Mpox: Epidemiological, immunopathogenic aspects and pre- and post-infection management

Main Article Content

Yago Soares Fonseca
https://orcid.org/0000-0001-6012-7298
Calila Oliveira Alves
Gabriela Garcia de Carvalho Laguna
https://orcid.org/0000-0001-7396-647X
Beatriz Rihs Matos Tavares
https://orcid.org/0000-0002-4373-1159
Lohana Guimarães Souza
Grasiely Faccin Borges
https://orcid.org/0000-0002-5771-6259
Luiz Henrique Santos Guimarães

Abstract

Mpox or Variola M is a zoonosis caused by viruses of the genus Orthopoxvirus, which also cause common smallpox. It is a disease considered rare and self-limiting, being endemic in African countries. However, in 2022, it gained prominence due to the global outbreak that began when the world was still recovering from the COVID-19 pandemic. Thus, as it is an emerging disease, this review aims to point out general aspects of what is known so far about Mpox, from its immunopathogenesis to current forms of prevention and post-infection care.



Article Details

How to Cite
1.
Fonseca YS, Alves CO, Laguna GG de C, Tavares BRM, Souza LG, Borges GF, et al. Mpox: Epidemiological, immunopathogenic aspects and pre- and post-infection management. HSJ [Internet]. 2023 Jun. 19 [cited 2024 Nov. 2];13(2):3-10. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/1374
Section
NARRATIVE REVIEW
Author Biographies

Yago Soares Fonseca, Federal University of Southern Bahia

Interdisciplinary Bachelor in Health, majoring in Medicine. Member of the Nucleus of Studies and Research in Health/UFSB.

Calila Oliveira Alves, Federal University of Southern Bahia

Interdisciplinary Bachelor in Health, undergraduate student in Medicine. Member of the Nucleus of Studies and Research in Health/UFSB.

Gabriela Garcia de Carvalho Laguna, Federal University of Bahia

Graduate student in Medicine. Member of the Nucleus of Studies and Research in Health/UFSB.

Beatriz Rihs Matos Tavares, Federal University of Southern Bahia

Interdisciplinary Bachelor in Health, majoring in Medicine. Member of the Nucleus of Studies and Research in Health/UFSB.

Lohana Guimarães Souza, Federal University of Southern Bahia

Interdisciplinary Bachelor in Health, undergraduate student in Medicine. Member of the Nucleus of Studies and Research in Health/UFSB.

Grasiely Faccin Borges, Federal University of Southern Bahia

PhD in Sport Sciences and Physical Education from the Faculty of Sport Sciences and Physical Education at the University of Coimbra/Portugal, associate professor at the Federal University of Southern Bahia. Coordinator of the Center for Studies and Research in Health.

Luiz Henrique Santos Guimarães, Federal University of Reconcavo da Bahia

PhD in Health Sciences from the Federal University of Bahia with a sandwich period at the University of Basel - Switzerland. Associate Professor at the Federal University of Recôncavo da Bahia. Specialist in the study of cutaneous leishmaniasis.

References

Ulaeto D, Agafonov A, Burchfield J, Carter L, Happi C, Jakob R, et al. New nomenclature for mpox (monkeypox) and monkeypox virus clades. Lancet Infect Dis .2023;23(3):273-5. https://doi.org/10.1016/S1473-3099(23)00055-5 DOI: https://doi.org/10.1016/S1473-3099(23)00055-5

World Health Organization. 2022-23 Mpox (Monkeypox) Outbreak: Global Trends [Internet]. 23 May 2023 [cited 24 May 2023]. Available from: https://bit.ly/3q4Z1EC

Kozlov M. The monkeypox virus is mutating. Are scientists worried? Nature. 5 Oct 2022 [cited 24 May 2023]. https://doi.org/10.1038/d41586-022-03171-z DOI: https://doi.org/10.1038/d41586-022-03171-z

Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis. Lancet Infect Dis. 2004;4(1):15-25. https://doi.org/10.1016/S1473-3099(03)00856-9. Erratum in: Lancet Infect Dis. 2004;4(4):251. DOI: https://doi.org/10.1016/S1473-3099(03)00856-9

Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, et al. Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Infect Dis Clin North Am. 2019;33(4):1027-43. https://doi.org/10.1016/j.idc.2019.03.001 DOI: https://doi.org/10.1016/j.idc.2019.03.001

Kozlov M. Monkeypox goes global: why scientists are on alert. Nature. 2022;606(7912):15-6. https://doi.org/10.1038/d41586-022-01421-8 DOI: https://doi.org/10.1038/d41586-022-01421-8

Schneider KA, Eichner M. Does it matter who is spreading monkeypox? Lancet Infect Dis. 2022;22(9):1266-7.https://doi.org/10.1016/S1473-3099(22)00431-5 DOI: https://doi.org/10.1016/S1473-3099(22)00431-5

Breman JG, Kalisa-Ruti, Steniowski MV, Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970-79. Bull World Health Organ. 1980;58(2):165-82. PMID: 6249508

Kabuga AI, El Zowalaty ME. A review of the monkeypox virus and a recent outbreak of skin rash disease in Nigeria. J Med Virol. 2019;91(4):533-540. https://doi.org/10.1002/jmv.25348 DOI: https://doi.org/10.1002/jmv.25348

Alakunle E, Moens U, Nchinda G, Okeke MI. Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution. Viruses. 2020;12(11):1257. https://doi.org/10.3390/v12111257 DOI: https://doi.org/10.3390/v12111257

Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141. https://doi.org/10.1371/journal.pntd.0010141 DOI: https://doi.org/10.1371/journal.pntd.0010141

Guarner J, Del Rio C, Malani PN. Monkeypox in 2022-What Clinicians Need to Know. JAMA. 2022;328(2):139-40. https://doi.org/10.1001/jama.2022.10802 DOI: https://doi.org/10.1001/jama.2022.10802

World Health Organization. Multi-country monkeypox outbreak: situation update [Internet].22 Jun 2022 [cited 24 May 2023]. Available from: https://bit.ly/421B4eE

Riopelle JC, Munster VJ, Port JR. Atypical and Unique Transmission of Monkeypox Virus during the 2022 Outbreak: An Overview of the Current State of Knowledge. Viruses. 2022;14(9):2012. https://doi.org/10.3390/v14092012 DOI: https://doi.org/10.3390/v14092012

Brasil. Ministério da Saúde. Atualização dos Casos [Internet]. 25 Ago 2022 [cited 24 May 2023]. Available from: https://bit.ly/432FxyZ

Pascom ARP, Souza IN de, Krummenauer A, Duarte MMS, Sallas J, Rohlfs DB, et al. Características epidemiológicas e clínicas dos casos de monkeypox no Brasil em 2022: estudo transversal. Epidemiol Serv Saúde. 2022;31:e2022851. https://doi.org/10.1590/s2237-96222022000300036 DOI: https://doi.org/10.1590/s2237-96222022000300036

Brasil. Ministério da Saúde. Conheça o cenário epidemiológico da varíola dos macacos no mundo e o perfil dos casos [Internet]. 22 Ago 2022 [updated 03 Nov 2022; cited 24 May 2023]. Available from: https://bit.ly/4310Ctr

Patrono LV, Pléh K, Samuni L, Ulrich M, Röthemeier C, Sachse A, et al. Monkeypox virus emergence in wild chimpanzees reveals distinct clinical outcomes and viral diversity. Nat Microbiol. 2020;5(7):955-965. https://doi.org/10.1038/s41564-020-0706-0 DOI: https://doi.org/10.1038/s41564-020-0706-0

Lansiaux E, Jain N, Laivacuma S, Reinis A. The virology of human monkeypox virus (hMPXV): A brief overview. Virus Res. 2022;322:198932. https://doi.org/10.1016/j.virusres.2022.198932 DOI: https://doi.org/10.1016/j.virusres.2022.198932

Bengali Z, Satheshkumar PS, Moss B. Orthopoxvirus species and strain differences in cell entry. Virology. 2012;433(2):506-12. https://doi.org/10.1016/j.virol.2012.08.044 DOI: https://doi.org/10.1016/j.virol.2012.08.044

