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Bonilla-Aldana DK, Bonilla-Aldana JL, Ulloque-Badaracco JR, Al-Kassab-Córdova A, Hernandez-Bustamante EA, Alarcon-Braga EA, Benites-Zapata VA, Copaja-Corzo C, Silva-Cajaleon K, Rodriguez-Morales AJ. Mpox infection in animals: A systematic review and meta-analysis. J Infect Public Health 2024; 17:102431. [PMID: 38820901 DOI: 10.1016/j.jiph.2024.04.015] [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: 02/05/2024] [Revised: 03/26/2024] [Accepted: 04/17/2024] [Indexed: 06/02/2024] Open
Abstract
Mpox is a zoonotic disease that became epidemic in multiple countries in 2022. There is a lack of published systematic reviews on natural animal infection due to Mpox. We performed a systematic literature review with meta-analysis to assess animal Mpox prevalence. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI) for prevalence studies. After the screening, 15 reports were selected for full-text assessment and included in qualitative and quantitative analyses. Ten reports assessed Mpox infection by molecular or serological tests (n = 2680), yielding a pooled prevalence of 16.0% (95%CI: 3.0-29.0%) for non-human primates; 8.0% (95%CI: 4.0-12.0%) for rodents and 1.0% (95%CI: 0.0-3.0%) for shrews. Further studies in other animals are required to define the extent and importance of natural infection due to Mpox. These findings have implications for public human and animal health. OneHealth approach is critical for prevention and control.
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Affiliation(s)
| | - Jorge Luis Bonilla-Aldana
- Grupo de Investigación en Ciencias Animales Macagual, Universidad de La Amazonia, Florencia, Caquetá 180002, Colombia
| | | | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima 15012, Peru
| | - Enrique A Hernandez-Bustamante
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15012, Peru; Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo 13011, Peru
| | | | | | - Cesar Copaja-Corzo
- Unidad de Investigación para la generación y síntesis de evidencias en salud, Universidad San Ignacio de Loyola, Lima 15012, Peru; Servicio de infectología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima 15072, Peru
| | - Kenneth Silva-Cajaleon
- Faculties of Environmental and Health Sciences, Universidad Científica del Sur, Lima 4861, Peru
| | - Alfonso J Rodriguez-Morales
- Faculties of Environmental and Health Sciences, Universidad Científica del Sur, Lima 4861, Peru; Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, 660003 Risaralda, Colombia; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
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2
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Al-Eitan L, Haddad M, Mihyar A. Poxviruses from the Concept of One Health. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:21-33. [PMID: 38801569 DOI: 10.1007/978-3-031-57165-7_2] [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
In the last 4 years, the world has experienced two pandemics of bat-borne viruses. Firstly, in 2019 the SARS-CoV-2 pandemic started and has been causing millions of deaths around the world. In 2022, a Monkeypox pandemic rose in various countries of the world. Those pandemics have witnessed movements and initiatives from healthcare and research institutions to establish a worldwide understanding to battle any future pandemics and biological threats. One Health concept is a modern, comprehensive, unifying ways to improve humans, animals, and ecosystems' health. This concept shows how much they are intertwined and related to one another, whether it is an environmental, or a pathological relation. This review aims to describe Poxviridae and its impact on the One Health concept, by studying the underlying causes of how poxviruses can affect the health of animals, humans, and environments. Reviewing the effect of disease transmission between animal to human, human to human, and animal to animal with pox viruses as a third party to achieve a total understanding of infection and viral transmission. Thus, contributing to enhance detection, diagnosis, research, and treatments regarding the application of One Health.
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Affiliation(s)
- Laith Al-Eitan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Mountaser Haddad
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ahmad Mihyar
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, 22110, Jordan
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3
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Yu Z, Zou X, Deng Z, Zhao M, Gu C, Fu L, Xiao W, He M, He L, Yang Q, Liang S, Wen C, Lü M. Genome analysis of the mpox (formerly monkeypox) virus and characterization of core/variable regions. Genomics 2024; 116:110763. [PMID: 38110129 DOI: 10.1016/j.ygeno.2023.110763] [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: 07/02/2023] [Revised: 11/04/2023] [Accepted: 12/14/2023] [Indexed: 12/20/2023]
Abstract
Since smallpox was eradicated in 1980, the monkeypox virus (MPXV) has emerged as the most threatening orthopoxvirus in the world. In this study, we conducted a comprehensive analysis of the currently published complete genome sequences of the monkeypox virus. The core/variable regions were identified through core-pan analysis of MPXV. Besides single-nucleotide polymorphisms, our study also revealed that specific genes, multi-copy genes, repeat sequences, and recombination fragments are primarily distributed in the variable region. This result suggests that variable regions are not only more susceptible to single-base mutations, but also to events such as gene loss or gain, as well as recombination. Taken together, our results demonstrate the genomic characteristics of the core/variable regions of MPXV, and contribute to our understanding of the evolution of MPXV.
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Affiliation(s)
- Zehui Yu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China; Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Scholl of Basic Medical Sciences, Zhejiang University, Hangzhou, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Xiaoxia Zou
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China; Suining First People's Hospital, Suining, PR China
| | - Zhaobin Deng
- Department of Medicine and Naomi Berrie Diabetes Center, Columbia University, New York, USA
| | - Mingde Zhao
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Congwei Gu
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Lu Fu
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China
| | - Wudian Xiao
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Manli He
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Lvqin He
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Qian Yang
- Laboratory Animal Center, Southwest Medical University, Luzhou, Sichuan, PR China; Model Animal and Human Disease Research of Luzhou Key Laboratory, Luzhou, PR China
| | - Sicheng Liang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China; Human Microecology and Precision Diagnosis and Treatment of Luzhou Key Laboratory, Luzhou, PR China
| | - Chengli Wen
- Department of Intensive Care Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China.
| | - Muhan Lü
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China; Human Microecology and Precision Diagnosis and Treatment of Luzhou Key Laboratory, Luzhou, PR China.
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4
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Bartáčková J, Kouba V, Dostálková A, Čermáková E, Lopez Marin MA, Chmel M, Milanová M, Demnerová K, Rumlová M, Sýkora P, Bartáček J, Zdeňková K. Monitoring of monkeypox viral DNA in Prague wastewater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 902:166110. [PMID: 37567313 DOI: 10.1016/j.scitotenv.2023.166110] [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: 03/17/2023] [Revised: 07/24/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023]
Abstract
Monkeypox virus (Mpxv) is a dsDNA virus that has become a global concern for human health in 2022. As both infected people and non-human hosts can shed the virus from their skin, faeces, urine and other body fluids, and the resulting sewage contains viral load representative of the whole population, it is highly promising to detect the spread of monkeypox virus in municipal wastewater. We established a methodology for sewage-based monitoring of Mpxv in Prague and analysed samples (n = 24) already early August-October of 2022 in a municipality with 1.4 million inhabitants that only reported 29 cumulative cases in this period. We isolated Mpxv DNA with the Wizard Enviro Total Nucleic Acid Kit, and thereafter detected Mpxv DNA using the EliGene® Monkeypox RT-PCR Kit. Prague wastewater was positive for Mpxv (in total 9 positive samples in periods with 1-9 new cases per week, coinciding with a weekly incidence of 0.07-0.64 per 100,000 inhabitants. The method for confirmation of wastewater positivity via semi-nested PCR and Sanger sequencing was successfully confirmed on positive controls including Mpxv particles and Mpxv-positive wastewater from the Netherlands. However, for Prague wastewater samples, amplification of Mpxv DNA via semi-semi-nested PCR was unsuccessful. This was probably due to extremely low case count, leading to the amplification of non-target bacterial DNA. Compared to other studies with much higher Mpxv prevalence, we show the outstanding sensitivity of our approach for monitoring the spread of monkeypox using wastewater.
