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Li Q, Chen Y, Zhang W, Li C, Tang D, Hua W, Hou F, Chen Z, Liu Y, Tian Y, Sun K, Xu X, Zeng Y, Xia F, Lu J, Wang Z. Mpox virus Clade IIb infected Cynomolgus macaques via mimic natural infection routes closely resembled human mpox infection. Emerg Microbes Infect 2024; 13:2332669. [PMID: 38494777 PMCID: PMC10984234 DOI: 10.1080/22221751.2024.2332669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
Generating an infectious non-human primate (NHP) model using a prevalent monkeypox virus (MPXV) strain has emerged as a crucial strategy for assessing the efficacy of vaccines and antiviral drugs against human MPXV infection. Here, we established an animal model by infecting cynomolgus macaques with the prevalent MPXV strain, WIBP-MPXV-001, and simulating its natural routes of infection. A comprehensive analysis and evaluation were conducted on three animals, including monitoring clinical symptoms, collecting hematology data, measuring viral loads, evaluating cellular and humoral immune responses, and examining histopathology. Our findings revealed that initial skin lesions appeared at the inoculation sites and subsequently spread to the limbs and back, and all infected animals exhibited bilateral inguinal lymphadenopathy, eventually leading to a self-limiting disease course. Viral DNA was detected in post-infection blood, nasal, throat, rectal and blister fluid swabs. These observations indicate that the NHP model accurately reflects critical clinical features observed in human MPXV infection. Notably, the animals displayed clinical symptoms and disease progression similar to those of humans, rather than a lethal outcome as observed in previous studies. Historically, MPXV was utilized as a surrogate model for smallpox. However, our study contributes to a better understanding of the dynamics of current MPXV infections while providing a potential infectious NHP model for further evaluation of vaccines and antiviral drugs against mpox infection. Furthermore, the challenge model closely mimics the primary natural routes of transmission for human MPXV infections. This approach enhances our understanding of the precise mechanisms underlying the interhuman transmission of MPXV.
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Affiliation(s)
- Qingni Li
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Yunfeng Chen
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Wenjing Zhang
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Chunyang Li
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Ding Tang
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Wanlu Hua
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Fan Hou
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Zhuo Chen
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Yuanlang Liu
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Yi Tian
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Kaili Sun
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Xiuli Xu
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Yan Zeng
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Fei Xia
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Jia Lu
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
| | - Zejun Wang
- Biosafety Level 3 Laboratory, Wuhan Institute of Biological Products Co., Ltd., Wuhan, People’s Republic of China
- National Engineering Technology Research Center for Combined Vaccines, Wuhan, People’s Republic of China
- National Key Laboratory for Novel Vaccines Research and Development of Emerging Infectious Diseases, Wuhan, People’s Republic of China
- Hubei Provincial Vaccine Technology Innovation Center, Wuhan, People’s Republic of China
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2
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Ghosn J, Assoumou L, Ouattara M, Rubenstein E, Pialoux G, Katlama C, Surgers L, Duvivier C, Pavie J, Viard JP, Algarte-Genin M, Gibowski S, Ollivier M, Costagliola D, Molina JM. Impact of vaccination with third generation modified vaccinia Ankara and sexual behaviour on mpox incidence in men who have sex with men: analysis among participants of the ANRS-174 DOXYVAC trial. THE LANCET REGIONAL HEALTH. EUROPE 2024; 45:101020. [PMID: 39188858 PMCID: PMC11345388 DOI: 10.1016/j.lanepe.2024.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024]
Abstract
Background Mpox was first reported in France on May 19 and third-generation live Modified Vaccinia Ankara (MVA-BN) vaccination of multiple-partner men who have sex with men (MSM) was recommended as of July 11, 2022. We assessed the impact of vaccination and of sexual behavior adopted during the epidemic period on mpox incidence in the ANRS-174-DOXYVAC trial enrolling MSM on HIV pre-exposure prophylaxis (PrEP) with history of sexually-transmitted infections (STI) in the previous year. Methods We compared pre-epidemic socio-behavioral characteristics and change in sexual behaviors after the onset of the epidemic of participants with mpox and mpox-free. Then we compared incidence rates of mpox per 1000 person-months (p-m) between May 9-July 10 (before vaccination of MSM, period-1) and July 11-September 20 2022 (after vaccination launch, period-2) and explored factors explaining the period effect using Poisson regression model. Findings 472 MSM had data before and after May 9, 2022. Twenty percent had received smallpox vaccine during childhood. Mpox occurred in 77/472 participants (incidence 49.3 per 1000 p-m (95% CI 38.9-61.6)). MVA-BN vaccination roll-out was rapid, with 86% (341/398) of eligible participants having received at least one dose by September 20, 2022. Sexual behavior significantly changed before and after May 9, with a decrease in the proportion of mpox-free participants with >10 partners during last 3 months (45% vs 38%, p = 0.0035). Mpox incidence was 67.4 per 1000 p-m (95% CI 51.6-86.6) in period-1, and 24.4 per 1000 p-m (95% CI 13.9-39.6) in period-2, with an incidence rate ratio of 0.36 (95% CI 0.21-0.63). In multivariable Poisson regression model, only MVA-BN vaccination in 2022 remained significantly associated with mpox incidence, with a 99% risk reduction (95% CI 96.6-99.7). Interpretation In MSM on PrEP enrolled in the ANRS-174-DOXYVAC trial, rapid roll-out of MVA-BN vaccination was associated with a strong reduction in mpox incidence. Funding ANRS Maladies Infectieuses Emergentes (ANRS/MIE).
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Affiliation(s)
- Jade Ghosn
- Assistance Publique-Hôpitaux de Paris.Nord, Hôpital Bichat-Claude Bernard, Service des Maladies Infectieuses et Tropicales, Paris F75018, France
- Université Paris Cité, INSERM, UMRS 1137 IAME, Paris F75018, France
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris F75012, France
| | - Moussa Ouattara
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris F75012, France
| | - Emma Rubenstein
- Assistance Publique-Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris F75010, France
| | - Gilles Pialoux
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, Paris F75020, France
| | - Christine Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris F75012, France
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, Paris F75013, France
| | - Laure Surgers
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris F75012, France
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris F75012, France
| | - Claudine Duvivier
- Assistance Publique-Hôpitaux de Paris-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center, Paris F75015, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- IHU Imagine, Paris, France
| | - Juliette Pavie
- Assistance Publique-Hôpitaux de Paris-Centre, Unité de Thérapeutique en Immuno-Infectiologie, Hôpital Hôtel-Dieu, Paris F75004, France
| | - Jean-Paul Viard
- Assistance Publique-Hôpitaux de Paris-Centre, Unité de Thérapeutique en Immuno-Infectiologie, Hôpital Hôtel-Dieu, Paris F75004, France
| | - Michèle Algarte-Genin
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris F75012, France
| | - Severine Gibowski
- Agence Nationale de Recherche sur le SIDA et les Hépatites virales – Maladies Infectieuses et Émergentes (ANRS-MIE), Paris F75015, France
| | - Manon Ollivier
- Agence Nationale de Recherche sur le SIDA et les Hépatites virales – Maladies Infectieuses et Émergentes (ANRS-MIE), Paris F75015, France
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris F75012, France
| | - Jean-Michel Molina
- Assistance Publique-Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Louis, Paris F75010, France
- Université Paris Cité, INSERM UMR 944, Paris F75010, France
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3
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İnkaya AÇ. Mpox: what sexual health physicians need to know? Int J Impot Res 2024:10.1038/s41443-024-00964-w. [PMID: 39154147 DOI: 10.1038/s41443-024-00964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/09/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
Monkeypox virus (MPXV) is another zoonotic virus spilled over to the man and resulted in pandemic. World Health Organization declared it as a 'Public Health Emergency of International Concern (PHEIC) on July 22, 2022. Mpox affected over 95226 individuals among them claimed the lives of 185. Despite the fact that Mpox is generally mild and self-limited, immunocompromised people with low CD4 counts may experience severe disease course. Management of Mpox patients has three pillars. First symptomatic approach includes pain management, prophylaxis for secondary infections and when needed effective treatment of superinfections. Second, vaccines developed against smallpox can be used in preexposure or postexposure prophylaxis strategies against Mpox. Third, current antiviral options include tecovirimat, cidofovir and birincidofovir all of which have been recommended relying on experience from animal studies, clinical case reports or case series. Results of well-planned randomized control trials are not available. Occupational exposure to MPXV is especially a manageable risk for health care workers. Prevention of Mpox also requires risk communication with vulnerable population and their involvement in mitigation efforts.
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Affiliation(s)
- Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases, Sihhiye, Ankara, 06230, Turkey.
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4
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Nakamura H, Yamamoto K. Mpox in people with HIV: A narrative review. HIV Med 2024; 25:910-918. [PMID: 38745559 DOI: 10.1111/hiv.13661] [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: 01/10/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies. RECENT FINDINGS Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population. CONCLUSION Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.
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Affiliation(s)
- Hideta Nakamura
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
| | - Kazuko Yamamoto
- First Department of International Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Nishihara-cho, Japan
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5
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Croasdale CR, Weinlander E, Boyce TG. Mpox Keratitis: A Case Report and Review. Cornea 2024:00003226-990000000-00605. [PMID: 38967497 DOI: 10.1097/ico.0000000000003614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 05/28/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Mpox is a rare infectious disease. Lack of knowledge among eye care professionals regarding mpox keratitis greatly reduces the likelihood of diagnosis and effective management. This report and review seek to increase the knowledge of mpox keratitis among eye care professionals. METHODS We report a patient with mpox keratitis who underwent successful penetrating keratoplasty, with 20 years of follow-up. A systematic literature search and review of cases of mpox keratitis from 1970 to 2024 was performed. RESULTS A total of 24 articles and 2 abstracts reporting 35 cases of mpox keratitis were identified. A frequency of 0.5% to 1.0% may be the lower range of mpox keratitis among symptomatic patients with a confirmed mpox diagnosis. Mpox keratitis occurred with and without systemic mpox. Initial misdiagnoses were common (40%). Polymerase chain reaction results aided clinical diagnosis. Corneal disease ranged from mild epitheliopathy to fulminant ulcerative keratitis. Outcomes ranged from 20/20 acuity to no light perception. In the absence of fulminant systemic disease, tecovirimat was associated with clinical improvement of mpox keratitis in almost all cases. Our case is the only known report of successful penetrating keratoplasty for mpox keratitis and the only case whereby monkeypox virus was cultured from the corneal surface. CONCLUSIONS Mpox keratitis is rare but can result in severe vision loss and blindness. Systemic tecovirimat seems to be effective in treating mpox keratitis, although the low frequency of keratitis precludes clinical trials. Topical steroids may extend virus survival in the cornea. Polymerase chain reaction may help confirm mpox corneal involvement.
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Affiliation(s)
| | - Eric Weinlander
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI; and
| | - Thomas G Boyce
- Pediatric Infectious Diseases, Marshfield Clinic, Marshfield, WI
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6
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Ponce L, Linton NM, Toh WH, Cheng HY, Thompson RN, Akhmetzhanov AR, Dushoff J. Incubation Period and Serial Interval of Mpox in 2022 Global Outbreak Compared with Historical Estimates. Emerg Infect Dis 2024; 30:1173-1181. [PMID: 38781950 PMCID: PMC11138990 DOI: 10.3201/eid3006.231095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Understanding changes in the transmission dynamics of mpox requires comparing recent estimates of key epidemiologic parameters with historical data. We derived historical estimates for the incubation period and serial interval for mpox and contrasted them with pooled estimates from the 2022 outbreak. Our findings show the pooled mean infection-to-onset incubation period was 8.1 days for the 2022 outbreak and 8.2 days historically, indicating the incubation periods remained relatively consistent over time, despite a shift in the major mode of transmission. However, we estimated the onset-to-onset serial interval at 8.7 days using 2022 data, compared with 14.2 days using historical data. Although the reason for this shortening of the serial interval is unclear, it may be because of increased public health interventions or a shift in the mode of transmission. Recognizing such temporal shifts is essential for informed response strategies, and public health measures remain crucial for controlling mpox and similar future outbreaks.
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7
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Marchi S, Piccini G, Cantaloni P, Guerrini N, Zannella R, Coluccio R, Benincasa L, Solfanelli N, Remarque EJ, Viviani S, Kistner O, Temperton N, Montomoli E, Manenti A, Trombetta CM. Evaluation of monkeypox- and vaccinia-virus neutralizing antibodies before and after smallpox vaccination: A sero-epidemiological study. J Med Virol 2024; 96:e29728. [PMID: 38860589 DOI: 10.1002/jmv.29728] [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: 01/15/2024] [Revised: 05/17/2024] [Accepted: 06/01/2024] [Indexed: 06/12/2024]
Abstract
Since May 2022, several countries outside of Africa experienced multiple clusters of monkeypox virus (MPXV)-associated disease. In the present study, anti-MPXV and anti-vaccinia virus (VACV) neutralizing antibody responses were evaluated in two cohorts of subjects from the general Italian population (one half born before the WHO-recommended end of smallpox vaccination in 1980, the other half born after). Higher titers (either against MPXV or VACV) were observed in the cohort of individuals born before the interruption of VACV vaccination. An association between VACV and MPXV antibody levels was observed, suggesting that the smallpox vaccination may confer some degree of cross-protection against MPXV infection. Results from this study highlight low levels of immunity toward the assessed Orthopoxviruses, especially in young adults, advocating the introduction of a VACV- or MPXV-specific vaccine in case of resurgence of monkeypox disease outbreaks.
