Differences in the US Mpox Outbreaks of 2003 and 2022: A Review

Objectives: This research aims to focus on the differences in mpox outbreaks that occurred in 2003 and 2022 in the United States. Methods: We searched the following databases Medline, Google Scholar, Gayle Power Search, PubMed, and Springerlink using the following search terms “mpox virus”, “MPX”, “mpox in the US”, “US mpox virus 2003”, “US mpox virus 2022”, “US mpox outbreak 2003” and US mpox outbreak 2022”. The only articles selected were those written between 2003 and 2022. Results: Findings showed more Mpox research was conducted during the first US Mpox outbreak in 2003 compared to the US Mpox outbreak in 2022. Findings also indicated that the mpox outbreak of 2003 consisted of more animal-to-human transmissions acquired from sick prairie dogs compared to more human-to-human from an infected international traveler from Nigeria to the US. Conclusion: Major differences in the mpox outbreaks in the US include the number, location of lesions, and transmission type. We recommend further research to increase awareness of the human-to-human transmission of mpox via sexual contact to assist healthcare professionals and public health leaders in providing prevention and wellness in US communities.

Mpox and related poxviruses:A literature review of evolution,pathophysiology,and clinical manifestations

The recently re-emerged mpox(monkeypox)virus that causes mpox disease is a member of genus Orthopoxvirus and has unprecedentedly spread worldwide.Numerous studies have contributed to our understanding of its evolution,pathophysiology,and clinical manifestations.The current outbreak of the mpox virus depicts its novel route of transmission as a new variant.However,the exact reason for its transition from an epidemic to a pandemic remains unclear.Furthermore,other poxviruses such as vaccinia virus,variola virus,and cowpox virus,also belong to the same genus,Orthopoxvirus.In the present review,our objective was to summarize the evidence on evolution,pathophysiology,and clinical manifestations of mpox virus and its related poxviruses.The present review would aid in a better understanding of the current circulating mpox virus and its differences from other poxviruses.In addition,the shared genetic factors contributing to virulence in these Orthopoxvirus highlight their evolutionary connections and genetic similarities.While they exhibit differences in virulence,studying these genetic relationships is crucial for understanding their biology,pathogenicity,and the development of effective vaccines and antiviral therapeutics to curb mpox disease.

Epidemiology of Mpox Outbreaks and Implications for Surveillance in Imo State, Nigeria

Mpox disease is caused by a double-stranded DNA virus, genus Orthopoxvirus of the family Poxviridae. The incubation period is usually 6 to 13 days but can range from 5 to 21 days while symptoms and signs may persist for 2 to 5 weeks. Although, the clinical features are usually less severe when compared to the deadly smallpox, the disease can be fatal with case fatality rate between 1% and 10%. In Imo State, Nigeria, there has been a changing epidemiology of the disease in the last 6 years and the frequency and geographic distribution of cases have progressively increased. This study aims to conduct a review of the disease epidemiology between 2017 and 2023 and implications for surveillance in Imo State. Surveillance data from the Surveillance Outbreak Response and Management System (SORMAS) was extracted between January 2017 and December 2023 across the 27 Local Government Areas (LGAs) of Imo State. A line list of 231 suspected cases was downloaded into an excel template and analyzed using SPSS® version 20 software. Analysis was done using descriptive statistics and associations were tested using Fischer’s exact at 0.05 level of significance. Of the 231 suspected cases, 57.1% (132) were males, 42.9% (99) were females and the modal age group was between the ages of 0 - 4 (32.5%). Eight (8) LGAs (districts) accounted for 71% (n = 164) of all the suspected cases. 21.2% (49) were confirmed positive, 27 males (55.1%) and 22 females (44.9%) (p > 0.05). Modal age group was 20 - 24 (22.4%, n = 11), 18% (9) were children under 14 years, p > 0.05. Case fatality rate was 8% (n = 4). There was no significant association between mortality and age group. Five (5) LGAs accounted for about 60% (29) of all confirmed cases. These LGAs contribute only 20% to the total population in the State. Only 5.6% and 4% of suspected and confirmed cases, respectively, had knowledge of contact with an infectious source. The study described the epidemiology of Mpox outbreaks between 2017 and 2023 and the findings have significant implications on detection and outbreak response activities.