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Affiliation(s)
- Jana Bartáčková
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Vojtěch Kouba
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia.
| | - Alžběta Dostálková
- Department of Biotechnology, University of Chemistry and Technology Prague, Czechia
| | - Eliška Čermáková
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
| | - Marco A Lopez Marin
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Martin Chmel
- Military Health Institute, Military Medical Agency, Czechia; Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czechia
| | - Marcela Milanová
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Kralove, Czech Republic
| | - Kateřina Demnerová
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
| | - Michaela Rumlová
- Department of Biotechnology, University of Chemistry and Technology Prague, Czechia
| | - Petr Sýkora
- Prazske vodovody a kanalizace, a.s., Czechia
| | - Jan Bartáček
- Department of Water Technology and Environmental Engineering, University of Chemistry and Technology Prague, Czechia
| | - Kamila Zdeňková
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Czechia
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5
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Mahmmoud Fadelallah Eljack M, Elnaiem W, Abdelwahed AE, Hasabo E, Abbas AA, Ahmed AS, Jobran AW, AbdAlla Mohamed MT, Muhalil MG, Jagran Idris LM, Bakour RK, Eltaib Elseed LZ, Al Komi O, Mugibel TA, Nour AB, Ibrahim H, Owish Sukar KA, Ahmed FMT, Elkhazin Mohamed Ali KS, Hussien Mohamed Ahmed KA. Fear of a new pandemic: perception and prediction of monkeypox among the middle east general population. Ann Med Surg (Lond) 2023; 85:5908-5918. [PMID: 38098587 PMCID: PMC10718370 DOI: 10.1097/ms9.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/09/2023] [Indexed: 12/17/2023] Open
Abstract
Background Monkeypox is a zoonotic disease caused by the monkeypox virus, an Orthopox virus. The 2022 monkeypox outbreak provoked fear among the public. Public awareness about the disease could be an important factor in its control. The authors conducted this study to assess the perception and prediction of monkeypox among the Middle East public. Methods This cross-sectional study was conducted in August 2022. Data were conveniently collected from eight Middle Eastern countries using an online self-administered questionnaire distributed through educational and social media platforms. Statistical analysis was conducted using R software. Results Approximately 11 016 individuals participated in this study. The participants' overall knowledge score indicated poor knowledge about monkeypox. Most of the participants knew the causative organism (66.7%). However, numerous participants were not aware of the disease mode of transmission, symptoms, complications, and vaccination. Participants' awareness was mostly gained from social media (61.8%). The majority predicted acquiring monkeypox when protective measures are not taken (72.7%), progression to a pandemic with economic consequences (50.8 and 52%, respectively), and the ability of the Ministry of Health to control the epidemic (51.5%). Conclusion In the Middle East, public knowledge about monkeypox is poor. Raising awareness about monkeypox would be of benefit in controlling the epidemic. This study constitutes evidence upon which health education programs could be designed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Omar Al Komi
- College of Medicine, Sulaiman Alrajhi University, Albukayriah, Al-Qassim, Saudi Arabia
| | | | - Alshareef B. Nour
- Faculty of Medicine, Wad Medani Collage of Medical Sciences, Wad Medani
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Abdelaal A, Reda A, Hassan AR, Mashaal A, Abu Serhan H, Katamesh BE, Abdelazeem B, Mohanty A, Padhi BK, Rodriguez-Morales AJ, Sah R. Monkeypox-Associated Manifestations and Complications Involving the Eye: A Systematic Review and Meta-Analysis of Previous and Current Outbreaks. Asia Pac J Ophthalmol (Phila) 2023; 12:326-337. [PMID: 37249903 DOI: 10.1097/apo.0000000000000608] [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: 10/12/2022] [Accepted: 03/13/2023] [Indexed: 05/31/2023] Open
Abstract
PURPOSE The purpose of this study was to pool the prevalence rate of monkeypox-associated eye manifestations and/or complications during the current and previous outbreaks. DESIGN A systematic review and meta-analysis. MATERIALS AND METHODS On August 7, 2022, PubMed, Scopus, Web of Science, EMBASE, and Google Scholar were searched for relevant articles. We included all studies that reported the involvement of the eye (either as a manifestation or a complication) among patients with monkeypox. The primary outcome included pooling the effect size (ES) of reported manifestations and complications, and the secondary outcome included the conduct of a subgroup analysis based on the timing of the monkeypox outbreak (before vs. during 2022). RESULTS Eleven studies reporting 3179 monkeypox-confirmed cases were included. Eye manifestations included conjunctivitis, corneal, conjunctival, and eyelid lesions, photophobia, and eye pain. Compared with previous monkeypox outbreaks, the current outbreak revealed much lower rates of ocular involvement in terms of conjunctivitis (ES=1%; 95% CI: 0%-1% vs. ES=17%; 95% CI: 11%-22%), corneal and conjunctival lesions (ES=1%; 95% CI: 0%-2% vs. ES=13%; 95% CI: 4%-22%), and eyelid lesions (ES=1%; 95% CI: 0%-4% vs. ES=13%; 95% CI: 5%-28%). Monkeypox-associated eye complications were reported only in the previous outbreaks which included keratitis (ES=4%; 95% CI: 3%-6%), corneal ulceration (ES=4%; 95% CI: 2%-5%), unilateral (ES=3%; 95% CI: 1%-4%) and bilateral blindness (ES=0%; 95% CI: 0%-2%), and impaired vision (ES=4%; 95% CI: 1%-8%). CONCLUSIONS Ophthalmic manifestations and complications are common among monkeypox-confirmed cases. Although these data are mainly related to previous outbreaks, health care workers should familiarize themselves with these signs to provide better care for monkeypox patients.
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Affiliation(s)
- Abdelaziz Abdelaal
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Harvard Medical School, Boston, MA, US
- Boston University School of Medicine, Boston, MA, US
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, US
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
| | - Abdullah Reda
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdul Rhman Hassan
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
| | - Abdelhafeez Mashaal
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
| | - Hashem Abu Serhan
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar
| | - Basant E Katamesh
- Tanta Research Team, Tanta, El-Gharbia Governorate, Egypt
- Faculty of Medicine, Tanta University, Tanta, El-Gharbia Governorate, Egypt
- Mayo Clinic, Rochester, MN, US
| | - Basel Abdelazeem
- McLaren Health Care, Flint, Michigan, US
- Michigan State University, East Lansing, Michigan, US
| | - Aroop Mohanty
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
| | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alfonso J Rodriguez-Morales
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- Master's Program of Clinical Epidemiology and Biostatistics, Scientific University of the South (Universidad Científica del Sur), Lima, Peru
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
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7
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Rampogu S, Kim Y, Kim SW, Lee KW. An overview on monkeypox virus: Pathogenesis, transmission, host interaction and therapeutics. Front Cell Infect Microbiol 2023; 13:1076251. [PMID: 36844409 PMCID: PMC9950268 DOI: 10.3389/fcimb.2023.1076251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
Orthopoxvirus is one of the most notorious genus amongst the Poxviridae family. Monkeypox (MP) is a zoonotic disease that has been spreading throughout Africa. The spread is global, and incidence rates are increasing daily. The spread of the virus is rapid due to human-to-human and animals-to-human transmission. World Health Organization (WHO) has declared monkeypox virus (MPV) as a global health emergency. Since treatment options are limited, it is essential to know the modes of transmission and symptoms to stop disease spread. The information from host-virus interactions revealed significantly expressed genes that are important for the progression of the MP infection. In this review, we highlighted the MP virus structure, transmission modes, and available therapeutic options. Furthermore, this review provides insights for the scientific community to extend their research work in this field.
