lecture

1. Monkeypox
DR. Magdy Shafik
Senior Pediatric Consultant
Diploma, M.S ,Ph.D of Pediatric

2. ‫افريقيا‬ ‫خارج‬ ‫القردة‬ ‫لجدري‬ ‫الوبائي‬ ‫التفشي‬ ‫مقدمة‬
‫يا‬
- ‫في‬
7
‫مايو‬
2022
‫المتحددة‬ ‫المملكة‬ ‫في‬ ‫الدولية‬ ‫الصحة‬ ‫للوائح‬ ‫الوطنية‬ ‫االتصال‬ ‫جهة‬ ‫أخطرت‬ ،
‫الي‬ ‫المتحددة‬ ‫المملكة‬ ‫من‬ ‫سافر‬ ‫لشخص‬ ‫القردة‬ ‫جدري‬ ‫من‬ ‫مؤكدة‬ ‫بحالة‬ ‫العالمية‬ ‫الصحة‬ ‫منظمة‬
‫مايو‬ ‫أوائل‬ ‫لى‬ ‫أبريل‬ ‫أواخر‬ ‫من‬ ‫نيجيريا‬
2022
‫مايو‬ (.
- ‫في‬ ‫الجلدي‬ ‫الطفح‬ ‫ظهر‬
29
‫في‬ ‫نيجيريا‬ ‫الحالة‬ ‫غادرت‬ ، ‫أبريل‬
3
‫مدايو‬
2022
‫في‬ ‫المتحدة‬ ‫المملكة‬ ‫الي‬ ‫ووصلت‬
4
‫اليوم‬ ‫نفس‬ ‫وفي‬ ، ‫مايو‬
(
4
‫مايو‬
)
‫علي‬ ‫وبناء‬ ‫المستشفى‬ ‫علي‬ ‫الحالة‬ ‫عرضت‬
‫وتدم‬ ‫مبكدرة‬ ‫مرحلة‬ ‫في‬ ‫القردة‬ ‫جدري‬ ‫في‬ ‫االشتباه‬ ‫تم‬ ، ‫الجلدي‬ ‫الطفح‬ ‫ومرض‬ ‫السفر‬ ‫تاريخ‬ ‫على‬
‫العكسدي‬ ‫للنسخ‬ ‫المتسلسل‬ ‫البوليميراز‬ ‫تفاعل‬ ‫خاالل‬ ‫من‬ ‫الحالة‬ ‫تأكيد‬ ‫وتم‬ ،‫الفور‬ ‫على‬ ‫الحالة‬ ‫عزل‬
.)RT-PCR(
- ‫منذ‬
13
‫مايو‬
2022
‫يوجد‬ ‫ال‬ ‫والتي‬ ‫العدالم‬ ‫دول‬ ‫مدن‬ ‫وعددد‬ ‫المتحددة‬ ‫المملكة‬ ‫فى‬ ‫حاالت‬ ‫ظهور‬ ‫توالى‬
‫بينهم‬
‫وبائى‬ ‫ارتباط‬

3. ‫يوم‬ ‫حتي‬ ‫القردة‬ ‫بجدري‬ ‫مؤكدة‬ ‫حاالت‬ ‫عن‬ ‫ابلغت‬ ‫التي‬ ‫الدول‬ ‫اجمالي‬
26
‫مايو‬
2022
‫المؤكدة‬ ‫الحاالت‬ ‫الدولة‬ ‫م‬ ‫المؤكدة‬ ‫الحاالت‬ ‫الدولة‬ ‫م‬
15 ‫كندا‬ 11 71 ‫المتحدة‬ ‫المملكة‬ 1
9 ‫المتحدة‬ ‫الواليات‬ 12 4 ‫بلجيكا‬ 2
2 ‫استراليا‬ 13 5 ‫فرنسا‬ 3
1 ‫اسرائيل‬ 14 5 ‫ايطاليا‬ 4
5 ‫المانيا‬ 15 37 ‫البرتغال‬ 5
2 ‫سويسرا‬ 16 51 ‫اسبانيا‬ 6
6 ‫هولندا‬ 17 1 ‫السويد‬ 7
1 ‫النمسا‬ 18 1 ‫سلوفينيا‬ 8
1 ‫الدنمارك‬ 19 1 ‫التشيك‬ 9
1 ‫االمارت‬ 10