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Affiliation(s)
- Serena Marchi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | - Paolo Cantaloni
- VisMederi Srl, Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Noemi Guerrini
- VisMederi Srl, Siena, Italy
- Department of Life Sciences, University of Siena, Siena, Italy
| | | | | | | | | | - Edmond J Remarque
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, Netherlands
| | - Simonetta Viviani
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, Universities of Kent and Greenwich, Kent, UK
| | - Emanuele Montomoli
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi Srl, Siena, Italy
- VisMederi Research Srl, Siena, Italy
| | | | - Claudia Maria Trombetta
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
- VisMederi Research Srl, Siena, Italy
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8
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Okoli GN, Van Caeseele P, Askin N, Abou-Setta AM. A global systematic evidence review with meta-analysis of the epidemiological characteristics of the 2022 Mpox outbreaks. Infection 2024; 52:901-921. [PMID: 38051425 DOI: 10.1007/s15010-023-02133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND In 2022, there were outbreaks of Mpox where the disease is not endemic. We summarized published full-text epidemiological data from the outbreaks. METHODS A global evidence review (protocol: osf.io/j3kb7) with systematic literature search up to February 09, 2023. We focused on experimental/observational studies of laboratory confirmed Mpox, excluding case reports and case series of < 5 cases. Epidemiological data were pooled using an inverse variance, random-effects model, and pooled estimates presented with associated 95% confidence intervals. RESULTS We included 66 studies. Mean incubation period was 7.8 days (6.6-9.0 days, 8 studies: 560 cases), reproductive number 1.8 (1.7-1.9, 6 studies), mean duration from symptom onset to diagnosis 5.8 days (4.8-6.8 days, 4 studies: 982 cases), mean symptom duration 17.5 days (14.7-20.2 days, 3 studies: 292 cases), mean serial interval 8.5 days (7.3-9.9 days, 1 study), hospitalisation 6% (4-9%, 26 studies: 5339 cases), and vaccine effectiveness 78% (65-91%, 3 studies: 953 cases). Highly relevant clinical manifestations were pleomorphic skin lesions 82% (68-94%, 26 studies: 4093 cases), anogenital lesions 64% (51-77%, 9 studies: 10,398 cases), fever 54% (50-57%, 52 studies: 25,992 cases), and lymphadenopathy 51% (46-57%, 42 studies: 17,803 cases), with cases mostly men who have sex with men (MSM). Possibly relevant manifestations were perianal lesions, fatigue, asthenia, myalgia, and headache. CONCLUSIONS The 2022 Mpox outbreaks presented with sex-related clinical manifestations and were mostly reported among MSM.
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Affiliation(s)
- George N Okoli
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada.
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Paul Van Caeseele
- Department of Medical Microbiology & Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
| | - Nicole Askin
- Neil John Maclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0T6, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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9
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Das HK. Exploring the dynamics of monkeypox transmission with data-driven methods and a deterministic model. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1334964. [PMID: 38840980 PMCID: PMC11150605 DOI: 10.3389/fepid.2024.1334964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/01/2024] [Indexed: 06/07/2024]
Abstract
Introduction Mpox (formerly monkeypox) is an infectious disease that spreads mostly through direct contact with infected animals or people's blood, bodily fluids, or cutaneous or mucosal lesions. In light of the global outbreak that occurred in 2022-2023, in this paper, we analyzed global Mpox univariate time series data and provided a comprehensive analysis of disease outbreaks across the world, including the USA with Brazil and three continents: North America, South America, and Europe. The novelty of this study is that it delved into the Mpox time series data by implementing the data-driven methods and a mathematical model concurrently-an aspect not typically addressed in the existing literature. The study is also important because implementing these models concurrently improved our predictions' reliability for infectious diseases. Methods We proposed a traditional compartmental model and also implemented deep learning models (1D- convolutional neural network (CNN), long-short term memory (LSTM), bidirectional LSTM (BiLSTM), hybrid CNN-LSTM, and CNN-BiLSTM) as well as statistical time series models: autoregressive integrated moving average (ARIMA) and exponential smoothing on the Mpox data. We also employed the least squares method fitting to estimate the essential epidemiological parameters in the proposed deterministic model. Results The primary finding of the deterministic model is that vaccination rates can flatten the curve of infected dynamics and influence the basic reproduction number. Through the numerical simulations, we determined that increased vaccination among the susceptible human population is crucial to control disease transmission. Moreover, in case of an outbreak, our model showed the potential for epidemic control by adjusting the key epidemiological parameters, namely the baseline contact rate and the proportion of contacts within the human population. Next, we analyzed data-driven models that contribute to a comprehensive understanding of disease dynamics in different locations. Additionally, we trained models to provide short-term (eight-week) predictions across various geographical locations, and all eight models produced reliable results. Conclusion This study utilized a comprehensive framework to investigate univariate time series data to understand the dynamics of Mpox transmission. The prediction showed that Mpox is in its die-out situation as of July 29, 2023. Moreover, the deterministic model showed the importance of the Mpox vaccination in mitigating the Mpox transmission and highlighted the significance of effectively adjusting key epidemiological parameters during outbreaks, particularly the contact rate in high-risk groups.
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Affiliation(s)
- Haridas K. Das
- Department of Mathematics, Oklahoma State University, Stillwater, OK, United States
- Department of Mathematics, Dhaka University, Dhaka, Bangladesh
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10
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Monzón S, Varona S, Negredo A, Vidal-Freire S, Patiño-Galindo JA, Ferressini-Gerpe N, Zaballos A, Orviz E, Ayerdi O, Muñoz-Gómez A, Delgado-Iribarren A, Estrada V, García C, Molero F, Sánchez-Mora P, Torres M, Vázquez A, Galán JC, Torres I, Causse Del Río M, Merino-Diaz L, López M, Galar A, Cardeñoso L, Gutiérrez A, Loras C, Escribano I, Alvarez-Argüelles ME, Del Río L, Simón M, Meléndez MA, Camacho J, Herrero L, Jiménez P, Navarro-Rico ML, Jado I, Giannetti E, Kuhn JH, Sanchez-Lockhart M, Di Paola N, Kugelman JR, Guerra S, García-Sastre A, Cuesta I, Sánchez-Seco MP, Palacios G. Monkeypox virus genomic accordion strategies. Nat Commun 2024; 15:3059. [PMID: 38637500 PMCID: PMC11026394 DOI: 10.1038/s41467-024-46949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
The 2023 monkeypox (mpox) epidemic was caused by a subclade IIb descendant of a monkeypox virus (MPXV) lineage traced back to Nigeria in 1971. Person-to-person transmission appears higher than for clade I or subclade IIa MPXV, possibly caused by genomic changes in subclade IIb MPXV. Key genomic changes could occur in the genome's low-complexity regions (LCRs), which are challenging to sequence and are often dismissed as uninformative. Here, using a combination of highly sensitive techniques, we determine a high-quality MPXV genome sequence of a representative of the current epidemic with LCRs resolved at unprecedented accuracy. This reveals significant variation in short tandem repeats within LCRs. We demonstrate that LCR entropy in the MPXV genome is significantly higher than that of single-nucleotide polymorphisms (SNPs) and that LCRs are not randomly distributed. In silico analyses indicate that expression, translation, stability, or function of MPXV orthologous poxvirus genes (OPGs), including OPG153, OPG204, and OPG208, could be affected in a manner consistent with the established "genomic accordion" evolutionary strategies of orthopoxviruses. We posit that genomic studies focusing on phenotypic MPXV differences should consider LCR variability.
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Affiliation(s)
- Sara Monzón
- Unidad de Bioinformática, Unidades Centrales Científico Técnicas, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Sarai Varona
- Unidad de Bioinformática, Unidades Centrales Científico Técnicas, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Escuela Internacional de Doctorado de la UNED (EIDUNED), Universidad Nacional de Educación a Distancia (UNED), 2832, Madrid, Spain
| | - Anabel Negredo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Santiago Vidal-Freire
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | | | - Angel Zaballos
- Unidad de Genómica, Unidades Centrales Científico Técnicas, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Eva Orviz
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, 28040, Madrid, Spain
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, 28040, Madrid, Spain
| | - Ana Muñoz-Gómez
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, 28040, Madrid, Spain
| | | | - Vicente Estrada
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, 28040, Madrid, Spain
| | - Cristina García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Francisca Molero
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Patricia Sánchez-Mora
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Montserrat Torres
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Ana Vázquez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Juan-Carlos Galán
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), 28034, Madrid, Spain
| | - Ignacio Torres
- Servicio de Microbiología, Hospital Clínico Universitario, Instituto de Investigación INCLIVA, 46010, Valencia, Spain
| | - Manuel Causse Del Río
- Unidad de Microbiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, 14004, Córdoba, Spain
| | - Laura Merino-Diaz
- Unidad Clínico de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, 41013, Sevilla, Spain
| | - Marcos López
- Servicio de Microbiología y Parasitología, Hospital Universitario Puerta de Hierro Majadahonda, 28222, Madrid, Spain
| | - Alicia Galar
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain
| | - Laura Cardeñoso
- Servicio de Microbiología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, 28006, Madrid, Spain
| | - Almudena Gutiérrez
- Servicio de Microbiología y Parasitología Clínica, Hospital Universitario La Paz, 28046, Madrid, Spain
| | - Cristina Loras
- Servicio de Microbiología, Hospital General y Universitario, 13005, Ciudad Real, Spain
| | - Isabel Escribano
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis, 03010, Alicante, Spain
| | | | | | - María Simón
- Servicio de Microbiología, Hospital Central de la Defensa "Gómez Ulla", 28947, Madrid, Spain
| | - María Angeles Meléndez
- Servicio de Microbiología y Parasitología, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
| | - Juan Camacho
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Laura Herrero
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Pilar Jiménez
- Unidad de Genómica, Unidades Centrales Científico Técnicas, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - María Luisa Navarro-Rico
- Unidad de Genómica, Unidades Centrales Científico Técnicas, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Isabel Jado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Elaina Giannetti
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, 21702, USA
| | - Mariano Sanchez-Lockhart
- United States Army Research Institute for Infectious Disease, Fort Detrick, Frederick, MD, 21702, USA
| | - Nicholas Di Paola
- United States Army Research Institute for Infectious Disease, Fort Detrick, Frederick, MD, 21702, USA
| | - Jeffrey R Kugelman
- United States Army Research Institute for Infectious Disease, Fort Detrick, Frederick, MD, 21702, USA
| | - Susana Guerra
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Departmento de Medicina Preventiva, Salud Publica y Microbiología, Universidad Autónoma de Madrid, 28029, Madrid, Spain
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Isabel Cuesta
- Unidad de Bioinformática, Unidades Centrales Científico Técnicas, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Maripaz P Sánchez-Seco
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Gustavo Palacios
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
- Global Health Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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11
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Rainey JJ, Lin XM, Murphy S, Velazquez-Kronen R, Do T, Hughes C, Harris AM, Maitland A, Gundlapalli AV. Deployment of the National Notifiable Diseases Surveillance System during the 2022-23 mpox outbreak in the United States-Opportunities and challenges with case notifications during public health emergencies. PLoS One 2024; 19:e0300175. [PMID: 38603766 PMCID: PMC11008850 DOI: 10.1371/journal.pone.0300175] [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: 07/13/2023] [Accepted: 02/23/2024] [Indexed: 04/13/2024] Open
Abstract
Timely case notifications following the introduction of an uncommon pathogen, such as mpox, are critical for understanding disease transmission and for developing and implementing effective mitigation strategies. When Massachusetts public health officials notified the Centers for Disease Control and Prevention (CDC) about a confirmed orthopoxvirus case on May 17, 2023, which was later confirmed as mpox at CDC, mpox was not a nationally notifiable disease. Because existing processes for new data collections through the National Notifiable Disease Surveillance System were not well suited for implementation during emergency responses at the time of the mpox outbreak, several interim notification approaches were established to capture case data. These interim approaches were successful in generating daily case counts, monitoring disease transmission, and identifying high-risk populations. However, the approaches also required several data collection approvals by the federal government and the Council for State and Territorial Epidemiologists, the use of four different case report forms, and the establishment of complex data management and validation processes involving data element mapping and record-level de-duplication steps. We summarize lessons learned from these interim approaches to inform and improve case notifications during future outbreaks. These lessons reinforce CDC's Data Modernization Initiative to work in close collaboration with state, territorial, and local public health departments to strengthen case-based surveillance prior to the next public health emergency.
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Affiliation(s)
- Jeanette J. Rainey
- Division of Global Health Security, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Xia Michelle Lin
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Sylvia Murphy
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Raquel Velazquez-Kronen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, United States of America
| | - Tuyen Do
- Office of the Director, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Christine Hughes
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Aaron M. Harris
- Detect and Monitor Division, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Aaron Maitland
- Division of Health Interview Statistics, National Center of Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States of America
| | - Adi V. Gundlapalli
- Office of the Director, Office of Public Health Data, Surveillance, and Technology, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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12
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Yang CH, Song AL, Qiu Y, Ge XY. Cross-species transmission and host range genes in poxviruses. Virol Sin 2024; 39:177-193. [PMID: 38272237 PMCID: PMC11074647 DOI: 10.1016/j.virs.2024.01.007] [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: 06/20/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The persistent epidemic of human mpox, caused by mpox virus (MPXV), raises concerns about the future spread of MPXV and other poxviruses. MPXV is a typical zoonotic virus which can infect human and cause smallpox-like symptoms. MPXV belongs to the Poxviridae family, which has a relatively broad host range from arthropods to vertebrates. Cross-species transmission of poxviruses among different hosts has been frequently reported and resulted in numerous epidemics. Poxviruses have a complex linear double-strand DNA genome that encodes hundreds of proteins. Genes related to the host range of poxvirus are called host range genes (HRGs). This review briefly introduces the taxonomy, phylogeny and hosts of poxviruses, and then comprehensively summarizes the current knowledge about the cross-species transmission of poxviruses. In particular, the HRGs of poxvirus are described and their impacts on viral host range are discussed in depth. We hope that this review will provide a comprehensive perspective about the current progress of researches on cross-species transmission and HRG variation of poxviruses, serving as a valuable reference for academic studies and disease control in the future.
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Affiliation(s)
- Chen-Hui Yang
- College of Biology, Hunan Provincial Key Laboratory of Medical Virology, Hunan University, Changsha, 410012, China
| | - A-Ling Song
- College of Biology, Hunan Provincial Key Laboratory of Medical Virology, Hunan University, Changsha, 410012, China
| | - Ye Qiu
- College of Biology, Hunan Provincial Key Laboratory of Medical Virology, Hunan University, Changsha, 410012, China.
| | - Xing-Yi Ge
- College of Biology, Hunan Provincial Key Laboratory of Medical Virology, Hunan University, Changsha, 410012, China.
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13
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Brien SC, LeBreton M, Doty JB, Mauldin MR, Morgan CN, Pieracci EG, Ritter JM, Matheny A, Tafon BG, Tamoufe U, Missoup AD, Nwobegahay J, Takuo JM, Nkom F, Mouiche MMM, Feussom JMK, Wilkins K, Wade A, McCollum AM. Clinical Manifestations of an Outbreak of Monkeypox Virus in Captive Chimpanzees in Cameroon, 2016. J Infect Dis 2024; 229:S275-S284. [PMID: 38164967 DOI: 10.1093/infdis/jiad601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Monkeypox virus (MPXV) is a reemerging virus of global concern. An outbreak of clade I MPXV affected 20 captive chimpanzees in Cameroon in 2016. We describe the epidemiology, virology, phylogenetics, and clinical progression of this outbreak. Clinical signs included exanthema, facial swelling, perilaryngeal swelling, and eschar. Mpox can be lethal in captive chimpanzees, with death likely resulting from respiratory complications. We advise avoiding anesthesia in animals with respiratory signs to reduce the likelihood of death. This outbreak presented a risk to animal care staff. There is a need for increased awareness and a One Health approach to preparation for outbreaks in wildlife rescue centers in primate range states where MPXV occurs. Control measures should include quarantining affected animals, limiting human contacts, surveillance of humans and animals, use of personal protective equipment, and regular decontamination of enclosures.