Mpox re-emerges:Historical background,symptom overview,and contemporary treatment options

As the global community continues to recover from the COVID-19 pandemic,the World Health Organization has issued a warning of another viral infection,mpox(monkeypox),that can pose a significant threat to public health.Mpox was once endemic in Africa but has spread globally,prompting the World Health Organization to declare it a public health emergency.In response,healthcare personnel must initiate timely,decisive,and robust action before the infection escalates.Moreover,accurate diagnosis is crucial,given the similarity between mpox and other rash-causing infections.This article provides a comprehensive overview of the symptoms,differentiating it from similar diseases,risk assessment,and treatment strategies.In addition,it aims to educate healthcare personnel with the necessary knowledge to educate others and take preventative measures when handling cases,thereby avoiding the spread of infection.

Knowledge and awareness of human mpox infection among healthcare workers:A cross-sectional study in southwestern Nigeria

Objective:To identify the knowledge and awareness level of human mpox viral infection among healthcare workers in southwestern Nigeria.Methods:A cross-sectional study was conducted in Ekiti State,southwest Nigeria among 316 healthcare workers that were selected through a systematic random sampling.Data were collected with the aid of a semi-structured,self-administered questionnaire.The Chi-square test and binary logistic regression were used to find the association between the independent and dependent variables.The significance level was set at P-value<0.05.Results:Two hundred and twenty-two(70.3%)of the respondents were aged≤40 years,mean age(36±9)years,189(59.8%)were female,306(96.8%)were Christians,and 203(64.2%)were married.Three hundred and fourteen(99.4%)of the respondents were aware of mpox infection.Main sources of information about mpox were medical education(44.0%),radio/television(32.0%)and newspaper(21.0%).However,among those aware of the disease,209(67.0%)demonstrated poor knowledge levels.Longer than 5 years’experience of medical practice was the only significant predictor of higher knowledge level of the disease(OR 1.76,95%CI 1.01-3.06;P=0.046).Conclusions:Despite the high awareness level of mpox infection among healthcare workers,there still exists a huge knowledge gap.It is recommended that targeted intervention could be directed towards continuous medical education and simulation exercises on re-emerging infectious diseases like mpox to improve the knowledge of the healthcare workers.

Human mpox co-infection with advanced HIV-1 and XDR-TB in a MSM patient previously vaccinated against smallpox:A case report

Mpox is a zoonotic infectious disease caused by the mpox virus(MPXV).Historically,the majority of mpox cases have been documented in Central Africa.However,since May 2022,there has been a notable rise in reported cases from regions beyond Africa.Currently,over 110 countries spanning Europe,North America,South America,Asia,and other territories have reported mpox infections.This report details a case involving a patient who identifies as a man who has sex with men(MSM)and is concurrently infected with MPXV,human immunodeficiency virus type 1(HIV-1),Pneumocystis jiroveci,as well as extensively drug-resistant tuberculosis(XDR-TB).This patient had also received a vaccination for smallpox in the past.Additionally,we provide photographic documentation charting the progression of dermatological manifestations associated with mpox.This case highlights the significance of sexual intercourse as a crucial mode of transmission for mpox.The rapid and widespread dissemination of the MPXV across various regions,especially among MSM communities,underscores the importance of enhancing preventive education efforts targeted at high-risk populations.