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Affiliation(s)
- Shailima Rampogu
- Department of Bio & Medical Big Data (BK4 Program), Division of Life Sciences, Research Institute of Natural Science (RINS), Gyeongsang National University (GNU), Jinju, Republic of Korea
| | - Yongseong Kim
- Department of Pharmaceutical Engineering, Kyungnam University, Changwon, Republic of Korea
| | - Seon-Won Kim
- Division of Applied Life Science (BK21 Four), ABC-RLRC, PMBBRC, Gyeongsang National University, Jinju, Republic of Korea
| | - Keun Woo Lee
- Department of Bio & Medical Big Data (BK4 Program), Division of Life Sciences, Research Institute of Natural Science (RINS), Gyeongsang National University (GNU), Jinju, Republic of Korea
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8
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Lokhande KB, Shrivastava A, Singh A. In silico
discovery of potent inhibitors against monkeypox's major structural proteins. J Biomol Struct Dyn 2023; 41:14259-14274. [PMID: 36841550 DOI: 10.1080/07391102.2023.2183342] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 02/27/2023]
Abstract
Monkeypox virus (MPXV) outbreak in non-endemic countries is a worldwide public health emergency. An enveloped double-stranded DNA virus belongs to the genus Orth poxvirus. A viral zoonotic infection known as monkeypox has been a serious risk to public health, especially in Africa. However, it has recently spread to other continents, so it might soon become a worldwide problem. There is an increased risk of transmission of the virus because there is a lack of effective treatment that cures the disease. To stop the multi-country outbreak from spreading, it is important to discover effective medications urgently. The objective of the current study is to swiftly find new treatments for the monkeypox virus using advanced computational approaches. By investigating five potential MPXV targets (DNA ligase, Palmytilated Extracellular Enveloped Virus (EEV) membrane protein, Scaffold protein D13, Thymidylate Kinase, and Viral core cysteine proteinase), this research was carried out using cutting-edge computational techniques against human monkeypox virus infection. Here we present the accurate 3D structures and their binding cavities of the selected targets with higher confidence using AlphaFold 2 and SiteMap analysis. Molecular docking and MD simulation analysis revealed the top five potential lead compounds with higher binding affinity and stability toward selected targets. Binding free energy calculations and other essential dynamics analysis supports the finding. The selected lead compounds utilizing virtual screening and drug repurposing approach reported in this study are beneficial for medical scientists and experimental biologists in drug development for the treatment of human MPXV.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Kiran Bharat Lokhande
- Translational Bioinformatics and Computational Genomics Research Lab, Department of Life Sciences, Shiv Nadar Institution of Eminence, Gautam Buddha Nagar, Uttar Pradesh, India
| | - Ashish Shrivastava
- Translational Bioinformatics and Computational Genomics Research Lab, Department of Life Sciences, Shiv Nadar Institution of Eminence, Gautam Buddha Nagar, Uttar Pradesh, India
| | - Ashutosh Singh
- Translational Bioinformatics and Computational Genomics Research Lab, Department of Life Sciences, Shiv Nadar Institution of Eminence, Gautam Buddha Nagar, Uttar Pradesh, India
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9
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Begum JPS, Ngangom L, Semwal P, Painuli S, Sharma R, Gupta A. Emergence of monkeypox: a worldwide public health crisis. Hum Cell 2023; 36:877-893. [PMID: 36749539 PMCID: PMC9903284 DOI: 10.1007/s13577-023-00870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/28/2023] [Indexed: 02/08/2023]
Abstract
The human monkeypox virus (MPV), a zoonotic illness that was hitherto solely prevalent in Central and West Africa, has lately been discovered to infect people all over the world and has become a major threat to global health. Humans unintentionally contract this zoonotic orthopoxvirus, which resembles smallpox, when they come into contact with infected animals. Studies show that the illness can also be transferred through frequent proximity, respiratory droplets, and household linens such as towels and bedding. However, MPV infection does not presently have a specified therapy. Smallpox vaccinations provide cross-protection against MPV because of antigenic similarities. Despite scant knowledge of the genesis, epidemiology, and ecology of the illness, the incidence and geographic distribution of monkeypox outbreaks have grown recently. Polymerase chain reaction technique on lesion specimens can be used to detect MPV. Vaccines like ACAM2000, vaccinia immune globulin intravenous (VIG-IV), and JYNNEOS (brand name: Imvamune or Imvanex) as well as FDA-approved antiviral medications such as brincidofovir (brand name: Tembexa), tecovirimat (brand name: TPOXX or ST-246), and cidofovir (brand name: Vistide) are used as therapeutic medications against MPV. In this overview, we provide an outline of the MPV's morphology, evolution, mechanism, transmission, diagnosis, preventative measures, and therapeutic approaches. This study offers the fundamental information required to prevent and manage any further spread of this emerging virus.
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Affiliation(s)
- J. P. Shabaaz Begum
- grid.448909.80000 0004 1771 8078Department of Life Sciences, Graphic Era (Deemed to Be University), Dehradun, Uttarakhand 248002 India
| | - Leirika Ngangom
- grid.448909.80000 0004 1771 8078Department of Life Sciences, Graphic Era (Deemed to Be University), Dehradun, Uttarakhand 248002 India
| | - Prabhakar Semwal
- grid.448909.80000 0004 1771 8078Department of Life Sciences, Graphic Era (Deemed to Be University), Dehradun, Uttarakhand 248002 India
| | - Sakshi Painuli
- Uttarakhand Council for Biotechnology (UCB), Prem Nagar, Dehradun, Uttarakhand 248007 India
| | - Rohit Sharma
- grid.411507.60000 0001 2287 8816Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043 USA ,South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA ,BioIntegrate, Lawrenceville, GA 30043 USA ,Regenerative Orthopaedics, Uttar Pradesh, Noida, 201301 India
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10
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Zhou J, Xiao F, Fu J, Jia N, Huang X, Sun C, Liu C, Huan H, Wang Y. Rapid detection of monkeypox virus by multiple cross displacement amplification combined with nanoparticle-based biosensor platform. J Med Virol 2023; 95:e28479. [PMID: 36609918 DOI: 10.1002/jmv.28479] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
The current outbreak of monkeypox virus (MPXV) has become a public health emergency of international concern that highlights the need for rapid, sensitive MPXV diagnostic assays. Here, we combined isothermal multiple cross displacement amplification (MCDA) with nanoparticle-based lateral flow biosensor (LFB) to devise a diagnostic test for the diagnosis of MPXV infection (called MPXV-MCDA-LFB) and differentiation of West and Central African MPXV isolates. The MPXV-MCDA-LFB protocol conducts isothermal MCDA reaction for DNA templates followed by LFB detection of preamplification target sequences. Two MCDA primer sets were designed targeting the D41L and ATI genes of Central and West African MPXV isolates, respectively, and the optimal condition of two MCDA reactions was 64°C for 30 min. The two MCDA reactions were decoded by LFB, which was devised for detecting three targets, including two amplicons yielded from two MCDA reactions and a chromatography control. Thus, the MPXV-MCDA-LFB assay could be completed within 50 min including rapid template preparation (15 min), MCDA reaction (30 min) and reporting of result (<5 min). The MPXV-MCDA-LFB method is very sensitive and can detect the target genes (D14L and ATI) with as low as five copies of plasmid template per reaction and 12.5 copies of pseudotyped virus in human blood samples. The MPXV-MCDA-LFB assay does not cross-react with non-MPXV templates, validating its specificity. Therefore, the MPXV-MCDA-LFB assay developed here is a useful tool for rapid and reliable diagnosis of MPXV infection.