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Affiliation(s)
- Stephanie C Brien
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, Easter Bush Campus, The University of Edinburgh, Roslin, United Kingdom
- Ape Action Africa, Mefou Park, Cameroon
| | | | - Jeffrey B Doty
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew R Mauldin
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clint N Morgan
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily G Pieracci
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jana M Ritter
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Audrey Matheny
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Alain D Missoup
- Zoology Unit, Laboratory of Biology and Physiology of Animal Organisms, Faculty of Science, University of Douala, Cameroon
| | | | | | | | - Moctar M M Mouiche
- Mosaic, Yaoundé, Cameroon
- School of Veterinary Medicine and Sciences, University of Ngaounderé, Cameroon
| | - Jean Marc K Feussom
- Cameroon Epidemiological Network for Animal Diseases, Directorate of Veterinary Services, Ministry of Livestock, Fisheries and Animal Industries, Yaoundé, Cameroon
| | - Kimberly Wilkins
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Abel Wade
- National Veterinary Laboratory, Garoua, Cameroon
| | - Andrea M McCollum
- Division of High Consequence Pathogens and Pathology, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Ritter JM, Martines RB, Bhatnagar J, Rao AK, Villalba JA, Silva-Flannery L, Lee E, Bullock HA, Hutson CL, Cederroth T, Harris CK, Hord K, Xu Y, Brown CA, Guccione JP, Miller M, Paddock CD, Reagan-Steiner S. Pathology and Monkeypox virus Localization in Tissues From Immunocompromised Patients With Severe or Fatal Mpox. J Infect Dis 2024; 229:S219-S228. [PMID: 38243606 DOI: 10.1093/infdis/jiad574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Pathology and Monkeypox virus (MPXV) tissue tropism in severe and fatal human mpox is not thoroughly described but can help elucidate the disease pathogenesis and the role of coinfections in immunocompromised patients. METHODS We analyzed biopsy and autopsy tissues from 22 patients with severe or fatal outcomes to characterize pathology and viral antigen and DNA distribution in tissues by immunohistochemistry and in situ hybridization. Tissue-based testing for coinfections was also performed. RESULTS Mucocutaneous lesions showed necrotizing and proliferative epithelial changes. Deceased patients with autopsy tissues evaluated had digestive tract lesions, and half had systemic tissue necrosis with thrombotic vasculopathy in lymphoid tissues, lung, or other solid organs. Half also had bronchopneumonia, and one-third had acute lung injury. All cases had MPXV antigen and DNA detected in tissues. Coinfections were identified in 5 of 16 (31%) biopsy and 4 of 6 (67%) autopsy cases. CONCLUSIONS Severe mpox in immunocompromised patients is characterized by extensive viral infection of tissues and viremic dissemination that can progress despite available therapeutics. Digestive tract and lung involvement are common and associated with prominent histopathological and clinical manifestations. Coinfections may complicate mpox diagnosis and treatment. Significant viral DNA (likely correlating to infectious virus) in tissues necessitates enhanced biosafety measures in healthcare and autopsy settings.
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Affiliation(s)
| | | | | | - Agam K Rao
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Elizabeth Lee
- Infectious Diseases Pathology Branch
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Christina L Hutson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kristin Hord
- Office of Chief Medical Examiner, New York City, New York
| | - Ya Xu
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology and Laboratory Medicine, Ben Taub Hospital, Harris Health System, Houston, Texas
| | - Cameron A Brown
- Department of Pathology and Immunology, Baylor College of Medicine
- Department of Pathology and Laboratory Medicine, Ben Taub Hospital, Harris Health System, Houston, Texas
| | - Jack P Guccione
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California
| | - Matthew Miller
- Department of Medical Examiner-Coroner, Los Angeles County, Los Angeles, California
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, National Center for Zoonotic and Emerging Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Miura F, Backer JA, van Rijckevorsel G, Bavalia R, Raven S, Petrignani M, Ainslie KEC, Wallinga J. Time Scales of Human Mpox Transmission in The Netherlands. J Infect Dis 2024; 229:800-804. [PMID: 37014716 PMCID: PMC10938196 DOI: 10.1093/infdis/jiad091] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/05/2023] Open
Abstract
Mpox has spread rapidly to many countries in nonendemic regions. After reviewing detailed exposure histories of 109 pairs of mpox cases in the Netherlands, we identified 34 pairs where transmission was likely and the infectee reported a single potential infector with a mean serial interval of 10.1 days (95% credible interval, 6.6-14.7 days). Further investigation into pairs from 1 regional public health service revealed that presymptomatic transmission may have occurred in 5 of 18 pairs. These findings emphasize that precaution remains key, regardless of the presence of recognizable symptoms of mpox.
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Affiliation(s)
- Fuminari Miura
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Center for Marine Environmental Studies, Ehime University, Ehime, Japan
| | - Jantien A Backer
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Gini van Rijckevorsel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Infectious Diseases, Public Health Service Amsterdam
| | - Roisin Bavalia
- Department of Infectious Diseases, Public Health Service Amsterdam
| | - Stijn Raven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Infectious Diseases, Public Health Service Region Utrecht, Zeist
| | - Mariska Petrignani
- Department of Infectious Diseases, Public Health Service Haaglanden, Den Haag, The Netherlands
| | - Kylie E C Ainslie
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jacco Wallinga
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
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16
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Ward T, Overton CE, Paton RS, Christie R, Cumming F, Fyles M. Understanding the infection severity and epidemiological characteristics of mpox in the UK. Nat Commun 2024; 15:2199. [PMID: 38467622 PMCID: PMC10928097 DOI: 10.1038/s41467-024-45110-8] [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: 05/30/2023] [Accepted: 01/15/2024] [Indexed: 03/13/2024] Open
Abstract
In May 2022, individuals infected with the monkeypox virus were detected in the UK without clear travel links to endemic areas. Understanding the clinical characteristics and infection severity of mpox is necessary for effective public health policy. The study period of this paper, from the 1st June 2022 to 30th September 2022, included 3,375 individuals that tested positive for the monkeypox virus. The posterior mean times from infection to hospital admission and length of hospital stay were 14.89 days (95% Credible Intervals (CrI): 13.60, 16.32) and 7.07 days (95% CrI: 6.07, 8.23), respectively. We estimated the modelled Infection Hospitalisation Risk to be 4.13% (95% CrI: 3.04, 5.02), compared to the overall sample Case Hospitalisation Risk (CHR) of 5.10% (95% CrI: 4.38, 5.86). The overall sample CHR was estimated to be 17.86% (95% CrI: 6.06, 33.11) for females and 4.99% (95% CrI: 4.27, 5.75) for males. A notable difference was observed between the CHRs that were estimated for each sex, which may be indicative of increased infection severity in females or a considerably lower infection ascertainment rate. It was estimated that 74.65% (95% CrI: 55.78, 86.85) of infections with the monkeypox virus in the UK were captured over the outbreak.
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Affiliation(s)
- Thomas Ward
- UK Health Security Agency, Data Analytics & Surveillance, London, UK.
| | - Christopher E Overton
- UK Health Security Agency, Data Analytics & Surveillance, London, UK
- Department of Mathematical Sciences, University of Liverpool, Liverpool, UK
| | - Robert S Paton
- UK Health Security Agency, Data Analytics & Surveillance, London, UK
| | - Rachel Christie
- UK Health Security Agency, Data Analytics & Surveillance, London, UK
| | - Fergus Cumming
- UK Health Security Agency, Data Analytics & Surveillance, London, UK
| | - Martyn Fyles
- UK Health Security Agency, Data Analytics & Surveillance, London, UK
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17
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Ejaz M, Jabeen M, Sharif M, Syed MA, Shah PT, Faryal R. Human monkeypox: An updated appraisal on epidemiology, evolution, pathogenesis, clinical manifestations, and treatment strategies. J Basic Microbiol 2024; 64:e2300455. [PMID: 37867205 DOI: 10.1002/jobm.202300455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/13/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
Monkeypox (Mpox) is a zoonotic viral disease caused by the monkeypox virus (MPXV), a member of the Orthopoxvirus genus. The recent occurrence of Mpox infections has become a significant global issue in recent months. Despite being an old disease with a low mortality rate, the ongoing multicountry outbreak is atypical due to its occurrence in nonendemic countries. The current review encompasses a comprehensive analysis of the literature pertaining to MPXV, with the aim of consolidating the existing data on the virus's epidemiological, biological, and clinical characteristics, as well as vaccination and treatment regimens against the virus.
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Affiliation(s)
- Mohammad Ejaz
- Department of Microbiology, Government Postgraduate College Mandian, Abbottabad, Pakistan
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Momina Jabeen
- National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mehmoona Sharif
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Ali Syed
- Department of Microbiology, The University of Haripur, Haripur, Pakistan
| | - Pir T Shah
- Institute of Biomedical Sciences, Shanxi University, Taiyuan, Shanxi, China
| | - Rani Faryal
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
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18
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Siddalingaiah N, Dhanya K, Lodha L, Pattanaik A, Mani RS, Ma A. Tracing the journey of poxviruses: insights from history. Arch Virol 2024; 169:37. [PMID: 38280957 DOI: 10.1007/s00705-024-05971-2] [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: 09/22/2023] [Accepted: 12/06/2023] [Indexed: 01/29/2024]
Abstract
The historical significance of the poxviruses is profound, largely due to the enduring impact left by smallpox virus across many centuries. The elimination of smallpox is a remarkable accomplishment in the history of science and medicine, with centuries of devoted efforts resulting in the development and widespread administration of smallpox vaccines. This review provides insight into the pivotal historical events involving medically significant poxviruses. Understanding the remarkable saga of combatting smallpox is crucial, serving as a guidepost for potential future encounters with poxvirus infections. There is a continual need for vigilant observation of poxvirus evolution and spillover from animals to humans, considering the expansive range of susceptible hosts. The recent occurrence of monkeypox cases in non-endemic countries stands as a stark reminder of the ease with which infections can be disseminated through international travel and trade. This backdrop encourages introspection about our journey and the current status of poxvirus research.
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Affiliation(s)
- Nayana Siddalingaiah
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - K Dhanya
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Lonika Lodha
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Amrita Pattanaik
- Manipal Institute of Virology, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Reeta S Mani
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Ashwini Ma
- Department of Neurovirology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
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19
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Ogunleye SC, Akinsulie OC, Aborode AT, Olorunshola MM, Gbore D, Oladoye M, Adesola RO, Gbadegoye JO, Olatoye BJ, Lawal MA, Bakare AB, Adekanye O, Chinyere EC. The re-emergence and transmission of Monkeypox virus in Nigeria: the role of one health. Front Public Health 2024; 11:1334238. [PMID: 38249416 PMCID: PMC10797020 DOI: 10.3389/fpubh.2023.1334238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
The Monkeypox virus, commonly abbreviated as mpox, is a viral zoonosis that is experiencing a resurgence in prevalence. It is endemic to regions of West and Central Africa that are characterized by dense forested areas. Various measures pertaining to animals, humans, and the environment have been recognized as potential factors and catalysts for the spread of the disease throughout the impacted regions of Africa. This study examines the various factors contributing to the transmission of the virus in Nigeria, with a particular focus on the animal-human and inter-human modes of transmission in rural communities and healthcare facilities. The One Health approach was emphasized as crucial in the prevention and management of this issue. Literature suggests that preventing repeated zoonotic introductions could potentially halt the transmission of the mpox virus from animal to human hosts, leading to a potential decrease in human infections.
