The 2022 outbreak and the pathobiology of the monkeypox virus

Mpox: Global epidemic situation and countermeasures

Mpox, is a zoonotic disease caused by the monkeypox virus and is primarily endemic to Africa. As countries gradually stop smallpox vaccination, resistance to the smallpox virus is declining, increasing the risk of infection with mpox and other viruses. On 14 August 2024, the World Health Organization announced that the spread of mpox constituted a public health emergency of international concern. Mpox's transmission routes and symptoms are complex and pose new challenges to global health. Several vaccines (such as ACAM2000, JYNNEOS, LC16m8, and genetically engineered vaccines) and antiviral drugs (such as tecovirimat, brincidofovir, cidofovir, and varicella immunoglobulin intravenous injection) have been developed and marketed to prevent and control this disease. This review aims to introduce the epidemic situation, epidemiological characteristics, physiological and pathological characteristics, and preventive measures for mpox in detail, to provide a scientific basis for the prevention and control of mpox viruses worldwide.

A Pathogen-Mimicking Monkeypox Virus Nanovaccine Inspired by Assembly of Viral Antigens with β-Glucan and Dendrimer

Monkeypox (mpox) is a zoonotic viral disease transmitted by the monkeypox virus (MPXV). Viral protein-based nanovaccines hold promise in preventing the infection of MPXV. MPXV-derived antigens (A29L, A35R, and M1R) were capable of eliciting protective immunity and suffered from low immunogenicity. Adjuvants and delivery systems were critical to improving the immunogenicity of antigens. In this study, a pathogen-mimicking nanovaccine was developed by conjugation of poly(amidoamine) (PAMAM) dendrimers with deoxycholic acid to form cationic nanoparticles as a delivery platform. The three antigens were individually conjugated with carboxylated β-glucan, a polysaccharide adjuvant, and subsequently self-assembled onto dendrimer nanoparticles via electrostatic interactions. The resulting nanovaccine induced robust antigen-specific antibody production, stimulated splenic levels of Th1- and Th2-type cytokines, and enhanced secretion of IFN-γ and IL-4 by CD4+ and CD8+ T cells. Additionally, it promoted the maturation of dendritic cells, activated T and B cells, and enhanced cytotoxic T cell activity. Notably, the vaccine stimulated the formation of B and T memory cells, providing long-term immune protection. Crucially, the vaccine conferred cross-protection against the lethal ectromelia virus (ECTV) challenge in mice while exhibiting no significant organ toxicity. These findings suggest that the vaccine is a promising candidate to deal with life-threatening mpox infections.

Development and validation of Mpox healthcare seeking barriers scale for MSM based on a multicenter study in China

China is one of the ten countries most severely affected by the monkeypox outbreak. Over 90% of Mpox cases are MSM, primarily identified through proactive healthcare visits. Mpox medical visit worries are barriers to MSM proactively seeking medical assistance. However, there are currently no tools available to measure the barriers of MSM regarding seeking medical care for Mpox. A total of 2347 MSM were recruited for this study from six cities in China. Factor analysis was used to explore and validate the factor structure of the 14-item MMHSBS, which utilizes a 5-point Likert scale. The model's structural validity was evaluated and compared using GFI, NFI, RFI, IFI, TLI, CFI, SRMR and RMSEA. Split-half reliability, Cronbach's α, and McDonald's ω were used to assess the reliability of MMHSBS. The three-factor structure model of MMHSBS performed best, comprising medical distrust, perceived costs, and interpersonal damage. The indices were as follows: GFI = 0.937, NFI = 0.926, RFI = 0.952, IFI = 0.967, TLI = 0.959, CFI = 0.967, SRMR = 0.046, RMSEA = 0.073. Split-half reliability was 0.844, Cronbach's α was 0.949, and McDonald's ω was 0.950. The three-factor structure of the MMHSBS demonstrated good reliability and validity among Chinese MSM. Chinese men who have sex with men face relatively strong barriers to seeking healthcare for Mpox, with the most prominent barrier being the impact on their personal social image.