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Affiliation(s)
- Juan Zhou
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Fei Xiao
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Jin Fu
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Nan Jia
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xiaolan Huang
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Chunrong Sun
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Chunyan Liu
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Hui Huan
- Department of Infectious Diseases, Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Yi Wang
- Experimental Research Center, Capital Institute of Pediatrics, Beijing, People's Republic of China
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11
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Lounis M, Riad A. Monkeypox (MPOX)-Related Knowledge and Vaccination Hesitancy in Non-Endemic Countries: Concise Literature Review. Vaccines (Basel) 2023; 11:vaccines11020229. [PMID: 36851107 PMCID: PMC9958664 DOI: 10.3390/vaccines11020229] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023] Open
Abstract
In May 2022, the world witnessed the emergence of human monkeypox (MPOX), a new zoonotic viral disease in multiple non-endemic countries. This health threat has been associated with increased anxiety, especially after the COVID-19 catastrophe. In addition, people are exposed to an unprecedented amount of information, making them vulnerable to misinformation that may lead to embracing conspiracy theories. This literature review was conducted to evaluate the levels of MPOX-related knowledge and attitudes toward its vaccination by reviewing studies indexed in MEDLINE® until 15 November 2022. A total of 16 studies conducted in non-endemic countries were included in this review, predominantly in Europe, the Middle East, and Asia. Nine studies investigated exclusively MPOX-related knowledge and awareness, and two studies were exclusively related to MPOX vaccines, while five studies dealt with both topics. The target populations were mainly healthcare professionals and the general adult population. The results revealed an unsatisfactory level of knowledge and awareness among certain groups. Regarding vaccination, the results showed that vaccine hesitancy is still common for healthcare professionals except among Chinese healthcare professionals, where the rate of vaccine acceptance was estimated at 90.1%. This review could help understand the MPOX-related knowledge and awareness and vaccine hesitancy in the first months of the emergence of the MPOX by comparing their evolution in recent studies.
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Affiliation(s)
- Mohamed Lounis
- Department of Agro-Veterinary Science, Faculty of Natural and Life Sciences, University of Ziane Achour, BP 3117, Road of Moudjbara, Djelfa 17000, Algeria
- Correspondence:
| | - Abanoub Riad
- Department of Public Health, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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12
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Tiwari A, Adhikari S, Kaya D, Islam MA, Malla B, Sherchan SP, Al-Mustapha AI, Kumar M, Aggarwal S, Bhattacharya P, Bibby K, Halden RU, Bivins A, Haramoto E, Oikarinen S, Heikinheimo A, Pitkänen T. Monkeypox outbreak: Wastewater and environmental surveillance perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:159166. [PMID: 36202364 PMCID: PMC9534267 DOI: 10.1016/j.scitotenv.2022.159166] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 04/13/2023]
Abstract
Monkeypox disease (MPXD), a viral disease caused by the monkeypox virus (MPXV), is an emerging zoonotic disease endemic in some countries of Central and Western Africa but seldom reported outside the affected region. Since May 2022, MPXD has been reported at least in 74 countries globally, prompting the World Health Organization to declare the MPXD outbreak a Public Health Emergency of International Concern. As of July 24, 2022; 92 % (68/74) of the countries with reported MPXD cases had no historical MPXD case reports. From the One Health perspective, the spread of MPXV in the environment poses a risk not only to humans but also to small mammals and may, ultimately, spread to potent novel host populations. Wastewater-based surveillance (WBS) has been extensively utilized to monitor communicable diseases, particularly during the ongoing COVID-19 pandemic. It helped in monitoring infectious disease caseloads as well as specific viral variants circulating in communities. The detection of MPXV DNA in lesion materials (e.g. skin, vesicle fluid, crusts), skin rashes, and various body fluids, including respiratory and nasal secretions, saliva, urine, feces, and semen of infected individuals, supports the possibility of using WBS as an early proxy for the detection of MPXV infections. WBS of MPXV DNA can be used to monitor MPXV activity/trends in sewerage network areas even before detecting laboratory-confirmed clinical cases within a community. However, several factors affect the detection of MPXV in wastewater including, but not limited to, routes and duration time of virus shedding by infected individuals, infection rates in the relevant affected population, environmental persistence, the processes and analytical sensitivity of the used methods. Further research is needed to identify the key factors that impact the detection of MPXV biomarkers in wastewater and improve the utility of WBS of MPXV as an early warning and monitoring tool for safeguarding human health. In this review, we shortly summarize aspects of the MPXV outbreak relevant to wastewater monitoring and discuss the challenges associated with WBS.
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Affiliation(s)
- Ananda Tiwari
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Department of Health Security, Expert Microbiology Research Unit, Finnish Institute for Health and Welfare, Finland.
| | - Sangeet Adhikari
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA
| | - Devrim Kaya
- School of Chemical, Biological, and Environmental Engineering, Oregon State University (OSU), Corvallis, OR, USA
| | - Md Aminul Islam
- COVID-19 Diagnostic Laboratory, Department of Microbiology, Noakhali Science and Technology University, Noakhali, 3814, Bangladesh; Advanced Molecular Laboratory, Department of Microbiology, President Abdul Hamid Medical College, Karimganj, Kishoreganj, Bangladesh
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Samendra P Sherchan
- Department of Biology, Morgan State University, Baltimore, MD, USA; Department of Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ahmad I Al-Mustapha
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Oyo State, Nigeria; Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin, Kwara State, Nigeria
| | - Manish Kumar
- Sustainability Cluster, School of Engineering, University of Petroleum & Energy Studies, Dehradun, Uttarakhand 248007, India
| | - Srijan Aggarwal
- Department of Civil, Geological and Environmental Engineering, College of Engineering and Mines, University of Alaska Fairbanks, PO Box 755900, Fairbanks, AK 99775, USA
| | - Prosun Bhattacharya
- Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, SE-10044 Stockholm, Sweden
| | - Kyle Bibby
- Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, IN 46556, USA
| | - Rolf U Halden
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA
| | - Aaron Bivins
- Department of Civil & Environmental Engineering, Louisiana State University, LA, USA
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Sami Oikarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Annamari Heikinheimo
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Finnish Food Authority, Seinäjoki, Finland
| | - Tarja Pitkänen
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Finland; Department of Health Security, Expert Microbiology Research Unit, Finnish Institute for Health and Welfare, Finland
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13
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Sabeena S. The changing epidemiology of monkeypox and preventive measures: an update. Arch Virol 2023; 168:31. [PMID: 36604361 DOI: 10.1007/s00705-022-05677-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/14/2022] [Indexed: 01/07/2023]
Abstract
Monkeypox is a systemic exanthematous viral disease presenting with fever, lymphadenopathy, and vesicular rash. The zoonotic virus causing this disease is endemic to many sub-Saharan African countries, where a steady rise in cases has been witnessed for the past 30 years. However, monkeypox re-emerged as the largest outbreak of the West African clade (clade II) of monkeypox virus in Nigeria in 2017. This poxvirus received only minimal global attention until recently, when cases emerged in Europe and rapidly spread globally in certain sections of the community, such as men having sex with men or bisexuals, with human-to-human transmission. Monkeypox virus has established its presence in humans, crossing geographical boundaries, and clusters of infections may occur among individuals in close contact. All six WHO regions have reported monkeypox cases without any epidemiological association with endemic regions. The ongoing multicountry outbreak suggests that silent human-to-human transmission has been happening in Europe and the United States for a while. For containment of the outbreak, active surveillance and rapid identification of new cases are essential. The availability of vaccines is currently limited. Policymakers must focus on awareness programmes, primary preventive or post-exposure vaccination, and treatment with antivirals to control the ongoing outbreak.