4. Monkeypox is a rare disease that is caused by infection with
monkeypox virus. Monkeypox virus belongs to the Orthopoxvirus
genus in the family Poxviridae.
The Orthopoxvirus genus also includes variola virus (which causes
smallpox), vaccinia virus (used in the smallpox vaccine), and
cowpox virus.

5. • Monkeypox was first discovered in 1958 when two outbreaks
of a pox-like disease occurred in colonies of monkeys kept
for research, hence the name ‘monkeypox.’
• The first human case of monkeypox was recorded in 1970
in the Democratic Republic of Congo during a period of
intensified effort to eliminate smallpox.
• Since then monkeypox has been reported in humans in other
central and western African countries.

6. Signs and Symptoms
• In humans, the symptoms of monkeypox are similar to but milder
than the symptoms of smallpox.
• Monkeypox begins with fever, headache, muscle aches, and
exhaustion.
• The main difference between symptoms of smallpox and monkeypox
is that monkeypox causes lymph nodes to swell (lymphadenopathy)
while smallpox does not.
• The incubation period (time from infection to symptoms) for
monkeypox is usually 7−14 days but can range from 5−21 days.

7. • The illness begins with:
• Fever ,Headache ,Muscle aches ,Backache ,Swollen lymph nodes ,Chills ,
Exhaustion.
• Within 1 to 3 days (sometimes longer) after the appearance of fever, the
patient develops a rash, often beginning on the face then spreading to other
parts of the body.
• Lesions progress through the following stages before falling off:
• Macules
• Papules
• Vesicles
• Pustules
• Scabs
• The illness typically lasts for 2−4 weeks.
• In Africa, monkeypox has been shown to cause death in as many as 1 in 10
persons who contract the disease.

8. ‫الشديدة‬ ‫الحاالت‬ ‫في‬ ‫االف‬ ‫عدة‬ ‫الي‬ ‫تقرحات‬ ‫بضعة‬ ‫من‬ ‫التقرحات‬ ‫عدد‬ ‫يختلف‬
‫في‬
95
%
‫الوجه‬ ‫علي‬ ‫الجلدي‬ ‫الطفح‬ ‫ينتشر‬
,
75
%
‫القدمين‬ ‫وباطن‬ ‫اليدين‬ ‫راحتي‬ ‫علي‬
,
70
%
‫الفم‬ ‫اغشية‬ ‫علي‬
,
30
%
‫التناسيلية‬ ‫االعضاء‬ ‫علي‬

10. ‫الحالة‬ ‫تعريف‬
• ‫المشتبهة‬ ‫الحالة‬
:
‫من‬ ‫أكثر‬ ‫أو‬ ‫واحد‬ ‫وجود‬ ‫مع‬ ‫جلدى‬ ‫طفح‬ ‫ولديه‬ ‫عمر‬ ‫أى‬ ‫فى‬ ‫شخص‬ ‫أى‬
• ‫التالية‬ ‫األعراض‬
:
• 
‫الحرارة‬ ‫درجة‬ ‫فى‬ ‫ارتفاع‬
≤
38.5
°
• 
‫الليمفاوية‬ ‫الغدد‬ ‫فى‬ ‫تورم‬
• 
‫صداع‬
• 
‫االم‬
‫العضاالت‬ ‫أو‬ ‫بالجسم‬
• 
‫بالظهر‬ ‫االم‬
• 
‫عام‬ ‫ضعف‬
‫مع‬
‫مثل‬ ‫الطفح‬ ‫لحدوث‬ ‫معروفة‬ ‫أسباب‬ ‫وجود‬ ‫عدم‬
(
‫مائى‬ ‫جديرى‬
–
‫الهربس‬
)
‫النارى‬ ‫الحزام‬
-
• ‫البكتيرية‬ ‫الجلد‬ ‫عدوى‬
–
‫السيالن‬ ‫لمرض‬ ‫المصاحب‬ ‫الطفح‬
)
• ‫اخ‬