The need for pre-emptive control strategies for mpox in Asia and Oceania

Introduction:The transmission dynamics of the recent mpox outbreak highlights the lack of infrastructure available to rapidly respond to novel STI outbreaks,of which Asia and Oceania remains particularly susceptible.Here,we simulate outbreaks in this setting and propose the use of pre-emptive vaccination within the men who have sex with men(MSM)community before the arrival and establishment of the virus.Materials and methods Using data driven heterogeneous sexual contact networks,we simulated outbreaks of mpox in Singapore,Hong Kong,and Sydney.An individual based SEIR compartmental model was used to simulate epidemic trajectories and the impact of different vaccination uptakes was assessed in their ability to avert or suppress outbreaks upon the arrival of mpox within the MSM populations.Results:The highly dense sexual networks of Singapore and Sydney experience rapid outbreaks,with infection peaks occurring at day 41 and 23 respectively,compared to Hong Kong which occurs at day 77.Across the simulations with no vaccination,68.2%–89.7%of the MSM community will become infected with mpox across the different cities,over a simulation period of 1 year.By implementing vaccination strategies,the infection rate across the cities can be reduced to as low as 3.1%of the population(range:3.1%–82.2%)depending on the implementation and uptake of the vaccine.Vaccination is also extremely effective in slowing the start of the epidemic,delaying the epidemic peak by 36–50 days in Hong Kong,or even preventing the outbreak of mpox.Discussion:With extremely dense and well-connected sexual contact networks,where 65.2%–83.2%of the population are connected to a super-spreader in the different contact networks,pre-emptive or immediate vaccination upon identification of the first case is strongly recommended to help better manage the outbreak of mpox and prevent potential straining of healthcare systems.

The unique immune evasion mechanisms of the mpox virus and their implication for developing new vaccines and immunotherapies

Mpox is an infectious and contagious zoonotic disease caused by the mpox virus(MPXV),which belongs to the genus Orthopoxvirus.Since 2022,MPXV has posed a significant threat to global public health.The emergence of thousands of cases across the Western Hemisphere prompted the World Health Organization to declare an emergency.The extensive coevolutionary history of poxviruses with humans has enabled these viruses to develop sophisticated mechanisms to counter the human immune system.Specifically,MPXV employs unique immune evasion strategies against a wide range of immunological elements,presenting a considerable challenge for treatment,especially following the discontinuation of routine smallpox vaccination among the general population.In this review,we start by discussing the entry of the mpox virus and the onset of early infection,followed by an introduction to the mechanisms by which the mpox virus can evade the innate and adaptive immune responses.Two caspase-1 inhibitory proteins and a PKR escape-related protein have been identified as phylogenomic hubs involved in modulating the immune environment during the MPXV infection.With respect to adaptive immunity,mpox viruses exhibit unique and exceptional T-cell inhibition capabilities,thereby comprehensively remodeling the host immune environment.The viral envelope also poses challenges for the neutralizing effects of antibodies and the complement system.The unique immune evasion mechanisms employed by MPXV make novel multi-epitope and nucleic acid-based vaccines highly promising research directions worth investigating.Finally,we briefly discuss the impact of MPXV infection on immunosuppressed patients and the current status of MPXV vaccine development.This review may provide valuable information for the development of new immunological treatments for mpox.

The risk of mpox importation and subsequent outbreak potential in Chinese mainland: a retrospective statistical modelling study

Background The 2022-2023 mpox(monkeypox)outbreak has spread rapidly across multiple countries in the non-endemic region,mainly among men who have sex with men(MSM).In this study,we aimed to evaluate mpox's importation risk,border screening effectiveness and the risk of local outbreak in Chinese mainland.Methods We estimated the risk of mpox importation in Chinese mainland from April 14 to September 11,2022 using the number of reported mpox cases during this multi-country outbreak from Global.health and the international air-travel data from Official Aviation Guide.We constructed a probabilistic model to simulate the effectiveness of a border screening scenario during the mpox outbreak and a hypothetical scenario with less stringent quarantine requirement.And we further evaluated the mpox outbreak potential given that undetected mpox infections were introduced into men who have sex with men,considering different transmissibility,population immunity and population activity.Results We found that the reduced international air-travel volume and stringent border entry policy decreased about 94% and 69% mpox importations respectively.Under the quarantine policy,15-19% of imported infections would remain undetected.Once a case of mpox is introduced into active MSM population with almost no population immunity,the risk of triggering local transmission is estimated at 42%,and would rise to>95% with over six cases.Conclusions Our study demonstrates that the reduced international air-travel volume and stringent border entry policy during the COvID-19 pandemic reduced mpox importations prominently.However,the risk could be sub-stantially higher with the recovery of air-travel volume to pre-pandemic level.Mpox could emerge as a public health threat for Chinese mainland given its large MSM community.

