, Singapore, Singapore
| | - Dilruk Perera
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; and HeHealth.ai, Singapore, Singapore
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Bakare D, Salako J, Sogbesan A, Olojede O, Bakare A. ASSESSMENT OF THE LEVEL OF AWARENESS, KNOWLEDGE, AND RISK PERCEPTION OF COMMUNITY MEMBERS ABOUT MPOX INFECTION IN NIGERIA. Ann Ib Postgrad Med 2024; 22:76-87. [PMID: 38939883 PMCID: PMC11205717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/01/2024] [Indexed: 06/29/2024] Open
Abstract
Background Since the resurgence of mpox disease in 2017, Nigeria alone has accounted for about 60% of confirmed cases reported in the African region. This study therefore aimed to understand the knowledge and perception of the general public towards the mpox infection. Methods We conducted a cross-sectional study among 958 community members across three states (Oyo, Lagos and Jigawa) in Nigeria. Knowledge of mpox infection was assessed across four domains: (1) general knowledge, (2) transmission, (3) signs and symptoms, and (4) prevention and treatment where we assigned a score of 1 for each correct response. Binary logistic regression was conducted to explore factors associated with knowledge of mpox infection at 5% level of significance. We assessed perception of mpox infection across 5 constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) from the health belief model, using 3-point Likert scales. We used Kruskal-Wallis and Mann-Whitney- U tests to assess factors associated with each construct. Results Overall, only about one-third (38.3%) of community members were aware of mpox infection. There were variations in perceptions and knowledge across the three states. Knowledge of mpox infection transmission, prevention, and treatment was low across the states. Only 28.9% of respondents knew that sharing utensils with an infected person is a means of contracting the disease, and just 15.9% were aware that mpox infection may resolve spontaneously. The mean of general knowledge scores was higher in Jigawa 14.8 (±3.2) compared to Lagos 12.1 (±4.1) and Oyo states 12.5 (±5.6) (p<0.001).Respondents with tertiary-level education (p=0.001) were significantly more likely to perceive themselves as susceptible to mpox while males (p<0.001) and respondents who live in Jigawa state (p=0.002) were significantly more likely to perceive mpox as severe with 90.5% believing that being infected will stop their daily activity (p<0.001). Perceived barriers to adherence to mpox preventive strategies were higher in Jigawa state (p<0.001), with 68.3% reporting that use of hand sanitizers might be expensive for them. Conclusion The analysis of our findings revealed significant knowledge gaps and a very low level of public awareness about mpox. Key areas of limited knowledge included the disease's route of transmission, as well as its prevention and treatment. To control the spread of mpox infection, there is need to strengthen public health risk communication focusing on the transmission and preventive actions.
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Affiliation(s)
- D. Bakare
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - J. Salako
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - A. Sogbesan
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - O.E Olojede
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - A.A Bakare
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
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11
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Manabe YC, Hardick J, Uhteg K, Ramdeep N, Armington G, Mostafa HH, Hamill MM. Retrospective monkeypox virus (MPXV) surveillance among male users of I Want The Kit in Maryland, United States. Clin Infect Dis 2024:ciae208. [PMID: 38629511 DOI: 10.1093/cid/ciae208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
Retrospective surveillance leveraging male rectal swab sample remnants from I Want The Kit from July 2021 through October 2023, identified one symptomatic and one asymptomatic mpox case at the peak of transmission in 2022. Although sporadic cases continue to be reported in Maryland, additional asymptomatic cases were not identified in this leveraged surveillance.
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Affiliation(s)
- Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin Hardick
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine Uhteg
- Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nisha Ramdeep
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gretchen Armington
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Heba H Mostafa
- Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew M Hamill
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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12
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Zhao B, Liu Q, Du Q, Kang J, Tang R, Tu Y, Liu D. Characteristics and Differences in Mpox Patients with and without HIV Infection: A Retrospective Cross-Sectional Study in Chengdu, China. Int J Gen Med 2024; 17:1381-1393. [PMID: 38617056 PMCID: PMC11011692 DOI: 10.2147/ijgm.s456198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose To date, there are few reports about mpox case series in China, and scarce information is available about the in-vivo kinetics of T-cell responses in the early stage of mpox infection. This study aims to investigate the clinical difference among mpox patients with and without human immunodeficiency virus (HIV) infection. Patients and Methods A total of 56 patients diagnosed with mpox by Chengdu Center for Disease Control and Prevention (CDC) and hospitalized in Public Health Clinical Center of Chengdu were retrospectively included and divided into an HIV-infected group (n=23) and a non-HIV-infected group (n=33). Clinical characteristics and serum chemistry findings of mpox patients were collected in order to analyze the differences between the HIV-infected group and the non-HIV-infected group. Results Multiple laboratory abnormalities, including elevated C-reactive protein (69.1%), hypocalcemia (50.9%), elevated CD3+CD8+T counts (47.0%) and inverted ratio of CD3+CD4+T to CD3+CD8+T (64.7%) were common in mpox cases. There were statistically significant differences (all P < 0.05) in age, serum calcium levels, CD3+CD4+T counts, the ratio of CD3+CD4+T to CD3+CD8+T, proportion with >10 rashes, incidence of proctitis anus and time from rash growth to rash scab shedding between HIV-infected group and non-HIV-infected group. In the early stage of mpox infection, the median of CD3+CD8+T counts in the non-HIV-infected group was significantly higher than that in healthy donors (P<0.001), and the median of CD3+CD4+T/CD3+CD8+T ratio was significantly lower (P<0.001). The median of CD3+CD4+T counts in mpox patients co-infected with HIV significantly decreased compared to the pre-infection level (p =0.033). Conclusion Our study indicates that mpox co-infected with HIV patients have longer lasting rash lesions and a higher incidence of proctitis anus. T-cell responses may be different between HIV-infected and non-HIV-infected individuals in the early stage of mpox infection.
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Affiliation(s)
- Bennan Zhao
- The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Qingxiao Liu
- Department of Neurology, Hospital of Chengdu University of TCM, Chengdu, People’s Republic of China
| | - Qing Du
- The Second Ward of ICU, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Jun Kang
- The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Rong Tang
- Department of Integrated Chinese and Western Medicine, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Yalan Tu
- Scientific Research and Teaching Department, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Dafeng Liu
- The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
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13
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Hassan R, Meehan AA, Hughes S, Beeson A, Spencer H, Howard J, Tietje L, Richardson M, Schultz A, Zawitz C, Ghinai I, Hagan LM. Health Belief Model to Assess Mpox Knowledge, Attitudes, and Practices among Residents and Staff, Cook County Jail, Illinois, USA, July-August 2022. Emerg Infect Dis 2024; 30:S49-S55. [PMID: 38561645 PMCID: PMC10986831 DOI: 10.3201/eid3013.230643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
In summer 2022, a case of mpox was confirmed in a resident at the Cook County Jail (CCJ) in Chicago, Illinois, USA. We conducted in-depth interviews with CCJ residents and staff to assess mpox knowledge, attitudes, and practices; hygiene and cleaning practices; and risk behaviors. We characterized findings by using health belief model constructs. CCJ residents and staff perceived increased mpox susceptibility but were unsure about infection severity; they were motivated to protect themselves but reported limited mpox knowledge as a barrier and desired clear communication to inform preventive actions. Residents expressed low self-efficacy to protect themselves because of contextual factors, including perceived limited access to cleaning, disinfecting, and hygiene items. Our findings suggest correctional facilities can support disease prevention by providing actionable and tailored messages; educating residents and staff about risk and vaccination options; and ensuring access to and training for hygiene, cleaning, and disinfecting supplies.
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14
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Mazumder A, Lim L, White CM, Van Gerwen OT. A Case of Varicella Zoster and Mpox Coinfection in a Patient Living With HIV. Sex Transm Dis 2024; 51:e14-e16. [PMID: 38301635 DOI: 10.1097/olq.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT We present a case of recurrent, cutaneous mpox with coinfection of disseminated varicella zoster in an immunocompromised patient with poorly controlled HIV. This case demonstrates the importance of maintaining a high index of suspicion for mpox despite prior infection and vaccination, as suboptimal immune response is possible in immunocompromised patients, and also noting the potential for coinfection necessitating timely diagnosis and appropriate testing.
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Affiliation(s)
- Archisman Mazumder
- From the Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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15
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Jaleel A, Farid G, Irfan H, Mahmood K, Baig S. A Systematic Review on the Mental Health Status of Patients Infected With Monkeypox Virus. Soa Chongsonyon Chongsin Uihak 2024; 35:107-118. [PMID: 38601106 PMCID: PMC11001497 DOI: 10.5765/jkacap.230064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 04/12/2024] Open
Abstract
Objectives This study aims to extract and summarize the literature on the mental health status of patients with monkeypox. Methods This review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using different databases and publishers such as Scopus, Sage, ScienceDirect, PubMed, BMJ, Wiley Online Library, Wolters Kluwer OVID-SP, and Google Scholar. The literature review was based on monkeypox and mental health. The year of publication was 2021-2023, during the monkeypox disease period. Data were extracted from opinions, editorials, empirical studies, and surveys. Results Based on the literature related to the mental status of patients with monkeypox, the following themes and subthemes were identified: anxiety and depression, self-harm and suicidal tendencies, neuropsychiatric symptoms, mental health, social stigma, sex workers, vaccination, and stress-related diseases. Conclusion A review of monkeypox virus infection studies reveals that 25%-50% of patients experience anxiety and depression due to isolation, boredom, and loneliness. Factors such as infected people, a lack of competence among healthcare professionals, and shame over physical symptoms exacerbate mental insults. The implications of society include increased self-harm, suicide, low productivity, fear of stigmatization, and transmission of infection.
