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.

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.

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.

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.

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.

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].

“国际公共卫生紧急事件”下的mRNA疫苗研发

“国际公共卫生紧急事件”(简称PHEIC)是指疾病的国际传播对其他国家构成公共卫生风险,需要采取协调一致的国际应对措施的不同寻常事件。迄今为止,世界卫生组织(WHO)一共宣布了7次PHEIC,包括甲型H1N1流感、埃博拉、脊髓灰质炎、寨卡、新型冠状病毒感染和猴痘疫情。疫苗是应对传染病疫情的有力武器,合成生物学的发展突破了传统疫苗存在的难点问题和技术瓶颈,为病毒性传染病防控提供了全新的思路,尤其是mRNA疫苗作为下一代疫苗研发的平台技术,具有安全性强、有效性良好、研发周期短、易规模化生产、易扩大产能等特点,在应对新突发传染病疫情方面具有明显的优势。目前,新冠mRNA疫苗已正式获批上市,针对流感、寨卡和猴痘病毒的多款mRNA疫苗已进入临床研究阶段,埃博拉mRNA疫苗处于临床前研究阶段,而针对脊髓灰质炎病毒尚无mRNA疫苗研究的报道。本文就历次PHEIC应对中mRNA疫苗的研发进展进行了详细梳理和评述,同时对mRNA疫苗应对PHEIC的未来发展趋势和挑战进行了展望和讨论。结合合成生物学、生物化学和人工智能等多学科技术对mRNA分子设计、高效递送以及疫苗生产和储存运输等进行优化,有望进一步提高mRNA疫苗的有效性和可及性。综上,尽管尚无法预知下一次PHEIC何时会出现,但当下一次PHEIC出现时,mRNA疫苗技术一定会成为人类防范PHEIC的有力武器。

实时荧光定量PCR检测猴痘病毒的方法研究

目的建立猴痘病毒(mpox virus)的实时荧光定量PCR(RT-PCR)检测方法。方法以猴痘病毒F3L基因为靶序列,设计特异性引物和探针,建立猴痘病毒RT-PCR检测方法,并对方法的灵敏度、特异性和重复性进行检测;对疑似猴痘阳性的人脓拭子临床样本核酸进行检测,对RT-PCR方法检测临床样本能力进行评价。结果本研究建立的RT-PCR检测方法可实现猴痘病毒的特异性检测,与天花、痘苗、牛痘等其他正痘病毒无交叉反应,检测重复性好,最低检测限为103copies/μL。可以对人皮肤拭子样本中的猴痘病毒进行准确检测。结论本研究建立了猴痘病毒的RT-PCR检测方法,可在临床样本中快速、特异、灵敏的检测猴痘病毒。

猴痘的流行特点与防控对策

猴痘是由猴痘病毒引起的一种人兽共患病,传统流行于非洲中部和西部的热带雨林地区。2022年5月英国报告首例猴痘确诊病例,触发了全球2022—2023年猴痘疫情危机。此次疫情,是自1958年发现和鉴定猴痘病毒以来,世界上规模最大、传播最广的猴痘疫情,主要在非传统流行国家传播。WHO于2022年7月宣布此次猴痘疫情危机为国际关注的突发公共卫生事件。根据WHO报告,2022年1月至2024年2月,有117个国家或地区报告了94 707例确诊病例和662例可能病例,死亡181例。中国共报告猴痘确诊病例2 031例,其中中国内地1 611例,中国香港83例,中国台湾335例,中国澳门2例,死亡1例(中国台湾)。此次疫情最大的特点是非传统流行的美洲地区和欧洲地区病例占比达到93.10%。全球报告病例中96.4%为男性,其中18~44岁的男性占病例的79.4%。男同性恋者占比达85.4%。虽然此次全球大流行疫情已基本消退,但非传统流行地区可能无法回复到以前的发病水平,疫情复燃的不确定性和远距离传播的危险仍然存在,防控形势依然严峻。文章阐述了猴痘的病原学、临床学和流行病学特征,分析了世界和中国猴痘疫情情况和特点,探讨了中国应对猴痘的防控对策。

猴痘抗病毒药物及疫苗研究现状

猴痘(Mpox)是一种由猴痘病毒(MPXV)感染引起的疾病,目前国际上没有针对猴痘病毒的特异性治疗药物,应用的抗病毒药物及疫苗既往主要用于治疗和预防天花等正痘病毒属相关疾病,抗病毒药物主要包括特考韦瑞、西多福韦、布林西多福韦等;疫苗主要使用ACAM2000、MVA-BN、LC16等,能够较好治疗和预防猴痘疾病的发生与发展。在无特效药物且无更有效、更安全疫苗的前提下,这些药物与疫苗可在早期治疗及预防中应用,以缓解猴痘病毒带来的临床症状,降低重症率和死亡率。本文从作用机制、临床试验、安全性等方面对抗病毒药物及疫苗进行论述,以期为我国猴痘的治疗和预防提供参考。

猴痘病毒B.1谱系遗传分支、毒力基因及蛋白功能

2022年以来,猴痘疫情在全球暴发和流行。相较以往的猴痘病毒,2022年流行的猴痘毒株传播能力和宿主适应性等明显增强,猴痘B.1谱系毒株已成为全球猴痘疫情流行的主要毒株。为此,本文对猴痘病毒B.1谱系遗传分支、毒力基因及蛋白功能进行综述,并就部分基因产物的蛋白功能进行了注释,以期为猴痘疫情的科学防控提供参考。