Development of an ARMS-Quadruplex-qPCR assay for the rapid identification of MPXV and the clades Ia, Ib, IIa and IIb

Monkeypox was re-emerging in 2022 and spread to more than 100 countries. Two clades of Monkeypox virus (MPXV) result in different lethality rates and varying transmission capabilities. Rapid identification of MPXV and differentiation of its clades and subclades are crucial for effective control of the disease. In this study, we developed an ARMS-Quadruplex-qPCR method to detect MPXV and distinguish clades (Ia, Ib, IIa and IIb). F3L gene was used to detect all clades of MPXV from other orthopoxviruses. A 1953 bp fragment containing the C3L gene was found to be completely absent in clade II. Additionally, a sequence spanning from the 177th to the 1318th position (1142 bp) within the 1953 bp fragment was missing in Ib. Therefore, the 1142 bp sequence was used to distinguish Ia from other subclades, and the sequence with the 1142 bp region missing in Ib was used to discriminate Ib from other subclades. Since subclades IIa and IIb are too close to have large deletions and insertions, a unique single nucleotide polymorphism (SNP) was used to design a primer/probe set for ARMS-qPCR to differentiate clade IIa from IIb. The ARMS-Quadruplex-qPCR system can detect down to 2 copies per reaction of MPXV and effectively differentiate all the four subclades. Altogether, four qPCR primer/probe sets in one tube were deployed to recognize MPXV and differentiate MPXV subclades. The high sensitivity, rapidity and specificity of the developed system make it a promising alternative for the diagnosis of MPXV and the determination of the subclades of the infected MPXV.

Advancing the understanding and management of Mpox: insights into epidemiology, disease pathways, prevention, and therapeutic strategies

Mpox, previously known as monkeypox, is a zoonotic viral disease caused by the Mpox virus (MPXV), a member of the Orthopoxvirus genus. This disease is of significant concern due to its zoonotic transmission, which can be challenging to control, its ability to spread easily from person to person, the potential for severe symptoms or even fatality, and its history of frequent global outbreaks. Despite the growing threat, there is still limited research on the pathophysiology of the disease and available disease-modifying treatments. To address this gap, the latest developments in Mpox epidemiology, viral variant detection, and advanced diagnostic tools for accurate MPXV detection have been reviewed. Ongoing preventive measures, including vaccination strategies, have also been examined. Additionally, the genomic and proteomic characteristics of MPXV have been explored, and network and pathway enrichment analyses have been performed to identify potential therapeutic targets. The findings presented in this manuscript suggest the potential for novel disease-modifying treatments. Moreover, emerging technologies, such as artificial intelligence and "big data," are playing a crucial role in advancing disease management and enhancing prevention strategies. This review emphasizes the evolving understanding of Mpox and MPXV variants and underscores the importance of continued research and public health initiatives to combat the disease and prevent future global outbreaks.

Comparative bibliometric analysis of highly cited monkeypox research in general and specialized infectious disease journals: Dissecting trends, collaborations, and impact

This study employs bibliometric methods to analyze global publication trends in monkeypox (MPX) research from 2022 to 2024. Using the Web of Science Core Collection database, we identified the top 100 cited articles from all journals and infectious disease specialty journals. The United States and the United Kingdom were the most productive countries, with significant contributions from African nations like Nigeria. Key institutions included the Centers for Disease Control and Prevention (CDC) and the University of London. Research focused on virus transmission, clinical manifestations, and treatments, especially vaccines and antiviral strategies after MPX was declared a Public Health Emergency of International Concern (PHEIC). Our findings offer micro-level insights into biological mechanisms and targeted therapies, as well as macro-level perspectives on international collaboration and policy impact. These results are essential for guiding future diagnostic, therapeutic, and preventive strategies.

An epidemiological model of monkeypox: model prediction and control application

BACKGROUND

Monkeypox (Mpox) is an  emerging infectious disease caused by the Mpox virus (MPX Virus). The outbreak of Mpox epidemic has caused global panic and is now a public health incident. Various approaches have been proposed in the recent literature to study and analyze the epidemiological dynamics of this infection and effective prevention and control measures. Using mathematical model to understand the transmission dynamics and control strategy is a useful way to understand the prevention of Mpox.

METHODS

A new compartment model is established to examine the effectiveness of vaccine on Mpox based on previous studies. Nonlinear least squares fitting is used for model's parameter estimation. The impact of a series of preventive and control measures on the epidemic control is explored with optimal control theory in conjunction with the official data released by the authorities.