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Affiliation(s)
- Anila Jaleel
- Department of Biochemistry, Shalimar Medical and Dental College, Lahore, Pakistan
| | - Ghulam Farid
- Shalimar Medical and Dental College, Lahore, Pakistan
| | - Haleema Irfan
- Department of Biochemistry, Shalimar Medical and Dental College, Lahore, Pakistan
| | - Khalid Mahmood
- Information Management, University of Punjab, Lahore, Pakistan
| | - Saeeda Baig
- Department of Biochemistry, Ziauddin University, Karachi, Pakistan
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16
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García-Hernández L, Hernández-Aceituno A, Moreno Saavedra RJ, Larumbe-Zabala E. Case report: clinical presentation of Monkeypox in pregnancy. Rev Clin Esp 2024; 224:245-247. [PMID: 38401666 DOI: 10.1016/j.rceng.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Affiliation(s)
- Laura García-Hernández
- Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Spain
| | - Ana Hernández-Aceituno
- Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
| | - Ricardo Jesus Moreno Saavedra
- Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eneko Larumbe-Zabala
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FCIISC), Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Spain
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17
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Sun Y, Nie W, Tian D, Ye Q. Human monkeypox virus: Epidemiologic review and research progress in diagnosis and treatment. J Clin Virol 2024; 171:105662. [PMID: 38432097 DOI: 10.1016/j.jcv.2024.105662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
Monkeypox virus (MPXV) is responsible for causing a zoonotic disease called monkeypox (mpox), which sporadically infects humans in West and Central Africa. It first infected humans in 1970 and, along with the variola virus, belongs to the genus Orthopoxvirus in the poxvirus family. Since the World Health Organization declared the MPXV outbreak a "Public Health Emergency of International Concern" on July 23, 2022, the number of infected patients has increased dramatically. To control this epidemic and address this previously neglected disease, MPXV needs to be better understood and reevaluated. In this review, we cover recent research on MPXV, including its genomic and pathogenic characteristics, transmission, mutations and mechanisms, clinical characteristics, epidemiology, laboratory diagnosis, and treatment measures, as well as prevention of MPXV infection in light of the 2022 and 2023 global outbreaks. The 2022 MPXV outbreak has been primarily associated with close intimate contact, including sexual activity, with most cases diagnosed among men who have sex with men. The incubation period of MPXV infection usually lasts from 6 to 13 days, and symptoms include fever, muscle pains, headache, swollen lymph nodes, and a characteristic painful rash, including several stages, such as macules, papules, blisters, pustules, scabs, and scab shedding involving the genitals and anus. Polymerase chain reaction (PCR) is usually used to detect MPXV in skin lesion material. Treatment includes supportive care, antivirals, and intravenous vaccinia immune globulin. Smallpox vaccines have been designed with four givens emergency approval for use against MPXV infection.
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Affiliation(s)
- Yanhong Sun
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Wenjian Nie
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Dandan Tian
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Qing Ye
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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18
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Sanchez Clemente N, Coles C, Paixao ES, Brickley EB, Whittaker E, Alfven T, Rulisa S, Agudelo Higuita N, Torpiano P, Agravat P, Thorley EV, Drysdale SB, Le Doare K, Muyembe Tamfum JJ. Paediatric, maternal, and congenital mpox: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e572-e588. [PMID: 38401556 DOI: 10.1016/s2214-109x(23)00607-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 02/26/2024]
Abstract
BACKGROUND Although mpox has been detected in paediatric populations in central and west Africa for decades, evidence synthesis on paediatric, maternal, and congenital mpox, and the use of vaccines and therapeutics in these groups, is lacking. A systematic review is therefore indicated to set the research agenda. METHODS We conducted a systematic review and meta-analysis, searching articles in Embase, Global Health, MEDLINE, CINAHL, Web of Science, Scopus, SciELO, and WHO databases from inception to April 17, 2023. We included studies reporting primary data on at least one case of confirmed, suspected, or probable paediatric, maternal, or congenital mpox in humans or the use of third-generation smallpox or mpox vaccines, targeted antivirals, or immune therapies in at least one case in our population of interest. We included clinical trials and observational studies in humans and excluded reviews, commentaries, and grey literature. A pooled estimate of the paediatric case fatality ratio was obtained using random-effects meta-analysis. This study is registered with PROSPERO (CRD420223336648). FINDINGS Of the 61 studies, 53 reported paediatric outcomes (n=2123 cases), seven reported maternal or congenital outcomes (n=32 cases), two reported vaccine safety (n=28 recipients), and three reported transmission during breastfeeding (n=4 cases). While a subset of seven observational studies (21 children and 12 pregnant individuals) reported uneventful treatment with tecovirimat, there were no randomised trials reporting safety or efficacy for any therapeutic agent. Among children, the commonest clinical features included rash (86 [100%] of 86), fever (63 [73%] of 86), and lymphadenopathy (40 [47%] of 86). Among pregnant individuals, rash was reported in 23 (100%) of 23; fever and lymphadenopathy were less common (six [26%] and three [13%] of 23, respectively). Most paediatric complications (12 [60%] of 20) arose from secondary bacterial infections. The pooled paediatric case fatality ratio was 11% (95% CI 4-20), I2=75%. Data from 12 pregnancies showed half resulted in fetal death. Research on vaccine and immune globulin safety remains scarce for children and absent for pregnant individuals. INTERPRETATION Our review highlights critical knowledge gaps in the epidemiology, prevention, and treatment of mpox in children and pregnant individuals, especially those residing in endemic countries. Increased funding, international collaboration, and equitable research is needed to inform mpox control strategies tailored for at-risk communities in endemic countries. FUNDING None. TRANSLATIONS For the French, Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Nuria Sanchez Clemente
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK; Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Charlotte Coles
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Enny S Paixao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK; Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Stephen Rulisa
- School of Medicine and Pharmacy, University of Rwanda and University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Nelson Agudelo Higuita
- Department of Medicine, Section of Infectious Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal, Tegucigalpa, Honduras
| | - Paul Torpiano
- Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Malta
| | - Priyesh Agravat
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Emma V Thorley
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Simon B Drysdale
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St George's University, London, UK; Centre of Excellence in Maternal Vaccination, Makerere University, John Hopkins University, Kampala, Uganda; Pathogen Immunology Group, UK Health Security Agency, Porton Down, UK
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19
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Cadmus S, Akinseye V, Besong M, Olanipekun T, Fadele J, Cadmus E, Ansumana R, Oluwayelu D, Odemuyiwa SO, Tomori O. Dynamics of Mpox infection in Nigeria: a systematic review and meta-analysis. Sci Rep 2024; 14:7368. [PMID: 38548826 PMCID: PMC10978922 DOI: 10.1038/s41598-024-58147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/26/2024] [Indexed: 04/01/2024] Open
Abstract
The seasonal outbreaks of Mpox continue in most parts of West and Central Africa. In the past year, Nigeria had the highest number of reported cases. Here, we used the PRISMA guidelines to carry out a systematic review and meta-analysis of available evidence on Mpox in Nigeria to assess the prevalence, transmission pattern, diagnostic approach, and other associated factors useful for mitigating the transmission of the disease. All relevant observational studies in PubMed/MEDLINE, Embase, AJOL, Web of Science, Scopus and Google Scholar on Mpox in Nigeria were assessed within the last fifty years (1972 to 2022). In all, 92 relevant articles were retrieved, out of which 23 were included in the final qualitative analysis. Notably, most of the cases of Mpox in Nigeria were from the southern part of the country. Our findings showed a progressive spread from the southern to the northern region of the country. We identified the following factors as important in the transmission of Mpox in Nigeria; poverty, lack of basic healthcare facilities, and risk of exposure through unsafe sexual practices. Our findings reiterate the need to strengthen and expand existing efforts as well as establish robust multi-sectoral collaboration to understand the dynamics of Mpox Nigeria.
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Affiliation(s)
- Simeon Cadmus
- Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria.
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria.
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria.
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria.
| | - Victor Akinseye
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
- Department of Chemical Sciences, Augustine University, Ilara-Epe, Lagos, Nigeria
| | - Matthias Besong
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
- Federal Ministry of Agriculture and Food Security, Abuja, Nigeria
| | - Tobi Olanipekun
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
| | - John Fadele
- Damien Foundation Genomics and Mycobacteria Research and Training Centre, University of Ibadan, Ibadan, Nigeria
| | - Eniola Cadmus
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Daniel Oluwayelu
- Centre for Control and Prevention of Zoonoses, University of Ibadan, Ibadan, Nigeria
- Department of Microbiology, University of Ibadan, Ibadan, Nigeria
| | - Solomon O Odemuyiwa
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA
| | - Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun State, Nigeria
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20
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Wendorf KA, Ng R, Stainken C, Haddix M, Peterson E, Watson J, Sachdev D. Household Transmission of Mpox to Children and Adolescents, California, 2022. J Infect Dis 2024; 229:S203-S206. [PMID: 37831784 DOI: 10.1093/infdis/jiad448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND In California, the 2022 mpox outbreak cumulated 5572 cases, 20% of US cases, as of November 28, 2022; 0.3% of cases were among children <16 years old. The secondary attack rate (SAR) for children sharing households with infected adults is unknown. METHODS A line list of pediatric mpox household contacts aged <16 years reported through August 31, 2022 was created. It included demographic and clinical information on the contacts. Pediatric contact lists were crossmatched with the state vaccination database to identify those who received postexposure prophylaxis (PEP) with the JYNNEOS vaccine. RESULTS We identified 129 pediatric household contacts with median age of 7 years (range, 0-15 years). Among 18 symptomatic contacts, 12 (66.7%) underwent mpox testing; 5 (41.2%) were confirmed cases, 6 (50%) were negative, and 1 (0.8%) had an indeterminate result. Six symptomatic children were not tested for mpox (33.3%). Overall, 6 infected contacts were identified, resulting in a SAR of 4.7% (6 of 129). The majority of pediatric household contacts and 4 of 6 infected children identified as Hispanic/Latino. Only 18 children (14%) reported receiving PEP. CONCLUSIONS The SAR was overall low among pediatric household contacts; none had severe disease. This may be underestimated given low testing rates.
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Affiliation(s)
| | - Rilene Ng
- California Department of Public Health, Richmond, California, USA
| | - Cameron Stainken
- California Department of Public Health, Richmond, California, USA
| | - Meredith Haddix
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Erin Peterson
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Jessica Watson
- California Department of Public Health, Richmond, California, USA
| | - Darpun Sachdev
- California Department of Public Health, Richmond, California, USA
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21
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Brien SC, LeBreton M, Doty JB, Mauldin MR, Morgan CN, Pieracci EG, Ritter JM, Matheny A, Tafon BG, Tamoufe U, Missoup AD, Nwobegahay J, Takuo JM, Nkom F, Mouiche MMM, Feussom JMK, Wilkins K, Wade A, McCollum AM. Clinical Manifestations of an Outbreak of Monkeypox Virus in Captive Chimpanzees in Cameroon, 2016. J Infect Dis 2024; 229:S275-S284. [PMID: 38164967 DOI: 10.1093/infdis/jiad601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Monkeypox virus (MPXV) is a reemerging virus of global concern. An outbreak of clade I MPXV affected 20 captive chimpanzees in Cameroon in 2016. We describe the epidemiology, virology, phylogenetics, and clinical progression of this outbreak. Clinical signs included exanthema, facial swelling, perilaryngeal swelling, and eschar. Mpox can be lethal in captive chimpanzees, with death likely resulting from respiratory complications. We advise avoiding anesthesia in animals with respiratory signs to reduce the likelihood of death. This outbreak presented a risk to animal care staff. There is a need for increased awareness and a One Health approach to preparation for outbreaks in wildlife rescue centers in primate range states where MPXV occurs. Control measures should include quarantining affected animals, limiting human contacts, surveillance of humans and animals, use of personal protective equipment, and regular decontamination of enclosures.