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Affiliation(s)
- Seto C. Ogunleye
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | - Olalekan C. Akinsulie
- Department of Veterinary Biochemistry, Nigeria College of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | | | - Mercy M. Olorunshola
- Department of Pharmaceutical Microbiology, Pharmacy, University of Ibadan, Ibada, Nigeria
| | - Damilola Gbore
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | | | - Ridwan O. Adesola
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
| | - Joy O. Gbadegoye
- Department of Veterinary Biochemistry, Nigeria College of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
- Healthy Africans Platform, Research and Development, Ibada, Nigeria
| | | | - Mariam A. Lawal
- Department of Biochemistry, Department of Biochemistry, Federal University of Agriculture, Abeokuta, Nigeria
| | - Akeem B. Bakare
- Faculty of Veterinary Medicine, University of Ibadan, Ibada, Nigeria
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20
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Rabaan AA, Halwani MA, Alshehri AA, Al-Subaie MF, Almansour ZH, AlShehail BM, Alotaibi N, Khamis F, Al Kaabi NA, Alsomali G, Alqahtani AS, Alissa M. Bioprospecting of Meliaceae family phytomolecules for the treatment of monkeypox virus infection: a QSAR modeling and MD simulation approach. J Biomol Struct Dyn 2024:1-23. [PMID: 38174404 DOI: 10.1080/07391102.2023.2294180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
Recent monkeypox virus (MPXV) infections show the risk of MPXV transmission that persists today and the significance of surveillance and quick response methods to stop the virus's spread. Currently, the monkeypox virus infection is not specifically treated. In this study, QSAR models were designed using known inhibitors of cysteine proteinase from the vaccinia virus, where the Random Forest model and Ridge model had showed the best correlation between predicted and observed EC50. These models were used to screen Maliaceae family phytochemicals against MPXV cysteine proteinase. The compound, IMPHY010637 was detected in top 5 from both the QSAR screening models and showed best docked score (-8.6 kcal/mol) and thus selected for further investigation. Further, the IMPHY010637 showed interaction with the catalytic residue His241 of the protein as reported in earlier studies. The ADMET analysis of the compound showed the acceptable drug-like properties of IMPHY010637. However, these properties could be improved after experimental validation of protein-ligand binding. Both docked complex and poses created in 100 ns MD simulation of the protein-ligand complex showed the presence of multiple hydrogen bonds. RMSD and conformation analysis showed stable binding of IMPHY010637 with the cysteine proteinase of MPXV at its active site. Compared to the known inhibitor, IMPHY010637 showed better binding with the protein as observed by the PCA and MM/GBSA analysis. This study concluded IMPHY010637 as a potential inhibitor for the cysteine proteinase of MPXV using computational methods that could be tested in in-vitro experiments.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Muhammad A Halwani
- Department of Medical Microbiology, Faculty of Medicine, Al Baha University, Al Baha, Saudi Arabia
| | - Ahmad A Alshehri
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
| | - Maha F Al-Subaie
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Research Center, Dr. Sulaiman Alhabib Medical Group, Riyadh, Saudi Arabia
| | - Zainab H Almansour
- Biological Science Department, College of Science, King Faisal University, Hofuf, Saudi Arabia
| | - Bashayer M AlShehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nouf Alotaibi
- Clinical pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Faryal Khamis
- Infection Diseases unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Nawal A Al Kaabi
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
- Sheikh Khalifa Medical City, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, United Arab Emirates
| | - Ghaneema Alsomali
- Infection prevention and control Department, Imam Abdulrahman bin Faisal hospital, Dammam, Saudi Arabia
| | - Ali S Alqahtani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Mohammed Alissa
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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21
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Obermeier PE, Buder SC, Hillen U. Pockenvirusinfektionen in der Dermatologie: Poxvirus infections in dermatology - the neglected, the notable, and the notorious. J Dtsch Dermatol Ges 2024; 22:56-96. [PMID: 38212918 DOI: 10.1111/ddg.15257_g] [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: 01/31/2023] [Accepted: 08/20/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungDie Familie Poxviridae umfasst derzeit 22 Gattungen, die Wirbeltiere infizieren können. Humanpathogene Pockenviren gehören den Gattungen Ortho‐, Para‐, Mollusci‐ und Yatapoxvirus an. Bis zur Eradikation der Variola vera im Jahr 1979 waren die Pocken, im Volksmund auch Blattern genannt, eine schwerwiegende Gesundheitsbedrohung für die Bevölkerung. Noch heute sind Dermatologen mit zahlreichen Pockenvirusinfektionen konfrontiert, wie den Bauernhofpocken, die als Zoonosen nach Tierkontakten in ländlichen Gebieten oder nach Massenversammlungen auftreten können. In den Tropen können Erkrankungen durch Tanapox‐ oder Vaccinia‐Viren zu den Differenzialdiagnosen gehören. Dellwarzen sind weltweit verbreitet und werden in bestimmten Fällen als sexuell übertragbare Pockenvirusinfektion angesehen. In jüngster Zeit hatten sich Mpox (Affenpocken) zu einer gesundheitlichen Notlage von internationaler Tragweite entwickelt, die eine rasche Identifizierung und angemessene Behandlung durch Dermatologen und Infektiologen erfordert. Fortschritte und neue Erkenntnisse über Epidemiologie, Diagnose, klinische Manifestationen und Komplikationen sowie Behandlung und Prävention von Pockenvirusinfektionen erfordern ein hohes Maß an Fachwissen und interdisziplinärer Zusammenarbeit in den Bereichen Virologie, Infektiologie und Dermatologie. Dieser CME‐Artikel bietet einen aktualisierten systematischen Überblick, um praktizierende Dermatologen bei der Identifizierung, Differenzialdiagnose und Behandlung klinisch relevanter Pockenvirusinfektionen zu unterstützen.
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Affiliation(s)
- Patrick E Obermeier
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Abteilung für Infektionskrankheiten, Vaccine Safety Initiative, Berlin, Deutschland
| | - Susanne C Buder
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Konsiliarlabor für Gonokokken, Fachgebiet Sexuell übertragbare bakterielle Krankheitserreger, Robert Koch-Institut, Berlin, Deutschland
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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22
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Kibungu EM, Vakaniaki EH, Kinganda-Lusamaki E, Kalonji-Mukendi T, Pukuta E, Hoff NA, Bogoch II, Cevik M, Gonsalves GS, Hensley LE, Low N, Shaw SY, Schillberg E, Hunter M, Lunyanga L, Linsuke S, Madinga J, Peeters M, Cigolo JCM, Ahuka-Mundeke S, Muyembe JJ, Rimoin AW, Kindrachuk J, Mbala-Kingebeni P, Lushima RS. Clade I-Associated Mpox Cases Associated with Sexual Contact, the Democratic Republic of the Congo. Emerg Infect Dis 2024; 30:172-176. [PMID: 38019211 PMCID: PMC10756366 DOI: 10.3201/eid3001.231164] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
We report a cluster of clade I monkeypox virus infections linked to sexual contact in the Democratic Republic of the Congo. Case investigations resulted in 5 reverse transcription PCR-confirmed infections; genome sequencing suggest they belonged to the same transmission chain. This finding demonstrates that mpox transmission through sexual contact extends beyond clade IIb.
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Affiliation(s)
- Emile M. Kibungu
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Emmanuel H. Vakaniaki
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Eddy Kinganda-Lusamaki
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Thierry Kalonji-Mukendi
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Elisabeth Pukuta
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Nicole A. Hoff
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Isaac I. Bogoch
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Muge Cevik
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Gregg S. Gonsalves
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Lisa E. Hensley
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Nicola Low
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Souradet Y. Shaw
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Erin Schillberg
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Mikayla Hunter
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Lygie Lunyanga
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Sylvie Linsuke
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Joule Madinga
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Martine Peeters
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Jean-Claude Makangara Cigolo
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Steve Ahuka-Mundeke
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | - Jean-Jacques Muyembe
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
| | | | | | | | | | - International Mpox Research Consortium
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo (E.M. Kibungu, T. Kalonji-Mukendi, R.S. Lushima)
- Institut National de Recherche Biomédicale, Kinshasa (E.H. Vakaniaki, E. Kinganda-Lusamaki, E. Pukuta, L. Lunyanga, S. Linsuke, J. Madinga, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa (E. Kinganda-Lusamaki, J.-C. Makangara Cigolo, S. Ahuka-Mundeke, J.-J. Muyembe, P. Mbala-Kingebeni)
- TransVIHMI (Recherches Translationnelles sur le VIH et les Maladies Infectieuses endémiques et émergentes)
- University of Montpellier, French National Research Institute for Sustainable Development, INSERM, Montpellier, France (E. Kinganda-Lusamaki, M. Peeters)
- University of California, Los Angeles, California, USA (N.A. Hoff, A.W. Rimoin)
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (I.I. Bogoch)
- University of St. Andrews, St. Andrews, Scotland, UK (M. Cevik)
- Yale School of Public Health, New Haven, Connecticut, USA (G.S. Gonsalves)
- USDA Agricultural Research Service, Manhattan, Kansas, USA (L.E. Hensley)
- University of Bern, Bern, Switzerland (N. Low)
- University of Manitoba, Winnipeg, Manitoba, Canada (S.Y. Shaw, E. Schillberg, M. Hunter, J. Kindrachuk)
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23
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Obermeier PE, Buder SC, Hillen U. Poxvirus infections in dermatology - the neglected, the notable, and the notorious. J Dtsch Dermatol Ges 2024; 22:56-93. [PMID: 38085140 DOI: 10.1111/ddg.15257] [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: 01/31/2023] [Accepted: 08/20/2023] [Indexed: 12/22/2023]
Abstract
The family Poxviridae currently comprises 22 genera that infect vertebrates. Of these, members of the Ortho-, Para-, Mollusci- and Yatapoxvirus genera have been associated with human diseases of high clinical relevance in dermatology. Historically, smallpox had been a notorious health threat until it was declared eradicated by the World Health Organization in 1979. Today, dermatologists are confronted with a variety of poxviral infections, such as farmyard pox, which occurs as a zoonotic infection after contact with animals. In the tropics, tanapox or vaccinia may be in the differential diagnosis as neglected tropical dermatoses. Molluscum contagiosum virus infection accounts for significant disease burden worldwide and is classified as a sexually transmitted infection in certain scenarios. Recently, mpox (monkeypox) has emerged as a public health emergency of international concern, requiring rapid recognition and appropriate management by dermatologists and infectious disease specialists. Advances and new insights into the epidemiology, diagnosis, clinical manifestations and complications, treatment, and prevention of poxviral infections require a high level of expertise and interdisciplinary skills from healthcare professionals linking virology, infectious diseases, and dermatology. This CME article provides a systematic overview and update to assist the practicing dermatologist in the identification, differential diagnosis, and management of poxviral infections.
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Affiliation(s)
- Patrick E Obermeier
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
- Department of Infectious Diseases, Vaccine Safety Initiative, Berlin, Germany
| | - Susanne C Buder
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
- German Reference Laboratory for Gonococci, Unit Sexually Transmitted Bacterial Pathogens, Department for Infectious Diseases, Robert Koch-Institute, Berlin, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
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24
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Kalaba MH, El-Sherbiny GM, Sharaf MH, Farghal EE. Biological Characteristics and Pathogenesis of Monkeypox Virus: An Overview. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:91-109. [PMID: 38801573 DOI: 10.1007/978-3-031-57165-7_6] [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
Although the smallpox virus has been eradicated worldwide, the World Health Organization (WHO) has issued a warning about the virus's potential to propagate globally. The WHO labeled monkeypox a world public health emergency in July 2022, requiring urgent prevention and treatment. The monkeypox virus is a part of the Poxviridae family, Orthopoxvirus genus, and is accountable for smallpox, which has killed over a million people in the past. Natural hosts of the virus include squirrels, Gambian rodents, chimpanzees, and other monkeys. The monkeypox virus has transmitted to humans through primary vectors (various animal species) and secondary vectors, including direct touch with lesions, breathing particles from body fluids, and infected bedding. The viral particles are ovoid or brick-shaped, 200-250 nm in diameter, contain a single double-stranded DNA molecule, and reproduce only in the cytoplasm of infected cells. Monkeypox causes fever, cold, muscle pains, headache, fatigue, and backache. The phylogenetic investigation distinguished between two genetic clades of monkeypox: the more pathogenic Congo Basin clade and the West Africa clade. In recent years, the geographical spread of the human monkeypox virus has accelerated despite a paucity of information regarding the disease's emergence, ecology, and epidemiology. Using lesion samples and polymerase chain reaction (PCR), the monkeypox virus was diagnosed. In the USA, the improved Ankara vaccine can now be used to protect people who are at a higher risk of getting monkeypox. Antivirals that we have now work well against smallpox and may stop the spread of monkeypox, but there is no particular therapy for monkeypox.
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Affiliation(s)
- Mohamed H Kalaba
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt
| | - Gamal M El-Sherbiny
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt.
| | - Mohammed H Sharaf
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, 11884, Egypt
| | - Eman E Farghal
- Clinical and Chemical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Estrada Alvarez JM, Acuña MH, García Arias HF, Alvarado FEP, Ospina Ramírez JJ. Estimation of Incubation Period of Mpox during 2022 Outbreak in Pereira, Colombia. Emerg Infect Dis 2024; 30:180-182. [PMID: 38063085 PMCID: PMC10756364 DOI: 10.3201/eid3001.221663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
We estimated the incubation period for mpox during an outbreak in Pereira, Colombia, using data from 11 confirmed cases. Mean incubation period was 7.1 (95% CI 4.9-9.9) days, consistent with previous outbreaks. Accurately estimating the incubation period provides insights into transmission dynamics, informing public health interventions and surveillance strategies.
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26
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Nucera F, Bonina L, Cipolla A, Pirina P, Hansbro PM, Adcock IM, Caramori G. Poxviridae Pneumonia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1451:183-204. [PMID: 38801579 DOI: 10.1007/978-3-031-57165-7_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Poxviridae family includes several viruses that infecting humans usually causes skin lesions only, but in some cases their clinical course is complicated by viral pneumonia (with or without bacterial superinfections). Historically variola virus has been the poxviridae most frequently associated with the development of pneumonia with many large outbreaks worldwide before its eradication in 1980. It is still considered a biological threat for its potential in biological warfare and bioterrorism. Smallpox pneumonia can be severe with the onset of acute respiratory distress syndrome (ARDS) and death. Vaccinia virus, used for vaccination against smallpox exceptionally, in immunocompromised patients, can induce generalized (with also lung involvement) severe disease after vaccination. MPXV virus occasionally can cause pneumonia particularly in immunocompromised patients. The pathophysiology of poxviridae pneumonia is still an area of active research; however, in animal models these viruses can cause both direct damage to the lower airways epithelium and a hyperinflammatory syndrome, like a cytokine storm. Multiple mechanisms of immune evasion have also been described. The treatment of poxviridae pneumonia is mainly based on careful supportive care. Despite the absence of randomized clinical trials in patients with poxviridae pneumonia there are antiviral drugs, such as tecovirimat, cidofovir and brincidofovir, FDA-approved for use in smallpox and also available under an expanded access protocol for treatment of MPXV. There are 2 (replication-deficient modified vaccinia Ankara and replication-competent vaccinia virus) smallpox vaccines FDA-approved with the first one also approved for prevention of MPXV in adults that are at high risk of infection.
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Affiliation(s)
- Francesco Nucera
- Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF), Università degli Studi di Messina, Messina, Italy
| | - Letterio Bonina
- Virologia, Dipartimento di Patologia delle Malattie Umane "G. Barresi", Università degli Studi di Messina, Messina, Italy
| | - Antonino Cipolla
- Pneumologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Catania, Catania, Italy
| | - Pietro Pirina
- Pneumologia, Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, Sassari, Italy
| | - Philip M Hansbro
- Centre for Inflammation, Centenary Institute and University of Technology Sydney, Sydney, Australia
| | - Ian M Adcock
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Gaetano Caramori
- Pulmonology, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Asquith W, Hueston L, Dwyer D, Kok J, Ko D, Fennel M, Rockett R, Rai NJ, Li Y, Sriramoju S, Sutor A, O'Sullivan M. Characterizing the acute antibody response of monkeypox and MVA-BN vaccine following an Australian outbreak. J Med Virol 2024; 96:e29407. [PMID: 38240403 DOI: 10.1002/jmv.29407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
In response to the emergence of the monkeypox virus (MPXV) in Australia in May 2022, we developed and evaluated indirect immunofluorescence assays (IFA) for MPXV and Vaccinia virus (VACV) IgG and IgM antibodies using serum samples from patients with nucleic acid amplification test (NAAT)-confirmed mpox and uninfected unvaccinated controls. Additionally, 47 healthcare workers receiving two doses of the third-generation smallpox vaccine Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) undertook serial serum collection to describe the serological response to vaccination. MPXV antibodies were detected in 16/18 individuals with NAAT-confirmed mpox (sensitivity 0.89, specificity 1.00), and VACV antibodies were detected in 28/29 individuals who received two doses of MVA-BN vaccine (sensitivity 0.97, specificity 1.00). Detectable antibody in subjects historically vaccinated with early-generation vaccines against smallpox was found in 7/7 subjects, at a median of 48 years following vaccination. MPXV NAAT-positive patients with serum samples collected within the first 14 days after rash onset had detectable IgG and IgM in 9/12 and 5/12 of patients, respectively, with maintenance of IgG and disappearance of IgM titers after 60 days. While specificity was high when testing unvaccinated and uninfected subjects, significant cross-reactivity between MPXV and VACV antibodies was observed.