RESULTS

Firstly, a stability analysis of the developed model was carried out to show that, under certain circumstances, its equilibrium is both locally and globally stable. Secondly, based on the reported cases of Mpox infection in the United States between 2022 and 2023, the model's optimal parameter values were obtained. A sensitivity analysis of the model parameters was then conducted to identify the key parameters that affect the development of Mpox epidemics in the United States. Lastly, the comparison of control effects under various control strategies showed that implementing the all suggested four control measures at the same time was the most effective way to curb the development of monkeypox epidemic in the United States.

CONCLUSIONS

This study has theoretical significance for understanding and controlling Mpox virus transmission.

Differential susceptibility of immunodeficient mice to MPXV infection and the impact of various inoculation routes

Monkeypox virus (MPXV), a member of the Orthopoxvirus genus, caused a large-scale global outbreak in 2022. Developing mouse models for MPXV infection is crucial for advancing research on vaccines and therapeutic interventions. To address this, we conducted a comparative study on the susceptibility of six mouse strains-severe combined immune-deficiency (SCID), nude, genetically diabetic (db/db) and obese (ob/ob), C57BL/6J, and BALB/c-to MPXV infection. Mouse strains were infected with MPXV via intranasal inoculation, and body weight changes and mortality were monitored post-infection. Additionally, the tissue distribution of MPXV and the pathological changes in the lung tissues of the infected mice were evaluated. The results demonstrated that SCID and nude mice exhibited significant weight loss following MPXV infection, with 100 ​% mortality observed in SCID mice, while no mortality occurred in nude mice. In contrast, the other mouse strains showed no significant weight loss or mortality. Notably, the viral load in the lung tissues of SCID and nude mice was the highest among the tested strains. Furthermore, we investigated the impact of different inoculation routes-intranasal (I.N.), intraperitoneal (I.P.), and intravenous (I.V.)-on the pathogenicity of MPXV in mice. The results revealed that the intravenous route induced more pronounced pathogenic effects compared to the intranasal and intraperitoneal routes. In summary, this study provides valuable insights into the development of MPXV-infected mouse models, offering a foundation for further research on MPXV pathogenesis and therapeutic drug development.

Understanding the resurgence of mpox: key drivers and lessons from recent outbreaks in Africa

Mpox has re-emerged as a significant public health threat, particularly in Africa. This study explores the key drivers behind the recent resurgence, focusing on epidemiological trends, transmission dynamics, and lessons learned from recent outbreaks. The research involved a comprehensive review of recent mpox outbreaks, analyzing factors, such as socio-economic conditions, environmental influences, and genetic evolution. Findings indicate that the resurgence is linked to the cessation of smallpox vaccination, increased human-wildlife interactions, and rapid urbanization in endemic regions. The virus, which was previously confined to rural areas, has now spread to urban populations, and crossed national borders, driven by high population mobility and socio-economic instability. A notable shift in transmission dynamics has been observed, with increased human-to-human transmission, particularly among men who have sex with men (MSM), contributing to more severe and widespread outbreaks. The study highlights the urgent need to strengthen health systems in Africa, particularly in the areas of diagnostics, surveillance, and public health preparedness. Challenges such as inadequate laboratory infrastructure and delayed response mechanisms have exposed vulnerabilities in current public health frameworks. To prevent future outbreaks, targeted strategies must be implemented, including enhanced community engagement, improved access to vaccines and treatments, and timely, accurate reporting of cases. Coordinated global action is essential to prevent mpox from becoming a more persistent and widespread public health threat. This research discusses the importance of proactive measures and international cooperation in addressing the ongoing threat posed by mpox, particularly in regions with limited healthcare resources.

Mpox primer for clinicians: what makes the difference in 2024?

PURPOSE OF REVIEW

The 2024 mpox outbreak, primarily driven by the possibly more virulent clade Ib strain, prompted the WHO declaring it a public health emergency of international concern (PHEIC) on August 14, 2024. This review provides essential guidance for clinicians managing mpox cases, as it contrasts the features of the 2024 outbreak with those of the 2022 epidemic to support better clinical decision-making.