基于数据挖掘的藏医药治疗痘疫用药规律研究

目的:研究藏医药治疗痘疫疾病的用药规律,为临床用药及成药研发提供参考。方法:在《藏医药经典文献集成》等藏医古籍中寻找用于治疗痘疫的方剂,建立组方数据库。采用R语言和Excel进行药性药味、三化味、五源、归经、使用频次、剂量,对高频药物进行关联规则分析、聚类分析。结果:共纳入452首方剂,共183味药物,累计频次4102次,其中,使用频次≥100的有11味,分别是麝香、露蕊乌头、天竺黄、藏红花、穆库尔没药、诃子、牛黄、檀香、硬石膏、瘤状硅灰石、肉豆蔻,均以清热解毒、排黄水为主;相关药物的药性以凉性最多,其次是温性、平性;五源以水性最多,其次是风性、土性;主入胆经、肝经、胃经、大肠;药味以甘、苦为主;三化味中苦化味居多;以及麝香、牛黄的最小剂量与2020年版《中华人民共和国药典》一致,诃子、天竺黄、藏红花、檀香、肉豆蔻等的剂量与《中华人民共和国卫生部药品标准-藏药》一致。关联规则分析获得14个组合,以牛黄、藏红花、天竺黄、麝香、穆库尔没药、露蕊乌头为主,均有清热解毒、抗炎、提高机体免疫力、排黄水等作用。聚类分析得到7类证型组方。结论:该研究可为临床防治和研究痘疫疾病提供理论依据和数据参考。

重庆口岸2例输入性猴痘病例处置

目的 回顾重庆口岸两例输入性猴痘确诊病例的发病过程、流行病学特征和疫情处置过程,为今后口岸猴痘等疫情防控提供参考依据。结论 对病例开展现场流行病学调查。采集病例的口咽拭子、鼻咽拭子和疱疹液等标本,应用实时荧光定量多聚核苷酸链式反应方法对标本进行猴痘病毒核酸检测。结论 病例1于2022年9月3日在欧洲某国发生一次高风险男男性行为,9月9日出现上呼吸道症状,11日发现皮疹,9月14日回国后,主动向隔离点医生报告相关症状,其口咽拭子等样本均为猴痘病毒阳性,16日确诊为猴痘病例,基因测序结果显示,病例感染的猴痘病毒属西非系B.1分支;病例2于2023年9月9日从泰国入境,在重庆江北机场海关抽检样本检测中被发现,自述8月初有过发热史,8月12日大腿内侧出现斑丘疹,很快结痂痊愈,无其他临床症状。根据患者的临床表现、流行病学史、实验室检测结果,确诊为猴痘病例。结论 综合流行病学调查和实验室结果,口岸仍存在猴痘病毒输入的风险,需加强口岸卫生检疫工作,防止猴痘病例输入。

中国内地报告首起本地感染猴痘疫情的调查处置

目的 描述中国内地报告首起本土猴痘疫情处置过程及防控措施,探讨其中的经验和教训,以期对今后猴痘疫情处置有所启示。方法 依据《猴痘防控技术指南(2022年版)》(以下简称指南)对疫情开展流行病学调查、溯源和密切接触者排查管理。结果 此次疫情是我国内地报告首起本地猴痘疫情。指示病例由北京市疾病预防控制中心及中国疾病预防控制中心的实验室确证,同时由北京市卫生健康委员会组织专家会诊后确诊病例。通过对指示病例详细的流行病学和行程轨迹、支付记录等大数据搜索,溯源成功,并判定密切接触者5人,其中高危性伴2人,医务人员3人(接诊指示病例);一般接触者4人,为指示病例的同办公室同事。对密切接触者开展21 d医学观察,期间第0、7、14、21天进行咽拭子样本检测;一般接触者进行21 d健康监测。结论 本起疫情参照新型冠状感染疫情处置模式,在疾控和多个部门配合下溯源成功并追踪管理密切接触者,并依据指南对病例进行强制隔离治疗及医学观察,我国内地报告的首起猴痘疫情得到有效控制。

猴痘病毒的感染与猴痘的动物模型

猴痘是猴痘病毒(monkeypox virus,MPXV)感染引起的传染性疾病。猴痘病毒的宿主依然没有完全明确,啮齿类与非人灵长类动物被认为是潜在的宿主。猴痘正在全世界范围内逐渐扩散,但我国一直以来并未开展猴痘的动物模型的研究。作为一种严重危害人类健康的病原体,猴痘病毒有多种感染类型;其在人群中的传播呈现新的特点。因此本文论述了猴痘病毒发现的经过与早期疫情、不同的感染类型和共感染。此外,本文还介绍了啮齿类和非人灵长类动物的实验性感染与猴痘动物模型。

中山市1例本地猴痘确诊病例的流行病学调查

目的针对中山市报告的1例本地猴痘病例开展流行病学调查,分析其传播链,探讨猴痘病毒的传染期特征。方法按照《猴痘防控技术指南(2022版)》要求开展病例的流行病学调查和采样检测。结果病例于7月1日出现发热;7月2日起先后在手掌、脚底、肛周、生殖器、躯干等部位出现皮疹,伴明显疼痛感;7月12日其咽拭子和皮疹表面涂抹样本检测结果均为猴痘病毒核酸阳性,被诊断报告为猴痘确诊病例。病例于6月23日在B市、6月30日在A市发生男男性行为。6月30日A市的3名性伴分别在7月6日、7月8日出现猴痘相关症状,并均被诊断为猴痘确诊病例。病例的同住人无不适,猴痘病毒核酸检测结果为阴性。结论病例在6月23日发生暴露,7月1日发病,从暴露到发病间隔9 d。病例发病前1 d通过男男性行为传播病毒致性伴发病。日常生活接触传播风险低。