Estimating the size of the monkeypox virus outbreak in Nigeria and implications for global control.

Monkeypox: Considerations as a New Pandemic Looms

Recently spreading human monkeypox virus infection and its transmission during COVID-19 pandemic period: A travelers' prospective

Monkeypox (MPX) is a viral zoonotic infection caused by the monkeypox virus (MPXV) (1,2). It can spread not only from animals to humans but also from humans to humans and from the environment to humans (1,2). MPXV was first identified in monkey colonies in Denmark in 1958 (2,3). The first human infection of MPXV was observed in 1970 in Congo and then spread to neighboring countries, especially western and central African countries (2,4). Afterward, MPXV-infected cases were reported from non-African countries from time to time. The largest MPXV outbreak described thus far in non-endemic countries was identified in May 2022 (1,2,5). According to the summary of the Centers for Disease Control and Prevention (CDC), MPXV has spread over 110 countries worldwide, and approximately 83,539 infected cases were reported as of December 23, 2022 (6). Evolutionary study is a significant area for infection biology. Since June 2022, following a phylogenomic approach, some studies have uncovered the origin and evolution of the current MPXV, revealed the occurrence of epidemic clusters with geographic consistency, identified distinct phylogenetic clusters, and described the microevolution of MPXV (7-11). We have taken this work a step further. Up-to-date evolution analysis was conducted, and marker mutations in different clades of MPXV were proposed This article is protected by copyright. All rights reserved.

Background/Objectives: Monkeypox (mpox) is currently the most common orthopoxvirus (OPXV) zoonotic disease, and, since 2022, there has been atypical person-to-person transmission observed in non-endemic countries. The present study aimed to investigate the frequency of monkeypox virus (MPXV) and OPXV DNA detection in recommended and alternative clinical materials taken during the acute and convalescent phases of infection in Bulgarian patients. Methods: The study included laboratory investigation by real time PCR of 181 clinical samples from 42 Bulgarian patients with possible mpox infections. Results: MPXV DNA was detected in 23/181 (12.71%), and OPXV DNA in 20/181 (11.05%) clinical samples. There were six mpox-confirmed patients aged 23 to 44. At the highest frequency, MPXV and OPXV DNA were detected in samples of vesicular contents (6/6) and nasal/oropharyngeal secretions (5/6 and 4/6) during the first three days from the appearance of clinical symptoms. We demonstrated MPXV and OPXV DNA in alternative samples (urine, feces, ejaculate, and saliva), and in follow-up patient samples, taken two weeks after mpox confirmation in the convalescent phase (vesicular contentsand urine). Conclusions: Our findings suggested that MPXV may be detected in a larger set of clinical materials, including alternatives, where the virus can persist for more than two weeks.

BackgroundOutbreaks of monkeypox have been ongoing in non-endemic countries since May 2022. A thorough assessment of its global zoonotic niche and potential transmission risk is lacking.MethodsWe established an integrated database on global monkeypox virus (MPXV) occurrence during 1958 − 2022. Phylogenetic analysis was performed to examine the evolution of MPXV and effective reproductive number (Rt) was estimated over time to examine the dynamic of MPXV transmissibility. The potential ecological drivers of zoonotic transmission and inter-regional transmission risks of MPXV were examined.ResultsAs of 24 July 2022, a total of 49 432 human patients with MPXV infections have been reported in 78 countries. Based on 525 whole genome sequences, two main clades of MPXV were formed, of which Congo Basin clade has a higher transmissibility than West African clade before the 2022-monkeypox, estimated by the overall Rt (0.81 vs. 0.56), and the latter significantly increased in the recent decade. Rt of 2022-monkeypox varied from 1.14 to 4.24 among the 15 continuously epidemic countries outside Africa, with the top three as Peru (4.24, 95% CI: 2.89–6.71), Brazil (3.45, 95% CI: 1.62–7.00) and the United States (2.44, 95% CI: 1.62–3.60). The zoonotic niche of MPXV was associated with the distributions of Graphiurus lorraineus and Graphiurus crassicaudatus, the richness of Rodentia, and four ecoclimatic indicators. Besides endemic areas in Africa, more areas of South America, the Caribbean States, and Southeast and South Asia are ecologically suitable for the occurrence of MPXV once the virus has invaded. Most of Western Europe has a high-imported risk of monkeypox from Western Africa, whereas France and the United Kingdom have a potential imported risk of Congo Basin clade MPXV from Central Africa. Eleven of the top 15 countries with a high risk of MPXV importation from the main countries of 2022-monkeypox outbreaks are located at Europe with the highest risk in Italy, Ireland and Poland.ConclusionsThe suitable ecological niche for MPXV is not limited to Africa, and the transmissibility of MPXV was significantly increased during the 2022-monkeypox outbreaks. The imported risk is higher in Europe, both from endemic areas and currently epidemic countries. Future surveillance and targeted intervention programs are needed in its high-risk areas informed by updated prediction.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12992-023-00959-0.