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Affiliation(s)
- Will Asquith
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Linda Hueston
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Dominic Dwyer
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
- Sydney Infectious Disease Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jen Kok
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
- Sydney Infectious Disease Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Danny Ko
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Michael Fennel
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Rebecca Rockett
- Sydney Infectious Disease Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Neela Joshi Rai
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Ying Li
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Shirisha Sriramoju
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Allison Sutor
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Matthew O'Sullivan
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, New South Wales, Australia
- Sydney Infectious Disease Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
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Mrosik S, Rasokat H, Fabri M, Bopp L. [Human monkeypox (Mpox)]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:40-47. [PMID: 38063873 DOI: 10.1007/s00105-023-05268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/12/2024]
Abstract
Until recently, human monkeypox (Mpox) were rarely observed outside of Africa, where the Mpox virus (MPXV) is endemic in some regions. In early May 2022, a global Mpox outbreak occurred. Crucial to this outbreak was human-to-human transmission during sexual activity. In particular, young men who have sex with men (MSM) became ill. In July 2022, this Mpox epidemic was declared a public health emergency of international concern by the World Health Organization. As of 26 September 2023, 90,618 confirmed cases of Mpox have been reported worldwide, with Germany accounting for around 3700 cases. The strongest increase in incidence occurred from May to mid-August 2022; since then, the number of cases has declined significantly as a result of intensive prevention efforts (education, vaccination). Currently, there are only sporadic, smaller outbreaks-in Germany (Berlin) most recently in August 2023. Despite the current calm epidemiological situation worldwide, isolated cases must therefore still be expected in Germany. The clinical picture of the "new" clade IIb-associated Mpox variant, which is mostly transmitted sexually from person to person, differs markedly from that of the "classical" Mpox (clades I and IIa), which, apart from rapidly breaking human infection chains, essentially occur as a zoonosis.
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Affiliation(s)
- Sebastian Mrosik
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Heinrich Rasokat
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Mario Fabri
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Luisa Bopp
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Zebardast A, Latifi T, Shafiei-Jandaghi NZ, Gholami Barzoki M, Shatizadeh Malekshahi S. Plausible reasons for the resurgence of Mpox (formerly Monkeypox): an overview. Trop Dis Travel Med Vaccines 2023; 9:23. [PMID: 38143281 PMCID: PMC10749502 DOI: 10.1186/s40794-023-00209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/28/2023] [Indexed: 12/26/2023] Open
Abstract
Poxviruses are large and diversified viruses that cause an emerging zoonotic disease known as monkeypox (mpox). In the past, mpox predominated primarily in the rural rainforests of Central and West Africa. Recently, the exportation of mpoxv from Africa to other continents has been progressively reported. However, the lack of travel history to Africa in most of the currently reported cases in 2022 promotes the sign of changing epidemiology of this disease. Concerns over the geographic distribution and continued resurgence of mpox is growing. In this review, we addressed the geographic distribution, transmission, reasons for the resurgence of mpox, and vaccination. Although the precise cause of the resurgence in mpox cases is mostly unknown, several suggested factors are believed to be waning immunity, accumulation of unvaccinated people, ecological conditions, risk behaviors of men who have sex with men, and genetic evolution.
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Affiliation(s)
- Arghavan Zebardast
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tayebeh Latifi
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Gholami Barzoki
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Moawad MHE, Taha AM, Nguyen D, Ali M, Mohammed YA, Moawad WAET, Hamouda E, Bonilla-Aldana DK, Rodriguez-Morales AJ. Attitudes towards Receiving Monkeypox Vaccination: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2023; 11:1840. [PMID: 38140243 PMCID: PMC10747893 DOI: 10.3390/vaccines11121840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The public's attitude towards Mpox vaccination is a critical factor in the success of immunisation programmes. Understanding the factors contributing to vaccine acceptance or hesitancy is critical for developing effective health communication strategies. This systematic review and meta-analysis aims to bring together evidence from observational studies on attitudes towards Mpox vaccination, including willingness and rejection. METHODS From this review's inception until June 2023, a comprehensive search was conducted across four major electronic databases: PubMed, Web of Science, Scopus, and EBSCO. The inclusion criteria included studies investigating public attitudes towards Mpox vaccination, as defined by acceptance and willingness to be vaccinated versus rejection and unwillingness. RESULTS Thirty studies met the inclusion criteria among the screened literature. An analysis of 27 studies involving 81,792 participants revealed that 45,926 (56.14%) were willing to receive the Mpox vaccination. In contrast, ten studies involving 7448 participants revealed that 2156 people (28.94%) were unwilling to receive the Mpox vaccination. Females were less willing to receive the vaccine than males, with an odds ratio (OR) of 0.61 (95% CI, 0.43-0.86). Furthermore, homosexuals were found to be more willing than heterosexuals, with an OR of 1.44 (95% CI, 1.14-1.80). CONCLUSION Vaccination is emerging as a critical strategy for preventing Mpox infection and fostering herd immunity against potential outbreaks. Improving public awareness and acceptance of vaccination is critical to avoiding a situation similar to the COVID-19 pandemic. Targeted educational and outreach programmes could explain the benefits of vaccination, bridging the information gap and encouraging a proactive public health approach to emerging infectious diseases.
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Affiliation(s)
- Mostafa Hossam-Eldin Moawad
- Clinical Department, Faculty of Pharmacy, Alexandria University, Alexandria 21544, Egypt;
- Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | | | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Mohammed Ali
- Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt;
| | | | - Wesam Abd El-Tawab Moawad
- Faculty of Pharmacy (Girls), Al-Azhar University, Cairo 11884, Egypt;
- MARS Global, London WC2H 9JQ, UK
| | - Esraa Hamouda
- Faculty of Medicine, Menoufia University, Menoufia 32511, Egypt;
| | | | - Alfonso J. Rodriguez-Morales
- Clinical Epidemiology and Biostatistics Master Program, Faculty of Health Sciences, Universidad Científica del Sur, Lima 15097, Peru;
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut P.O. Box 36, Lebanon
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31
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Okwor T, Mbala PK, Evans DH, Kindrachuk J. A contemporary review of clade-specific virological differences in monkeypox viruses. Clin Microbiol Infect 2023; 29:1502-1507. [PMID: 37507009 DOI: 10.1016/j.cmi.2023.07.011] [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: 03/10/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Monkeypox virus (MPXV) is an emerging zoonotic virus that has had on-going public health impacts in endemic regions of Central and West Africa for over a half-century. Historically, the MPXV clade endemic in regions of Central Africa is associated with higher morbidity and mortality as compared with the clade endemic in West Africa. OBJECTIVES Here, we review the virological characteristics of MPXV and discuss potential relationships between virulence factors and clade- (and subclade-) specific differences in virulence and transmission patterns. SOURCES Targeted search was conducted in PubMed using ((monkeypox virus) OR (Orthopoxvirus)) AND (zoonosis)) OR ((monkeypox) OR (human mpox). CONTENT Forty-seven references were considered that included three publicly available data reports and/or press releases, one book chapter, and 44 published manuscripts. IMPLICATIONS Although zoonosis has been historically linked to emergence events in humans, epidemiological analyses of more recent outbreaks have identified increasing frequencies of human-to-human transmission. Furthermore, viral transmission during the 2022 global human mpox outbreak, caused by a recently identified MPXV subclade, has relied exclusively on human-to-human contact with no known zoonotic link.
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Affiliation(s)
- Tochi Okwor
- Department of Planning, Research & Statistics, Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Placide K Mbala
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Département de Biologie Médicale, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - David H Evans
- Department of Medical Microbiology & Immunology and Li Ka Shing Institute of Virology, The University of Alberta, Edmonton, Alberta, Canada
| | - Jason Kindrachuk
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
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Ogoina D, Dalhat MM, Denue BA, Okowa M, Chika-Igwenyi NM, Yusuff HA, Christian UC, Adekanmbi O, Ojimba AO, Aremu JT, Habila KL, Oiwoh SO, Tobin EA, Johnson SM, Olaitan A, Onyeaghala C, Gomerep SS, Alasia D, Onukak AE, Mmerem J, Unigwe U, Falodun O, Kwaghe V, Awang SK, Sunday M, Maduka CJ, Na'uzo AM, Owhin SO, Mohammed AA, Adeiza MA. Clinical characteristics and predictors of human mpox outcome during the 2022 outbreak in Nigeria: a cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:1418-1428. [PMID: 37625431 DOI: 10.1016/s1473-3099(23)00427-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Research from sub-Saharan Africa that contributes to our understanding of the 2022 mpox (formerly known as monkeypox) global outbreak is insufficient. Here, we describe the clinical presentation and predictors of severe disease among patients with mpox diagnosed between Feb 1, 2022, and Jan 30, 2023 in Nigeria. METHODS We did a cohort study among laboratory-confirmed and probable mpox cases seen in 22 mpox-treatment centres and outpatient clinics across Nigeria. All individuals with confirmed and probable mpox were eligible for inclusion. Exclusion criteria were individuals who could not be examined for clinical characterisation and those who had unknown mortality outcomes. Skin lesion swabs or crust samples were collected from each patient for mpox diagnosis by PCR. A structured questionnaire was used to document sociodemographic and clinical data, including HIV status, complications, and treatment outcomes from the time of diagnosis to discharge or death. Severe disease was defined as mpox associated with death or with a life-threatening complication. Two logistic regression models were used to identify clinical characteristics associated with severe disease and potential risk factors for severe disease. The primary outcome was the clinical characteristics of mpox and disease severity. FINDINGS We enrolled 160 people with mpox from 22 states in Nigeria, including 134 (84%) adults, 114 (71%) males, 46 (29%) females, and 25 (16%) people with HIV. Of the 160 patients, distinct febrile prodrome (n=94, 59%), rash count greater than 250 (90, 56%), concomitant varicella zoster virus infection (n=48, 30%), and hospital admission (n=70, 48%) were observed. Nine (6%) of the 160 patients died, including seven (78%) deaths attributable to sepsis. The clinical features independently associated with severe disease were a rash count greater than 10 000 (adjusted odds ratio 26·1, 95% CI 5·2-135·0, p<0·0001) and confluent or semi-confluent rash (6·7, 95% CI 1·9-23·9). Independent risk factors for severe disease were concomitant varicella zoster virus infection (3·6, 95% CI 1·1-11·5) and advanced HIV disease (35·9, 95% CI 4·1-252·9). INTERPRETATION During the 2022 global outbreak, mpox in Nigeria was more severe among those with advanced HIV disease and concomitant varicella zoster virus infection. Proactive screening, management of co-infections, the integration and strengthening of mpox and HIV surveillance, and preventive and treatment services should be prioritised in Nigeria and across Africa. FUNDING None.
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Affiliation(s)
- Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University Teaching Hospital, Niger Delta University, Yenagoa, Bayelsa, Nigeria.