11. • ‫المحتملة‬ ‫الحالة‬
:
‫أو‬ ‫واحد‬ ‫وجود‬ ‫مع‬ ‫المشتبهة‬ ‫الحالة‬ ‫تعريف‬ ‫عليه‬ ‫ينطبق‬ ‫شخص‬
‫األتي‬ ‫من‬ ‫أكثر‬
:
• ‫خالل‬ ‫في‬ ‫مؤكدة‬ ‫حالة‬ ‫مع‬ ‫مباشر‬ ‫وبائي‬ ‫ارتباط‬
21
‫االعراض‬ ‫بداية‬ ‫فبل‬ ‫يوم‬
• ‫خالل‬ ‫في‬ ‫بالمرض‬ ‫موبؤة‬ ‫لدولة‬ ‫سفر‬ ‫تاريخ‬ ‫وجود‬
21
‫االعراض‬ ‫ظهور‬ ‫فبل‬ ‫يوم‬
• ‫المؤكدة‬ ‫الحالة‬
:
• ‫طري‬ ‫عن‬ ‫القردة‬ ‫جدري‬ ‫لفيروس‬ ‫معلميا‬ ‫تاكيدها‬ ‫وتم‬ ‫االكلينكية‬ ‫لالعراض‬ ‫المستوفاة‬ ‫الحالة‬
‫ق‬
RT.PCR

12. Differential Diagnosis of monkypox
• 1-Varicella
• The fever, malaise, and headache of varicella are usually less severe than
monkeypox infection.
• Lesions in varicella are superficial, heterogeneous and have a
centripital(rash first appears on the chest, back, and face. Then it spreads over the entire
body) distribution,
• in contrast to the homogeneous, centrifugal rash of monkeypox. ( Rash
often begins on the face and then spreads to other parts of the body.
• Involvement of the palms and soles is rare in varicella, but common in
monkeypox.
• Lymphadenopathy is another important feature for differentiating
monkeypox from varicella, since it is a prominent feature in monkeypox but
is not present in varicella

14. • 2 -Smallpox
• Smallpox is caused by the variola virus, which is a member
of the genus Orthopoxvirus, family Poxviridae.
• The lesions of smallpox usually start on the face, then spread
to other areas of the body with a centrifugal distribution.
• Palmar and plantar lesions occur in most patients.
• Lesions on one area of the body are all in the same stage of
development, unlike chickenpox.
• The fever and headache in smallpox infection tend to be
more severe compared to monkeypox
• Lymphadenopathy is a prominent, distinguishing feature that is
common in monkeypox infection, but absent in smallpox .
•

15. • 3-vaccinia virus
• The vaccinia virus is a member of the Orthopoxvirus genus and is used
for smallpox vaccination.
• Typically, patients develop an erythematous papule at the site of
vaccination 3-5 days after receiving the vaccine.
• The papule progresses to a vesicular lesion, then forms a pustule and
enlarges.
• As the pustule dries, a crust forms over the lesion, which then resolves 2
to 3 weeks after the vaccination, resulting in scar formation.
• This typical reaction pattern signifies that the individual has responded
successfully to the vaccination. Patients may also experience symptoms
such as fatigue, headache, fever, myalgias, regional lymphadenopathy, and
satellite lesions.
•

16. • The lesions of vaccinia may appear similar to smallpox, but they
lack the centrifugal distribution usually seen in smallpox infection.
• Other diseases that should be considered in the differential diagnosis
of monkeypox include herpes zoster, herpes simples, molluscum
contagiosum, erythema multiforme, acne, drug reactions,
impetigo, allergic dermatitis, scabies, and syphilis

17. Measles

18. Transmission
• contact with the virus from an infected animal, infected
person, or materials contaminated with the virus.
• The virus can also cross the placenta from the mother to her
fetus.
• Monkeypox virus may spread from animals to people
through the bite or scratch of an infected animal, by handling
wild game, or through the use of products made from
infected animals.
• direct contact with body fluids or sores on an infected
person or with materials that have touched body fluids or
sores, such as clothing or linens.