RECENT FINDINGS

The review highlights significant differences between the 2024 and 2022 outbreaks, including total case numbers, demographic distribution, and fatality rates. It also examines the increased severity associated with clade Ib. The article reviews the differential diagnosis of mpox, diagnostic tools, updates on Tecovirimat treatment, and infection control practices, particularly among healthcare workers. Vaccination strategies, including the role of smallpox vaccines and at-risk groups, are also discussed, along with recommendations for countries outside Africa.

SUMMARY

The findings underscore the importance of early diagnosis and appropriate treatment for mpox in light of the 2024 outbreak's unique characteristics. Clinicians are advised to stay informed about updated diagnostic and therapeutic strategies, including vaccine recommendations, to mitigate the spread of the disease.

Knowledge, Perceptions, and Attitudes of Israeli Healthcare Professionals Toward Mpox: A Survey-Based, Cross-Sectional Study

Background: Mpox, a zoonotic viral disease, has recently emerged as a significant global public health challenge. Historically confined to endemic regions in West and Central Africa, recent outbreaks in non-endemic areas have highlighted the critical role of healthcare professionals (HCPs) in disease management and prevention. Methods: This cross-sectional study surveyed 709 Israeli HCPs, with a mean age of 40.6 ± 9.4 years, to evaluate their knowledge, perceptions, and attitudes toward mpox and identify gaps to inform educational and public health strategies. Results: Findings revealed that only 38.9% of respondents demonstrated good knowledge about mpox, while 61.1% exhibited poor knowledge. Misconceptions were prevalent: 37.9% identified paracetamol as a management option, with only 31.0% recognizing the need for antivirals. Notably, 67.1% correctly identified mpox as a viral disease, yet only 47.2% were aware that lymphadenopathy is a distinguishing symptom. Multivariable analysis identified several predictors of good knowledge, including marital status, being a medical doctor (versus an allied health professional), work seniority, and previous exposure to mpox-related information. Attitudes varied, with 57.7% expressing confidence in the ability of global health authorities to control mpox, and 59.0% expressing confidence in the Israeli Ministry of Health. Interest in learning more about mpox and related topics was high, with 67.4% showing interest in the epidemiology of emerging diseases. Respondents with good knowledge consistently exhibited more positive attitudes and confidence in managing mpox-related challenges. Conclusions: These findings underscore the urgent need for targeted educational interventions to enhance HCPs' readiness and response capabilities. Strengthening professional training, incorporating emerging infectious diseases into curricula, and leveraging accurate media communication are critical steps toward improving preparedness for mpox and future outbreaks.

Vaccines and Antiviral Therapies for Mpox Virus in Pregnant and Breastfeeding Women: Efficacy and Maternal-Child Outcomes

Mpox (formerly known as monkeypox), the major public health concern of 2022, has elicited much attention globally. In addition to the usual symptoms observed in smallpox virus infections, infected mothers were found to hold a possible risk of transmission to newborns during delivery. This review aimed to summarize recent clinical trials that involved antiviral therapy, vaccines, immunoglobulin therapy, and other pharmacological interventions specifically for treating infected pregnant women. A comprehensive search was performed using databases such as PubMed, Google Scholar, and Medline to find appropriate disease management strategies. Amongst the vaccines and antivirals being used for treatment, vaccines such as Modified Vaccinia Ankara (MVA/MVA-BN) and Lister clone 16-medium pocket size-8 (LC16m8), while prophylactically effective, have been deemed unsafe for pregnant and lactating females. Antivirals like Tecovirimat, on the other hand, are considered to be a better alternative, but they are not without risks that may outweigh the potential benefits. Additionally, efforts to reduce maternal and fetal complications include administering the MVA-BN vaccine and awareness campaigns regarding herd immunity. Therefore, necessary precautions, prophylactic vaccinations in high-risk outbreak regions, and symptomatic treatment in pregnant and lactating females currently appear to be more feasible approaches against the mpox virus.