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Affiliation(s)
- Stephanie C Brien
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, Easter Bush Campus, The University of Edinburgh, Roslin, United Kingdom
- Ape Action Africa, Mefou Park, Cameroon
| | | | - Jeffrey B Doty
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Mauldin
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint N Morgan
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily G Pieracci
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jana M Ritter
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Audrey Matheny
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Alain D Missoup
- Zoology Unit, Laboratory of Biology and Physiology of Animal Organisms, Faculty of Science, University of Douala, Cameroon
| | | | | | | | - Moctar M M Mouiche
- Mosaic, Yaoundé, Cameroon
- School of Veterinary Medicine and Sciences, University of Ngaounderé, Cameroon
| | - Jean Marc K Feussom
- Cameroon Epidemiological Network for Animal Diseases, Directorate of Veterinary Services, Ministry of Livestock, Fisheries and Animal Industries, Yaoundé, Cameroon
| | - Kimberly Wilkins
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Abel Wade
- National Veterinary Laboratory, Garoua, Cameroon
| | - Andrea M McCollum
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mmerem JI, Umenzekwe CC, Johnson SM, Onukak AE, Chika-Igwenyi NM, Chukwu SK, Onyeaghala CA, Ozougwu JJ, Alasia D, Ehiakhamen O, Nwankwo HM, Ezejiofor OI, Unigwe US, Iroezindu MO. Mpox and Chickenpox Coinfection: Case Series From Southern Nigeria. J Infect Dis 2024; 229:S260-S264. [PMID: 38058122 DOI: 10.1093/infdis/jiad556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND We describe clinicoepidemiologic characteristics of mpox-chickenpox coinfection in Nigeria. METHODS A retrospective cohort analysis was performed of confirmed mpox cases in Nigeria from January 2022 to March 2023. Mpox and chickenpox were confirmed by real-time polymerase chain reaction (RT-PCR). RESULTS Of 94 (60.0%) suspected cases, 56 had confirmed mpox, of whom 16 (28.6%) had chickenpox coinfection. The median age of confirmed mpox cases was 29 years (interquartile range, 20-37 years), 24 were men (60.7%), 6 (10.7%) were bisexual, and 5 (8.9%) died. Mpox-chickenpox-coinfected patients had more complications than mpox-monoinfected cases (56.3% vs 22.5%, P = .015). CONCLUSIONS The high frequency of mpox-chickenpox coinfection argues for accelerated access to mpox and chickenpox vaccines in Africa.
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Affiliation(s)
- Juliet I Mmerem
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
| | - Chukwudi C Umenzekwe
- Department of Internal Medicine, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Simon M Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo State, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Nneka M Chika-Igwenyi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Sunday K Chukwu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Chizaram A Onyeaghala
- Department of Internal Medicine, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria
| | - Jideofor J Ozougwu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo State, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port-Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria
| | - Odianosen Ehiakhamen
- National Mpox Emergency Operating Centre, National Centre for Disease Control, Abuja, Nigeria
| | - Henry M Nwankwo
- Department of Internal Medicine, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Ogochukwu I Ezejiofor
- Department of Internal Medicine, Nnamdi Azikwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Uche S Unigwe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Michael O Iroezindu
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Enugu State, Nigeria
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Wahl V, Olson VA, Kondas AV, Jahrling PB, Damon IK, Kindrachuk J. Variola Virus and Clade I Mpox Virus Differentially Modulate Cellular Responses Longitudinally in Monocytes During Infection. J Infect Dis 2024; 229:S265-S274. [PMID: 37995376 DOI: 10.1093/infdis/jiad516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023] Open
Abstract
Variola virus (VARV), the etiological agent of smallpox, had enormous impacts on global health prior to its eradication. In the absence of global vaccination programs, mpox virus (MPXV) has become a growing public health threat that includes endemic and nonendemic regions across the globe. While human mpox resembles smallpox in clinical presentation, there are considerable knowledge gaps regarding conserved molecular pathogenesis between these 2 orthopoxviruses. Thus, we sought to compare MPXV and VARV infections in human monocytes through kinome analysis. We performed a longitudinal analysis of host cellular responses to VARV infection in human monocytes as well as a comparative analysis to clade I MPXV-mediated responses. While both viruses elicited strong activation of cell responses early during infection as compared to later time points, several key differences in cell signaling events were identified and validated. These observations will help in the design and development of panorthopoxvirus therapeutics.
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Affiliation(s)
- Victoria Wahl
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Victoria A Olson
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley V Kondas
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter B Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Inger K Damon
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason Kindrachuk
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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24
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Chika-Igwenyi NM, Unigwe US, Ajayi NA, Onwe OE, Ewa RL, Ojide CK, Una AF, Igwenyi C, Chukwu KS, Okorie GM, Nnadozie UU, Ifebunandu NA, Ugwu CN, Emeka S, Ibemesi D, Nnaji TO, Primus NO, Odianosen E. Atypical Mpox in a Nigerian Tertiary Health Facility. J Infect Dis 2024; 229:S181-S187. [PMID: 38157416 DOI: 10.1093/infdis/jiad607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND We describe diverse clinical characteristics and course of confirmed mpox cases managed in a Nigerian tertiary health facility. METHODS Clinical and epidemiologic data were analyzed, highlighting the unusual presentations of polymerase chain reaction (PCR)-confirmed mpox cases observed during the 2022 outbreak. RESULTS Out of 17 suspected cases, 13 (76.4%) were PCR confirmed for mpox. The mean ± SD age for the participants was 28.62 ± 10.29 years (range, 2-55), of which 9 (64.3%) were male. Of the 13 PCR-confirmed cases, 5 (38.5%) had varicella zoster virus coinfection, 2 (15.4%) had HIV coinfection, and 1 (7.7%) had diabetes mellitus comorbidity. All patients experienced rash, with 6 (46.2%) having significant genital lesions and 1 (7.7%) having a severe perianal lesion. A lack of prodromal symptoms was reported in 3 (23.1%), and a prolonged prodrome (>1 week) occurred in 5 (38.5%). Skin lesions were polymorphic in 6 (46.2%), and solitary skin lesions occurred in 3 (23.1%), which persisted for >120 days in 7.7%. CONCLUSIONS Clinical recognition, diagnosis, and prevention remain a concern in resource-limited settings. Our findings highlight the need to further evaluate unusual skin lesions and to include mpox screening for genital skin lesions that are presumed to be sexually transmitted infections. Revision of clinical case definition and enhanced surveillance are key to early recognition and prevention of spread.
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Affiliation(s)
- Nneka M Chika-Igwenyi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Uche S Unigwe
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla
| | - Nnennaya A Ajayi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Ogah E Onwe
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Richard L Ewa
- Department of Anaesthesia, Alex Ekwueme FederalUniversity Teaching Hospital Abakliki
| | - Chiedozie K Ojide
- Department of Medical Microbiology, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Alfred F Una
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla
| | - Chikaodiri Igwenyi
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Kyrian S Chukwu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Gabriel M Okorie
- Department of Plastic Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Ugochukwu U Nnadozie
- Department of Plastic Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Ngozi A Ifebunandu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | - Collins N Ugwu
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
| | | | - Desi Ibemesi
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla
| | - Thomas O Nnaji
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki
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25
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Ritter JM, Martines RB, Bhatnagar J, Rao AK, Villalba JA, Silva-Flannery L, Lee E, Bullock HA, Hutson CL, Cederroth T, Harris CK, Hord K, Xu Y, Brown CA, Guccione JP, Miller M, Paddock CD, Reagan-Steiner S. Pathology and Monkeypox virus Localization in Tissues From Immunocompromised Patients With Severe or Fatal Mpox. J Infect Dis 2024; 229:S219-S228. [PMID: 38243606 DOI: 10.1093/infdis/jiad574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Pathology and Monkeypox virus (MPXV) tissue tropism in severe and fatal human mpox is not thoroughly described but can help elucidate the disease pathogenesis and the role of coinfections in immunocompromised patients. METHODS We analyzed biopsy and autopsy tissues from 22 patients with severe or fatal outcomes to characterize pathology and viral antigen and DNA distribution in tissues by immunohistochemistry and in situ hybridization. Tissue-based testing for coinfections was also performed. RESULTS Mucocutaneous lesions showed necrotizing and proliferative epithelial changes. Deceased patients with autopsy tissues evaluated had digestive tract lesions, and half had systemic tissue necrosis with thrombotic vasculopathy in lymphoid tissues, lung, or other solid organs. Half also had bronchopneumonia, and one-third had acute lung injury. All cases had MPXV antigen and DNA detected in tissues. Coinfections were identified in 5 of 16 (31%) biopsy and 4 of 6 (67%) autopsy cases. CONCLUSIONS Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings.
