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Pourkarim F, Entezari‐Maleki T. Clinical considerations on monkeypox antiviral medications: An overview. Pharmacol Res Perspect 2024; 12:e01164. [PMID: 38149674 PMCID: PMC10751857 DOI: 10.1002/prp2.1164] [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: 06/10/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023] Open
Abstract
Monkeypox (mpox), a virus belonging to the orthopoxvirus family, can cause a zoonotic infectious disease with morbidity and cosmetic complications. Therefore, effective antiviral drugs with appropriate safety profiles are important for the treatment of patients with mpox. To date, there is no FDA-approved drug for the treatment of mpox. However, tecovirimat, brincidofovir, and cidofovir are the candidate therapies for the management of mpox. Given the safety concerns following the use of these medications, we aimed to review evidence on the clinical considerations of mpox antiviral medications that will be useful to guide clinicians in the treatment approach. Based on the current evidence, tecovirimat has favorable clinical efficacy, safety, and side effect profile and it can be considered as first-line treatment for mpox.
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Affiliation(s)
- Fariba Pourkarim
- Student Research Committee, Faculty of PharmacyTabriz University of Medical SciencesTabrizIran
- Department of Clinical Pharmacy, Faculty of PharmacyTabriz University of Medical SciencesTabrizIran
| | - Taher Entezari‐Maleki
- Department of Clinical Pharmacy, Faculty of PharmacyTabriz University of Medical SciencesTabrizIran
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
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Yan K, Tang LK, Xiao FF, Zhang P, Lu CM, Hu LY, Wang LS, Cheng GQ, Zhou WH. Monkeypox and the perinatal period: what does maternal-fetal medicine need to know? World J Pediatr 2023; 19:213-223. [PMID: 36378482 PMCID: PMC9665008 DOI: 10.1007/s12519-022-00630-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND After the global elimination of smallpox, monkeypox has become the most threatening orthopoxvirus to human health. Very few studies have been reported on pregnant women and newborns. In the case of monkeypox infection, the virus can cause serious adverse pregnancy events in women, which can lead to fetal or neonatal death. DATA SOURCES We made a comprehensive review after an extensive literature search in the PubMed/Medline database and websites concerning smallpox and monkeypox. RESULTS Two case reports reported a total of nine pregnant women, six of whom had fetal deaths. In the autopsy of a stillbirth, researchers found that the placenta was infected with monkeypox virus, but the mechanism of infection remains unclear. Smallpox vaccine should be administered to acutely exposed pregnant women and newborns. Several novel recombinant vaccinia immunogloblin (rVIG) and human-specific monoclonal antibodies are being developed for the prevention and treatment of monkeypox virus infection. After the fetus was delivered, the newborn should take a bath as soon as possible to remove the amniotic fluid and dirt from the body. The appropriate isolation protocol for the newborn should be selected according to the infection status of the mother. It is not known whether monkeypox virus is present in breast milk, and pasteurized breast milk can be given to newborns when breastfeeding is considered. CONCLUSION This review presents an overview of monkeypox in the perinatal period and guides the future research direction.
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Affiliation(s)
- Kai Yan
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Lu-Kun Tang
- Kunming Medical University, Kunming, 678400, China
- Department of Neonatology, Dehong People's Hospital, Kunming, 650000, China
| | - Fei-Fan Xiao
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Peng Zhang
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Chun-Mei Lu
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
- Department of Nursing, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Li-Yuan Hu
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Lai-Shuan Wang
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Guo-Qiang Cheng
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Wen-Hao Zhou
- Department of Neonatology, Children Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China.
- Key Laboratory of Neonatal Diseases of National Health Ministry, Shanghai, 201102, China.
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Javelle E, Ficko C, Savini H, Mura M, Ferraris O, Tournier JN, de Laval F. Monkeypox clinical disease: Literature review and a tool proposal for the monitoring of cases and contacts. Travel Med Infect Dis 2023; 52:102559. [PMID: 36809829 PMCID: PMC9946014 DOI: 10.1016/j.tmaid.2023.102559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/26/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
The human monkeypox disease has mainly been described in Western and Central Africa. Since May 2022, the monkeypox virus has been spreading worldwide in a new epidemiological pattern, where cases result from person-to-person transmission, and develop clinically milder or less typical illness than during previous outbreaks in endemic areas. The newly-emerging monkeypox disease needs to be described over the long term, to improve cases definitions, to implement prompt control measures against epidemics, and to provide supportive care. Hence, we first conducted a review of historical and recent outbreaks to define the full clinical spectrum of the monkeypox disease and its course known so far. Then, we built a self-administrated questionnaire collecting daily symptoms of the monkeypox infection to follow cases and their contacts, even remotely. This tool will assist in the management of cases, the surveillance of contacts, and the conduct of clinical studies.