| | | | | | - Mildred Okowa
- Department of Public Health, Ministry of Health, Asaba, Delta, Nigeria
| | - Nneka Marian Chika-Igwenyi
- Infectious Diseases Unit, Internal Medicine Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi , Nigeria
| | | | - Umenzekwe Chukwudi Christian
- Infectious Diseases and Tropical Medicine Unit, Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | - John Tunde Aremu
- Infectious Diseases Unit, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Kambai Lalus Habila
- Kaduna State Emergency Medical Services and Ambulance System, Kaduna, Kaduna, Nigeria
| | | | - Ekaete Alice Tobin
- Institute of Viral Haemorrhagic Fever and Emerging Pathogens, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
| | - Simon Mafuka Johnson
- Department of Internal Medicine, Federal University Teaching Hospital, Owerri, Imo, Nigeria
| | - Abimbola Olaitan
- Department of Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
| | - Chizaram Onyeaghala
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Simji Samuel Gomerep
- Infectious Diseases Unit, Jos University Teaching Hospital, and Medicine Department, University of Jos, Plateau, Nigeria
| | - Datonye Alasia
- Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers, Nigeria
| | - Asukwo E Onukak
- Department of Internal Medicine, University of Uyo, Uyo, Nigeria
| | - Juliet Mmerem
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Uche Unigwe
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Olanrewaju Falodun
- Department of Internal Medicine, National Hospital Abuja, Federal Capital Territory, Nigeria
| | - Vivian Kwaghe
- Department of Internal Medicine, University of Abuja Teaching Hospital, Gwagalada, Abuja, Federal Capital Territory, Nigeria
| | - Sati Klein Awang
- Infectious Diseases Unit, Department of Internal Medicine, Modibo Adama University Teaching Hospital, Yola, Adamawa, Nigeria
| | - Mogaji Sunday
- Department of Public Health, Federal Medical Centre, Ebute Metta, Lagos, Nigeria
| | | | - Aliyu Mamman Na'uzo
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Kebbi, Nigeria
| | - Sampson Omagbemi Owhin
- Department of Medicine, Clinical Haematology Unit, Federal Medical Center, Owo, Ondo, Nigeria
| | - Abdullahi Asara Mohammed
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
| | - Mukhtar Abdulmajid Adeiza
- Infectious Diseases and Tropical Medicine Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna, Nigeria
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Khan S, Irfan M, Hameed AR, Ullah A, Abideen SA, Ahmad S, Haq MU, El Bakri Y, Al-Harbi AI, Ali M, Haleem A. Vaccinomics to design a multi-epitope-based vaccine against monkeypox virus using surface-associated proteins. J Biomol Struct Dyn 2023; 41:10859-10868. [PMID: 36533379 DOI: 10.1080/07391102.2022.2158942] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
In 2022, the ongoing multi-country outbreak of monkeypox virus-now occurring outside Africa, too is a global health concern. Monkeypox is a zoonotic virus, which causes disease mainly in animals, and then it is transferred to humans. Recently, in the monkeypox epidemic, a large number of human cases emerged while the global health community worked to tackle the outbreak and save lives. Herein, a multi-epitope-based vaccine is designed against monkeypox virus using two surface-associated proteins: MPXVgp002 accession number > YP_010377003.1 and MPXVgp008 accession number > YP_010377007.1 proteins. These proteins were utilized for B- and T-cell epitopes prediction. The epitopes were further screened, and the screen filtered KCKDNEYRSR, RSCNTTHNR, and RTRRETGAS with the antigenicity scores of 0.5279, 0.5604, and 0.7628, respectively. Overall, the epitopes can induce immunity in 99.74% population of the world. Further, GPGPG linkers were used for joining the epitopes and EAAAK linker was used for adjuvant attachment. It has a three-dimensional structure modelled for retaining the structural stability. Three pairs of amino acid residues that were able to make disulfide bonds were chosen: Gly1-Ser82, Cys7-Tyr10, and Phe51-Ile55. Molecular docking of vaccine was done with toll-like receptors, viz., 2, 3, 4, and 8 immune cell receptors. The docking results revealed that the vaccine as potential molecule due to its better binding affinity with toll-like receptors 2, 3, 4 and 8. Top complex in docking in with each receptor was selected based on lowest energy scores- -888.7 kcal/mol (TLR-2), -976.3 kcal/mol (TLR-3), -801.9 kcal/mol (TLR-4), and -955.4 kcal/mol (TLR-4)-were subjected to simulation. The docked complexes were evaluated in 500 ns of MD simulation. Throughout the simulation time, no significant deviation occurred. This confirmed that the vaccine as potential vaccine candidate to interact with immune cell receptors. This interaction is important for the immune system activation. In conclusion, the proposed vaccine construct against monkeypox could induce an effective immune response and speed up the vaccine development process. However, the study is completely based on the computational approach, hence, the experimental validation is required.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Saifullah Khan
- Institute of Biotechnology and Microbiology, Bacha Khan University, Charsadda, Pakistan
| | - Muhammad Irfan
- Department of Oral Biology, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Alaa R Hameed
- Department of Medical Laboratory Techniques, School of Life Sciences, Dijlah University College, Baghdad, Iraq
| | - Asad Ullah
- Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
| | - Syed Ainul Abideen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
| | - Mahboob Ul Haq
- Department of Pharmacy, Abasyn University, Peshawar, Pakistan
| | - Youness El Bakri
- Department of Theoretical and Applied Chemistry, South Ural State University, Chelyabinsk, Russian Federation
| | - Alhanouf I Al-Harbi
- Department of Medical Laboratory, College of Applied Medical Sciences, Taibah University, Yanbu, Saudi Arabia
| | - Mahwish Ali
- Department of Biological Science, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Abdul Haleem
- Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan
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Krug C, Tarantola A, Chazelle E, Fougère E, Velter A, Guinard A, Souares Y, Mercier A, François C, Hamdad K, Tan-Lhernould L, Balestier A, Lahbib H, Etien N, Bernillon P, De Lauzun V, Durand J, Fayad M, De Valk H, Beck F, Che D, Coignard B, Lot F, Mailles A. Mpox outbreak in France: epidemiological characteristics and sexual behaviour of cases aged 15 years or older, 2022. Euro Surveill 2023; 28:2200923. [PMID: 38099346 PMCID: PMC10831416 DOI: 10.2807/1560-7917.es.2023.28.50.2200923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/21/2023] [Indexed: 12/17/2023] Open
Abstract
BackgroundLocally-acquired mpox cases were rarely reported outside Africa until May 2022, when locally-acquired-mpox cases occurred in various European countries.AimWe describe the mpox epidemic in France, including demographic and behavioural changes among a subset of cases, during its course.MethodsData were retrieved from the enhanced national surveillance system until 30 September 2022. Laboratory-confirmed cases tested positive for monkeypox virus or orthopoxviruses by PCR; non-laboratory-confirmed cases had clinical symptoms and an epidemiological link to a laboratory-confirmed case. A subset of ≥ 15-year-old male cases, notified until 1 August, was interviewed for epidemiological, clinical and sexual behaviour information. Association of symptom-onset month with quantitative outcomes was evaluated by t- or Wilcoxon tests, and with binary outcomes, by Pearson's chi-squared or Fisher exact tests.ResultsA total of 4,856 mpox cases were notified, mostly in Île-de-France region (62%; 3,025/4,855). Cases aged ≥ 15 years were predominantly male (97%; 4,668/4,812), with 37 years (range: 15-81) as mean age. Between May and July, among the subset interviewed, mpox cases increased in regions other than Île-de-France, and mean age rose from 35 (range: 21-64) to 38 years (range: 16-75; p = 0.007). Proportions of cases attending men-who-have-sex-with-men (MSM) meeting venues declined from 60% (55/91) to 46% (164/359; p = 0.012); median number of sexual partners decreased from four (interquartile range (IQR): 1-10) to two (IQR: 1-4; p < 0.001).ConclusionChanges in cases' characteristics during the epidemic, could reflect virus spread from people who were more to less behaviourally vulnerable to mpox between May and July, or MSM reducing numbers of sexual partners as recommended.
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Affiliation(s)
- Catarina Krug
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- ECDC Fellowship Program, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
- These first authors contributed equally to this article
| | - Arnaud Tarantola
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These first authors contributed equally to this article
| | - Emilie Chazelle
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These first authors contributed equally to this article
| | - Erica Fougère
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Annie Velter
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- Aix Marseille Univ, INSERM, IRD, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Marseille, France
| | - Anne Guinard
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Yvan Souares
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Anna Mercier
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Céline François
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Katia Hamdad
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | | | - Anita Balestier
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Hana Lahbib
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Nicolas Etien
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Pascale Bernillon
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Virginie De Lauzun
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Julien Durand
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Myriam Fayad
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Henriette De Valk
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - François Beck
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Inserm U1018, Université Paris-Saclay, Université Paris-Sud, Université Versailles Saint-Quentin (UVSQ), Villejuif, France
| | - Didier Che
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Bruno Coignard
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
| | - Florence Lot
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These authors contributed equally to this article
| | - Alexandra Mailles
- Santé publique France, The French Public Health Agency, Saint-Maurice, France
- These authors contributed equally to this article
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Van Dijck C, Hoff NA, Mbala-Kingebeni P, Low N, Cevik M, Rimoin AW, Kindrachuk J, Liesenborghs L. Emergence of mpox in the post-smallpox era-a narrative review on mpox epidemiology. Clin Microbiol Infect 2023; 29:1487-1492. [PMID: 37574113 DOI: 10.1016/j.cmi.2023.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/09/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The 2022 mpox outbreak drew global attention to this neglected pathogen. While most of the world was taken by surprise, some countries have seen this pathogen emerge and become endemic several decades prior to this epidemic. OBJECTIVES This narrative review provides an overview of mpox epidemiology since its discovery through the 2022 global outbreak. SOURCES We searched PubMed for relevant literature about mpox epidemiology and transmission through 28 February 2023. CONTENT The emergence of human mpox is intertwined with the eradication of smallpox and the cessation of the global smallpox vaccination campaign. The first human clade I and II monkeypox virus (MPXV) infections were reported as zoonoses in Central and West Africa, respectively, around 1970 with sporadic infections reported throughout the rest of the decade. Over the next five decades, Clade I MPXV was more common and caused outbreaks of increasing size and frequency, mainly in the Democratic Republic of the Congo. Clade II MPXV was rarely observed, until its re-emergence and ongoing transmission in Nigeria, since 2017. Both clades showed a shift from zoonotic to human-to-human transmission, with potential transmission through sexual contact being observed in Nigeria. In 2022, clade II MPXV caused a large human outbreak which to date has caused over 86,000 cases in 110 countries, with strong evidence of transmission during sexual contact. By February 2023, the global epidemic has waned in most countries, but endemic regions continue to suffer from mpox. IMPLICATIONS The changing epidemiology of mpox demonstrates how neglected zoonosis turned into a global health threat within a few decades. Thus, mpox pathophysiology and transmission dynamics need to be further investigated, and preventive and therapeutic interventions need to be evaluated. Outbreak response systems need to be strengthened and sustained in endemic regions to reduce the global threat of mpox.
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Affiliation(s)
- Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Placide Mbala-Kingebeni
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo; Université de Kinshasa, Democratic Republic of Congo
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Muge Cevik
- Division of Infection and Global Health, University of St Andrews, St Andrews, Scotland
| | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Jason Kindrachuk
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
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Ogoina D, Damon I, Nakoune E. Clinical review of human mpox. Clin Microbiol Infect 2023; 29:1493-1501. [PMID: 37704017 DOI: 10.1016/j.cmi.2023.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Historically, human mpox was predominantly a zoonotic disease occurring more frequently in rural children in Africa and characterized by a largely self-limiting febrile centrifugal monomorphic rash illness. However, the 2022 mpox global outbreak has shown that the disease is changing in many ways, including sustained human-to-human transmission via sexual contact, novel clinical presentations, and adverse associations between mpox and advanced HIV. OBJECTIVES The aim of this paper is to review the traditional and emerging clinical aspects of human mpox and provide updated information on the clinical course and outcome of the disease. SOURCES We searched electronic databases including PubMed and Google Scholar and identified relevant published literature on mpox. CONTENT The clinical presentation of human mpox is influenced by the route of infectious exposure, the strain and dose of the infecting virus, and the host immune system. Exposure to the virus can result in sub-clinical or clinical diseases of variable severity. Infections caused by clade I viral strains are more severe than class IIa and IIb strains, which are associated with a milder febrile rash illness, and with anogenital skin lesions in clade IIb infections. Most cases of mpox recover entirely within 2-4 weeks after onset of illness and a few develop skin-related sequelae. Overall, people with advanced HIV infection, children <5 years of age, and pregnant women may present with more severe disease and higher case fatalities. IMPLICATIONS The continued endemicity of the classical mpox in Africa, the emergence of a new clinical form of the disease during the 2022 global outbreak, and the adverse associations between advanced HIV and mpox have implications for the surveillance, clinical diagnosis, and management of human mpox.
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Affiliation(s)
- Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Bayelsa, Nigeria.
| | - Inger Damon
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Emmanuel Nakoune
- Department of Viral Haemorrhagic Fevers, Institut Pasteur de Bangui, Bangui, Central African Republic
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O'Shea JG, Bonacci RA, Cholli P, Kimball A, Brooks JT. HIV and mpox: a rapid review. AIDS 2023; 37:2105-2114. [PMID: 37877274 PMCID: PMC10962215 DOI: 10.1097/qad.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
In this review, we discuss the history and epidemiology of mpox, prevention strategies, clinical characteristics and management, severity of mpox among persons with advanced HIV, and areas for future research relevant to persons with HIV.
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Affiliation(s)
- Jesse G O'Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ghazy RM, Elrewany E, Gebreal A, ElMakhzangy R, Fadl N, Elbanna EH, Tolba MM, Hammad EM, Youssef N, Abosheaishaa H, Hamouda EEM, Mehana ZEE, Al Zomia AS, A Alnami RA, Salma EAS, Alqahtani AS, Alshehri AF, Hussein M. Systematic Review on the Efficacy, Effectiveness, Safety, and Immunogenicity of Monkeypox Vaccine. Vaccines (Basel) 2023; 11:1708. [PMID: 38006040 PMCID: PMC10674429 DOI: 10.3390/vaccines11111708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The variation in the reported vaccine safety and effectiveness could contribute to the high rates of vaccine hesitancy among the general population and healthcare workers in areas where monkeypox (mpox) is circulating. In this review, our objective was to evaluate the safety, immunogenicity, effectiveness, and efficacy of the mpox vaccines. METHODS An extensive search for articles across multiple databases was performed, including searching six databases (PubMed Central, PubMed Medline, Scopus, Web of Science, Cochrane, ProQuest), two pre-print databases (European PMC Preprint and MedRxiv), and Google Scholar. RESULTS A total of 4290 citations were retrieved from the included databases. Following the removal of duplicates and the initial screening of records, a total of 36 studies were included into the analysis. Additionally, we identified five more studies through manual searches, resulting in a total of 41 eligible articles for qualitative synthesis. The study findings revealed that mpox vaccines demonstrate the ability to generate adequate antibodies; however, their effectiveness may decrease over time, exhibiting varying safety profiles. Most of the included studies consistently reported substantial levels of effectiveness and efficacy against mpox. Interestingly, the number of vaccine doses administered was found to influence the degree of immunogenicity, subsequently impacting the overall effectiveness and efficacy of the vaccines. Furthermore, we found that smallpox vaccines exhibited a form of cross-protection against mpox. CONCLUSIONS Vaccines can be used to prevent mpox and effectively control its spread.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt; (R.M.G.); (E.E.)
| | - Ehab Elrewany
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt; (R.M.G.); (E.E.)
| | - Assem Gebreal
- Alexandria Faculty of Medicine, Alexandria University, Alexandria 21561, Egypt; (A.G.); (E.M.H.); (Z.E.E.M.)
| | - Rony ElMakhzangy
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt; (R.E.); (N.F.)
| | - Noha Fadl
- Family Health Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt; (R.E.); (N.F.)
| | - Eman Hassan Elbanna
- Health Administration and Behavioral Sciences Department, High Institute of Public Health, Alexandria University, Alexandria 21561, Egypt;
| | - Mahmoud M. Tolba
- Pharmaceutical Division, Ministry of Health and Population, Faiyum City 63723, Egypt;
| | - Elsayed Mohamed Hammad
- Alexandria Faculty of Medicine, Alexandria University, Alexandria 21561, Egypt; (A.G.); (E.M.H.); (Z.E.E.M.)
| | - Naglaa Youssef
- Medical-Surgical Nursing, Faculty of Nursing, Cairo University, Cairo 11562, Egypt;
| | | | | | - Zeyad Elsayed Eldeeb Mehana
- Alexandria Faculty of Medicine, Alexandria University, Alexandria 21561, Egypt; (A.G.); (E.M.H.); (Z.E.E.M.)
| | - Ahmed Saad Al Zomia
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (A.S.A.Z.); (R.A.A.A.); (E.A.S.S.); (A.S.A.); (A.F.A.)
| | - Raad Ahmed A Alnami
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (A.S.A.Z.); (R.A.A.A.); (E.A.S.S.); (A.S.A.); (A.F.A.)
| | - Emad Ali Saeed Salma
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (A.S.A.Z.); (R.A.A.A.); (E.A.S.S.); (A.S.A.); (A.F.A.)
| | - Abdulaziz Saleh Alqahtani
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (A.S.A.Z.); (R.A.A.A.); (E.A.S.S.); (A.S.A.); (A.F.A.)