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Affiliation(s)
| | | | | | - Agam K Rao
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Elizabeth Lee
- Infectious Diseases Pathology Branch
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Christina L Hutson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kristin Hord
- Office of Chief Medical Examiner, New York City, New York
| | - Ya Xu
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology and Laboratory Medicine, Ben Taub Hospital, Harris Health System, Houston, Texas
| | - Cameron A Brown
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology and Laboratory Medicine, Ben Taub Hospital, Harris Health System, Houston, Texas
| | - Jack P Guccione
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California
| | - Matthew Miller
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Zoonotic and Emerging Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Alakunle E, Kolawole D, Diaz-Cánova D, Alele F, Adegboye O, Moens U, Okeke MI. A comprehensive review of monkeypox virus and mpox characteristics. Front Cell Infect Microbiol 2024; 14:1360586. [PMID: 38510963 PMCID: PMC10952103 DOI: 10.3389/fcimb.2024.1360586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Monkeypox virus (MPXV) is the etiological agent of monkeypox (mpox), a zoonotic disease. MPXV is endemic in the forested regions of West and Central Africa, but the virus has recently spread globally, causing outbreaks in multiple non-endemic countries. In this paper, we review the characteristics of the virus, including its ecology, genomics, infection biology, and evolution. We estimate by phylogenomic molecular clock that the B.1 lineage responsible for the 2022 mpox outbreaks has been in circulation since 2016. We interrogate the host-virus interactions that modulate the virus infection biology, signal transduction, pathogenesis, and host immune responses. We highlight the changing pathophysiology and epidemiology of MPXV and summarize recent advances in the prevention and treatment of mpox. In addition, this review identifies knowledge gaps with respect to the virus and the disease, suggests future research directions to address the knowledge gaps, and proposes a One Health approach as an effective strategy to prevent current and future epidemics of mpox.
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Affiliation(s)
- Emmanuel Alakunle
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
| | - Daniel Kolawole
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
| | - Diana Diaz-Cánova
- Department of Medical Biology, UIT – The Arctic University of Norway, Tromsø, Norway
| | - Faith Alele
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Oyelola Adegboye
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ugo Moens
- Department of Medical Biology, UIT – The Arctic University of Norway, Tromsø, Norway
| | - Malachy Ifeanyi Okeke
- Department of Natural and Environmental Sciences, American University of Nigeria, Yola, Nigeria
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27
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Bagde H, Dhopte A, Bukhary F, Momenah N, Akhter F, Mahmoud O, Shetty KP, Shayeb MAL, Abutayyem H, Alam MK. Monkeypox and oral lesions associated with its occurrence: a systematic review and meta-analysis. F1000Res 2024; 12:964. [PMID: 38845619 PMCID: PMC11153993 DOI: 10.12688/f1000research.137363.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 06/09/2024] Open
Abstract
Background A zoonotic, double-stranded DNA virus belonging to the genus Orthopoxvirus, the mpox virus (MPXV) is most common in tropical regions of Central and West Africa. The frequency of monkeypox (mpox) cases, however, has sharply climbed globally since May 2022. Objectives To establish the threat of mpox in terms of the oral lesions caused in sufferers. Materials and methods After a thorough study of the literature identified in the PubMed, Web of Science, and Cochrane library databases using the PRISMA framework, 103 papers were found. Using inclusion and exclusion criteria, we chose research that was relevant for our review before shortlisting 14 papers that conformed to the review's guidelines. Results In the 14 selected studies, it was found that oral lesions were among the first clinical signs of a mpox affliction, with ulcers on the dorsal surface of tongue lips being the most common areas affected. Conclusion The rarely observed oral lesions of mpox infection may help in the diagnosis and management of this condition. It is critical to keep in mind that recognising and detecting oral lesions in mpox patients opens the door to more research and efficient patient management.
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Affiliation(s)
- Hiroj Bagde
- Periodontology, Rama University, Kanpur, Uttar Pradesh, 208024, India
| | - Ashwini Dhopte
- Oral Medicine and Radiology, Rama University, Kanpur, Uttar Pradesh, 208024, India
| | - Ferdous Bukhary
- Preventive Dental Sciences, Dar Al Uloom University, Riyadh, Riyadh Province, 13314, Saudi Arabia
| | - Naif Momenah
- Riyadh Second Health Cluster, Saudi Ministry of Health, Riyadh, Riyadh Province, 13314, Saudi Arabia
| | - Fatema Akhter
- Surgical and Diagnostic Sciences, Dar Al Uloom University, Riyadh, Riyadh Province, 13314, Saudi Arabia
| | - Okba Mahmoud
- Clinical Science Department, College of Dentistry, Ajman University, Ajman, Ajman, United Arab Emirates
| | - Krishna Prasad Shetty
- Clinical Science Department, College of Dentistry, Ajman University, Ajman, Ajman, United Arab Emirates
| | - Maher AL Shayeb
- Clinical Science Department, College of Dentistry, Ajman University, Ajman, Ajman, United Arab Emirates
| | - Huda Abutayyem
- Clinical Science Department, College of Dentistry, Ajman University, Ajman, Ajman, United Arab Emirates
| | - Mohammad Khursheed Alam
- Orthodontic Division, Preventive Dentistry Department, Jouf University, Sakaka, Al Jowf, 72345, Saudi Arabia
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28
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Corma-Gómez A, Cabello A, Orviz E, Morante-Ruiz M, Ayerdi O, Al-Hayani A, Muñoz-Gómez A, Santos IDL, Gómez-Ayerbe C, Rodrigo D, Riestra SDLR, Reus-Bañuls S, Silva-Klug A, Galindo MJ, Santos M, Serrano-Fuentes M, Faro-Míguez N, Pérez-Camacho I, Corona-Mata D, Morano L, López-Ruz MÁ, Montero M, Anaya-Baz B, Merino D, Castillo-Navarro A, Pineda JA, Macías J. Long or complicated mpox in patients with uncontrolled HIV infection. J Med Virol 2024; 96:e29511. [PMID: 38469884 DOI: 10.1002/jmv.29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.
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Affiliation(s)
- Anaïs Corma-Gómez
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Alfonso Cabello
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Miguel Morante-Ruiz
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Aws Al-Hayani
- Unit of Infectious Diseases, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Ana Muñoz-Gómez
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid
| | - Ignacio De Los Santos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Servicio de Medicina Interna-Enfermedades Infecciosas, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina Gómez-Ayerbe
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - David Rodrigo
- Unit of Infectious Diseases, Consorcio Hospital General de Valencia, Valencia, Spain
| | - Sandra De la Rosa Riestra
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Valencia, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Sergio Reus-Bañuls
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Sevilla, Spain
| | - Ana Silva-Klug
- Unit of Infectious Diseases, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Sevilla, Spain
| | - María José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Sevilla, Spain
| | - Marta Santos
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Miriam Serrano-Fuentes
- Servicio de Medicina Interna, Hospital de Gran Canaria Dr Negrín, Las Palmas De Gran Canaria, Spain
| | - Naya Faro-Míguez
- Unit of Infectious Diseases, Hospital Universitario San Cecilio, Granada, Spain
| | - Inés Pérez-Camacho
- Unit of Infectious Diseases· Hospital Regional Universitario Málaga, Sevilla, Spain
| | - Diana Corona-Mata
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Infectious Diseases Unit, Reina Sofía University Hospital of Córdoba, Spain
- Maimonides Institute of Biomedical Research of Córdoba (Instituto Maimónides de Investigación Biomédica de Córdoba IMIBIC), Cordoba, Spain
- Department of Medicine, University of Córdoba, Cordoba, Spain
| | - Luis Morano
- Unit of Infectious Diseases, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Miguel Ángel López-Ruz
- Unit of infectious Diseases, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Montero
- Unit of infectious Diseases, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Blanca Anaya-Baz
- Unit of Infectious diseases, Hospital Universitario Puerto Real, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - Juan A Pineda
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Juan Macías
- Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain
- Grupo de Virología Clínica e ITS, Hospital Universitario Virgen de Valme, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Sevilla, Spain
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29
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Kumar A, Singh N, Anvikar AR, Misra G. Monkeypox virus: insights into pathogenesis and laboratory testing methods. 3 Biotech 2024; 14:67. [PMID: 38357674 PMCID: PMC10861412 DOI: 10.1007/s13205-024-03920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
The monkeypox virus (MPXV) is a zoonotic pathogen that transmits between monkeys and humans, exhibiting clinical similarities with the smallpox virus. Studies on the immunopathogenesis of MPXV revealed that an initial strong innate immune response is elicited on viral infection that subsequently helps in circumventing the host defense. Once the World Health Organization (WHO) declared it a global public health emergency in July 2022, it became essential to clearly demarcate the MPXV-induced symptoms from other viral infections. We have exhaustively searched the various databases involving Google Scholar, PubMed, and Medline to extract the information comprehensively compiled in this review. The primary focus of this review is to describe the diagnostic methods for MPXV such as polymerase chain reaction (PCR), and serological assays, along with developments in viral isolation, imaging techniques, and next-generation sequencing. These innovative technologies have the potential to greatly enhance the accuracy of diagnostic procedures. Significant discoveries involving MPXV immunopathogenesis have also been highlighted. Overall, this will be a knowledge repertoire that will be crucial for the development of efficient monitoring and control strategies in response to the MPXV infection helping clinicians and researchers in formulating healthcare strategies.
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Affiliation(s)
- Anoop Kumar
- National Institute of Biologicals, A-32, Sector-62, Institutional Area, Noida, U.P. 201309 India
| | - Neeraj Singh
- National Institute of Biologicals, A-32, Sector-62, Institutional Area, Noida, U.P. 201309 India
| | - Anupkumar R. Anvikar
- National Institute of Biologicals, A-32, Sector-62, Institutional Area, Noida, U.P. 201309 India
| | - Gauri Misra
- National Institute of Biologicals, A-32, Sector-62, Institutional Area, Noida, U.P. 201309 India
- Head Molecular Diagnostics and COVID-19 Kit Testing Laboratory, National Institute of Biologicals (Ministry of Health and Family Welfare), Noida, U.P. 201309 India
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Djuicy DD, Sadeuh-Mba SA, Bilounga CN, Yonga MG, Tchatchueng-Mbougua JB, Essima GD, Esso L, Nguidjol IME, Metomb SF, Chebo C, Agwe SM, Ankone PA, Ngonla FNN, Mossi HM, Etoundi AGM, Eyangoh SI, Kazanji M, Njouom R. Concurrent Clade I and Clade II Monkeypox Virus Circulation, Cameroon, 1979-2022. Emerg Infect Dis 2024; 30:432-443. [PMID: 38325363 PMCID: PMC10902553 DOI: 10.3201/eid3003.230861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
During 1979-2022, Cameroon recorded 32 laboratory-confirmed mpox cases among 137 suspected mpox cases identified by the national surveillance network. The highest positivity rate occurred in 2022, indicating potential mpox re-emergence in Cameroon. Both clade I (n = 12) and clade II (n = 18) monkeypox virus (MPXV) were reported, a unique feature of mpox in Cameroon. The overall case-fatality ratio of 2.2% was associated with clade II. We found mpox occurred only in the forested southern part of the country, and MPXV phylogeographic structure revealed a clear geographic separation among concurrent circulating clades. Clade I originated from eastern regions close to neighboring mpox-endemic countries in Central Africa; clade II was prevalent in western regions close to West Africa. Our findings suggest that MPXV re-emerged after a 30-year lapse and might arise from different viral reservoirs unique to ecosystems in eastern and western rainforests of Cameroon.