Kumar N, Acharya A, Gendelman HE, Byrareddy SN. The 2022 outbreak and the pathobiology of the monkeypox virus. J Autoimmun. 2022;131:102855. https://doi.org/10.1016/j.jaut.2022.102855 DOI: https://doi.org/10.1016/j.jaut.2022.102855

Babkin IV, Babkina IN, Tikunova NV. An Update of Orthopoxvirus Molecular Evolution. Viruses. 2022;14:388. https://doi.org/10.3390/v14020388 DOI: https://doi.org/10.3390/v14020388

Gao L, Shi Q, Dong X, Wang M, Liu Z, Li Z. Mpox, Caused by the MPXV of the Clade IIb Lineage, Goes Global. Trop Med Infect Dis. 2023;8(2):76. https://doi.org/10.3390/tropicalmed8020076 DOI: https://doi.org/10.3390/tropicalmed8020076

Happi C, Adetifa I, Mbala P, Njouom R, Nakoune E, Happi A, et al. Urgent need for a non-discriminatory and non-stigmatizing nomenclature for monkeypox virus. PLOS Biol. 2022;20(8):e3001769. https://doi.org/10.1371/journal.pbio.3001769 DOI: https://doi.org/10.1371/journal.pbio.3001769

Likos AM, Sammons SA, Olson VA, Frace AM, Li Y, Olsen-Rasmussen M, et al. A tale of two clades: monkeypox viruses. J Gen Virol. 2005;86 (Pt 10):2661-72. https://doi.org/10.1099/vir.0.81215-0 DOI: https://doi.org/10.1099/vir.0.81215-0

Hughes AL, Irausquin S, Friedman R. The evolutionary biology of poxviruses. Infect Genet Evol. 2010;10(1):50-9. https://doi.org/10.1016/j.meegid.2009.10.001 DOI: https://doi.org/10.1016/j.meegid.2009.10.001

Schnierle BS. Monkeypox Goes North: Ongoing Worldwide Monkeypox Infections in Humans. Viruses. 2022;14(9):1874. https://doi.org/10.3390/v14091874 DOI: https://doi.org/10.3390/v14091874

Moss B. Membrane fusion during poxvirus entry. Semin Cell Dev Biol. 2016;60:89-96. https://doi.org/10.1016/j.semcdb.2016.07.015 DOI: https://doi.org/10.1016/j.semcdb.2016.07.015

Kieser Q, Noyce RS, Shenouda M, Lin YJ, Evans DH. Cytoplasmic factories, virus assembly, and DNA replication kinetics collectively constrain the formation of poxvirus recombinants. PLoS One. 2020;15(1):e0228028. https://doi.org/10.1371/journal.pone.0228028 DOI: https://doi.org/10.1371/journal.pone.0228028

Stanford MM, McFadden G, Karupiah G, Chaudhri G. Immunopathogenesis of poxvirus infections: forecasting the impending storm. Immunol Cell Biol. 2007;85(2):93-102. https://doi.org/10.1038/sj.icb.7100033 DOI: https://doi.org/10.1038/sj.icb.7100033

Takemura M. Poxviruses and the origin of the eukaryotic nucleus. J Mol Evol. 2001;52(5):419-25. https://doi.org/10.1007/s002390010171 DOI: https://doi.org/10.1007/s002390010171

Haller SL. Host range functions of poxvirus proteins are mediated by species- specific inhibition of the antiviral protein kinase PKR 2016 [PhD Thesis]. Kansas University: Manhattan, KS; 2016 [cited 24 May 2023]. Available from: http://hdl.handle.net/2097/32871

Smith GL, Murphy BJ, Law M. Vaccinia virus motility. Annu Rev Microbiol. 2003;57:323-42. https://doi.org/10.1146/annurev.micro.57.030502.091037 DOI: https://doi.org/10.1146/annurev.micro.57.030502.091037

Okyay R, Bayrak E, Kaya E, Sahin A, Kocyigit B, Tasdogan A, et al. Another Epidemic in the Shadow of Covid 19 Pandemic: A Review of Monkeypox. EJMO. 2022; 6(2):95-99. https://doi.org/10.14744/ejmo.2022.2022 DOI: https://doi.org/10.14744/ejmo.2022.2022

