Pharmacophore an International Research Journal
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Open Access | Published: 2022 - Issue 6

RESURGENCE OF MONKEYPOX: TRANSMISSION, CLINICAL FEATURES WITH EMPHASIS ON COUNTERMEASURES AND TREATMENT

Fathimath Ina Shareef1, Mariyam Luba Abdulla1, Aminath Efa Ibrahim1, Kannan Subbaram1*

 

  1. School of Medicine, The Maldives National University, Male’, Maldives.

ABSTRACT

Monkeypox virus is a DNA virus classified under the family Poxviridae and the genus Orthopoxvirus. Monkeypox is usually restricted to the Central and Western zones of the African continent. In 2022, many monkeypox cases were reported from non-endemic countries in North America, Europe, Asia, and Australasia. On 23rd July 2022, the Chief of the World Health Organization (WHO) declared the 2022 monkeypox epidemic as a public health emergency of international concern (PHEIC). It announced recommendations to curb the transmission of the disease around the globe. Monkeypox is a zoonotic disease, but human-to-human transmission can occur through direct or indirect contact with body fluids, skin lesions, and respiratory droplets. The recent outbreak was noticed commonly in homosexual men. A pregnant mother infected with monkeypox resulted in congenital monkeypox, resulting in miscarriage. Clinical manifestation of monkeypox lesions follows four stages: macules, papules, vesicles, and pustules, followed by crusts/scabs. There have been some cases of complications like septicemia, bronchopneumonia, ocular involvement, and central nervous system manifestations. There are effective antiviral agents like tecovirimat (TPOXX), cidofovir, and brincidofovir, which are all available for treatment. The vaccines which are administered for monkeypox are LC16, MVA-BN (JYNNEOS in the United States of America), and ACAM2000..

Keywords: Monkeypox, Outbreak, Modes of transmission, Clinical features, Vaccines, Antiviral drugs


Introduction

After the eradication of smallpox in West Africa and Central Africa, monkeypox (MPX) infections in humans were discovered in these regions in the early 1970s [1]. Prior to this, it was first found in captive monkeys in 1958. While there is no primary reservoir for the virus, it can be found in various types of rodents, shrews, and small mammals [2]. This initial case was found in Bukenda, the Democratic Republic of Congo, in a 9-month-old baby with a vesicular eruption. Between 1970-1971, cases were found in Ivory Coast, Liberia, Sierra Leone, as well as Nigeria.

The most cases have been reported from the Democratic Republic of Congo with 6000 cases, and Nigeria with 3000 cases. Since September 2017, there have been many monkeypox cases reported in Nigeria. Before this, Nigeria’s last confirmed case was in 1978 [3].

Outside of Africa, an outbreak occurred in May 2003 in the USA in the Midwest, where 72 cases were found in 2 months, 42 of which were confirmed cases. It was believed to have been passed on from prairie dogs that were with an animal distributor to whom several African rodents had been imported from Ghana. A ban on importing and breeding African rodents was then put into place, as genomic analysis showed identical sequences from a person, a prairie dog, and two rodents [4].

The monkeypox virus (MPXV) is classified under the genus Orthopoxvirus of the subfamily Chordopoxvirinae and the family Poxviridae. It is closely related to other Orthopoxviruses, mainly variola, which causes smallpox. Both diseases show similar symptoms and are difficult to distinguish through laboratory tests. The main structural elements in the monkeypox virus are the core, lateral bodies, outer membrane, and envelope [5]. The core contains viral DNA and proteins, and lateral bodies are on either side of the core (Figure 1). They are enclosed within an outer membrane with a ridged surface. The virions are enveloped by a lipoprotein membrane, which includes polypeptides such as orthodox hemagglutinin.