Monkeypox (MPX) belongs to the genus Orthopoxvirus (OPV), family Poxviridae, and sub-family Chordopoxvirinae. Human monkeypox (HMPX) is a viral zoonotic illness caused by the monkeypox virus (MPXV). Several non-endemic countries have confirmed MPX cases across the globe. Therefore, consider an outbreak to be a global health emergency. MPXV transmits from animals to humans via infected animals, and there is currently human-to-human transmission, notably among guys who have sexual relations with males. Healthcare interventions are required to stop outbreaks. These include strict isolation and care for MPX patients while they are still contagious or until the skin lesions dry out and crust over. JYNNEOS was approved as a vaccine for the prevention of MPXV. Tecovirimat is licensed to treat severe MPX or risk developing a serious disease. We should encourage international cooperation to conduct clinical trials investigating the effectiveness and safety of MPXV vaccines and antiviral medications. Precautions must be taken at the global level to prevent an MPXV outbreak.

An outbreak of human mpox infection in nonendemic countries appears to have been driven largely by transmission through body fluids or skin-to-skin contact during sexual activity. We evaluated the stability of monkeypox virus (MPXV) in different environments and specific body fluids and tested the effectiveness of decontamination methodologies. MPXV decayed faster at higher temperatures, and rates varied considerably depending on the medium in which virus was suspended, both in solution and on surfaces. More proteinaceous fluids supported greater persistence. Chlorination was an effective decontamination technique, but only at higher concentrations. Wastewater was more difficult to decontaminate than plain deionized water; testing for infectious MPXV could be a helpful addition to PCR-based wastewater surveillance when high levels of viral DNA are detected. Our findings suggest that, because virus stability is sufficient to support environmental MPXV transmission in healthcare settings, exposure and dose-response will be limiting factors for those transmission routes.

Since April 2022, cases of simian orthopoxvirosis (commonly known as monkeypox) have been reported in more than hundred non-endemic countries. The causative agent, the Monkeypox virus (MPXV), is a virus of the family Poxviridae belonging to the genus Orthopoxvirus (OPXV). The sudden and unusual emergence of this virus mainly in Europe and in the United States has highlighted a previously neglected infectious disease. This virus has been endemic in Africa for at least several decades, since its discovery in 1958 in captive monkeys. MPXV, because of its proximity to the smallpox virus, is part of the list of Microorganisms and Toxins (MOT), which includes all human pathogens considered to be potentially misused for malicious purposes (biological weapons proliferation, bioterrorism) or susceptible to provoke laboratory accidents. As such, its use is subjected to strict regulations in level-3 biosafety laboratories, which de facto limits the possibilities of its study in France. The objective of this article is to review the current knowledge about OPXV in general, and then to focus on the virus responsible for the 2022 MPXV outbreak.

The risk of biological threats has been constantly increasing in recent years. This is due both to the adaptation of avian and animal pathogens to the human organism as a result of the expansion of the area of human activity and to the development of biotechnologies. Viruses predominate among these pathogens. Examples in recent years are the COVID-19 pandemic and the continued spread of monkeypox (MPX). The situation requires the search for objects for research that would have a high informative value and could help in assessing and predicting the spread of infections. The article analyzed and assessed the potential and importance of virological monitoring of wastewater as an element of surveillance for emergent and re-emergent infections, using the example of some of them (enterovirus infections – poliomyelitis and infection caused by enterovirus D68, COVID-19, and MPX). Monitoring of enteroviruses in wastewater is a routine practice in many countries. Poliomyelitis is subject to eradication, and its incidence is extremely low. The study of wastewater makes it possible to indirectly detect the circulation of poliovirus among people, determine its molecular genetic characteristics (“wild”, vaccine, vaccine-derived poliovirus), the duration of circulation, and ways of spread and take appropriate measures in a timely manner. Enterovirus type D68 gained relevance as a re-emergent infection starting in 2014. Large outbreaks caused by it began to be registered in the USA, Canada, and then in the European region. Previously, the virus caused minor respiratory symptoms, but now it has become the cause of severe acute respiratory disease, particularly in children, and has also acquired neurovirulent properties. Its monitoring in wastewater allows for assessing the actual intensity of the epidemic process of this infection in certain territories and in certain countries, which cannot always be done based on clinical diagnosis without an additional etiological diagnosis. During the 3 years of the pandemic, SARS-CoV-2 has taken root in the human population, but a new parasitic system continues to develop. Wastewater monitoring makes it possible to assess the intensity of the epidemic process of COVID-19, which is supported by manifest forms of infection, asymptomatic persistence of the virus, and convalescents. It also allows for analyzing the effectiveness of quarantine and other restrictive measures, detecting genetic changes in the virus and trends in the formation of new variants of the virus. Since May 2022, MРХ has gone beyond the borders of endemic countries and began to spread rapidly, acquiring the character of a re-emergent infection. A variant of the pathogen (clade 3) began to evolve and became transmissible from person to person. The disease it causes began to radically differ from the previously known MRC due to changes in pathogenesis and epidemiological features. First of all, this concerns the pronounced anthroponotic characteristics of re-emergent MРХ in comparison with the zoonotic manifestations of the previously known endemic MРХ. The article discusses the results of studies conducted in different countries on the determination of MPX virus (MPXV) nucleic acids in wastewater samples using OPG002 gene analysis of all MPXVs (G2R_G), the West African clade (G2R_WA), and virus reference genomes of MPXV of the outbreak in 2022 (G2R_NML). Thus, virological monitoring of wastewater can be used as an effective element of surveillance for most infectious diseases, in particular, emergent and re-emergent ones.