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Affiliation(s)
- Emilie Javelle
- Institut de Recherche Biomédicale des Armées IRBA, Microbiology and Infectious Diseases Department, Marseille, France; Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; Laveran Military Teaching Hospital, Marseille, France.
| | - Cécile Ficko
- Bégin Military Teaching Hospital, Saint-Mandé, France; Ecole Du Val-de-Grâce, Paris, France
| | - Hélène Savini
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; Laveran Military Teaching Hospital, Marseille, France
| | - Marie Mura
- Institut de Recherche Biomédicale des Armées IRBA, Microbiology and Infectious Diseases Department, Brétigny-sur-Orge, France; Institut Pasteur, Innovation Lab: Vaccines, Paris, France
| | - Olivier Ferraris
- Institut de Recherche Biomédicale des Armées IRBA, Microbiology and Infectious Diseases Department, Brétigny-sur-Orge, France; CNR-LE National Reference Center-expert Laboratory Orthopoxvirus, IRBA, Brétigny-sur-Orge, France
| | - Jean Nicolas Tournier
- Ecole Du Val-de-Grâce, Paris, France; Institut de Recherche Biomédicale des Armées IRBA, Microbiology and Infectious Diseases Department, Brétigny-sur-Orge, France; Institut Pasteur, Innovation Lab: Vaccines, Paris, France
| | - Franck de Laval
- Service de Santé des Armées SSA, French Armed Forces Center for Epidemiology and Public Health CESPA, Marseille, France; Aix Marseille University, INSERM, IRD, Sciences Economiques Sociales de La Santé & Traitement de L'Information Médicale SESSTIM, Marseille, France
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Mpox and pregnancy: A neglected disease and its impact on perinatal health. Rev Clin Esp 2023; 223:32-39. [PMID: 36341988 PMCID: PMC9620439 DOI: 10.1016/j.rceng.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
Viral infections during pregnancy have been one of the leading causes associated with significant perinatal problems, such as congenital defects, fetal neurological syndromes, stillbirths, and adverse pregnancy outcomes. The mpox virus infection, caused by an Orthopoxvirus related to the human smallpox virus, was declared a global health emergency by the World Health Organization in July 2022 due to the large number of cases emerging outside the usual endemic area in Africa. There is little information on the impact of mpox virus infection during pregnancy, although the limited evidence available shows a high rate of fetal harm. This review addresses the problem of mpox virus infection in pregnant women and provides indications for its prevention, diagnosis, and treatment.
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Velázquez-Cervantes MA, Ulloa-Aguilar JM, León-Juárez M. [Mpox and pregnancy: A neglected disease and its impact on perinatal health]. Rev Clin Esp 2023; 223:32-39. [PMID: 36277866 PMCID: PMC9576805 DOI: 10.1016/j.rce.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
Viral infections during pregnancy have been one of the leading causes associated with significant perinatal problems, such as congenital defects, fetal neurological syndromes, stillbirths, and adverse pregnancy outcomes. The mpox virus infection, caused by an Orthopoxvirus related to the human smallpox virus, was declared a global health emergency by the World Health Organization in July 2022 due to the large number of cases emerging outside the usual endemic area in Africa. There is little information on the impact of mpox virus infection during pregnancy, although the limited evidence available shows a high rate of fetal harm. This review addresses the problem of mpox virus infection in pregnant women and provides indications for its prevention, diagnosis, and treatment.
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Affiliation(s)
- M A Velázquez-Cervantes
- Departamento de Inmuno-bioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
| | - J M Ulloa-Aguilar
- Departamento de Inmuno-bioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
| | - M León-Juárez
- Departamento de Inmuno-bioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, México
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Kumar R, Singh S, Singh SK. A Systematic Review of 5110 Cases of Monkeypox: What Has Changed Between 1970 and 2022? Cureus 2022; 14:e30841. [DOI: 10.7759/cureus.30841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
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Meaney-Delman DM, Galang RR, Petersen BW, Jamieson DJ. A Primer on Monkeypox Virus for Obstetrician-Gynecologists: Diagnosis, Prevention, and Treatment. Obstet Gynecol 2022; 140:391-397. [PMID: 36356237 PMCID: PMC9377490 DOI: 10.1097/aog.0000000000004909] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 01/05/2023]
Abstract
Since May 2022, more than 6,900 cases of monkeypox virus infection have been reported in 52 countries. The World Health Organization is planning to rename the virus and its clades to reduce stigma. As of July 5, 2022, 556 cases have been reported in 33 U.S. states and the District of Columbia. The initial cases were travel-associated; however, person-to-person transmission is now occurring domestically. Close, sustained skin-to-skin contact, including during sexual activity, appears to be the primary mode of transmission. The risk of widespread community transmission remains low; however, rapid identification of monkeypox virus infection and isolation of affected individuals is critical to prevent further transmission. Most but not all cases have occurred in males; some infections have started with anogenital lesions and can be mistaken for common sexually transmitted infections. To facilitate rapid, accurate diagnosis of monkeypox virus infection, obstetrician-gynecologists (ob-gyns) in the United States should ask about recent travel history and new ulcers or lesions and perform a thorough visual inspection of skin and mucosal sites (oral, genital, perianal area) in patients presenting with new rash. Obstetrician-gynecologists should become familiar with the appearance of monkeypox lesions and know whom to call to report a suspected case, how and when to test for monkeypox virus, and how to counsel patients. In the event of a suspected case, ob-gyns should follow infection-control guidelines to prevent transmission and make recommendations to prevent further community spread. This article outlines the diagnosis, prevention, and treatment of monkeypox virus infection, monkeypox virus infection during pregnancy, and implications for practicing ob-gyns in the United States.