| | - Abdulaziz Fayez Alshehri
- College of Medicine, King Khalid University, Abha 61421, Saudi Arabia; (A.S.A.Z.); (R.A.A.A.); (E.A.S.S.); (A.S.A.); (A.F.A.)
| | - Mai Hussein
- Clinical Research Administration, Alexandria Directorate of Health Affairs, Alexandria 21561, Egypt
- Egyptian Ministry of Health and Population, Cairo 11562, Egypt
- Master of Medical Science in Clinical Investigation, Harvard Medical School, Boston, MA 02115, USA
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Shah J, Saak TM, Desai AN, Gudis DA, Cheema HA, Abuelazm M, Preciado D, Zucker J, Overdevest JB. Otolaryngologic manifestations among MPOX patients: A systematic review and meta-analysis. Am J Otolaryngol 2023; 44:103991. [PMID: 37487464 DOI: 10.1016/j.amjoto.2023.103991] [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: 06/01/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE MPOX has numerous otolaryngologic presentations that have been recognized as clinically important, especially with the onset of the 2022 outbreak. However, how these features vary across region and outbreak have yet to be elucidated or supported by meta-analysis. The objective of this study is to identify the otolaryngologic manifestations of MPOX across previous and current outbreaks and among endemic and non-endemic regions. BASIC PROCEDURES Data sources of MEDLINE (PubMed), the Cochrane Library, Scopus, Embase, Web of Science, Google Scholar, and OpenGrey were searched through August 2022. All observational studies reporting data on laboratory-confirmed MPOX patients with otolaryngologic symptoms were included. Two authors independently performed the screening process while a third resolved disagreements. Data were extracted into a structured form by two authors independently. We performed a meta-analysis of the prevalence of otorhinolaryngologic symptoms using MetaXL software (version 5.3) under a random-effects model. MAIN FINDINGS 38 studies with 5952 patients were included. The four most prevalent manifestations were headache at 31 % (95 % CI [0.16-0.49], I 2 = 99 %), sore throat at 22 % (95 % CI [0.09-0.37], I 2 = 99 %), cough at 16 % (95 % CI [0.05-0.30], I 2 = 99 %), and cervical lymphadenopathy at 10 % (95 % CI [0.01-0.26], I 2 = 100 %). Otolaryngologic features were more prevalent in previous outbreaks as compared to the 2022 outbreak including 37 % prevalence of headache (95 % CI [0.11-0.66], I 2 = 100 %), 33 % prevalence of cough (95 % CI [0.21-0.47], I 2 = 98 %), 27 % prevalence of sore throat (95 % CI [0.07-0.53], I 2 = 99 %), 15 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.428], I 2 = 100 %), 13 % prevalence of oral ulcers (95 % CI [0.02-0.30], I 2 = 99 %), 6 % prevalence of oral exanthem (95 % CI [0.00-0.17], I 2 = 99 %), 5 % prevalence of dysphagia (95 % CI [0.00-0.18], I 2 = 99 %), and 5 % prevalence of tonsillar signs (95 % CI [0.00-0.13], I 2 = 99 %). Features that were more prevalent in endemic areas versus non-endemic areas include 27 % prevalence of cough (95 % CI [0.14-0.41], I 2 = 99 %), 15 % prevalence of oral ulcers (95 % CI [0.02-0.36], I 2 = 99 %), 6 % prevalence of tonsillar signs (95 % CI [0.00-0.18], I 2 = 99 %), and 19 % prevalence of cervical lymphadenopathy (95 % CI [0.00-0.48], I 2 = 100 %), while the only feature more prevalent in non-endemic areas was headache with a prevalence of 36 % (95 % CI [0.24-0.47], I 2 = 96 %). PRINCIPAL CONCLUSIONS In this systematic review and meta-analysis, four symptoms - headache, sore throat, cough, and cervical lymphadenopathy - were found to be the most prevalent otolaryngologic features of MPOX. Otolaryngologic manifestations of MPOX were more pronounced in prior outbreaks and in endemic areas as compared to the 2022 outbreak and non-endemic areas. These findings may aid MPOX recognition in an otolaryngology setting.
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Affiliation(s)
- Jaffer Shah
- Weill Cornell Medicine, NY, New York, United States of America
| | - Tiana M Saak
- Columbia University Vagelos College of Physicians and Surgeons, NY, New York, United States of America
| | - Angel N Desai
- Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, United States of America
| | - David A Gudis
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, NY, New York, United States of America
| | | | | | - Diego Preciado
- Department of Otolaryngology-Head & Neck Surgery, George Washington University, Children's National Hospital, Washington, DC, United States of America
| | - Jason Zucker
- Division of Infectious Disease, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, NY, New York, United States of America
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, NY, New York, United States of America.
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Adom-Konadu A, Bonyah E, Sackitey AL, Anokye M, Asamoah JKK. A fractional order Monkeypox model with protected travelers using the fixed point theorem and Newton polynomial interpolation. HEALTHCARE ANALYTICS (NEW YORK, N.Y.) 2023; 3:100191. [PMID: 37214737 PMCID: PMC10167817 DOI: 10.1016/j.health.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/18/2023] [Accepted: 04/29/2023] [Indexed: 05/24/2023]
Abstract
This study formulates a Monkeypox model with protected travelers. The fixed point theorem is used to obtain the existence and uniqueness of the solution with Ulam-Hyers stability for the analysis of the solution to the model. The Newton polynomial interpolation scheme is employed to solve an approximate solution of the fractional Monkeypox model. The numerical simulations and the graphical representations suggest that the fractional order affects the dynamics of the Monkeypox. The fractional order shows other underlining transmission trends of the Monkeypox disease. We conclude that the result obtained for each compartment conforms to reality as the fractional order approaches unity.
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Affiliation(s)
- Agnes Adom-Konadu
- Department of Mathematics, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Bonyah
- Department of Mathematics Education, Akenten Appiah-Menka University of Skills Training and Entrepreneurial Development, Kumasi, Ghana
- Department of Mathematics, Faculty of Science and Technology Universitas Airlangga, Surabaya 60115, Indonesia
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa
| | | | - Martin Anokye
- Department of Mathematics, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Kiddy K Asamoah
- Department of Mathematics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Weber DJ, Rutala WA, Sickbert-Bennett E. Emerging infectious diseases, focus on infection prevention, environmental survival and germicide susceptibility: SARS-CoV-2, Mpox, and Candida auris. Am J Infect Control 2023; 51:A22-A34. [PMID: 37890950 DOI: 10.1016/j.ajic.2023.02.006] [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: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND New and emerging infectious diseases continue to represent a public health threat. Emerging infectious disease threats include pathogens increasing in range (eg, Mpox), zoonotic microbes jumping species lines to cause sustained infections in humans via person-to-person transmission (SARS-CoV-2) and multidrug-resistant pathogens (eg, Candida auris). MATERIALS AND METHODS We searched the published English literature and reviewed the selected articles on SARS-CoV-2, Mpox, and Candida auris with a focus on environmental survival, contamination of the patient's hospital environment, susceptibility of the pathogen to antiseptics and disinfectants and infection prevention recommendations. RESULTS All three pathogens (ie, SARS-CoV-2, Mpox, and Candida auris) can survive on surfaces for minutes to hours and for Mpox and C auris for days. Currently available antiseptics (eg, 70%-90% alcohol hand hygiene products) are active against SARS-CoV-2, Mpox and C auris. The U.S Environmental Protection Agency provides separate lists of surface disinfectants active against SARS-CoV-2, Mpox, and C auris. DISCUSSION The risk of environment-to-patient transmission of SARS-CoV-2, Mpox and Candida auris, is very low, low-moderate and high, respectively. In the absence of appropriate patient isolation and use of personal protection equipment, the risk of patient-to-health care provider transmission of SARS-CoV-2, Mpox, and C auris is high, moderate and low, respectively. CONCLUSIONS Appropriate patient isolation, use of personal protective equipment by health care personnel, hand hygiene, and surface disinfection can protect patients and health care personnel from acquiring SARS-CoV-2, Mpox, and C auris from infected patients.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Emily Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Akpoigbe K, Yannick J, Culpepper-Morgan J. Near obstructing painful anorectal mass and facial rash in a man with monkeypox: A case report. World J Clin Cases 2023; 11:7418-7423. [PMID: 37969438 PMCID: PMC10643086 DOI: 10.12998/wjcc.v11.i30.7418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/21/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Monkeypox (MPX) is a zoonotic infection that is endemic in Western and Central Africa along the Congo River basin. It has a high case fatality rate especially in younger age groups. It belongs to the virus family orthopoxvirus like smallpox. It is transmitted from wild animals to humans but human to human transmission has been established. It is often a self-limited infection in endemic regions. Recently, attention has been given to MPX with the spread of infection to Europe and the United States of America (USA). There is currently sporadic infection of MPX in the USA especially amongst men who have sex with men (MSM). It is a serious life-threatening infection in human immunodeficiency virus/acquired immunodeficiency syndrome co-infected individuals especially those who are treatment naïve with severe immunosuppression. CASE SUMMARY We report a 38-year old man who presented with rectal pain, and anal, torso, and facial rash. Abdominal computed tomography scan showed a near obstructive rectal mass with peri-anal fistula. MPX was positive. He was started on tecovirimat (TPOXX) and HAART therapy. Additional treatment provided included vaccinia immunoglobulin following his clinical deterioration. CONCLUSION This case highlights a rare presentation of MPX with peri-anal fistula and near obstructive rectal mass, and the significance of MPX as a differential diagnosis in proctitis in MSM in addition to other sexually transmitted infection like gonorrhea and chlamydia.
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Affiliation(s)
- Kesiena Akpoigbe
- Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
| | - Jones Yannick
- Department of Internal Medicine, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
| | - Joan Culpepper-Morgan
- Department of Gastroenterology, Columbia University Medical Center Health + Hospitals/Harlem Affiliation, New York, NY 10037, United States
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Alqthami OA, Alaseeri RH, Alzahrani AA, Al-Otaibi AA, Alghoraibi YA, Abdel-Moneim AS, A Mohamed IA, S Alzahrani AH, Al-Ghamdi AN. Assessing the Anxiety and Knowledge about Monkeypox Virus: A Cross-Sectional Cohort Study. Cureus 2023; 15:e47806. [PMID: 37899897 PMCID: PMC10608683 DOI: 10.7759/cureus.47806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Recent cases of human monkeypox virus (MPXV) infections have raised global health concerns, as sporadic instances have occurred in various regions, prompting investigations into the potential for increased transmission. This underscores the importance of effective communication strategies in addressing the emerging challenges associated with this viral ailment. The study was conducted to understand public anxiety and knowledge related to MPXV infection, particularly in the context of emerging infectious diseases. Our aims included assessing anxiety levels and knowledge about monkeypox infection among the Saudi population, as well as their willingness to receive vaccinations if available. Methods A cross-sectional cohort study among the adult Saudi population was conducted. A questionnaire with four sections, including demographic data and disease knowledge, comprised optimized questions of the standard generalized anxiety disorder assessment (GAD-7) as well as questions related to acceptance of getting the vaccine if it could be afforded. Results Out of a total of 5298 participants, 927 (17.5%) showed different degrees of GAD-7 anxiety. Females showed a significantly higher rate of anxiety (487/2189, 22.2%) than males (440/3109, 14.2%). People aged 46 to 55 and >55 years old showed significantly higher rates of anxiety (30.7% and 27.2%). There is an overall decrease in knowledge and awareness about the MPXV. Interestingly, 59% of the participants admitted that they would get the MPXV vaccine if it were made available. There was a positive correlation between the anxiety level and the response of people toward the MPXV vaccine if it were available. Conclusion Our study underscores a significant level of anxiety and a notable lack of awareness concerning MPXV infection. Although a substantial number of participants expressed their willingness to receive an MPXV vaccine, our findings emphasize the pressing need for improved public education and awareness campaigns to alleviate anxiety levels and enhance understanding of this infectious disease. This effort is crucial for mitigating health concerns and facilitating well-informed decision-making among the Saudi population.
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Affiliation(s)
| | | | | | | | | | | | - Imad A A Mohamed
- Department of Microbiology, College of Medicine, Taif University, Taif, SAU
| | - Ali H S Alzahrani
- Department of Community Medicine, College of Medicine, Taif University, Taif, SAU
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Kowalski J, Cielniak I, Garbacz-Łagożna E, Cholewińska-Szymańska G, Parczewski M. Comparison of clinical course of Mpox among HIV-negative and HIV-positive patients: A 2022 cohort of hospitalized patients in Central Europe. J Med Virol 2023; 95:e29172. [PMID: 37861345 DOI: 10.1002/jmv.29172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
Mpox has become the most significant orthopoxviral infection among humans. Since May 2022, there has been a multicountry outbreak of mpox across six continents. Retrospective observational cohort study of 94 patients with probable or confirmed mpox of whom 86.2% were hospitalized in Hospital for Infectious Diseases in Warsaw, Poland between May 16 and October 30, 2022. Most patients were young (median age: 31, IQR: 25-43 years), predominantly (88.3%) Polish men who have sex with men exposed most commonly in Poland (82.7%), Spain (6.2%), or Germany (4.9%). The median observed mpox incubation period was 7 (IQR: 4-8) days with the median hospitalization time of 7 (range: 2-24, IQR: 5-11) days. History of sexually transmitted infections (STIs) was common in the group (previous syphilis or hepatitis C virus in 33.3% and 17.3%, respectively, 6.2% of early syphilis or gonorrhea). A significant proportion (n = 43, 45.7%) of mpox cases were people with human immunodeficiency virus (HIV), all except one were on stable and virologically effective (88.4% with HIV viral load <50 copies/mL) antiretroviral treatment. Chemsex was reported in 34.6% of hospitalized cases, more commonly among people with HIV (48.5% vs. 25.0%, p = 0.029). None of the mpox infected patients presented with advanced HIV infection. Despite the fact that 6.3% of cases presented with >50 skin lesions the course of the disease was self-limited with no severe cases or deaths. There were no significant clinical or laboratory differences or complication rates between patients with and without HIV coinfection. Epidemiological and clinical characteristics of mpox in Poland are similar to other countries, but there were no targeted, population oriented interventions or vaccination programs. Mpox diagnosis provided an opportunity to screen and diagnose other STIs. As Central European populations, including refugees from Ukraine, are largely unvaccinated against mpox access to preventive vaccinations and antiviral therapy should be maximized.