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Deng X, Tian Y, Zou J, Yang J, Sun K, Yu H. The risk of mpox importation and subsequent outbreak potential in Chinese mainland: a retrospective statistical modelling study. Infect Dis Poverty 2024; 13:21. [PMID: 38419040 PMCID: PMC10902966 DOI: 10.1186/s40249-024-01189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The 2022-2023 mpox (monkeypox) outbreak has spread rapidly across multiple countries in the non-endemic region, mainly among men who have sex with men (MSM). In this study, we aimed to evaluate mpox's importation risk, border screening effectiveness and the risk of local outbreak in Chinese mainland. METHODS We estimated the risk of mpox importation in Chinese mainland from April 14 to September 11, 2022 using the number of reported mpox cases during this multi-country outbreak from Global.health and the international air-travel data from Official Aviation Guide. We constructed a probabilistic model to simulate the effectiveness of a border screening scenario during the mpox outbreak and a hypothetical scenario with less stringent quarantine requirement. And we further evaluated the mpox outbreak potential given that undetected mpox infections were introduced into men who have sex with men, considering different transmissibility, population immunity and population activity. RESULTS We found that the reduced international air-travel volume and stringent border entry policy decreased about 94% and 69% mpox importations respectively. Under the quarantine policy, 15-19% of imported infections would remain undetected. Once a case of mpox is introduced into active MSM population with almost no population immunity, the risk of triggering local transmission is estimated at 42%, and would rise to > 95% with over six cases. CONCLUSIONS Our study demonstrates that the reduced international air-travel volume and stringent border entry policy during the COVID-19 pandemic reduced mpox importations prominently. However, the risk could be substantially higher with the recovery of air-travel volume to pre-pandemic level. Mpox could emerge as a public health threat for Chinese mainland given its large MSM community.
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Affiliation(s)
- Xiaowei Deng
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Yuyang Tian
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Junyi Zou
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Juan Yang
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032, China
| | - Kaiyuan Sun
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
| | - Hongjie Yu
- School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, 200032, China.
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Lin M, Xin Y, Wang J, Nie P, Yan Q, Wang L, Wang L. Analysing monkeypox epidemic drivers: Policy simulation and multi-index modelling across 39 nations. J Glob Health 2024; 14:04037. [PMID: 38333932 PMCID: PMC10859682 DOI: 10.7189/jogh.14.04037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background This study aimed to analyse the drivers of the monkeypox (Mpox) epidemic and policy simulation to support health care policies against the Mpox epidemic. Methods We established a three-round selection mechanism for 164 factors using Lasso and negative binomial regression to investigate the correlation between significant drivers and the cumulative confirmed cases of Mpox. Policy simulation for each driver was evaluated, and the varying effects of implementation at different times were examined. Results HIV/AIDS prevalence and air transport passengers carried were significant determinants of the risk of the Mpox epidemic across various countries, with regression coefficients of 1.417 and 0.766, respectively. A decrease in HIV/AIDS prevalence by 10, 20, 30, and 40% corresponded to reductions in the number of Mpox cases by 6.28, 6.55, 6.87, and 7.26%, respectively. Similarly, 20, 40, 60, and 80% travel restrictions led to reductions in Mpox cases by 7.16, 15.63, 26.28%, and 41.46%, respectively. Controlling air transport passengers carried in the first month could postpone outbreak onset by 0.5-2.0 months. Conclusions Mpox prevention and control policies should primarily focus on travel restrictions during high disease-risk periods and flight suspensions from high-risk nations in combination with regular HIV/AIDS prevention and treatment strategies.
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Affiliation(s)
- Mengxuan Lin
- Academy of Military Medical Sciences, Academy of Military Science of Chinese People’s Liberation Army, Beijing, China
| | - Yingrong Xin
- Chinese People’s Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Jiaojiao Wang
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation Chinese Academy of Sciences, Beijing, China
| | - Pengyuan Nie
- Academy of Military Medical Sciences, Academy of Military Science of Chinese People’s Liberation Army, Beijing, China
| | - Qunjiao Yan
- Academy of Military Medical Sciences, Academy of Military Science of Chinese People’s Liberation Army, Beijing, China
| | - Ligui Wang
- Chinese People’s Liberation Army Center for Disease Control and Prevention, Beijing, China
| | - Lei Wang
- Academy of Military Medical Sciences, Academy of Military Science of Chinese People’s Liberation Army, Beijing, China
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Cuetos-Suárez D, Gan RK, Cuetos-Suárez D, Arcos González P, Castro-Delgado R. A Review of Mpox Outbreak and Public Health Response in Spain. Risk Manag Healthc Policy 2024; 17:297-310. [PMID: 38328470 PMCID: PMC10849094 DOI: 10.2147/rmhp.s440035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/12/2023] [Indexed: 02/09/2024] Open
Abstract
Objective In May 2022, an unprecedented Mpox outbreak was reported in several non-endemic countries with unknown epidemiological links. Since May 2022, more than 20,000 cases have been reported in Europe. Spain has been the most affected country in Europe. We aim to describe the Mpox epidemiological profile in Spain, identify its outbreak risks, and describe public health interventions implemented by the Spanish authorities. Methods A literature review was conducted, using specific selection criteria to obtain relevant publications describing Mpox clinical presentation and risk factors and the public health response in Spain to the ongoing outbreak. Results 63.1% of the cases presented an anogenital rash, considered a specific and early symptom in this outbreak. Low case fatality rate is observed, mainly in risk groups, such as the immunocompromised population. Patients evolution was generally favorable, although 3-8% required hospitalization and two deaths occurred; 40% of patients were previously diagnosed with HIV infection. Most of the cases were seen among young population and concentrated in men who had sex with other men, mainly with multiple sexual partners, who did not practice safe sex such as using condoms, and those attending mass event parties. Conclusion To date, the Mpox outbreak is not considered a public health emergency of international concern. The epidemiological trend of the virus in Spain shows that public health response interventions (health education, contact tracing, vaccination, etc.) have adequately controlled the epidemic curve in high-risk populations and avoided spreading the virus to other groups within the community.
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Affiliation(s)
- Daniel Cuetos-Suárez
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Rick Kye Gan
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - David Cuetos-Suárez
- Emergency Medicine Department, Spanish Central Defense Academy, Madrid, Spain
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster, Public Health Area, Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Rafael Castro-Delgado
- Health Service Principality of Asturias (SAMU-Asturias), Health Research Institute of Asturias, ISPA (Prehospital Care and Disasters Research Group, GIAPREDE)Oviedo, Asturias, Spain
- Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
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Pinnetti C, Cimini E, Mazzotta V, Matusali G, Vergori A, Mondi A, Rueca M, Batzella S, Tartaglia E, Bettini A, Notari S, Rubino M, Tempestilli M, Pareo C, Falasca L, Del Nonno F, Scarabello A, Camici M, Gagliardini R, Girardi E, Vaia F, Maggi F, Agrati C, Antinori A. Mpox as AIDS-defining event with a severe and protracted course: clinical, immunological, and virological implications. THE LANCET. INFECTIOUS DISEASES 2024; 24:e127-e135. [PMID: 37778364 DOI: 10.1016/s1473-3099(23)00482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023]
Abstract
A 59-year-old treatment-naive patient with advanced HIV infection presented with a severe and protracted course of mpox (formerly known as monkeypox) that did not respond to the current mpox treatment options. The patient worsened clinically, and developed new mucocutaneous lesions and necrotic evolution of pre-existing ones, along with multiple bilateral lung nodules and the appearance of a tracheal necrotic lesion. Although severe forms of mpox have been observed in people with severe immune system deficiency, including those with advanced HIV presentation, the immunological mechanisms underlying this observation have not yet been fully explained. To our knowledge, this is the first account of a necrotising mpox in a person living with HIV, with viral shedding for more than 11 months and a comprehensive immunological description. Moreover, we documented the virus' persistence by detecting mpox virus DNA from multiple sites and quantified anti-monkeypox virus IgA, IgM, IgG, and neutralising antibodies in serum samples. The severe HIV-driven immune depression and the presence of other co-infections might skew and impair immune responses, thus contributing to the persistence of monkeypox virus infection. Further investigations of immune responses to monkeypox virus infection in people with severe immunosuppression are required to improve management and prevention.
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Affiliation(s)
- Carmela Pinnetti
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Cimini
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Giulia Matusali
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Martina Rueca
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sandro Batzella
- Bronchopneumology and Interventional Pulmonology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Eleonora Tartaglia
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Aurora Bettini
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Notari
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marika Rubino
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Massimo Tempestilli
- Cellular Immunology and Pharmacology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carlo Pareo
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Laura Falasca
- Pathology Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Franca Del Nonno
- Pathology Unit, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Scarabello
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Camici
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Chiara Agrati
- Unit of Pathogen Specific Immunity, Department of Paediatric Haematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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Subissi L, Stefanelli P, Rezza G. Human mpox: global trends, molecular epidemiology and options for vaccination. Pathog Glob Health 2024; 118:25-32. [PMID: 37715739 PMCID: PMC10769137 DOI: 10.1080/20477724.2023.2258641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
The eradication of smallpox and the cessation of vaccination have led to the growth of the susceptible human population to poxviruses. This has led to the increasing detection of zoonotic orthopoxviruses. Among those viruses, monkeypox virus (MPV) is the most commonly detected in Western and Central African regions. Since 2022, MPV is causing local transmission in newly affected countries all over the world. While the virus causing the current outbreak remains part of clade II (historically referred to as West African clade), it has a significant number of mutations as compared to other clade II sequences and is therefore referred to as clade IIb. It remains unclear whether those mutations may have caused a change in the virus phenotype. Vaccine effectiveness data show evidence of a high cross-protection of vaccines designed to prevent smallpox against mpox. These vaccines therefore represent a great opportunity to control human-to-human transmission, provided that their availability has short time-frames and that mistakes from the recent past (vaccine inequity) will not be reiterated.