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Affiliation(s)
- Dana M. Meaney-Delman
- Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Romeo R. Galang
- Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Brett W. Petersen
- Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Denise J. Jamieson
- Centers for Disease Control and Prevention, and the Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
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Meaney-Delman D, Jamieson DJ, Rasmussen SA. Addressing the effects of established and emerging infections during pregnancy. Birth Defects Res 2019; 109:307-310. [PMID: 28398682 PMCID: PMC7161857 DOI: 10.1002/bdr2.1018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/24/2022]
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Kisalu NK, Mokili JL. Toward Understanding the Outcomes of Monkeypox Infection in Human Pregnancy. J Infect Dis 2017; 216:795-797. [PMID: 29029238 PMCID: PMC6279131 DOI: 10.1093/infdis/jix342] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Neville K Kisalu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - John L Mokili
- Donald P. Shiley BioScience Center
- Viral Information Institute
- Biology Department, San Diego State University, California
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Abstract
It has been recognized for centuries that pregnant women have unique susceptibilities to many infectious diseases that predispose them to untoward outcomes compared with the general adult population. It is thought a combination of adaptive alterations in immunity to allow for the fetal allograft combined with changes in anatomy and physiology accompanying pregnancy underlie these susceptibilities. Emerging infectious diseases are defined as those whose incidence in humans has increased in the past two decades or threaten to increase in the near future. The past decade alone has witnessed many such outbreaks, each with its own unique implications for pregnant women and their unborn fetuses as well as lessons for the health care community regarding response and mitigation. Examples of such outbreaks include, but are not limited to, severe acute respiratory syndrome, the 2009 H1N1 pandemic influenza, Ebola virus, and, most recently, the Zika virus. Although each emerging pathogen has unique features requiring specific considerations, there are many underlying principles that are shared in the recognition, communication, and mitigation of such infectious outbreaks. Some of these key principles include disease-specific delineation of transmission dynamics, understanding of pathogen-specific effects on both mothers and fetuses, and advance planning and contemporaneous management that prioritize communication among public health experts, clinicians, and patients. The productive and effective working collaboration among the Centers for Disease Control and Prevention, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine has been a key partnership in the successful communication and management of such outbreaks for women's health care providers and patients alike. Going forward, the knowledge gained over the past decade will undoubtedly continue to inform future responses and will serve to optimize the education and care given to pregnant women in the face of current and future emerging infectious disease outbreaks.
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Affiliation(s)
| | | | - Janet D. Cragan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joanne Cono
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Affiliation(s)
- Martha Anker
- University of Massachusetts, Amherst, Massachusetts, USA
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Cono J, Cragan JD, Jamieson DJ, Rasmussen SA. Prophylaxis and treatment of pregnant women for emerging infections and bioterrorism emergencies. Emerg Infect Dis 2006; 12:1631-7. [PMID: 17283610 PMCID: PMC3372351 DOI: 10.3201/eid1211.060618] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Emerging infectious disease outbreaks and bioterrorism attacks warrant urgent public health and medical responses. Response plans for these events may include use of medications and vaccines for which the effects on pregnant women and fetuses are unknown. Healthcare providers must be able to discuss the benefits and risks of these interventions with their pregnant patients. Recent experiences with outbreaks of severe acute respiratory syndrome, monkeypox, and anthrax, as well as response planning for bioterrorism and pandemic influenza, illustrate the challenges of making recommendations about treatment and prophylaxis for pregnant women. Understanding the physiology of pregnancy, the factors that influence the teratogenic potential of medications and vaccines, and the infection control measures that may stop an outbreak will aid planners in making recommendations for care of pregnant women during large-scale infectious disease emergencies.
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Affiliation(s)
- Joanne Cono
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Jamieson DJ, Jernigan DB, Ellis JE, Treadwell TA. Emerging infections and pregnancy: West Nile virus, monkeypox, severe acute respiratory syndrome, and bioterrorism. Clin Perinatol 2005; 32:765-76. [PMID: 16085032 PMCID: PMC7119112 DOI: 10.1016/j.clp.2005.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As new infectious diseases, such as West Nile virus, monkeypox, and severe acute respiratory syndrome (SARS) are recognized in the United States, there are critical questions about how these infectious diseases will affect pregnant women and their infants. In addition, the implications of bioterrorist attacks for exposed pregnant women need to be considered. In this article, the authors address the following questions for a number of infectious disease threats: (1) does pregnancy affect the clinical course of these novel infectious diseases?, (2) what are the implications for prophylaxis and treatment of exposed or infected pregnant women?, and (3) are these novel infectious diseases transmitted during pregnancy, labor and delivery, or breastfeeding?
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Affiliation(s)
- Denise J Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
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