3. Introduction
• Monkeypox is a zoonotic infection due to
monkeypox virus
• Presents with a rash similar to that of smallpox
but less severe
• Monkeypox highly seen in endemic areas of
Central &Western Africa
• Multiple new cases found Worldwide in the
last two decades
• Public health concerned about it as a pandemic
and its use as an agent of bioterrorism
5. History
• DNA Virus first isolated in Denmark in 1958
• Found in colony of laboratory monkeys from
Singapore: polio virus research
• US &Rotterdam: Lab animals outbreak a
decade later
• Caused disease in humans early 1970s in DRC
• Cases increased post eradication of smallpox
(1980s)
6. Hx –Cont’d
• Monkeypox virus infection detected in:
Squirrels
Rodents
species of monkeys
• West and Central Africa: 2 clades
Clade 1: Central Africa-Congo Basin Clade
Clade 2: West Africa (less virulent)-IIa&IIb
• Monkeys and Humans: Hosts, unknown reservoir
9. Epidemiology
• Reached in 76 countries Worlwide
• First cases in 1980 ~ Countries of CWA
• 2003: US outbreak
• DRC: 2005-2007 Surveillance report
a 20-fold ↑ in incidence of Mpox Vs 1980
Cessation of Smallpox vaccination /eradication
Risk : forested areas, male, and age <15 years.
• 2017: Cases of Nigeria from returning
• July 23, 2022, the WHO declared Mpox new outbreak
of a public health emergency of international concern
10. Number of suspected cases versus confirmed, probable and/or possible
cases
PLOS NEGLECTED TROPICAL DISEASES, Feb 2022
11. Epidem-Cont’d
• Outbreak of 2022: 57995 cases
• Clade I mortality: 10%
• Clade II: < 0.1% except in Nigeria(3.6%)
2017-18
• Predictors of severe form:
Immunocompromisation : HIV
Children
Small pox/𝜃 Immunisation
14. Virology
• Mpox virus , orthopoxvirus genus
• Poxviridae family, w/ other species like:
Variola virus that causes smallpox
Vaccinia virus, which was used in making smallpox vaccine
Mollusci virus that causes Molluscum Contagiosum
• Enveloped virus
• Double stranded DNA genome
15. Who is at high risk?
• Household of someone with Monkeypox
• HCP of an infected person/ IPC.
• Travel to an area with confirmed cases: 21 days
• Contact w/ a person who has a similar rash or a
dx of confirmed or suspected Monkeypox
• Sexual partners of diagnosed or suspected
Monkeypox, predominantly MSM
16. Transmission: How it spreads?
• Animal to human
transmission.
Non invasive
Complex
• Human to Human
Direct contact
Indirect contact: fomites
Respiratory secretions
Vertical transmission
Percutaneous inoculation
Body fluids~ seen
18. Symptoms
• Incubation period: 4-21 days
• Traditional : systemic illness with
fevers, chills, and myalgias
characteristic rash ≠other vesicular (eg,
varicella, smallpox)
• 2022 Mpox outbreak special attention:
genital, anal
and/or oral lesions without the systemic illness
19. Symptomatology- Cont’d
• Prodrome: Viremic phase of illness
From 1-5 days
Fever, headache, sore throat, back pain,
myalgia & fatigue
• Rash: Persist 2-3 weeks
• Generalized lymphadenopathies
• Proctitis and tonsillitis
• Encephalitis
20. Progression of the rash
• Within 1 to 3 days (may be longer) the patient
can develop a rash
• Rash progresses from red and flat (macular) ->
a bump (papular) -> water filled (vesicle) ->
pus-filled (pustule) -> crusting (desquamation)
• Starts on the face and then spreading to other
parts of the body (like the extremities and
genital areas) and palms and soles.
24. Investigations
• PCR: Confirmation of MPXV infection is
based on NAAT
Using real-time or conventional PCR
Detection of unique sequences of viral
DNA.
Viral swab taken from one or more
vesicles or ulcers, or a dry scraping of the
scab.
• Routine Chemistry, Hematology, and
Urinalysis
• Sodium and potassium
• Proteins – especially albumin
• Routine examination of bacterial and
mycotic cultures & sensitivity
27. Gilada/Unison/Mumbai
Complications and sequelae
• Features of illness that may be predictive of
illness severity and poor outcomes
• Consequences of compromised skin and mucosa
• Systemic Illness
• Hypoalbuminemia and low hematocrit, s/o
malnutrition
• Bronchopneumonia
• Secondary infection of the integument, sepsis,
• Encephalitis
• Infection of the cornea with ensuing loss of vision
28. Monkeypox Treatment
• There is no proven treatment
• Only supportive approach
• Some anti-virals: Brincidofovir/ Cidofovir
&Tecovirimat
• Smallpox vaccine
• Prevention & treatment of 2nd bacterial
infections + complications
• Ensuring adequate hydration and nutrition
• Protecting vulnerable anatomical locations such as
the eyes and genitals.
30. Prevention
• Isolate infected patients
• Practice IPC Measures
• Avoid contact with animals that could harbor the virus (including
sick or dead animals) where monkeypox is endemic
• Avoid direct contact with any materials, such as bedding or
laundry, that has been in contact with a sick patient.
• Use PPE when caring for patients, which includes gown,
gloves, respirator/mask and eye protection.
31. Prevention : Vaccine
• JYNNEOSTM
is a USFDA approved live attenuated virus
vaccine
has been approved for the prevention of
Monkeypox.
• Research ongoing for use in Preexposure
the protection: risk of occupational exposure
to orthopoxviruses.
• Smallpox vaccine can provide 85% protection
32. Take Home Message
• Mpox virus is expected to spread more, we
have to tackle it
• No perfect anti-Monkeypox treatment
• Mainstay: treat of symptoms & secondary
infections, fluid balance.
• Smallpox vaccine can be used for therapeutic
and prevention purposes
• Disaster management plan & Global Health
Security should be in place
33. References
• monkeypox—A potential threat? A systematic
review. Gromowski G, editor. PLoS Negl Trop
Dis. 2022 Feb 11;16(2):e0010141.
• El Eid R, Allaw F, Haddad SF, Kanj SS. Human
monkeypox: A review of the literature. PLoS
Pathog. 2022 Sep 22;18(9):e1010768.
• Huang Y, Mu L, Wang W. Monkeypox:
epidemiology, pathogenesis, treatment and
prevention. Signal Transduct Target Ther. 2022
Nov 2;7:373.
34. References
• monkeypox—A potential threat? A systematic review. Gromowski G, editor. PLoS
Negl Trop Dis. 2022 Feb 11;16(2):e0010141.
• 2. El Eid R, Allaw F, Haddad SF, Kanj SS. Human monkeypox: A review of the
literature. PLoS Pathog. 2022 Sep 22;18(9):e1010768.
• 3. Huang Y, Mu L, Wang W. Monkeypox: epidemiology, pathogenesis,
treatment and prevention. Signal Transduct Target Ther. 2022 Nov 2;7:373.