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Affiliation(s)
- Lorenzo Subissi
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Roma, Italy
| | - Giovanni Rezza
- Health Prevention Directorate, Ministry of Health, Roma, Italy
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Le Vavasseur B, Bendaoud S, Taieb S, Heym B, Ysmail Dahlouk S, Leclerc EJ, Metaye A, Bessanguem B, Bourguignon J, Taouk M, Gabarre A, Marot S, Tepper S, Lidove O, Etienney I. Anal Monkeypox Disease: Description of 65 Cases. Dis Colon Rectum 2024; 67:280-285. [PMID: 37878465 DOI: 10.1097/dcr.0000000000002899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Monkeypox is a zoonosis endemic in Africa caused by 3 orthopoxvirus clades. Knowledge of the disease is limited, but a worldwide outbreak involving a new route of transmission was declared in April 2022. OBJECTIVE This study aimed to describe anal symptoms and outcomes in patients infected with Monkeypox virus presenting to an emergency proctology unit in Paris. DESIGN This was an observational study. SETTING We reported anal symptoms of all consecutive patients with monkeypox anal infection in a single proctology center between June 16, 2022, and July 26, 2022. Association with sexually transmitted infections and outcomes were also recorded. PATIENTS Sixty-five men with a mean age of 39.6 (19.9-64.6) years with confirmed monkeypox anal infection were included in the study. MAIN OUTCOME MEASURES Anal symptoms and their severity were clinically assessed. A favorable outcome consisted of a complete resolution of clinical manifestation. RESULTS Sexual transmission was reported in 51 patients (78.4%), among whom 63 (97%) were men who have sex with men. Twenty-eight (43%) were living with HIV, and 24 (36.9%) were taking tenofovir/emtricitabine for HIV preexposure prophylaxis. Anal symptoms appeared first in 36 patients (55.4%) and skin rash or other general symptoms in 22 patients (33.8%). Incubation time was 6.9 (1-26) days. Symptoms included painful perianal (n = 42 patients; 64.6%), anal (n = 28, 43%), and rectal (n = 25; 38.4%) ulcerations and perianal vesicles (n = 24; 36.9%). Proctitis was observed in 49 patients (75.4%). It was mild in 20 (40.8%) and intense in 29 (59.2%), and severe proctitis mimicking high intersphincteric suppuration was found in 4 (8.2%). Fifteen patients (23.1%) had concurrent sexually transmitted infection and 3 were hospitalized. Complete symptom resolution occurred within 12 days. LIMITATIONS We performed a single-center study during a short period of time. CONCLUSIONS Proctological symptoms are frequent in the current outbreak of monkeypox disease, probably linked to the route of transmission. Rectal ulcerations mimicking high intersphincteric suppuration should be recognized to avoid unnecessary surgery. See Video Abstract . ENFERMEDAD ANAL DE LA VIRUELA DEL MONO DESCRIPCIN DE CASOS ANTECEDENTES:La viruela del simio mono es una zoonosis endémica en África causada por tres clados de orthopoxvirus. El conocimiento de la enfermedad es limitado, pero en abril de 2022 se declaró un brote mundial que implica una nueva vía de transmisión.OBJETIVO:Describir los síntomas anales y los resultados en pacientes que sufren de infección por Monkeypox que asistieron a una unidad de proctología de emergencia en París.DISEÑO:Un estudio observacional.ESCENARIO:Informamos los síntomas anales de todos los pacientes consecutivos con infección anal por viruela del mono en un solo centro de proctología entre el 16/6/2022 y el 26/7/2022. También se registró la asociación con infecciones de transmisión sexual (ITS) y el resultado.PACIENTES:Sesenta y cinco hombres de 39,6 [19,9-64,6] años con infección anal confirmada.PRINCIPALES MEDIDAS DE RESULTADO:Los síntomas anales y su gravedad se evaluaron clínicamente. Un resultado favorable consistió en una resolución completa de la manifestación clínica.RESULTADOS:La transmisión sexual se informó en 51 (78,4%) pacientes, de los cuales 63 (97%) eran hombres que tuvieron sexo con hombres. Veintiocho (43%) vivían con el VIH y 24 (36,9%) tomaban Emtricitabina/Tenofovir para profilaxis previa por exposición al VIH. Los síntomas anales aparecieron primero en 36 (55,4%) pacientes y la erupción cutánea u otros síntomas generales en 22 (33,8%). El tiempo de incubación fue de 6,9 [1-26] días. Los síntomas incluyeron ulceraciones perianales dolorosas (n = 42 pacientes, 64,6%), anales (n = 28, 43%), rectales (n = 25, 38,4%) y vesículas perianales (n = 24, 36,9%). Se observó proctitis en 49 (75,4%) pacientes. Fue leve en 20 (40,8%) e intensa en 29 (59,2%) y proctitis severa simulando supuración interesfinteriana alta en 4 (8,2%). Quince (23,1%) pacientes presentaban ITS concurrentes y 3 fueron hospitalizados. La resolución completa de los síntomas ocurrió dentro de los 12 días.LIMITACIONES:Estudio de un solo centro y durante corto período de tiempo.CONCLUSIÓN:Los síntomas proctológicos son frecuentes en el brote actual de la enfermedad de la viruela del mono, probablemente relacionados con la vía de transmisión. Las ulceraciones rectales que simulan una supuración interesfinteriana alta deben reconocerse para evitar una cirugía innecesaria. (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Benjamin Le Vavasseur
- Department of Internal Medicine and Infectious Diseases, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Sihem Bendaoud
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Sarah Taieb
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Beate Heym
- Microbiology Laboratory, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | | | - Eloise J Leclerc
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Antonin Metaye
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | | | - Josée Bourguignon
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Milad Taouk
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Anne Gabarre
- Microbiology Laboratory, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Stéphane Marot
- Virology Laboratory, La Pitié Salpêtrière hospital, Paris, France
| | - Sarah Tepper
- Emergency Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Olivier Lidove
- Department of Internal Medicine and Infectious Diseases, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Isabelle Etienney
- Proctology Unit, Diaconesses Croix Saint-Simon Hospital, Paris, France
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Ejaz M, Jabeen M, Sharif M, Syed MA, Shah PT, Faryal R. Human monkeypox: An updated appraisal on epidemiology, evolution, pathogenesis, clinical manifestations, and treatment strategies. J Basic Microbiol 2024; 64:e2300455. [PMID: 37867205 DOI: 10.1002/jobm.202300455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
Monkeypox (Mpox) is a zoonotic viral disease caused by the monkeypox virus (MPXV), a member of the Orthopoxvirus genus. The recent occurrence of Mpox infections has become a significant global issue in recent months. Despite being an old disease with a low mortality rate, the ongoing multicountry outbreak is atypical due to its occurrence in nonendemic countries. The current review encompasses a comprehensive analysis of the literature pertaining to MPXV, with the aim of consolidating the existing data on the virus's epidemiological, biological, and clinical characteristics, as well as vaccination and treatment regimens against the virus.
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Affiliation(s)
- Mohammad Ejaz
- Department of Microbiology, Government Postgraduate College Mandian, Abbottabad, Pakistan
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Momina Jabeen
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mehmoona Sharif
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Ali Syed
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Pir T Shah
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, Shanxi, China
| | - Rani Faryal
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
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Thornhill JP, Gandhi M, Orkin C. Mpox: The Reemergence of an Old Disease and Inequities. Annu Rev Med 2024; 75:159-175. [PMID: 37788486 DOI: 10.1146/annurev-med-080122-030714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Mpox, previously known as monkeypox, is caused by an Orthopoxvirus related to the variola virus that causes smallpox. Prior to 2022, mpox was considered a zoonotic disease endemic to central and west Africa. Since May 2022, more than 86,000 cases of mpox from 110 countries have been identified across the world, predominantly in men who have sex with men, most often acquired through close physical contact or during sexual activity. The classical clinical presentation of mpox is a prodrome including fever, lethargy, and lymphadenopathy followed by a characteristic vesiculopustular rash. The recent 2022 outbreak included novel presentations of mpox with a predominance of anogenital lesions, mucosal lesions, and other features such as anorectal pain, proctitis, oropharyngeal lesions, tonsillitis, and multiphasic skin lesions. We describe the demographics and clinical spectrum of classical and novel mpox, outlining the potential complications and management.
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Affiliation(s)
- J P Thornhill
- SHARE Research Collaborative, The Blizard Institute, Queen Mary University of London, London, United Kingdom;
| | - M Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - C Orkin
- SHARE Research Collaborative, The Blizard Institute, Queen Mary University of London, London, United Kingdom;
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Desingu PA, Rubeni TP, Nagarajan K, Sundaresan NR. Molecular evolution of 2022 multi-country outbreak-causing monkeypox virus Clade IIb. iScience 2024; 27:108601. [PMID: 38188513 PMCID: PMC10770499 DOI: 10.1016/j.isci.2023.108601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/16/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
The monkeypox virus (Mpoxv) Clade IIb viruses that caused an outbreak in 2017-18 in Nigeria and its genetically related viruses have been detected in many countries and caused multi-country outbreak in 2022. Since the pandemic-causing Mpoxv Clade IIb viruses are closely related to Clade IIa viruses which mostly cause endemic, the Clade IIb Mpoxv might have certain specific genetic variations that are still largely unknown. Here, we have systematically analyzed genetic alterations in different clades of Mpox viruses. The results suggest that the Mpoxv Clade IIb have genetic variations in terms of genomic gaps, frameshift mutations, in-frame nonsense mutations, amino acid tandem repeats, and APOBEC3 mutations. Further, we observed specific genetic variations in the multiple genes specific for Clade I and Clade IIb, and exclusive genetic variations for Clade IIa and Clade IIb. Collectively, findings shed light on the evolution and genetic variations in the outbreak of 2022 causing Mpoxv Clade IIb.
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Affiliation(s)
- Perumal Arumugam Desingu
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bengaluru 560012, India
| | | | - K. Nagarajan
- Department of Veterinary Pathology, Madras Veterinary College, Vepery, Chennai 600007, Tamil Nadu
- Veterinary and Animal Sciences University (TANUVAS)
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Kuehn R, Fox T, Guyatt G, Lutje V, Gould S. Infection prevention and control measures to reduce the transmission of mpox: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002731. [PMID: 38236835 PMCID: PMC10796032 DOI: 10.1371/journal.pgph.0002731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on synthesis of available literature. METHODS The WHO Clinical Management and Infection Prevention and Control 2022 guideline and droplet precautions in healthcare facilities and home isolation infection prevention control measures for patients with mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies. RESULTS No studies were identified that directly addressed airborne and droplet precautions and home isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%) cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There were no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air. CONCLUSIONS Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of airborne and droplet infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients with mild disease at home.