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Affiliation(s)
- Jacek Kowalski
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Iwona Cielniak
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Ewelina Garbacz-Łagożna
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Grażyna Cholewińska-Szymańska
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
- Hospital for Infectious Diseases, Warsaw, Poland
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University, Szczecin, Poland
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Garcia-Junior MA, Andrade BS, Guevara-Vega M, de Melo IS, Cunha TM, Jardim ACG, Sabino-Silva R. Oral Infection, Oral Pathology and Salivary Diagnostics of Mpox Disease: Relevance in Dentistry and OMICs Perspectives. Int J Mol Sci 2023; 24:14362. [PMID: 37762664 PMCID: PMC10531708 DOI: 10.3390/ijms241814362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
In this narrative review, we aim to point out the close relationship between mpox virus (MPXV) infection and the role of saliva as a diagnostic tool for mpox, considering the current molecular approach and in the perspective of OMICs application. The MPXV uses the host cell's rough endoplasmic reticulum, ribosomes, and cytoplasmic proteins to replicate its genome and synthesize virions for cellular exit. The presence of oral mucosa lesions associated with mpox infection is one of the first signs of infection; however, current diagnostic tools find it difficult to detect the virus before the rashes begin. MPXV transmission occurs through direct contact with an infected lesion and infected body fluids, including saliva, presenting a potential use of this fluid for diagnostic purposes. Currently available diagnostic tests for MPXV detection are performed either by real-time quantitative PCR (RT-qPCR) or ELISA, which presents several limitations since they are invasive tests. Despite current clinical trials with restricted sample size, MPXV DNA was detected in saliva with a sensitivity of 85%-100%. In this context, the application of transcriptomics, metabolomics, lipidomics, or proteomics analyses coupled with saliva can identify novel disease biomarkers. Thus, it is important to note that the identification and quantification of salivary DNA, RNA, lipid, protein, and metabolite can provide novel non-invasive biomarkers through the use of OMICs platforms aiding in the early detection and diagnosis of MPXV infection. Untargeted mass spectrometry (MS)-based proteomics reveals that some proteins also expressed in saliva were detected with greater expression differences in blood plasma when comparing mpox patients and healthy subjects, suggesting a promising alternative to be applied in screening or diagnostic platforms for mpox salivary diagnostics coupled to OMICs.
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Affiliation(s)
- Marcelo Augusto Garcia-Junior
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Laboratory of Nanobiotechnology – “Luiz Ricardo Goulart”, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlândia 38496-017, Brazil (M.G.-V.)
| | - Bruno Silva Andrade
- Laboratory of Bioinformatics and Computational Chemistry, Department of Biological Sciences, State University of Southwest of Bahia (UESB), Jequié 45083-900, Brazil
| | - Marco Guevara-Vega
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Laboratory of Nanobiotechnology – “Luiz Ricardo Goulart”, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlândia 38496-017, Brazil (M.G.-V.)
| | - Igor Santana de Melo
- Department of Histology and Embryology, Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceió 57072-260, Brazil
| | - Thúlio M. Cunha
- Department of Pulmonology, School of Medicine, Federal University of Uberlandia, Uberlândia 38496-017, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Antiviral Research, Department of Microbiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlândia 38496-017, Brazil
| | - Robinson Sabino-Silva
- Innovation Center in Salivary Diagnostics and Nanobiotechnology, Laboratory of Nanobiotechnology – “Luiz Ricardo Goulart”, Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia, Uberlândia 38496-017, Brazil (M.G.-V.)
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46
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Khan SA, Parajuli SB, Rauniyar VK. Neurological manifestations of an emerging zoonosis-Human monkeypox virus: A systematic review. Medicine (Baltimore) 2023; 102:e34664. [PMID: 37657009 PMCID: PMC10476717 DOI: 10.1097/md.0000000000034664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/19/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The last few decades have witnessed an appalling rise in several emerging and re-emerging viral and zoonotic outbreaks. Amongst those emerging zoonosis, one of the diseases which is gaining popularity these days and has been declared as public health emergency of international concern by the world health organization, is human monkeypox virus (HMPX). Proper understanding of the clinical spectrum of the disease is of paramount importance for early diagnosis and treatment. In this review, we aimed to study and quantify the neurological manifestations of HMPX virus infection. METHODS Any study, released prior to April 13, 2023, that reported neurological manifestations in patients infected by HMPX virus were reviewed systematically on PubMed, Scopus, Google Scholar, and Cochrane Library using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) statement. RESULTS Our systematic review included data from 22 eligible studies: 10 cohort studies, 3 cross sectional studies, one retrospective study, 5 case series, and 2 case reports. The most commonly reported neurological manifestations of HMPX were headache (48.84%), myalgia (27.50%), fatigue (17.73%), and photophobia (4.43%). Uncommonly, HMPX can also present with visual deficit (0.57%), seizure (0.34%), encephalitis (0.8%), dizziness (0.34%), encephalomyelitis (0.23%), coma (0.11%), and transverse myelitis (0.11%). DISCUSSIONS Monkeypox virus usually presents with self-limiting painful rash, lymphadenitis, and fever, complications like secondary skin infection, eye problems and pneumonia can be life threatening, carrying a case fatality rate of 1% to 10%. Neurological manifestations are not uncommon and can further add-on to morbidity and mortality.
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Affiliation(s)
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
| | - Vivek K. Rauniyar
- Department of Clinical Neurology, Birat Medical College Teaching Hospital, Morang, Nepal
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Suvvari TK, Sandeep M, Kumar J, Satapathy P, Chenchula S, Gandhi AP, Shamim MA, Schlagenhauf P, Rodríguez-Morales AJ, Sah R, Pradhan KB, Rustagi S, Hermis AH, Padhi BK. A meta-analysis and mapping of global mpox infection among children and adolescents. Rev Med Virol 2023; 33:e2472. [PMID: 37529964 DOI: 10.1002/rmv.2472] [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: 04/13/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023]
Abstract
Monkeypox (mpox) is a significant health concern affecting children and adolescents globally. This systematic review and meta-analysis aims to synthesise the available evidence on the proportion of children and adolescents affected by the mpox virus. A comprehensive search was conducted in seven electronic databases (PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane) to identify the original reports on mpox cases in children and adolescents till 15 January 2023. Descriptive reports on probable or laboratory-confirmed mpox in children and adolescents (0-17 years old) were considered eligible. Studies not providing separate data for the above age group and case-control studies were excluded. The primary outcome was pooled proportion of mpox cases among children and adolescents. Proportion meta-analysis and heterogeneity between studies were determined using a restricted maximum likelihood estimator, and a random-effects model was fitted to the data. Sensitivity analysis and subgroup analysis were also conducted. A drapery plot was also provided as a complementary figure to the forest plot. The protocol was prospectively registered with PROSPERO (CRD42023392475). A total of 440 studies were identified, of which 37 were included in the review and 25 in the meta-analysis (62,701 participants with 3306 children and adolescents). The pooled proportion of children and adolescents was 0.46 (95% CI: 0.30-0.63, I2 :100%). The proportion of children and adolescents was significantly lower (p < 0.001) in the ongoing pandemic 0.04 (95% CI: 0.00-0.32) than before 2022 0.62 (95% CI: 0.49-0.74). The meta-regression showed that the higher the study's sample size, the lower the proportion of children among the mpox cases. Both overall and subgroup heterogeneity were high. Adolescents and children below 5 years are commonly affected by the ongoing pandemic. In conclusion, the high proportion of children affected by the mpox virus highlights the need for increased research and targeted interventions to prevent and control the spread of the virus in this population.
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Affiliation(s)
- Tarun Kumar Suvvari
- Rangaraya Medical College, Kakinada, Andhra Pradesh, India
- Squad Medicine and Research (SMR), Visakhapatnam, Andhra Pradesh, India
| | - Mokanpally Sandeep
- School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Jogender Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Santenna Chenchula
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, India
| | - Aravind P Gandhi
- Department of Community Medicine, ESIC Medical College & Hospital, Hyderabad, India
| | | | - Patricia Schlagenhauf
- WHO Collaborating Centre for Travellers' Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zürich Centre for Travel Medicine, MilMedBiol Competence Centre, University of Zürich, Zürich, Switzerland
| | - Alfonso J Rodríguez-Morales
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Dr. D.Y Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | | | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | | | - Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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48
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Ahmed SK, El-Kader RG, Abdulqadir SO, Abdullah AJ, El-Shall NA, Chandran D, Dey A, Emran TB, Dhama K. Monkeypox clinical symptoms, pathology, and advances in management and treatment options: an update. Int J Surg 2023; 109:2837-2840. [PMID: 36906774 PMCID: PMC10498893 DOI: 10.1097/js9.0000000000000091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/18/2022] [Indexed: 03/13/2023]
Affiliation(s)
- Sirwan K. Ahmed
- Department of Nursing, University of Raparin
- Department of Emergency, Rania Pediatric and Maternity Teaching Hospital, Rania, Sulaimani
| | - Rabab G.A. El-Kader
- RAK College of Nursing, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
- Faculty of Nursing, Mansoura University, Mansoura
| | | | - Ardalan J. Abdullah
- Department of Emergency Nursing, Haibat Sultan Technical Istitute, Koye, Kurdistan Region, Iraq
| | - Nahed A. El-Shall
- Department of Poultry and Fish Diseases, Faculty of Veterinary Medicine, Alexandria University, Edfina, El-Beheira, Egypt
| | - Deepak Chandran
- Department of Veterinary Sciences and Animal Husbandry, Amrita School of Agricultural Sciences, Amrita Vishwa Vidyapeetham University, Coimbatore, Tamil Nadu, India
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, West Bengal
| | - Talha B. Emran
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Uttar Pradesh
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49
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Brüssow H. Pandemic potential of poxviruses: From an ancient killer causing smallpox to the surge of monkeypox. Microb Biotechnol 2023; 16:1723-1735. [PMID: 37335284 PMCID: PMC10443337 DOI: 10.1111/1751-7915.14294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023] Open
Abstract
Smallpox caused by the variola virus (VARV) was one of the greatest infectious killers of mankind. Historical records trace back smallpox for at least a millennium while phylogenetic analysis dated the ancestor of VARV circulating in the 20th century into the 19th century. The discrepancy was solved by the detection of distinct VARV sequences first in 17th-century mummies and then in human skeletons dated to the 7th century. The historical records noted marked variability in VARV virulence which scientists tentatively associated with gene losses occurring when broad-host poxviruses narrow their host range to a single host. VARV split from camel and gerbil poxviruses and had no animal reservoir, a prerequisite for its eradication led by WHO. The search for residual pockets of VARV led to the discovery of the monkeypox virus (MPXV); followed by the detection of endemic smallpox-like monkeypox (mpox) disease in Africa. Mpox is caused by less virulent clade 2 MPXV in West Africa and more virulent clade 1 MPXV in Central Africa. Exported clade 2 mpox cases associated with the pet animal trade were observed in 2003 in the USA. In 2022 a world-wide mpox epidemic infecting more than 80,000 people was noted, peaking in August 2022 although waning rapidly. The cases displayed particular epidemiological characteristics affecting nearly exclusively young men having sex with men (MSM). In contrast, mpox in Africa mostly affects children by non-sexual transmission routes possibly from uncharacterized animal reservoirs. While African children show a classical smallpox picture, MSM mpox cases show few mostly anogenital lesions, low-hospitalization rates and 140 fatal cases worldwide. MPXV strains from North America and Europe are closely related, derived from clade 2 African MPXV. Distinct transmission mechanisms are more likely causes for the epidemiological and clinical differences between endemic African cases and the 2022 epidemic cases than viral traits.
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Affiliation(s)
- Harald Brüssow
- Laboratory of Gene Technology, Department of BiosystemsKU LeuvenLeuvenBelgium
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50
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Rabaan AA, Alwashmi ASS, Mashraqi MM, Alshehri AA, Alawfi A, Alshengeti A, Najim MA, AlShehail BM, AlShahrani AJ, Garout M. Cheminformatics and machine learning approaches for repurposing anti-viral compounds against monkeypox virus thymidylate kinase. Mol Divers 2023:10.1007/s11030-023-10705-8. [PMID: 37531040 DOI: 10.1007/s11030-023-10705-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023]
Abstract
One of the emerging epidemic concerns is Monkeypox disease which is spreading globally. This disease is caused by the monkeypox virus (MPXV), with an increasing global incidence with an outbreak in 2022. One of the novel targets for monkeypox disease is thymidylate kinase, which is involved in pyrimidine metabolism. In this study, docking-based virtual screening and molecular dynamics techniques were employed in addition to the machine learning (ML) model to investigate the potential anti-viral natural small compounds to inhibit thymidylate kinase of MPXV. Several potential hits were identified through high-throughput virtual screening, and further top three candidates were selected, which ranked using the ML model. These three compounds were then examined under molecular dynamics simulation and MM/GBSA-binding free energy analysis. Among these, Chlorhexidine HCl showed high potential for binding to the thymidylate kinase with stable and consistent conformation with RMSD < 0.3 nm. The MM/GBSA analysis also showed the minimum binding free energy (ΔGTOTAL) of -62.41 kcal/mol for this compound. Overall, this study used structure-based drug design complemented by machine learning-guided ligand-based drug design to screen potential hit compounds from the anti-viral natural compound database.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, 31311, Dhahran, Saudi Arabia.
- College of Medicine, Alfaisal University, 11533, Riyadh, Saudi Arabia.
- Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan.
| | - Ameen S S Alwashmi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, 51452, Buraydah, Saudi Arabia
| | - Mutaib M Mashraqi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, 61441, Najran, Saudi Arabia
| | - Ahmad A Alshehri
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, 61441, Najran, Saudi Arabia
| | - Abdulsalam Alawfi
- Department of Pediatrics, College of Medicine, Taibah University, 41491, Medina, Saudi Arabia
| | - Amer Alshengeti
- Department of Pediatrics, College of Medicine, Taibah University, 41491, Medina, Saudi Arabia
- Department of Infection prevention and control, Prince Mohammad Bin Abdulaziz Hospital, National Guard Health Affairs, 41491, Medina, Saudi Arabia
| | - Mustafa A Najim
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Taibah University, 41411, Medina, Saudi Arabia
| | - Bashayer M AlShehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, 31441, Dammam, Saudi Arabia
| | - Abdullah J AlShahrani
- Department of Public Health, Health affairs, Ministry of Health, 62523, Asir, Saudi Arabia
| | - Mohammed Garout
- Department of Community Medicine and Health Care for Pilgrims, Faculty of Medicine, Umm Al-Qura University, 21955, Mecca, Saudi Arabia.
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