Drug repositioning as a promising approach for the eradication of emerging and re-emerging viral agents

The global impact of emerging and re-emerging viral agents during epidemics and pandemics leads to serious health and economic burdens. Among the major emerging or re-emerging viruses include SARS-CoV-2, Ebola virus (EBOV), Monkeypox virus (Mpox), Hepatitis viruses, Zika virus, Avian flu, Influenza virus, Chikungunya virus (CHIKV), Dengue fever virus (DENV), West Nile virus, Rhabdovirus, Sandfly fever virus, Crimean-Congo hemorrhagic fever (CCHF) virus, and Rift Valley fever virus (RVFV). A comprehensive literature search was performed to identify existing studies, clinical trials, and reviews that discuss drug repositioning strategies for the treatment of emerging and re-emerging viral infections using databases, such as PubMed, Scholar Google, Scopus, and Web of Science. By utilizing drug repositioning, pharmaceutical companies can take advantage of a cost-effective, accelerated, and effective strategy, which in turn leads to the discovery of innovative treatment options for patients. In light of antiviral drug resistance and the high costs of developing novel antivirals, drug repositioning holds great promise for more rapid substitution of approved drugs. Main repositioned drugs have included chloroquine, ivermectin, dexamethasone, Baricitinib, tocilizumab, Mab114 (Ebanga™), ZMapp (pharming), Artesunate, imiquimod, saquinavir, capmatinib, naldemedine, Trametinib, statins, celecoxib, naproxen, metformin, ruxolitinib, nitazoxanide, gemcitabine, Dorzolamide, Midodrine, Diltiazem, zinc acetate, suramin, 5-fluorouracil, quinine, minocycline, trifluoperazine, paracetamol, berbamine, Nifedipine, and chlorpromazine. This succinct review will delve into the topic of repositioned drugs that have been utilized to combat emerging and re-emerging viral pathogens.

In silico evidence of monkeypox F14 as a ligand for the human TLR1/2 dimer

Recent emergence of zoonotic monkeypox virus (Mpox) in human has triggered the virologists to develop plausible preventive measures. Hitherto, our understanding on the mechanism of immunopathogenesis of Mpox infection is elusive. However, available experimental evidences suggest induction of inflammation as the main cause of pathogenesis. Toll-like receptors (TLRs) are critical in initiating and modulating the host immune response to pathogens. Inflammatory responses observed in various poxvirus infections have, in fact, been shown to be mediated through TLR activation. Therefore, by in silico approaches, this study seeks to identify the Mpox antigen(s) (MAg) that are most likely to interact with human cell-surface TLRs. The Mpox proteomics data available in UniProt database contain 174 protein sequences, among which 105 immunoreactive proteins were modeled for 3D structure and examined for comparative protein-protein interactions with the TLRs through molecular docking and molecular dynamics simulation. F14, an 8.28 kDa infective protein of Mpox, was found to exhibit strong binding affinity (ΔG=-12.5 Kcal mol-1) to TLR1/2 dimer to form a compact thermodynamically stable protein complex. Interestingly, a significant level of conformational change was also observed in both F14 and TLR6 while forming F14-TLR1/2 complex. Based on these data we propose F14 as a putative ligand of human TLR1/2 to initiate proinflammatory signaling in the Mpox-infected host.

Global epidemiology, viral evolution, and public health responses: a systematic review on Mpox (1958-2024)

Background

Monkeypox (Mpox), a zoonotic viral disease caused by the Mpox virus (MPOXV), was first identified in 1958 and remained largely confined to Central and West Africa for decades. While it usually exhibited limited international transmission, recent outbreaks, including in the USA in 2003 and globally in 2024, highlight significant epidemiological shifts. We aimed to systematically evaluate the evolution of Mpox from 1958 to 2024, focussing on its epidemiology, viral evolution, and public health responses.

Methods

We conducted a systematic review using data from global health reports, surveillance databases, and published literature. The analysis covered key outbreaks, transmission patterns, geographic distribution, public health responses, and the roles of viral mutations and vaccination in disease management.

Results

The 2022 Mpox outbreak, declared a Public Health Emergency of International Concern by the World Health Organization (WHO), was characterised by an unprecedented international spread of the virus. By July 2024, a total of 102 997 confirmed cases and 223 deaths were reported across 121 countries. Two distinct viral clades were identified: Central African (clade I) and West African (clade II), with the latter being the primary agent of global transmission. Research on Mpox has highlighted the protective effects of smallpox vaccination and emerging risk factors such as human-animal interactions and international travel.