In 2022–23, the human monkeypox virus (MPXV) caused a global outbreak in several non-endemic countries. Here, we evaluated the diagnostic performance of four real-time qualitative PCR assays for the laboratory diagnosis of mpox (monkeypox) monkeypox disease. From July to August 2022, 27 positive and 10 negative specimens (lesion, crust and exudate swabs) were tested in the laboratory of the Hygiene Unit of the San Martino Hospital (Genoa, Italy) by using home-made real-time PCR to detect MPXV generic G2R_G DNA. According to the manufacturer’s instructions, we also retrospectively analyzed these specimens using RealCycler MONK-UX/-GX (Progenie Molecular), STANDARD M10 MPX/OPX (SD Biosensor), Novaplex MPXV (Seegene Inc.) and RealStar Orthopoxvirus PCR Kit 1.0 (Altona Diagnostics) assays, recognized as research-use-only tests. The diagnostic accuracy and sensitivity of these assays ranged from 97.3% (95% CI: 86.2–99.5%) to 100% (95% CI: 90.6–100%) and 96.3% (95% CI: 81.72–99.34%) to 100% (95% CI: 72.2–100%), respectively. The RealCycler MONK-UX and STANDARD M10 MPX/OPX did not detect one positive sample with a cycle threshold of 36. The overall specificity was 100% (95% CI: 72.2–100%), and Cohen’s Kappa values ranged from 1 (95% CI: 0.67–1) to 0.93 (95% CI: 0.61–1). As they are highly accurate, reliable and user-friendly, these tests should be recommended for the routine or rapid laboratory discrimination of mpox from other rash illnesses.

Human monkeypox virus: A systematic critical review during the pandemic peak

Role of multi-site sampling in the diagnosis of human Monkeypox

Monkeypox is a viral zoonotic disease endemic in Central and West Africa. In May 2022, dozens of non-endemic countries reported hundreds of monkeypox cases, most with no epidemiological link to Africa. We identified two lineages of monkeypox virus (MPXV) among two 2021 and seven 2022 US monkeypox cases: the major 2022 outbreak variant called B.1 and a minor contemporaneously sampled variant called A.2. Analyses of mutations among these two variants revealed an extreme preference for GA-to-AA mutations indicative of human APOBEC3 cytosine deaminase activity among Clade IIb MPXV (previously West African, Nigeria) sampled since 2017. Such mutations were not enriched within other MPXV clades. These findings suggest that APOBEC3 editing may be a recurrent and a dominant driver of MPXV evolution within the current outbreak.

The 2022 outbreak of monkeypox is of worldwide significance. There has been a rapid escalation in case numbers despite efforts to contain it and the WHO has declared it a...

Recently monkeypox cases have been reported from many non-endemic countries. The objective of this article is to bring out the epidemiology, mode of transmission, clinical features, genetic clades, and molecular properties of monkeypox virus. A detailed literature review was conducted on monkeypox, using databases PubMed/Medline, EMBASE, PMC and Cochrane Library, for the period between 1985 to 2022. Genetically monkeypox virus can be classified into Central African clade and Western African clades. The sequence similarity between the two strains was found to be 99.5%. However, some significant differences were found in the virulent and nonvirulent genes of the strains, such as BR-203, BR-209, COP-C3L b and COP-H5R, COP-A9L, COP-A50R, and COP-A36R, respectively. Human to human transmission occurs after exposure to respiratory droplets, oral secretions, contact with lesions, fomites, and direct/sexual contact. Monkeypox can also be transmitted from the infected mother to the fetus through the placenta leading to congenital infection. In May 2022 several cases have been reported from Europe, North America, and Australia, particularly from homosexual men. Monkeypox is a zoonotic disease which was prevalent in Central and Western African countries. Recently, human to human spread was noticed in developed countries of Europe, North America and Australia. Despite with a close genetic similarity between the two clades, the Central African strain is comparatively very virulent with high mortality. Monkeypox should be considered a re-emerging, neglected disease and proper measures like hand hygiene, wearing masks and vaccination to the high-risk groups are advised.