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Affiliation(s)
- Rebecca Kuehn
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Gordon Guyatt
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
| | - Vittoria Lutje
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Susan Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ali Y, Khan AA, Alanazi AM, Abdikakharovich SA, Shah JA, Ren ZG, Khattak S. Identification of the myxobacterial secondary metabolites Aurachin A and Soraphinol A as promising inhibitors of thymidylate kinase of the Monkeypox virus. Mol Divers 2024:10.1007/s11030-023-10764-x. [PMID: 38183513 DOI: 10.1007/s11030-023-10764-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/03/2023] [Indexed: 01/08/2024]
Abstract
Thymidylate kinase (TMPK) of monkeypox virus (MPXV) has emerged as a promising target for potential therapeutics due to its significant role in pyrimidine metabolism. While smallpox drugs are advised for treating monkeypox, the European Medicine Agency has sanctioned Tecovirimat due to its potent nanomolar activity. Nonetheless, there is a need for monkeypox-specific therapeutic options. In this work, we employed docking-based virtual screening and molecular dynamics (MD) simulations to identify myxobacterial secondary metabolites as promising anti-viral natural compounds capable of inhibiting thymidylate kinase. The computational pharmacokinetics and manual curation of top-scoring compounds identified six lead compounds that were compared in terms of protein-ligand contacts and protein-essential dynamics. The study shows that among the six candidates, Aurachin A and the Soraphinol analogues such as Soraphinol A and Soraphinol C remain very stable compared to other compounds, enabling the active site integrity via a stable dynamics pattern. We also show that other compounds such as Phenoxan, Phenylnannolone C, and 8E-Aurafuron B remain unstable and have a negative impact on the active site integrity and may not be suitable binders for TMPK protein. Analyzing the Aurachin A and Soraphinol A binding, the established hydrogen bonds with Arg93 and the conserved hydrophobic interaction with Tyr101 are consistent with previous experimental interactions. Additionally, a deeper insight into the indole and the aromatic ring interaction through π-π stacking and π-cation interactions, as well as the background of Aurachin A and Soraphinol A as a bioactive compound, has significant implications not only for its potential as a promising drug but also for directing future drug discovery efforts targeting the TMPK protein.
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Affiliation(s)
- Yasir Ali
- Institute of Chemistry, Slovak Academy of Sciences, 845 38, Bratislava, Slovakia
| | - Azmat Ali Khan
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, 11451, Riyadh, Saudi Arabia
| | - Amer M Alanazi
- Pharmaceutical Biotechnology Laboratory, Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, 11451, Riyadh, Saudi Arabia
| | | | - Junaid Ali Shah
- Ferghana Medical Institute of Public Health, 104100, Ferghana, Uzbekistan
| | - Zhi-Guang Ren
- Henan International Joint Laboratory of Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University College of Medicine, Kaifeng, 475004, Henan, China.
| | - Saadullah Khattak
- Henan International Joint Laboratory of Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University College of Medicine, Kaifeng, 475004, Henan, China.
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Ramakrishnan R, Shenoy A, Madhavan R, Meyer D. Mpox gastrointestinal manifestations: a systematic review. BMJ Open Gastroenterol 2024; 11:e001266. [PMID: 38184298 PMCID: PMC10773419 DOI: 10.1136/bmjgast-2023-001266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/10/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Mpox is a viral infection caused by the monkeypox virus, a member of the Poxviridae family and Orthopoxvirus genus. Other well-known viruses of the Orthopoxvirus genus include the variola virus (smallpox), cowpox virus and vaccinia virus. Although there is a plethora of research regarding the dermatological and influenza-like symptoms of mpox, particularly following the 2022 mpox outbreak, more research is needed on the gastrointestinal (GI) effects. OBJECTIVES This systematic review is to outline the GI manifestations of the monkeypox virus. METHODS The authors conducted this systematic review using guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search was conducted through the PubMed, EMBASE and MEDLINE databases from January 1958 to June 2023. The authors selected English language papers that discussed the GI symptoms in mpox patients. A manual search was also conducted in the reference sections of these publications for other relevant papers. RESULTS 33 papers involving 830 patients were selected for this review. The GI manifestations in mpox patients are proctitis, vomiting, diarrhoea, rectal pain, nausea, tenesmus, rectal bleeding and abdominal pain. Although various papers explored transmission routes, one paper established a direct connection between anal-receptive sex transmission route and the development of a GI complication (proctitis). Another study reported that the mode of transmission could potentially impact the occurrence of GI symptoms and severity of the disease. The reviewed papers did not discover a relation between the severity of dermatological and influenza-like symptoms and the GI manifestations mentioned. CONCLUSION This systematic review confirms that GI manifestations are observed in mpox patients. GI symptoms of mpox are crucial for gastroenterologists and other healthcare professionals to recognise in order to address patient discomfort and further understand the pathophysiology of the virus.
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Affiliation(s)
- Rahul Ramakrishnan
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida, USA
| | - Atira Shenoy
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, Florida, USA
| | | | - Damon Meyer
- College of Health Sciences, California Northstate University, Rancho Cordova, California, USA
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Munir T, Khan M, Cheema SA, Khan F, Usmani A, Nazir M. Time series analysis and short-term forecasting of monkeypox outbreak trends in the 10 major affected countries. BMC Infect Dis 2024; 24:16. [PMID: 38166831 PMCID: PMC10762824 DOI: 10.1186/s12879-023-08879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Considering the rapidly spreading monkeypox outbreak, WHO has declared a global health emergency. Still in the category of being endemic, the monkeypox disease shares numerous clinical characters with smallpox. This study focuses on determining the most effective combination of autoregressive integrated moving average model to encapsulate time dependent flow behaviour of the virus with short run prediction. METHODS This study includes the data of confirmed reported cases and cumulative cases from eight most burdened countries across the globe, over the span of May 18, 2022, to December 31, 2022. The data was assembled from the website of Our World in Data and it involves countries such as United States, Brazil, Spain, France, Colombia, Mexico, Peru, United Kingdom, Germany and Canada. The job of modelling and short-term forecasting is facilitated by the employment of autoregressive integrated moving average. The legitimacy of the estimated models is argued by offering numerous model performance indices such as, root mean square error, mean absolute error and mean absolute prediction error. RESULTS The best fit models were deduced for each country by using the data of confirmed reported cases of monkeypox infections. Based on diverse set of performance evaluation criteria, the best fit models were then employed to provide forecasting of next twenty days. Our results indicate that the USA is expected to be the hardest-hit country, with an average of 58 cases per day with 95% confidence interval of (00-400). The second most burdened country remained Brazil with expected average cases of 23 (00-130). The outlook is not much better for Spain and France, with average forecasts of 52 (00-241) and 24 (00-121), respectively. CONCLUSION This research provides profile of ten most severely hit countries by monkeypox transmission around the world and thus assists in epidemiological management. The prediction trends indicate that the confirmed cases in the USA may exceed than other contemporaries. Based on the findings of this study, it remains plausible to recommend that more robust health surveillance strategy is required to control the transmission flow of the virus especially in USA.
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Affiliation(s)
- Tahir Munir
- Department of Anaesthesiology, Aga Khan University Hospital, Private Wing, Second Floor, Stadium Road, PO. Box 3500, Karachi, 74800, Pakistan.
| | - Maaz Khan
- Department of Anaesthesiology, Aga Khan University Hospital, Private Wing, Second Floor, Stadium Road, PO. Box 3500, Karachi, 74800, Pakistan
| | - Salman Arif Cheema
- Department of Applied Sciences, National Textile University, Faisalabad, 37610, Pakistan
| | - Fiza Khan
- Department of Anaesthesiology, Aga Khan University Hospital, Private Wing, Second Floor, Stadium Road, PO. Box 3500, Karachi, 74800, Pakistan
| | - Ayesha Usmani
- Department of Anaesthesiology, Aga Khan University Hospital, Private Wing, Second Floor, Stadium Road, PO. Box 3500, Karachi, 74800, Pakistan
| | - Mohsin Nazir
- Department of Anaesthesiology, Aga Khan University Hospital, Private Wing, Second Floor, Stadium Road, PO. Box 3500, Karachi, 74800, Pakistan
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Umar TP, Jain N, Sayad R, Tandarto K, Jain S, Reinis A. Overcoming Stigma: The Human Side of Monkeypox Virus. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:383-397. [PMID: 38801592 DOI: 10.1007/978-3-031-57165-7_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Monkeypox (Mpox) virus is a zoonotic disease that was recently declared a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). Symptoms of Mpox include fever, headache, muscle pain, and a rash which starts on the face and spreads to the rest of the body. The stigma surrounding the Mpox virus has been one of the greatest challenges in dealing with the disease. People with Mpox have been often shunned by their communities, and many are afraid to seek medical care for fear of ostracism. For those affected by the virus, this stigma can significantly impact their mental health and quality of life. It is further fueled by misinformation and societal norms. Hence, a multifaceted approach that includes education, awareness campaigns, and community engagement is needed to overcome the stigma associated with Mpox. Effective communication strategies are critical to the dispelling of rumors and the reduction of fear. Interventional measures need to be shaped according to the needs of those affected.
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Affiliation(s)
- Tungki Pratama Umar
- Faculty of Medicine, Sriwijaya University, Dr. Mohammad Ali Street-RSMH Complex, Palembang, 30126, Indonesia.
| | - Nityanand Jain
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, Riga, 1007, Latvia.
- Joint Microbiology Laboratory, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia.
| | - Reem Sayad
- Faculty of Medicine, Assiut University, Saad Zaghloul, Assiut, 71515, Egypt
| | - Kevin Tandarto
- Faculty of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Pluit Raya Street No.2, North Jakarta, Special Capital Region of Jakarta, 14440, Indonesia
| | - Shivani Jain
- Department of Oral and Maxillofacial Surgery and Oral Implantology, Genesis Institute of Dental Sciences and Research, Ferozepur - Moga Rd, Firozpur, Punjab, 152002, India
| | - Aigars Reinis
- Faculty of Medicine, Riga Stradiņš University, Dzirciema Street 16, Riga, 1007, Latvia
- Joint Microbiology Laboratory, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, Riga, 1002, Latvia
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Hoffman SA, Maldonado YA. Emerging and re-emerging pediatric viral diseases: a continuing global challenge. Pediatr Res 2024; 95:480-487. [PMID: 37940663 PMCID: PMC10837080 DOI: 10.1038/s41390-023-02878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.