Structure-based discovery of F.religiosa phytochemicals as potential inhibitors against Monkeypox(mpox)viral protein

Outbreaks of Monkeypox(mpox)in over 100 non-endemic countries in 2022 represented a serious global health concern.Once a neglected disease,mpox has become a global public health issue.A42R profilinlike protein from mpox(PDB ID:4QWO)represents a potential new lead for drug development and may interact with various synthetic and natural compounds.In this report,the interaction of A42R profilinlike protein with six phytochemicals found in the medicinal plant Ficus religiosa(abundant in India)was examined.Based on the predicted and compared protein–ligand binding energies,biological properties,IC_(50) values and toxicity,two compounds,kaempferol(C-1)and piperine(C-4),were selected.ADMET characteristics and quantitative structure–activity relationship(QSAR)of these two compounds were determined,and molecular dynamics(MD)simulations were performed.In silico examination of the kaempferol(C-1)and piperine(C-4)interactions with A42R profilin-like protein gave best-pose ligandbinding energies of–6.98 and–5.57 kcal/mol,respectively.The predicted IC_(50) of C-1 was 7.63 lM and 82 lM for C-4.Toxicity data indicated that kaempferol and piperine are non-mutagenic,and the QSAR data revealed that piperlongumine(5.92)and piperine(5.25)had higher log P values than the other compounds examined.MD simulations of A42R profilin-like protein in complex with C-1 and C-4 were performed to examine the stability of the ligand–protein interactions.As/C and C-4 showed the highest affinity and activities,they may be suitable lead candidates for developing mpox therapeutic drugs.This study should facilitate discovering and synthesizing innovative therapeutics to address other infectious diseases.

Automated robot and artificial intelligence-powered wastewater surveillance for proactive mpox outbreak prediction

In the wake of the largest‐ever recorded outbreak of mpox in terms of magnitude and geographical spread in human history since May 2022,we innovatively developed an automated online sewage virus enrichment and concentration robot for disease tracking.Coupled with an artificial intelligence(AI)model,our research aims to estimate mpox cases based on the concentration of the monkeypox virus(MPXV)in wastewater.Our research has revealed a compelling link between the levels of MPXV in wastewater and the number of clinically confirmed mpox infections,a finding that is reinforced by the ability of our AI prediction model to forecast cases with remarkable precision,capturing 87%of the data’s variability.However,it is worth noting that this high precision in predictions may be related to the relatively high frequency of data acquisition and the relatively non‐mobile isolated environment of the hospital itself.In conclusion,this study represents a significant step forward in our ability to track and respond to mpox outbreaks.It has the potential to revolutionize public health surveillance by utilizing innovative technologies for disease surveillance and prediction。

Mpox reinfection:A rapid systematic review of case reports

Background:Mpox re-emerged worldwide with the multi-country outbreaks that occurred in May 2022,threat-ening the public health of human beings.Methods:This rapid systematic review summarized mpox reinfection cases documented.Electronic databases(PubMed,MedRxiv,and Social Science Research Network)were searched without time limitation,using the key-words“mpox,”“monkeypox,”&“reinfection,”“reoccur,”“reoccurrence,”“episode,”and“relapse”.All laboratory-confirmed cases of mpox reinfection published in the literature were included in this study.Results:A total of seven publications(nine cases)from Africa,Europe,and South America were included.All mpox reinfection cases were male,with a median age of 36;88.89%of cases had unprotected sexual behaviors with other males before each illness episode.The average onset interval between the two episodes was about 4 months.Perianal lesions and lymphadenopathy were major symptoms in both episodes,and no differences in clinical severity were reported between the two episodes.The mean duration of the two episodes was approximately 22 days and 13 days,respectively;which the mean duration of the second episode was shorter than the first infection(t=2.17,p=0.0487).Sexually transmitted infections were commonly concurrent among most cases,accounting for 55.6%and 77.8%in the two episodes,respectively.Full vaccination against mpox was rare among reinfection cases.Conclusion:A second infection is possible even in a short period.Reinforcing monitoring,reducing high-risk behaviors,and heightening health education regarding mpox for high-risk populations are crucial to limit mpox spread,including persons with a history of mpox infection.