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14
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Silva MST, Coutinho C, Torres TS, Peixoto E, Ismério R, Lessa F, Nunes EP, Hoagland B, Echeverria Guevara AD, Bastos MO, Ferreira Tavares IC, Diniz Ribeiro MP, Meneguetti Seravalli Ramos MR, Andrade HB, Lovetro Santana AP, Santini-Oliveira M, Santos Netto JB, Reges P, Magalhães MA, Silva Rosadas LA, Nazer S, Velasque L, Cardoso SW, da Silva EE, Veloso VG, Wakimoto MD, Grinsztejn B, Trepow M, Ferreira IG, Villela L, Fraga RT, Castro de Souza Pires M, Otavio da Silva Escada R, Paiva de Sousa L, Umaña Robleda GL, Santos DV, Siqueira Camacho LR, Amparo P, Jaegger de França JV, de Oliveira Heluy Correa F, Costa de Sousa BI, Vicari do Valle B, Bortot Soares JP, Fonseca Ferreira LC, da Silva Martins P, Mesquita MB, Hildebrant Coutinho JR, de Moraes Perlingeiro R, Peixoto de Castro Oliveira P, Pedroso Barbosa HP, Accetta AF, Cunha M, Eiras RV, Martins dos Santos T, Davila da Silva W, Silveira MDV, de Souza Brum T, Calvet GA, Menezes RC, Pereira SA. Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from Brazil. LANCET REGIONAL HEALTH. AMERICAS 2022; 17:100406. [PMID: 36776570 PMCID: PMC9904017 DOI: 10.1016/j.lana.2022.100406] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
Background By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30-39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz).
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Affiliation(s)
- Mayara Secco Torres Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eduardo Peixoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ronaldo Ismério
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Flavia Lessa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Estevão Portela Nunes
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Matheus Oliveira Bastos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Maria Pia Diniz Ribeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Hugo Boechat Andrade
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Ana Paula Lovetro Santana
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Marilia Santini-Oliveira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Juliana Barbosa Santos Netto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Paula Reges
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Monica Avelar Magalhães
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (ICICT-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Sandro Nazer
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Departamento de Matemática e Estatística, Rio de Janeiro, RJ, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Edson Elias da Silva
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (IOC-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Valdilea Gonçalves Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Mayumi Duarte Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil,Corresponding author. Av Brasil 4365 Manguinhos, Rio de Janeiro, RJ, Brazil.
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15
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Ortiz-Saavedra B, León-Figueroa DA, Montes-Madariaga ES, Ricardo-Martínez A, Alva N, Cabanillas-Ramirez C, Barboza JJ, Siddiq A, Coaguila Cusicanqui LA, Bonilla-Aldana DK, Rodriguez-Morales AJ. Antiviral Treatment against Monkeypox: A Scoping Review. Trop Med Infect Dis 2022; 7:369. [PMID: 36355910 PMCID: PMC9696364 DOI: 10.3390/tropicalmed7110369] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 08/25/2023] Open
Abstract
During the COVID-19 pandemic, the increase in reports of human monkeypox virus infection cases spreading in many countries outside Africa is a major cause for concern. Therefore, this study aimed to explore the evidence of antiviral pharmacotherapy available for the treatment of adult patients with monkeypox. A scoping review of the literature was conducted using PubMed, Scopus, Web of Science, Embase, and CENTRAL databases until 12 September 2022. The key search terms used were "monkeypox" and "treatment". A total of 1927 articles were retrieved using the search strategy. After removing duplicates (n = 1007) and examining by title, abstract, and full text, 11 studies reporting case reports of monkeypox with antiviral treatment were included, detailing the number of monkeypox cases, clinical manifestations, number of participants with antiviral treatment, history of sexually transmitted diseases, method of diagnosis, location of skin lesions, drugs used in antiviral treatment, route of administration, and outcome. A total of 1281 confirmed cases of monkeypox have been reported, of which 65 monkeypox cases had antiviral treatment distributed most frequently in the United States (n = 30), the United Kingdom (n = 6), and Spain (n = 6). Of the total cases, 1269 (99.1%) were male with an age range of 18 to 76 years, and 1226 (95.7%) had a sexual behavior of being men who have sex with men. All confirmed cases of monkeypox were diagnosed by reverse transcriptase polymerase chain reaction (RT-PCR). The most frequent clinical manifestations were skin lesions, fever, lymphadenopathy, headache, fatigue, and myalgia. The most frequent locations of the lesions were perianal, genital, facial, and upper and lower extremities. The most commonly used drugs for antiviral treatment of monkeypox were: tecovirimat, cidofovir, and brincidofovir. All patients had a complete recovery. According to current evidence, the efficacy and safety of antiviral drugs against monkeypox is of low quality and scarce.
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Affiliation(s)
- Brando Ortiz-Saavedra
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
| | - Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 14012, Peru
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13001, Peru
| | | | | | - Niza Alva
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | | | - Joshuan J. Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15023, Peru
| | | | | | | | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira 660001, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15023, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 36, Lebanon
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16
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Choudhary OP, Priyanka, Chopra H, Shafaati M, Dhawan M, Metwally AA, Saied AA, Rabaan AA, Alhumaid S, Al Mutair A, Sarkar R. Reverse zoonosis and its relevance to the monkeypox outbreak 2022. New Microbes New Infect 2022; 49-50:101049. [PMCID: PMC9663440 DOI: 10.1016/j.nmni.2022.101049] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
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17
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Peptan C, Băleanu VD, Mărcău FC. Study on the Vaccination of the Population of Romania against Monkeypox in Terms of Medical Security. Vaccines (Basel) 2022; 10:1834. [PMID: 36366343 PMCID: PMC9697308 DOI: 10.3390/vaccines10111834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/30/2023] Open
Abstract
Although it has been shown in numerous studies that immunization of the population by vaccination is the most effective way to protect against smallpox or other polioviruses, the anti-vaccination public rhetoric recorded during the COVID-19 pandemic is likely to influence the populations acceptance of vaccination against newly emerging viruses. This fact influenced our decision to study the vaccination of the Romanian population against the virus that causes monkeypox, aiming to identify the degree of compliance regarding the decision related to vaccination acceptance/non-acceptance/hesitation, based on the survey of a representative sample of respondents. The study is based on an online questionnaire completed between 1 July and 31 July 2022 by 820 individuals, aged 18 years or above, with a permanent residency in Romania. The study was undertaken in order to observe the attitudes of the respondents regarding the acceptance, refusal, or hesitation of vaccination against monkeypox. The sociological data resulting from the application of the questionnaire on 820 people highlighted that 97.16% were vaccinated with the vaccines of the national mandatory scheme and 53.32% were vaccinated with the optional vaccines (rotavirus vaccine, anti-hepatitis A, meningococcal vaccine, etc.). Although 47.13% of respondents considered monkeypox to be a real problem facing humanity today, only 26.37% of those surveyed expressed their fear of becoming infected, and 29.30% were willing to immunize themselves against the virus by vaccination. Only 19.59% of respondents believed that the monkeypox disease will generate a new global pandemic, while 31.86% considered pandemics to be a human security issue, and 30.28% expressed their desire to accept a reduction in some rights and freedoms, in the short term, for the adoption of institutional measures to combat a possible pandemic caused by monkeypox. The study clearly highlights the fact that monkeypox is perceived as a threat to the health of the population, with relatively low acceptance of conspiracy theories regarding its origins/manifestation/consequences among respondents (between 21.7% and 28.9%). The vaccination of the population against monkeypox is strongly influenced by the validity of the results obtained over time, in the vaccination campaigns against the smallpox virus (vaccine found in the mandatory vaccination scheme in Romania until 1979). We believe that the negative public rhetoric regarding the COVID-19 vaccination is likely to negatively influence monkeypox vaccination. Although specialized studies and practical results showed that the immunization of the population through vaccination represents an important vector in the prevention/management of pandemic-type issues, we believe that a national pro-vaccination campaign, based on scientific evidence, can lead the population to accept vaccination when the epidemiological context requires it. We also believe that a culture of health security needs to be developed among citizens to raise awareness of the role of vaccines as an important vector in the field of population health.
