MonkeyPox
- 1. MONKEYPOX BY: ALI NAJAT JABBAR
- 2. Introduction ◦ Mpox formerly known as monkeypox is an infectious viral disease that can occur in humans and other animals ◦ The disease is caused by Orthopoxvirus monkeypox, formerly "monkeypox virus“ ◦ Mpox is endemic in Central and Western Africa, where several species of mammals are suspected to act as a natural reservoir of the virus. ◦ The subtypes of monkeypox virus are the Congo Basin (Central African) clade “clade I”, and the West African clade “clade II”.
- 3. Incubation Period ◦ Most mpox patients become symptomatic 4–11 days after infection. ◦ However, the incubation period can be as short as one day. ◦ The 2022–2023 outbreak revealed that incubation periods of up to 4 weeks are possible, with 5% of cases having incubation periods longer than the previously assumed 21 days.
- 4. Signs and symptoms ◦ Initial symptoms of mpox infection are fever, muscle pains, and sore throat, followed by an itchy or painful rash, headache, swollen lymph nodes, and fatigue. Not everyone will exhibit the complete range of symptoms. ◦ The rash comprises numerous small lesions, which may appear on the palms, soles, face, mouth, throat, genitals, or anus. They begin as small flat spots, before developing into small bumps, which then fill with fluid, eventually bursting and scabbing over, typically lasting around ten days. In rare cases, lesions may become necrotic, requiring debridement and taking longer to heal.
- 5. Signs and symptoms ◦ Some patients may manifest only a single sore from the disease, while others may have hundreds. ◦ An individual can be infected with Orthopoxvirus monkeypox without showing any symptoms. ◦ Symptoms typically last for two to four weeks but may persist longer in patients with weakened immune systems.
- 6. Differential diagnosis ◦ Clinical differential diagnosis must consider other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis and medication-associated allergies. Diagnosis ◦ can be verified by testing for the virus. PCR testing of samples from skin lesions is the preferred laboratory test.
- 7. Transmission ◦ The virus can be transmitted from animal to human from bites or scratches, or during activities such as hunting, skinning, or cooking infected animals. The virus enters the body through broken skin, or mucosal surfaces such as the mouth, respiratory tract, or genitals. ◦ Mpox can be transmitted from one person to another through contact with infectious lesion material or fluid on the skin, in the mouth or on the genitals; this includes touching, close contact, and during sex. It may also spread from prolonged close contact to an infected person via respiratory droplets. ◦ There is a lower risk of infection from fomites such as clothing or bedding
- 8. Vaccine ◦ As of August 2024 there are 4 vaccines in use to prevent mpox, although supplies are limited. All were originally developed to combat smallpox. 1. MVA-BN (marketed as Jynneos, Imvamune or Imvanex) manufactured by Bavarian Nordic. Licensed for use against mpox in Europe, United States and Canada. 2. LC16 from KMB Biologics (Japan) – licensed for use in Japan. 3. OrthopoxVac, licensed for use in Russia and manufactured by the State Research Center of Virology and Biotechnology VECTOR in Russia 4. ACAM2000, manufactured by Emergent Bio Solutions. Available (but not used) for use against mpox in the United States
- 9. Treatment ◦ Most cases of mpox present with mild symptoms and there is complete recovery within 2 to 4 weeks. ◦ There is no specific treatment for the disease, although antivirals such as tecovirimat have been approved for the treatment of severe mpox. ◦ Pain is common and may be severe; supportive care such as pain or fever control may be administered. Patients with mild disease should isolate at home, stay hydrated, eat well, and take steps to maintain their mental health. ◦ Patients who are at high risk from the disease include children, pregnant women, the elderly and those who are immunocompromised. For these patients, or those who have severe disease, hospital admission and careful monitoring of symptoms is recommended. Symptomatic treatment is recommended for complications such as proctitis and pruritis.
- 10. Complications ◦ Complications include secondary infections, pneumonia, sepsis, encephalitis, and loss of vision following corneal infection. Persons with weakened immune systems, whether due to medication, medical conditions, or HIV, are more likely to develop severe cases of the disease. If infection occurs during pregnancy, this may lead to stillbirth or other complications. Outcome ◦ Provided there are no complications, sequelae are rare; after healing, the scabs may leave pale marks before becoming darker scars.
- 11. Deaths ◦ Historically, the case fatality rate (CFR) of past outbreaks was estimated at between 1% and 10%, with clade I considered to be more severe than clade II. ◦ The case fatality rate of the 2022–2023 global outbreak caused by clade IIb has been very low, estimated at 0.16%, with the majority of deaths in individuals who were already immunocompromised. In contrast, as of April 2024 the outbreak of clade I in Democratic Republic of the Congo has a CFR of 4.9%. ◦ The huge difference between these estimates is attributed to: 1. differences in the virulence of clade I versus clade II. 2. under-reporting of mild or asymptomatic cases in the endemic areas of Africa, which generally have poor healthcare infrastructure. 3. evolution of the virus to cause milder disease in humans. 4. better general health, and better health care, in the populations most affected by the 2022– 2023 global outbreak.
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