The first laboratory-confirmed neonatal Mpox infection in Sri Lanka

In 2022-2023,a global outbreak of Mpox was reported especially in nonendemic countries.We report the first laboratory-confirmed neonatal case of Mpox infection complicated by bronchopneumonia in Sri Lanka.

The first local case of mpox caused by an imported case in the Chinese mainland

Monkeypox (mpox) is a zoonotic disease caused by the mpox virus (MPXV) that has been primarily limited to Central and West African nations since its discovery. The recent spread of the West African lineage of MPXV in historically unaffected countries has raised concerns for global public health. Despite a significant decrease in global mpox cases, there is still a risk of a global resurgence. This study reports the first local case of mpox caused by an imported case in the Chinese mainland. Polymerase chain reaction (PCR) diagnosed the two cases, and the viral genomes were obtained by next-generation sequencing. Genomic analysis revealed that the two strains shared an identical genome sequence and belonged to the B.1.3 branch of the West African lineage, which is the first local case of mpox caused by an imported case in the Chinese mainland, highlighting the potential threat of mpox in China and the immediate need for adequate surveillance measures.

Epidemiology and characteristics of identified early mpox cases in Guangdong Province,China:Implications for prevention and control

In June 2023,the 2022 global mpox(monkeypox)outbreak began to affect Guangdong Province,one of the first regions in China's Mainland to report mpox cases.By July 10,2023,93 mpox cases had been reported in Guangdong Province.This study describes the epidemiological characteristics of these patients by collecting and analyzing data on demographics,sexual behavior,medical history,travel history,clinical symptoms,and diagnostic pathways and processes.The 93 mpox cases were all men aged 20-48 years,95.70%were men who have sex with men(MSM),and 48.39%were HIV-positive.A few cases were married(to women)or living with children.The rash was present in almost all cases(98.91%),with the most common sites being the genital and perianal areas(70.33%).Intimate sexual contact was suspected to be the main route of infection,with a median incubation period of 8.5 days(IQR 5.0–11.8).The number of cases increased rapidly,and most patients had no history of international travel,suggesting sustained community transmission within the MSM population in Guangdong Province.In addition,93.55%of cases were detected by medical institutions,and more than half of these patients had two or more hospital visits before being diagnosed as an mpox case,indicating that clinicians need further training to increase their sensitivity to mpox.Targeted interventions should prioritize MSM while remaining vigilant for transmission to other populations,such as women and children.

Animal models of mpox virus infection and disease

Mpox(monkeypox)virus(MPXV),which causes a mild smallpox-like disease,has been endemic in Africa for several decades,with sporadic cases occurring in other parts of the world.However,the most recent outbreak of mpox mainly among men that have sex with men has affected several continents,posing serious global public health concerns.The infections exhibit a wide spectrum of clinical presentation,ranging from asymptomatic infection to mild,severe disease,especially in immunocompromised individuals,young children,and pregnant women.Some therapeutics and vaccines developed for smallpox have partial protective and therapeutic effects against MPXV historic isolates in animal models.However,the continued evolution of MPXV has produced multi-ple lineages,leading to significant gaps in the knowledge of their pathogenesis that constrain the development of targeted antiviral therapies and vaccines.MPXV infections in various animal models have provided a central plat-form for identification and comparison of diseased pathogenesis between the contemporary and historic isolates.In this review,we discuss the susceptibility of various animals to MPXV,and describe the key pathologic features of rodent,rabbit and nonhuman primate models.We also provide application examples of animal models in elu-cidating viral pathogenesis and evaluating effectiveness of vaccine and antiviral drugs.These animal models are essential to understand the biology of MPXV contemporary isolates and to rapidly test potential countermeasures.Finally,we list some remaining scientific questions of MPXV that can be resolved by animal models.