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Affiliation(s)
- Cătălin Peptan
- Faculty of Educational Sciences, Law and Public Administration, “Constantin Brâncuși” University of Târgu Jiu, 210185 Târgu Jiu, Romania
| | - Vlad Dumitru Băleanu
- Faculty of Medical and Behavioural Sciences, “Constantin Brâncuși” University of Târgu Jiu, 210185 Târgu Jiu, Romania
| | - Flavius Cristian Mărcău
- Faculty of Educational Sciences, Law and Public Administration, “Constantin Brâncuși” University of Târgu Jiu, 210185 Târgu Jiu, Romania
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18
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Integrated Analgesic Care in the Current Human Monkeypox Outbreak: Perspectives on an Integrated and Holistic Approach Combining Old Allies with Innovative Technologies. Medicina (B Aires) 2022; 58:medicina58101454. [PMID: 36295614 PMCID: PMC9612138 DOI: 10.3390/medicina58101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
Monkeypox (MPX) is a zoonotic infection caused by an orthopoxvirus that is endemic to Central and Western Africa. The MPX virus is a part of the same family of viruses as the variola virus, which causes smallpox. Since May 2022, there has been a global increase in the incidence of MPX infections in multiple countries where the illness is not usually prevalent. A growing number of publications have emphasized on the need for increased awareness among all health professionals for the rapid recognition and diagnosis of this disease and for proper public health measures. However, atypical presentations and occurrence of uncommon symptoms receive less than the desired attention. More specifically, MPX infection related nociceptive symptoms are currently underexposed. Nevertheless, reports from the current outbreak have revealed that (severe) pain is one of the major causes for distress and even hospitalization in these patients. As for all serious pain conditions, an integrated, multidisciplinary, and holistic approach is indicated. This approach should be multimodal and include non-pharmacological therapies alongside pharmacological approaches. Health care professionals should be aware of available alternatives when first choice analgesic therapies fail. Protocols for identification of pain type and prolonged monitoring of clinical status should be implemented to improve patient well-being during acute infection, but also prevent chronic nociceptive syndromes.
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León-Figueroa DA, Barboza JJ, Garcia-Vasquez EA, Bonilla-Aldana DK, Diaz-Torres M, Saldaña-Cumpa HM, Diaz-Murillo MT, Cruz OCS, Rodriguez-Morales AJ. Epidemiological Situation of Monkeypox Transmission by Possible Sexual Contact: A Systematic Review. Trop Med Infect Dis 2022; 7:267. [PMID: 36288008 PMCID: PMC9607952 DOI: 10.3390/tropicalmed7100267] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022] Open
Abstract
Monkeypox (MPX), a zoonotic infection caused by the monkeypox virus (MPXV), has re-emerged worldwide with numerous confirmed cases with person-to-person transmission through close contacts, including in sexual networks. Therefore, this study aimed to determine the epidemiological situation of monkeypox transmission by possible sexual contact. A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Embase databases until 18 August 2022. The key search terms used were "monkeypox", "sexual contact", "sexual intercourse" and "sexual transmission". A total of 1291 articles were retrieved using the search strategy. After eliminating duplicates (n = 738) and examining by title, abstract, and full text, 28 studies reporting case reports of monkeypox with a detailed description of clinical features, sexually transmitted diseases, method of diagnosis, location and course of skin lesions, and treatment were included. A total of 4222 confirmed cases of monkeypox have been reported, of which 3876 monkeypox cases are the result of transmission by sexual contact distributed in twelve countries: 4152 cases were male with a mean age of 36 years. All confirmed cases of monkeypox were diagnosed by reverse transcriptase-polymerase chain reaction (RT-PCR). The most frequent clinical manifestations were fever, lymphadenopathy, headache, malaise, and painful perianal and genital lesions. The most frequent locations of the lesions were perianal, genital, oral, trunk, upper and lower extremities. Patients were in good clinical condition, with treatment based on analgesics and antipyretics to relieve some symptoms of monkeypox. A high proportion of STIs and frequent anogenital symptoms were found, suggesting transmissibility through local inoculation during close skin-to-skin or mucosal contact during sexual activity. The highest risk of monkeypox transmission occurs in men who have sex with men, and MPXV DNA could be recovered in seminal fluid. It is essential to establish health policies for the early detection and management of patients with monkeypox.
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Affiliation(s)
- Darwin A. León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Joshuan J. Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
| | - Edwin A. Garcia-Vasquez
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - D. Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de Las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia
| | - Milagros Diaz-Torres
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Hortencia M. Saldaña-Cumpa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Melissa T. Diaz-Murillo
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Olga Campos-Santa Cruz
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 15011, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de Las Americas, Pereira 660001, Risaralda, Colombia
- Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima 15067, Peru
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Sah R, Hada V, Mohanty A, Alshahrani NZ, Chakraborty S, Bhattacharya M, Chakraborty C, Dhama K. Recent first report of human-to-dog transmission of Monkeypox virus emphasizes an urgent need of enhancing surveillance and strengthen further explorative research to reveal its real magnitude of reverse zoonosis from other animals including pets as like that happened with SARS-CoV-2 / COVID-19 pandemic - Correspondence. Int J Surg 2022; 106:106949. [PMID: 36174830 PMCID: PMC9534089 DOI: 10.1016/j.ijsu.2022.106949] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, 44600, Nepal; Research Scholar, Harvard Medical School, Boston, MA, 02115, USA.
| | - Vivek Hada
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, 273008, India.
| | - Aroop Mohanty
- All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, 273008, India.
| | | | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, R.K. Nagar, West Tripura, Tripura, Pin, 799008, India.
| | - Manojit Bhattacharya
- Department of Zoology, Fakir Mohan University, Vyasa Vihar, Balasore, 756020, Odisha, India.
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, 700126, West Bengal, India.
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar, Uttar Pradesh, 243122, India.
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Sah R, Mohanty A, Hada V, Singh P, Govindaswamy A, Siddiq A, Reda A, Dhama K. The Emergence of Monkeypox: A Global Health Threat. Cureus 2022; 14:e29304. [DOI: 10.7759/cureus.29304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
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22
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Amer FA, Hammad NM, Wegdan AA, ElBadawy NE, Pagliano P, Rodríguez-Morales AJ. Growing shreds of evidence for monkeypox to be a sexually transmitted infection. LE INFEZIONI IN MEDICINA 2022; 30:323-327. [PMID: 36148175 PMCID: PMC9448319 DOI: 10.53854/liim-3003-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 06/07/2023]
Affiliation(s)
- Fatma A. Amer
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig, Egypt
- Viral Infection Working Group/International Society for Antimicrobial Chemotherapy
| | - Noha M. Hammad
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig, Egypt
- Viral Infection Working Group/International Society for Antimicrobial Chemotherapy
| | - Ahmed Ashraf Wegdan
- Viral Infection Working Group/International Society for Antimicrobial Chemotherapy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Nissreen E. ElBadawy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig, Egypt
- Viral Infection Working Group/International Society for Antimicrobial Chemotherapy
| | - Pasquale Pagliano
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Alfonso J. Rodríguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira 660001, Risaralda, Colombia
- Program of Master in Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima 150142, Peru
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23
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Farahat RA, Sah R, El-Sakka AA, Benmelouka AY, Kundu M, Labieb F, Shaheen RS, Abdelaal A, Abdelazeem B, Bonilla-Aldana DK, Franco-Paredes C, Henao-Martinez AF, Garout MA, León-Figueroa DA, Pachar M, Suárez JA, Ramirez JD, Paniz-Mondolfi A, Rabaan AA, Al-Tawfiq JA, Nishiura H, Ortiz-Martínez Y, Garcia-Robledo JE, Cimerman S, Barbosa AN, Pagliano P, Zambrano-Sanchez G, Cardona-Ospina JA, Bížová B, Rodriguez-Morales AJ. Human monkeypox disease (MPX). LE INFEZIONI IN MEDICINA 2022; 30:372-391. [PMID: 36148174 PMCID: PMC9448318 DOI: 10.53854/liim-3003-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/24/2022] [Indexed: 05/24/2023]
Abstract
Monkeypox is a rare viral infection, endemic in many central and western African countries. The last international outbreak of monkeypox reported outside Africa occurred back in 2003. However, monkeypox has reemerged at a global scale with numerous confirmed cases across the globe in 2022. The rapid spread of cases through different countries has raised serious concerns among public health officials worldwide prompting accelerated investigations aimed to identify the origins and cause of the rapid expansion of cases. The current situation is reminiscent of the very early stages of the still ongoing COVID-19 pandemic. Overlapping features between these, two seemingly alike viral entities include the possibility for airborne transmission and the currently unexplained and rapid spread across borders. Early recognition of cases and timely intervention of potential transmission chains are necessary to contain further outbreaks. Measures should include rapid and accurate diagnosis of cases meeting case definitions, active surveillance efforts, and appropriate containment of confirmed cases. Governments and health policymakers must apply lessons learned from previous outbreaks and start taking active steps toward limiting the recent global spread of monkeypox. Herein, we discuss the status of the current monkeypox outbreaks worldwide, the epidemiological and public health situation at a global scale and what can be done to keep at bay its further expansion and future global implications.