Conclusions

Mpox has evolved from a regionally contained zoonotic disease to a global public health challenge. Enhanced surveillance, international collaboration, and targeted interventions in non-endemic regions are critical for mitigating future outbreaks and managing ongoing epidemiological changes.

An overview of the progress made in research into the Mpox virus

Mpox is a zoonotic illness caused by the Mpox virus (MPXV), a member of the Orthopoxvirus family. Although a few cases have been reported outside Africa, it was originally regarded as an endemic disease limited to African countries. However, the Mpox outbreak of 2022 was remarkable in that the infection spread to more than 123 countries worldwide, causing thousands of infections and deaths. The ongoing Mpox outbreak has been declared as a public health emergency of international concern by the World Health Organization. For a better management and control of the epidemic, this review summarizes the research advances and important scientific findings on MPXV by reviewing the current literature on epidemiology, clinical characteristics, diagnostic methods, prevention and treatment measures, and animal models of MPXV. This review provides useful information to raise awareness about the transmission, symptoms, and protective measures of MPXV, serving as a theoretical guide for relevant institutions to control MPXV.

Local and global stability analysis of HIV/AIDS by using a nonstandard finite difference scheme

This study presents a mathematical model incorporating both asymptomatic and symptomatic HIV-infected individuals to analyze the dynamics of HIV/AIDS. This expanded model offers a more comprehensive understanding of the epidemic's spread. We calculate the basic reproduction number (R0) to quantify the virus's transmission potential. To achieve accurate and robust simulations, we introduce the Nonstandard Finite Difference Scheme (NSFD). Compared to traditional methods like RK-4, NSFD offers improved dynamical consistency and numerical precision, leading to enhanced stability and efficiency in simulating infectious diseases like HIV/AIDS. Local and global stability analysis are performed using the Routh-Hurwitz method. The NSFD method effectively captures the dynamics of HIV propagation under various scenarios, providing valuable insights into HIV/AIDS progression. We demonstrate the superiority of the NSFD approach compared to existing methods, paving the way for further research in modeling viral infections.

"Mpox in MSM: Tackling stigma, minimizing risk factors, exploring pathogenesis, and treatment approaches"

Mpox is a zoonotic disease caused by the monkeypox virus (MPV), primarily found in Central and West African countries. The typical presentation of the disease before the 2022 mpox outbreak includes a febrile prodrome 5-13 days post-exposure, accompanied by lymphadenopathy, malaise, headache, and muscle aches. Unexpectedly, during the 2022 outbreak, several cases of atypical presentations of the disease were reported, such as the absence of prodromal symptoms and the presence of genital skin lesions suggestive of sexual transmission. As per the World Health Organization (WHO), as of March 20, 2024, 94,707 cases of mpox were reported worldwide, resulting in 181 deaths (22 in African endemic regions and 159 in non-endemic countries). The United States Centers for Disease Control and Prevention (CDC) reports a total of 32,063 cases (33.85% of total cases globally), with 58 deaths (32.04% of global deaths) due to mpox. Person-to-person transmission of mpox can occur through respiratory droplets and sustained close contact. However, during the 2022 outbreak of mpox, a high incidence of anal and perianal lesions among MSMs indicated sexual transmission of MPV as a major route of transmission. Since MSMs are disproportionately at risk for HIV transmission. In this review, we discusses the risk factors, transmission patterns, pathogenesis, vaccine, and treatment options for mpox among MSM and people living with HIV (PLWH). Furthermore, we provide a brief perspective on the evolution of the MPV in immunocompromised people like PLWH.

Sinefungin analogs targeting VP39 methyltransferase as potential anti-monkeypox therapeutics: a multi-step computational approach

The increasing spread of the Monkeypox virus (MPXV) presents a significant public health challenge, emphasising the urgent requirement for effective treatments. Our study focuses on the VP39 Methyltransferase enzyme of MPXV as a critical target for therapy. By utilising virtual screening, we investigated natural compounds with structural similarities to sinefungin, a broad-acting MTase inhibitor. From an initial set of 177 compounds, we identified three promising compounds-CNP0346326, CNP0343532, and CNP008361, whose binding scores were notably close to that of sinefungin. These candidates bonded strongly to the VP39 enzyme, hinting at a notable potential to impede the virus. Our rigorous computational assays, including re-docking, extended molecular dynamics simulations, and energetics analyses, validate the robustness of these interactions. The data paint a promising picture of these natural compounds as front-runners in the ongoing race to develop MPXV therapeutics and set the stage for subsequent empirical trials to refine these discoveries into actionable medical interventions.