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Affiliation(s)
- Seth A Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne A Maldonado
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Schuele L, Boter M, Nieuwenhuijse DF, Götz H, Fanoy E, de Vries H, Vieyra B, Bavalia R, Hoornenborg E, Molenkamp R, Jonges M, van den Ouden A, Simões M, van den Lubben M, Koopmans M, Welkers MRA, Oude Munnink BB. Circulation, viral diversity and genomic rearrangement in mpox virus in the Netherlands during the 2022 outbreak and beyond. J Med Virol 2024; 96:e29397. [PMID: 38235923 DOI: 10.1002/jmv.29397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/23/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
Mpox is an emerging zoonotic disease which has now spread to over 113 countries as of August 2023, with over 89,500 confirmed human cases. The Netherlands had one of the highest incidence rates in Europe during the peak of the outbreak. In this study, we generated 158 near-complete mpox virus (MPXV) genomes (12.4% of nationwide cases) that were collected throughout the Netherlands from the start of the outbreak in May 2022 to August 2023 to track viral evolution and investigate outbreak dynamics. We detected 14 different viral lineages, suggesting multiple introductions followed by rapid initial spread within the country. The estimated evolutionary rate was relatively high compared to previously described in orthopoxvirus literature, with an estimated 11.58 mutations per year. Genomic rearrangement events occurred at a rate of 0.63% and featured a large deletion event. In addition, based on phylogenetics, we identified multiple potential transmission clusters which could be supported by direct source- and contact tracing data. This led to the identification of at least two main transmission locations at the beginning of the outbreak. We conclude that whole genome sequencing of MPXV is essential to enhance our understanding of outbreak dynamics and evolution of a relatively understudied and emerging zoonotic pathogen.
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Affiliation(s)
- Leonard Schuele
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Marjan Boter
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - David F Nieuwenhuijse
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Hannelore Götz
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Department of Public Health, (Infectious Disease Control and Center Sexual Health) Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
| | - Ewout Fanoy
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | - Henry de Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Department of Dermatology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, Netherlands
| | - Bruno Vieyra
- Department of Public Health, (Infectious Disease Control and Center Sexual Health) Public Health Service Rotterdam-Rijnmond, Rotterdam, Netherlands
| | - Roisin Bavalia
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, Netherlands
| | - Richard Molenkamp
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Marcel Jonges
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Margarida Simões
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Mariken van den Lubben
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
| | - Marion Koopmans
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Matthijs R A Welkers
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bas B Oude Munnink
- Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Khan G, Perveen N. Monkeypox: Past, Present, and Future. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:1-20. [PMID: 38801568 DOI: 10.1007/978-3-031-57165-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Monkeypox (Mpox) is a zoonotic disease caused by a virus (monkeypox virus-MPV) belonging to the Poxviridae family. In humans, the disease has an incubation period of 5-21 days and then progresses in two phases, the prodromal phase and the rash phase. The prodromal phase is characterized by non-specific symptoms such as fever, muscle pain, malaise, lymphadenopathy, headache, and chills. Skin lesions appear in the rash phase of the disease. These lesions progress through different stages (macules, papules, vesicles, and pustules). In May 2022, WHO reported an outbreak of human Mpox in several countries which were previously Mpox-free. As per the CDC report of March 01, 2023, a total of 86,231 confirmed cases of Mpox and 105 deaths have been reported from 110 countries and territories across the globe. Notably, more than 90% of these countries were reporting Mpox for the first time. The phylogenetic analysis revealed that this outbreak was associated with the virus from the West African clade. However, most of the cases in this outbreak had no evidence of travel histories to MPV-endemic countries in Central or West Africa. This outbreak was primarily driven by the transmission of the virus via intimate contact in men who have sex with men (MSM). The changing epidemiology of Mpox raised concerns about the increasing spread of the disease in non-endemic countries and the urgent need to control and prevent it. In this chapter, we present all the documented cases of Mpox from 1970 to 2023 and discuss the past, present, and future of MPV.
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Affiliation(s)
- Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al-Ain, United Arab Emirates.
| | - Nighat Perveen
- Department of Biology, College of Science, United Arab Emirates University, P.O. Box 15551, Al-Ain, United Arab Emirates
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Nucera F, Bonina L, Cipolla A, Pirina P, Hansbro PM, Adcock IM, Caramori G. Poxviridae Pneumonia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:183-204. [PMID: 38801579 DOI: 10.1007/978-3-031-57165-7_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Poxviridae family includes several viruses that infecting humans usually causes skin lesions only, but in some cases their clinical course is complicated by viral pneumonia (with or without bacterial superinfections). Historically variola virus has been the poxviridae most frequently associated with the development of pneumonia with many large outbreaks worldwide before its eradication in 1980. It is still considered a biological threat for its potential in biological warfare and bioterrorism. Smallpox pneumonia can be severe with the onset of acute respiratory distress syndrome (ARDS) and death. Vaccinia virus, used for vaccination against smallpox exceptionally, in immunocompromised patients, can induce generalized (with also lung involvement) severe disease after vaccination. MPXV virus occasionally can cause pneumonia particularly in immunocompromised patients. The pathophysiology of poxviridae pneumonia is still an area of active research; however, in animal models these viruses can cause both direct damage to the lower airways epithelium and a hyperinflammatory syndrome, like a cytokine storm. Multiple mechanisms of immune evasion have also been described. The treatment of poxviridae pneumonia is mainly based on careful supportive care. Despite the absence of randomized clinical trials in patients with poxviridae pneumonia there are antiviral drugs, such as tecovirimat, cidofovir and brincidofovir, FDA-approved for use in smallpox and also available under an expanded access protocol for treatment of MPXV. There are 2 (replication-deficient modified vaccinia Ankara and replication-competent vaccinia virus) smallpox vaccines FDA-approved with the first one also approved for prevention of MPXV in adults that are at high risk of infection.
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Affiliation(s)
- Francesco Nucera
- Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), Università degli Studi di Messina, Messina, Italy
| | - Letterio Bonina
- Virologia, Dipartimento di Patologia delle Malattie Umane "G. Barresi", Università degli Studi di Messina, Messina, Italy
| | - Antonino Cipolla
- Pneumologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Catania, Catania, Italy
| | - Pietro Pirina
- Pneumologia, Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, Sassari, Italy
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia
| | - Ian M Adcock
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Gaetano Caramori
- Pulmonology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Son BWK, Wambalaba OW, Wambalaba WF. A Multi-pronged Approach to Addressing Global Poxviruses Vaccine Inequity: A Case of Monkeypox. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:317-330. [PMID: 38801587 DOI: 10.1007/978-3-031-57165-7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Monkeypox has been endemic in Congo and Nigeria for at least five decades. Since early May 2022, there have been numerous unprecedented outbreaks throughout the world in places without any previously reported cases. While a majority of the diagnosed cases have been within Europe and the Americas, several cases have occurred in non-endemic African countries. As of December 2022, 82,999 cases had been reported globally, prompting concern among the World Health Organization (WHO) members. While the WHO has not labeled this epidemic a Global Health Emergency, member states have begun to put forward plans to consolidate their emergency vaccine stockpiles and share the limited number of vaccines made by the single FDA-approved manufacturer, Bavarian Nordic. Many countries are concerned about how vaccines will be shared. Some of the larger donor States are positioned to be the biggest beneficiaries of vaccine sharing, while States from areas that have been suffering from the virus since the 1970s have not been allocated any. This pattern of vaccine distribution echoes that seen during the early part of the COVID-19 pandemic. Due to the similarities between Monkeypox and Smallpox, contact precautions and vaccination seem to be effective strategies to combat its rapid spread. We aim to evaluate how an eradication program model similar to that used for Smallpox can be applied to Monkeypox, and whether it can address vaccine inequity. To do this, we use a multi-pronged approach targeting disease surveillance, vaccine awareness, manufacturing, cost, and distribution strategies.
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Affiliation(s)
- Barbara W K Son
- Akio Morita School of Business, Anaheim University, 1240 South State College Blvd., Anaheim, CA, 92806, USA.
| | - Otioli W Wambalaba
- Internal Medicine, Griffin Hospital, 130 Division Street, Derby, CT, 06418, USA
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Jhancy M. Poxvirus Vaccines: Past, Present, and Future. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:273-287. [PMID: 38801584 DOI: 10.1007/978-3-031-57165-7_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Smallpox was a significant cause of mortality for over three thousand years, amounting to 10% of deaths yearly. Edward Jenner discovered smallpox vaccination in 1796, which rapidly became a smallpox infection preventive practice throughout the world and eradicated smallpox infection by 1980. After smallpox eradication, monkeypox vaccines have been used primarily in research and in outbreaks in Africa, where the disease is endemic. In the present, the vaccines are being used for people who work with animals or in high-risk areas, as well as for healthcare workers treating patients with monkeypox. Among all orthopoxviruses (OPXV), monkeypox viral (MPXV) infection occurs mainly in cynomolgus monkeys, natural reservoirs, and occasionally causes severe multi-organ infection in humans, who were the incidental hosts. The first case of the present epidemic of MXPV was identified on May 7, 2022, and rapidly increased the number of cases. In this regard, the WHO declared the outbreak, an international public health emergency on July 23, 2022. The first monkeypox vaccine was developed in the 1960s by the US Army and was based on the vaccinia virus, which is also used in smallpox vaccines. In recent years, newer monkeypox vaccines have been developed based on other viruses such as Modified Vaccinia Ankara (MVA). These newer vaccines are safer and can provide longer-lasting immunity with fewer side effects. For the future, there is ongoing research to improve the current vaccines and to develop new ones. One notable advance has been the development of a recombinant vaccine that uses a genetically modified vaccinia virus to express monkeypox antigens. This vaccine has shown promising results in pre-clinical trials and is currently undergoing further testing in clinical trials. Another recent development has been the use of a DNA vaccine, which delivers genetic material encoding monkeypox antigens directly into cells. This type of vaccine has shown effectiveness in animal studies and is also undergoing clinical testing in humans. Overall, these recent advances in monkeypox vaccine development hold promise for protecting individuals against this potentially serious disease.
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Affiliation(s)
- Malay Jhancy
- RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates.
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