19. • Monkeypox spreads between people primarily through
direct contact with infectious sores, scabs, or body fluids.
It also can be spread by respiratory secretions during
prolonged, face-to-face contact.
• Monkeypox can spread during intimate contact between
people, including during sex, as well as activities like kissing,
cuddling, or touching parts of the body with monkeypox
sores.
• At this time, it is not known if monkeypox can spread
through semen or vaginal fluids.
• Page last reviewed: May 29, 2022
•

20. Prevention
• Avoid contact with animals that could harbor the virus
(including animals that are sick or that have been found dead in
areas where monkeypox occurs).
• Avoid contact with any materials, such as bedding,(‫)الفرش‬ that
has been in contact with a sick animal.
• Isolate infected patients from others who could be at risk for
infection.
• Practice good hand hygiene after contact with infected animals
or humans. For example, washing your hands with soap and
water or using an alcohol-based hand sanitizer.
• Use personal protective equipment (PPE) when caring for
patients

21. Vaccination
• JYNNEOSTM (also known as Imvamune or Imvanex)
• is an attenuated live virus vaccine which has been approved
by the U.S.
• The Advisory Committee on Immunization Practices (ACIP)
is currently evaluating JYNNEOSTM for the protection of
people at risk of occupational exposure to orthopoxviruses
such as smallpox and monkeypox in a pre-event setting

22. Clinical Guidance for the Treatment of Monkeypox
• Many individuals infected with monkeypox virus have a mild,
self-limiting disease course in the absence of specific
therapy.
• Persons who should be considered for treatment following
consultation with CDC might include:
• Persons with severe disease (e.g., hemorrhagic disease, confluent
lesions, sepsis, encephalitis.
• Immunocompromised.
• Pediatric populations, particularly patients younger than 8 years of
age2
• Pregnant or breastfeeding women

23. Medical Countermeasures Available for the Treatment of Monkeypox
• Tecovirimat (also known as TPOXX) is an antiviral
medication that is approved for the treatment of human
smallpox disease in adults and pediatric patients weighing at
least 3 kg
• Tecovirimat is available as oral (200 mg capsule) and
injection for intravenous formulations.
• CDC allows for the use of Tecovirimat for the treatment of
non-variola orthopoxviruses (including monkeypox) in an
outbreak.

24. • Cidofovir (also known as Vistide) is an antiviral medication
that is approved by the FDA pdf icon[PDF – 6 pages]external
icon for the treatment of cytomegalovirus (CMV) retinitis
in patients with Acquired Immunodeficiency Syndrome
(AIDS).
• CDC allows for the use of Cidofovir for the treatment of
orthopoxviruses (including monkeypox) in an outbreak.

25. • Brincidofovir (also known as Tembexa) is an antiviral
medication that was on June 4, 2021 for the treatment of
human smallpox disease in adult and pediatric patients,
including neonates.

26. • Vaccinia Immune Globulin Intravenous (VIGIV)
is licensed by FDAexternal icon for the treatment of
complications due to vaccinia vaccination including eczema
vaccinatum, progressive vaccinia, severe generalized
vaccinia, vaccinia infections in individuals who have skin
conditions, and aberrant infections induced by vaccinia virus
(except in cases of isolated keratitis).
• CDC holds and EA-IND that allows the use of VIGIV for the
treatment of orthopoxviruses (including monkeypox) in an
outbreak.

27. Thank you