A structural snapshot of the multiple working states of the Mpox virus helicase-primase D5

The Mpox virus (or Monkeypox virus, MPXV) uses its own encoded proteins to form a replication machine that replicates the viral genome in the host cell cytoplasm, making this machinery a key target for antiviral drug design. The D5 (also known as the OPG117 or E5) protein, a bi-functional helicase-primase enzyme, is crucial in the MPXV replication machinery and genome uncoating process. Recently, cryo-electron microscopy (cryo-EM) structures of D5 in multiple states have been determined. These structures have elucidated the full trajectory of the MPXV D5 helicase-primase as it moves along single-stranded DNA, providing unprecedented advancements in the molecular dynamics and unwinding mechanism. This structural snapshot describes the structural features of the D5 protein and dissects the broader implications of its pivotal role in MPXV replication.

Monkeypox: A comprehensive review on mutation, transmission, pathophysiology, and therapeutics

Monkeypox virus (MPXV) is the causative agent of the monkeypox (Mpox) disease, belongs to the Orthopoxvirus genus of the Poxviridae family. Due to the recent re-emergence of Mpox in 2024, this is the second time when the World Health Organization (WHO) declared Mpox as a Public Health Emergency of International Concern (PHEIC). This review intends to offer an in-depth analysis of Mpox, including its key characteristics, epidemiological, mutation, pathophysiology, transmission, and therapeutics. The infection of MPXV is a lethal threat to children, pregnant women, and immunocompromised individuals. However, we can prevent the infection by proper precautions including hygiene practices and minimizing exposure to infected individuals or animals. Multivalent mRNA vaccines, antibody-based immunotherapy, and combination drug therapies have all shown significant effectiveness in treating Mpox infection. In addition to addressing antivirals and drug resistance, the review also explores potential targets for vaccine and drug development, as well as the use of animal models for studying MPXV. Because of multiple mutational events, Mpox began exhibiting drug resistance. Overall, this review will contribute significantly to advancing the development of new vaccines and drug options for combating emerging Mpox.

Dynamics of Mpox in an HIV endemic community: A mathematical modelling approach

During the 2022 monkeypox (Mpox) outbreak in non-endemic countries, sexual transmission was identified as the dominant mode of transmission, and particularly affected the community of men who have sex with men (MSM). This community experienced the highest incidence of Mpox cases, exacerbating the public health burden they already face due to the disproportionate impact of HIV. Given the simultaneous spread of HIV and Mpox within the MSM community, it is crucial to understand how these diseases interact. Specifically, since HIV is endemic within this population, understanding its influence on the spread and control of Mpox is essential. In this study, we analyze a mechanistic mathematical model of Mpox to explore the potential impact of HIV on the dynamics of Mpox within the MSM community. The model considered in this work incorporates the transmission dynamics of the two diseases, including antiretroviral therapy (ART) for HIV. We assumed that HIV was already endemic in the population at the onset of the Mpox outbreak. Through our analysis, we derived the Mpox invasion reproduction number within an HIV-endemic setting and established the existence and local asymptotic stability of the Mpox-free equilibrium under these conditions. Furthermore, we demonstrated the existence and local asymptotic stability of an Mpox-endemic equilibrium in an HIV-endemic regime. Notably, our findings revealed that the model exhibits a backward bifurcation, a phenomenon that may not have occurred in the absence of HIV within the population. The public health significance of our results is that the presence of HIV in the MSM community could hinder efforts to control Mpox, allowing the disease to become endemic even when its invasion reproduction number is below one. Additionally, we found that Mpox might be more challenging to control in scenarios where HIV increases susceptibility to Mpox. Finally, consistent with previous studies, our analysis confirms that reducing sexual contact can be effective for controlling the spread of Mpox within the MSM community.