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Affiliation(s)
| | - Ranjit Sah
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Amro A. El-Sakka
- Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt
| | | | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan, Bhubaneswar 751003, India
| | - Fatma Labieb
- Faculty of Medicine, Beni-Suef Univesity, Beni-Suef 62511, Egypt
| | | | - Abdelaziz Abdelaal
- Harvard Medical School, Boston, MA 02115, USA
- Boston University, MA 02215, USA
- Tanta University Hospitals, 31516 Egypt
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, Michigan 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, Michigan 48823, USA
| | - D. Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Latin American Network on MOnkeypox VIrus research (LAMOVI), Pereira, Risaralda, Colombia
| | | | | | - Mohammed A. Garout
- Community Medicine and Pilgrims Health Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Darwin A. León-Figueroa
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru
- Emerge, Unidad de Investigación en Enfermedades Emergentes y Cambio Climático, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Monica Pachar
- Medicine Department-Infectious Diseases Service, Hospital Santo Tomas, Panama City, Panama
| | - José Antonio Suárez
- Investigador SNI Senacyt Panamá, Clinical Research Deparment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
| | - Juan David Ramirez
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Alberto Paniz-Mondolfi
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, 11533, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hiroshi Nishiura
- Kyoto University School of Public Health, Yoshidakonoecho, Sakyoku, Kyoto City 6068501, Japan
| | - Yeimer Ortiz-Martínez
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Department of Internal Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | | | - Sergio Cimerman
- Instituto de Infectologia Emílio Ribas, São Paulo, SP, Brazil Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Alexandre Naime Barbosa
- Infectious Diseases Department, Botucatu Medical School, UNESP Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Pasquale Pagliano
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | | | - Jaime A. Cardona-Ospina
- Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, 660003, Pereira, Risaralda, Colombia
| | - Beatrice Bížová
- Department of Dermatovenerology, Second Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Latin American Network on MOnkeypox VIrus research (LAMOVI), Pereira, Risaralda, Colombia
- Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, 660003, Pereira, Risaralda, Colombia
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 4861, Peru
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Shuvo PA, Roy A, Dhawan M, Chopra H, Emran TB. Recent outbreak of monkeypox: Overview of signs, symptoms, preventive measures, and guideline for supportive management. Int J Surg 2022; 105:106877. [PMID: 36067960 PMCID: PMC9528169 DOI: 10.1016/j.ijsu.2022.106877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Pollob Ahmed Shuvo
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207, Dhaka, Bangladesh.
| | - Arpita Roy
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207, Dhaka, Bangladesh.
| | - Manish Dhawan
- Department of Microbiology, Punjab Agricultural University, Ludhiana, 141004, Punjab, India; Trafford College, Altrincham, Manchester, WA14 5PQ, UK.
| | - Hitesh Chopra
- Chitkara College of Pharmacy, Chitkara University, Punjab, India.
| | - Talha Bin Emran
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, 1207, Dhaka, Bangladesh; Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh.
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Lozada-Martinez ID, Fernández-Gómez MP, Acevedo-Lopez D, Bolaño-Romero MP, Picón-Jaimes YA, Moscote-Salazar LR. What has been researched on monkeypox in Latin America? A brief bibliometric analysis. Travel Med Infect Dis 2022; 49:102399. [PMID: 35817337 PMCID: PMC9264804 DOI: 10.1016/j.tmaid.2022.102399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia; International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua; Grupo Prometheus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia.
| | | | - Domenica Acevedo-Lopez
- Semillero de Investigación en Infecciones Emergentes y Medicina Tropical, Grupo de Investigación Biomedicina, School of Medicine, Institución Universitaria Visión de las Américas, Pereira, Colombia
| | - Maria Paz Bolaño-Romero
- Grupo Prometheus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Yelson Alejandro Picón-Jaimes
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia; Department of Epidemiology and Public Health, Valencian International University, Valencia, Spain
| | - Luis Rafael Moscote-Salazar
- Colombian Clinical Research Group in Neurocritical Care, Latin American Council of Neurocritical Care, Ontario, Canada
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Rodriguez-Morales AJ, Lopardo G, Verbanaz S, Orduna T, Lloveras S, Azeñas-Burgoa JM, Escalera-Antezana JP, Alvarado-Arnez LE, Barbosa AN, Diaz-Quijano F, Cimerman S, Chaves TDSS, Rodriguez-Morales AG, Perret C, Méndez CA, Riera JA, Bonilla-Aldana DK, Camacho-Moreno G, Mendoza H, Rodriguez-Sabogal IA, Oñate J, Escobedo AA, Thormann M, Roque Y, Zambrano PG, Carrero Y, Sandoval N, Zambrano L, Franco-Paredes C, Chacon-Cruz E, Lopez-Delgado I, Cuadra-Sánchez C, Pachar-Flores M, Correa R, Rodriguez-Enciso HD, Rotela-Fisch V, Maquera-Afaray J, Herrera-Añazco P, Benites-Zapata V, Savio-Larriera E, Ramírez JD, Paniz-Mondolfi A, Risquez A, Forero-Peña DA, Torres JR, Suarez JA. Latin America: Situation and preparedness facing the multi-country human monkeypox outbreak. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:100318. [PMID: 35813461 PMCID: PMC9257677 DOI: 10.1016/j.lana.2022.100318] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia.,Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Perú.,Latin American network of MOnkeypox VIrus research (LAMOVI), Pereira, Risaralda, Colombia
| | - Gustavo Lopardo
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina
| | - Sergio Verbanaz
- Servicio de Infectología, Hospital Británico de Buenos Aires. Buenos Aires, Argentina
| | - Tomas Orduna
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina.,Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Susana Lloveras
- Cátedra de Enfermedades Infecciosas, University of Buenos Aires, Buenos Aires, Argentina.,Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | | | - Juan Pablo Escalera-Antezana
- Direction, Centros de Salud de Primer Nivel, Secretaría de Salud, Gobierno Autónomo Municipal de Cochabamba, Cochabamba, Bolivia
| | | | - Alexandre Naime Barbosa
- Infectious Diseases Department, Botucatu Medical School, UNESP; Brazilian Society for Infectious Diseases, São Paulo, SP, Brazil
| | - Fredi Diaz-Quijano
- Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP, Brazil. Beneficiary of a fellowship for research productivity from the National Council for Scientific and Technological Development - CNPq, process/contract identification: 312656/2019-0, Brazil
| | - Sergio Cimerman
- Institute of Infectious Diseases Emilio Ribas, São Paulo, Brazil
| | - Tânia do Socorro Souza Chaves
- Evandro Chagas Institute, Health of Ministry of Brazil, Belém, Pará, Brazil; Faculdade de Medicina da Universidade Federal do Pará, Brazil
| | - Andrea G Rodriguez-Morales
- Unidad Procedimientos, Policlínico Neurología, Centro de Referencia de Salud Dr. Salvador Allende Gossens, Santiago de Chile, Chile
| | - Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Claudio A Méndez
- Instituto de Salud Pública, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Jorge A Riera
- Hospital de San Fernando, Ministerio de Salud, San Fernando, VI Region, Chile
| | - D Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - German Camacho-Moreno
- Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, DC, Colombia. Division of Infectious Diseases, HOMI, Hospital Pediátrico La Misericordia, Bogotá, DC, Colombia