Hudson PN, Self J, Weiss S, Braden Z, Xiao Y, Girgis NM, Emerson G, Hughes C, Sammons SA, Isaacs SN, Damon IK, Olson VA. Elucidating the role of the complement control protein in monkeypox pathogenicity. PLoS One. 2012;7(4):e35086. https://doi.org/10.1371/journal.pone.0035086 DOI: https://doi.org/10.1371/journal.pone.0035086

Matias WR, Koshy JM, Nagami EH, Kovac V, Moeng LR, Shenoy ES, et al. Tecovirimat for the Treatment of Human Monkeypox: An Initial Series From Massachusetts, United States. Open Forum Infect Dis. 2022;9(8):ofac377. https://doi.org/10.1093/ofid/ofac377 DOI: https://doi.org/10.1093/ofid/ofac377

Pauli G, Blümel J, Burger R, Drosten C, Gröner A, Gürtler L, et al. Orthopox Viruses: Infections in Humans. Transfus Med Hemother. 2010;37(6):351-364. https://doi.org/10.1159/000322101 DOI: https://doi.org/10.1159/000322101

Hammarlund E, Lewis MW, Carter SV, Amanna I, Hansen SG, Strelow LI, et al. Multiple diagnostic techniques identify previously vaccinated individuals with protective immunity against monkeypox. Nat Med. 2005;11(9):1005-11. https://doi.org/10.1038/nm1273 DOI: https://doi.org/10.1038/nm1273

World Health Organization. Surveillance, case investigation and contact tracing for mpox (monkeypox): interim guidance, 22 December [Internet]. 22 Dec 2022 [cited 24 May 2023]. Available from: https://bit.ly/3OAT10g

García V del R, Palacios JG, Morcillo AM, Duran-Pla E, Rodríguez BS, Lorusso N. Monkeypox outbreak in a piercing and tattoo establishment in Spain. Lancet Infect Dis. 2022;22(11):1526-8. https://doi.org/10.1016/S1473-3099(22)00652-1 DOI: https://doi.org/10.1016/S1473-3099(22)00652-1

Brasil P, Martins EB, Calvet GA, Werneck GL. What do we need to know about the monkeypox virus infection in humans? Cad Saúde Pública. 2022;38(9):e00129222. https://doi.org/10.1590/0102-311xen129222 DOI: https://doi.org/10.1590/0102-311xen129222

Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al; SHARE-net Clinical Group. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387(8):679-691. https://doi.org/10.1056/NEJMoa2207323 DOI: https://doi.org/10.1056/NEJMoa2207323

Lima EL de, Barra LAC, Borges LMS, Medeiros LA, Tomishige MYS, Santos L de SLA, et al. First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections. Rev Inst Med Trop Sao Paulo. 2022;64:e54. https://doi.org/10.1590/S1678-9946202264054 DOI: https://doi.org/10.1590/S1678-9946202264054

Menezes YR, Miranda AB. Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: first death report in Brazil. Rev Soc Bras Med Trop. 2022;55:e0392. https://doi.org/10.1590/0037-8682-0392-2022 DOI: https://doi.org/10.1590/0037-8682-0392-2022

McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014;58(2):260-7. https://doi.org/10.1093/cid/cit703. Epub 2013 Oct 24. Erratum in: Clin Infect Dis. 2014 Jun;58(12):1792. DOI: https://doi.org/10.1093/cid/ciu196

World Health Organization. Monkeypox: epidemiology, preparedness and response for African outbreak contexts [Internet]. [cited 24 May 2023]. Available from: https://openwho.org/courses/monkeypox-intermediate

Faye O, Pratt CB, Faye M, Fall G, Chitty JA, Diagne MM, et al. Genomic characterisation of human monkeypox virus in Nigeria. Lancet Infect Dis. 2018;18(3):246. https://doi.org/10.1016/S1473-3099(18)30043-4 DOI: https://doi.org/10.1016/S1473-3099(18)30043-4

Duque MP, Ribeiro S, Martins JV, Casaca P, Leite PP, Tavares M, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill. 2022;27(22):2200424 https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200424 DOI: https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200424