The important role of skin biopsies in the diagnosis of mpox

Human monkeypox(mpox)is an emerging zoonosis endemic in several Central and West African countries[1].There are two known clades of mpox virus—one that originated in Central Africa(Clade I)and one that originated in West Africa(Clade II).However,cases of mpox have been reported from countries where the disease is not endemic,especially during the 2003 outbreak in the U.S.[2]and the 2022 global outbreak[3,4].The mpox virus in the 2003 U.S.outbreak was transmitted from imported African rodents to domestic North American prairie dogs and subsequently to humans in contact with infected animals[5].No evidence of human‐to‐human transmission was identified,and most of the human cases presented with scattered skin lesions.The transmission route of the 2022 global outbreak,on the contrary,was mainly through intimate human‐to‐human contact,and many cases showed abundant skin lesions with mucosal involvement[6–8].

HIV阳性与HIV阴性猴痘患者临床特征分析

目的分析人HIV阳性与HIV阴性猴痘患者的临床和影像特征,为临床诊疗提供参考。方法回顾性分析2023年6月1日至11月30日首都医科大学附属北京佑安医院收治住院的36例确诊猴痘患者的临床和影像资料,按照是否合并HIV感染分为HIV阳性组和HIV阴性组。观察比较两组人群临床和影像特征。结果36例猴痘患者均为男性且为男男性行为者(men who have sex with men,MSM),平均年龄(31.5±6.4)岁;HIV阳性组28例,HIV阴性组8例。主要表现为皮疹、发热、淋巴结肿大。皮疹的首发部位(24例,66.7%)和最主要的分布部位(30例,83.3%)均为生殖器和肛门,以丘疹和脓疱疹为主。合并其他性传播性疾病14例(38.9%,14/36);合并细菌感染21例(58.3%,21/36),主要为皮肤软组织感染和肛周感染。影像检查结果异常者均为HIV阳性组患者。4例(11.1%,4/36)肺炎CT表现以磨玻璃影、实变、多发结节为主;2例并发肠梗阻,影像表现以胃肠道扩张为主,2例直肠炎表现为直肠壁增厚,肠腔狭窄。两组患者的流行病学资料、临床特征、皮疹分布及性质和实验室检查结果比较差异均无统计学意义(P>0.05)。结论36例猴痘患者以青壮年MSM人群为主,且多为HIV感染者;生殖器和肛周是皮疹首发和最多发部位,溃疡样皮疹仅见于HIV感染者;轻症患者预后良好,重症患者可合并细菌性感染、肠梗阻和直肠炎。并发肺炎者CT主要表现为实变和磨玻璃影,并可见两肺多发、随机分布的实性结节。

长春市18例猴痘病例流行病学调查情况

目的研究长春市猴痘病例的临床及流行病学基本特征,为今后的猴痘疫情防控工作提供参考。方法选取长春市医疗机构发现的18例猴痘病例开展流行病学调查,分析病例的三间分布、高危暴露特点、就诊情况及临床表现,并采集病例咽拭子、痘疱液擦拭物标本进行核酸检测。结果病例多为未婚青年男性、男男性行为人群(MSM);疾病通过同性接触的人传人方式传播,感染来源为非固定性伴,暴露地点较为隐匿,潜伏期平均值为9.06 d;病例发现方式以主动就诊和密切接触者排查为主;首发症状以发热和皮疹为主,分别为38.89%(7/18)和50%(9/18);所有病例均出疹,部位涉及全身,无特殊顺序;发病到确诊的时间平均为5.88 d;病例多为HIV感染者,为50%(6/12)。结论猴痘疫情在MSM人群中流行,通过男男性接触经人传人方式传播;症状上一般为发热、皮疹、腹股沟淋巴结肿大,多数患者发病后能及时就医,部分患者初次就医难以确诊,导致病例无法及时发现并管控,疫情调查处置存在一定难度。

猴痘临床特征的早期识别及其对疫情防控的意义

近日,猴痘病毒(MPXV)新出现的亚分支Ⅰb引发了新一轮猴痘(Mpox)疫情。2024-08-14,Mpox再次被WHO列为国际关注的突发公共卫生事件(PHEIC)。Mpox病例的早发现、早诊断是阻断其在医院内传播的关键。本文将从Mpox的病原学特征、流行病学特征、临床特征、诊断标准、防控措施等方面进行综述,以期为Mpox的早期识别和科学防控提供参考。