| | - Henry Mendoza
- Hemera Unidad de Infectología IPS SAS, Bogota, Colombia
| | | | - Jose Oñate
- Clinica Imbanaco Grupo Quironsalud, Cali, Colombia. Universidad Santiago de Cali, Cali, Colombia. Clinica de Occidente, Cali, Colombia. Clinica Sebastián de Belalcazar, Valle del Cauca, Colombia
| | - Angel A Escobedo
- Epidemiology Unit, National Institute of Gastroenterology, La Habana, Cuba
| | - Monica Thormann
- Hospital Salvador Bienvenido Gautier, Santo Domingo, Dominican Republic
| | - Yori Roque
- Pontificia Universidad Catolica Madre y Maestra (PUCMM), Santiago, Dominican Republic
| | | | | | | | - Lysien Zambrano
- Unit of Scientific Research, School of Medical, Faculty of Medical Sciences, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras
| | | | | | - Iván Lopez-Delgado
- Departamento de Infectología, Hospital General de Tijuana, Tijuana, Mexico
| | - Cesar Cuadra-Sánchez
- Asociación de Microbiólogos y Químicos Clínicos de Nicaragua, Managua, Nicaragua
| | - Monica Pachar-Flores
- Medicine Department-Infectious Diseases Service, Hospital Santo Tomas, Panama City, Panama. Instituto Oncologico Nacional, Panama city, Panama
| | - Ricardo Correa
- University of Arizona College of Medicine-Phoenix, Division of Endocrinology, Department of Medicine.650 E Indian School Rd, suite 117B, Phoenix, AZ 85022, USA
| | | | - Veronica Rotela-Fisch
- Division of Dermatology, Faculty of Medical Sciences, Universidad Nacional de Asunción, Asuncion, Paraguay
| | - Julio Maquera-Afaray
- Infectious Diseases Division, Instituto Nacional de Salud del Niño San Borja, Lima, Peru. Facultad de Ciencias de la Salud, Universidad Privada de Tacna, Tacna, Peru
| | | | - Vicente Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Juan David Ramírez
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.,Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Alberto Paniz-Mondolfi
- Hospital Evangélico de Montevideo, Montevideo, Uruguay.,Infectious Diseases Research Branch, Venezuelan Science Incubator and the Zoonosis and Emerging Pathogens Regional Collaborative Network, Cabudare, 3023, Lara, Venezuela
| | - Alejandro Risquez
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - David A Forero-Peña
- Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela.,Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolivar, Venezuela
| | - Jaime R Torres
- Tropical Medicine Institute, Infectious Diseases Section, Universidad Central de Venezuela, Caracas 1053, Venezuela
| | - Jose Antonio Suarez
- Investigador SNI Senacyt Panamá, Clinical Research Deparment, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama
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Benites-Zapata VA, Ulloque-Badaracco JR, Alarcon-Braga EA, Hernandez-Bustamante EA, Mosquera-Rojas MD, Bonilla-Aldana DK, Rodriguez-Morales AJ. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob 2022; 21:36. [PMID: 35948973 PMCID: PMC9364300 DOI: 10.1186/s12941-022-00527-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00527-1.
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Affiliation(s)
| | | | - Esteban A Alarcon-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Enrique A Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Perú.,Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Melany D Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.,Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - D Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia.,Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia. .,Latin American Network of MOnkeypox VIrus Research (LAMOVI), Pereira, Risaralda, Colombia. .,Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Perú. .,Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia.
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28
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Abstract
Recently, monkeypox has become a global concern amid the ongoing COVID-19 pandemic. Monkeypox is an acute rash zoonosis caused by the monkeypox virus, which was previously concentrated in Africa. The re-emergence of this pathogen seems unusual on account of outbreaks in multiple nonendemic countries and the incline to spread from person to person. We need to revisit this virus to prevent the epidemic from getting worse. In this review, we comprehensively summarize studies on monkeypox, including its epidemiology, biological characteristics, pathogenesis, and clinical characteristics, as well as therapeutics and vaccines, highlighting its unusual outbreak attributed to the transformation of transmission. We also analyze the present situation and put forward countermeasures from both clinical and scientific research to address it.
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29
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Luna N, Ramírez AL, Muñoz M, Ballesteros N, Patiño LH, Castañeda SA, Bonilla-Aldana DK, Paniz-Mondolfi A, Ramírez JD. Phylogenomic analysis of the monkeypox virus (MPXV) 2022 outbreak: Emergence of a novel viral lineage? Travel Med Infect Dis 2022; 49:102402. [PMID: 35840078 DOI: 10.1016/j.tmaid.2022.102402] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
Monkeypox is a zoonotic disease with clinical manifestations similar to smallpox in humans. Since May 13, 2022, an increasing number of suspected and confirmed cases have been reported, affecting non-endemic regions across the globe. More strikingly, reports from the current outbreak reveal unique aspects regarding transmission dynamics and an unprecedented, rapidly expanding and sustained community transmission. As demonstrated through the still-ongoing COVID-19 pandemic, genomic surveillance has been an essential resource for monitoring and tracking the evolution of pathogens of public health relevance. Herein, we performed a phylogenomic analysis of available Monkeypox virus (MPXV) genomes to determine their evolution and diversity. Our analysis revealed that all MPXV genomes grouped into three monophyletic clades: two previously characterized clades and a newly emerging clade harboring genomes from the ongoing 2022 multi-country outbreak with 286 genomes comprising the hMPXV-1A clade and the newly classified lineages: A.1 (n = 6), A.1.1 (n = 1), A.2 (n = 3) and B.1 (n = 262), where lineage B.1 includes all MPXV genomes from the 2022 outbreak. Finally, it was estimated that B.1 lineage of this clade emerged in Europe on 03/02/2022 [95%CI = 11/13/2021 to 05/10/2022]. The exceptional surge of cases and the broader geographical expansion suggest multifactorial factors as drivers of the current outbreak dynamics. Such factors may include the cessation of smallpox vaccination and its potential spread across particular networks. Integrating pertinent epidemiological information with genomic surveillance information will help generate real-time data to help implement adequate preventive and control measures by optimizing public health decisions to mitigate this outbreak.
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Affiliation(s)
- Nicolas Luna
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Angie L Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Marina Muñoz
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Nathalia Ballesteros
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Luz H Patiño
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Sergio Andres Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - D Katterine Bonilla-Aldana
- Grupo de Investigación Biomedicina, Faculty of Medicine, Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia; Latin American network of Monkeypox Virus research (LAMOVI), Pereira, Risaralda, Colombia
| | - Alberto Paniz-Mondolfi
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York city, NY, USA
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología - UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia; Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York city, NY, USA.
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