Jezek Z, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987;156(2):293-8. https://doi.org/10.1093/infdis/156.2.293 DOI: https://doi.org/10.1093/infdis/156.2.293

Heymann DL, Szczeniowski M, Esteves K. Re-emergence of monkeypox in Africa: a review of the past six years. Br Med Bull. 1998;54(3):693-702. https://doi.org/10.1093/oxfordjournals.bmb.a011720 DOI: https://doi.org/10.1093/oxfordjournals.bmb.a011720

Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and Treatment of Monkeypox. Drugs. 2022;82(9):957-963. https://doi.org/10.1007/s40265-022-01742-y DOI: https://doi.org/10.1007/s40265-022-01742-y

Harris E. Global Monkeypox Outbreaks Spur Drug Research for the Neglected Disease. JAMA. 2022;328(3):231-3. https://doi.org/10.1001/jama.2022.11224 DOI: https://doi.org/10.1001/jama.2022.11224

Centers for Disease Control and Prevention-CDC. 2022. Outbreak Cases and Data [Internet] [updated 17 May 2023; cited 24 May 2023]. Available from: https://bit.ly/3MSFsYU

Rao AK, Petersen BW, Whitehill F, Razeq JH, Isaacs SN, Merchlinsky MJ, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(22):734-742. https://doi.org/10.15585/mmwr.mm7122e1 DOI: https://doi.org/10.15585/mmwr.mm7122e1

Centers for Disease Control and Prevention-CDC. Information for Healthcare Providers: Tecovirimat (TPOXX) for Treatment of Mpox [Internet].[updated 28 Feb 2023; cited 24 May 2023]. Available from: https://bit.ly/3MxRrcT

US Food and Drug Administration. FDA. Office of the Commissioner. FDA approves first live, non-replicating vaccine to prevent smallpox and monkeypox [Internet]. 24 Sep 2019 [updated 24 Sep 2019; cited 24 May 2023]. Available from: https://bit.ly/3ol9VFL

Kupferschmidt K. As monkeypox threat grows, scientists debate best vaccine strategy [Internet]. Science. 7 Jun 2022 [cited 24 May 2023]. https://doi.org/10.1126/science.add3773 DOI: https://doi.org/10.1126/science.add3773

Agência Nacional de Vigilância Sanitária. Anvisa aprova liberação de vacina para monkeypox para uso pelo Ministério da Saúde [Internet]. 26 Aug 2022 [cited 24 May 2023]. Available from: https://bit.ly/4336lim

US Food and Drug Administration. FDA. [Internet]. [cited 24 May 2023]. Available from: https://www.fda.gov/media/75792/download

Sherwat A, Brooks JT, Birnkrant D, Kim P. Tecovirimat and the Treatment of Monkeypox - Past, Present, and Future Considerations. N Engl J Med. 2022;387(7):579-81. https://doi.org/10.1056/NEJMp2210125 DOI: https://doi.org/10.1056/NEJMp2210125

Berhanu A, Prigge JT, Silvera PM, Honeychurch KM, Hruby DE, Grosenbach DW. Treatment with the smallpox antiviral tecovirimat (ST-246) alone or in combination with ACAM2000 vaccination is effective as a postsymptomatic therapy for monkeypox virus infection. Antimicrob Agents Chemother. 2015;59(7):4296-300. https://doi.org/10.1128/AAC.00208-15 DOI: https://doi.org/10.1128/AAC.00208-15

Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, et al; NHS England High Consequence Infectious Diseases (Airborne) Network. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022;22(8):1153-1162. https://doi.org/10.1016/S1473-3099(22)00228-6 DOI: https://doi.org/10.1016/S1473-3099(22)00228-6

Centers for Disease Control and Prevention. Monitoring and Risk Assessment for Persons Exposed in the Community [Internet] [updated 25 Nov 2022; cited 24 May 2023]. Available from: https://bit.ly/3Mudl0Y

Centers for Disease Control and Prevention. Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak [Internet] [updated 22 Mar 2023; cited 24 May 2023]. Available from: https://bit.ly/45F8hzF