Complete Genome Sequence Analysis of the First Imported Mpox Virus Clade Ib Variant in China

Mpox, a zoonotic disease caused by the mpox virus (MPXV), has seen a significant shift in its epidemiological status since 2022, evolving from an initial local outbreak to a global epidemic. This recent outbreak of MPXV mainly emerged in several European and American countries and subsequently spread to over 100 countries and regions worldwide. The rapid evolution of MPXV, coupled with increased international interactions, has led to a gradual rise in mpox cases in certain regions of Asia, mostly involving MPXV clade II and its branch strains. In contrast, the more pathogenic and clinically severe MPXV clade Ib has been relatively rare, with no reports in China to date. Here, we analyzed the whole gene sequence of imported MPXV clade Ib variant from the first infection case detected in China. Through whole genome sequencing, we successfully obtained a full-length MPXV genome of 195,405 base pairs (bp). Phylogenetic analysis revealed that the genetic sequence of the MPXV in this case was predominantly clustered with MPXV clade Ib sequences previously reported from multiple African and European countries. Compared with the MPXV clade Ib reference strain DQ011155.1, there are 127 nucleotide alterations and 57 amino acid mutations in the MPXV genome of this case. Given that the MPXV clade Ib has started to appear in China, we must pay more attention to the prevention of and control measures for the spread of mpox.

A new STI in the city: MPOX in Barcelona. First outbreak (5/2022-5/2023) and subsequent resurgence

BACKGROUND

In May 2022, after the suspension of the mobility restrictions due to the COVID-19 pandemic, the first outbreak of MPOX virus, transmitted from human to human, was detected outside of Africa, affecting mostly sexually active men who have sex with men. Our aim is to report the first outbreak of MPOX in Barcelona city in the period from 5/2022 to 5/2023 and the subsequent surge of cases in 8/2023.

METHODS

We performed a descriptive study of all notified cases in city residents, obtained through epidemiological surveys. The analyses are presented for the hospitalized cases and the key population of men who have sex with men.

RESULTS

Of 2037 notified cases, 82.6% were confirmed. The cumulative incidence in the general population was 1.03 (95%CI 1.00-1.06) per 1000 inhabitants and 2.13 (2.01-2.17) per 1000 in men. Men were older than women, with a median age of 37 years (interquartile range 31-43). While 84.5% of men reported having sex with partners of the same gender, 70.9% of women only reported sex with partners of the opposite gender. Complications occurred in 4.1% of infected persons, 1.6% required hospitalization, and no deaths were registered. Georeferencing was highly associated with gay venues. Gay, bisexual and other men who have sex with men (GBMSM) accounted for most cases and severe cases, and were associated with attending public sex venues and not providing contact tracing information. Digital and printed prevention campaign materials were developed for GBMSM.

DISCUSSION

The 2022 MPOX outbreak posed a major challenge to surveillance and sexual health services worldwide. With new cases and re-infections on the rise, MPOX may become a regular infection to be incorporated in STI testing and management guidelines. Barcelona has some characteristics that may facilitate the occurrence and spread of emergencies related to sexual health.

Monkeypox: a re-emergent virus with global health implications - a comprehensive review

Monkeypox virus (MPXV) is an enclosed, double-stranded DNA virus from the Orthopoxvirus genus, which also contains variola, vaccinia, and cowpox. MPXV, which was once confined to West and Central Africa, has recently had a rebound, spreading beyond its original range since 2017. The virus is distinguished by its unique morphology, which includes an oval or brick-shaped structure and a complex lipid and protein makeup. The current multi-country outbreak designated a public health emergency in 2022, has highlighted MPXV's shifting epidemiology and ability to spread rapidly over the globe. 'No one is safe until everyone is safe' is a slogan we often heard during the COVID-19 pandemic, which is now also required for the growing global and regional mpox outbreaks. The epidemic is divided into two clades: Clade I and Clade II, which have distinct pathogenic characteristics. Diagnostic approaches have developed with advances in molecular techniques, yet problems persist in resource-constrained situations. This overview summarizes the virus's history, epidemiology, morphology, and clinical characteristics, offering insights into its recent comeback and current global response efforts.

Mpox virus (MPXV): comprehensive analysis of pandemic risks, pathophysiology, treatments, and mRNA vaccine development

Mpox, formerly known as monkeypox, is a zoonotic disease caused by the Mpox virus (MPXV), which has recently attracted global attention due to its potential for widespread outbreaks. Initially identified in 1958, MPXV primarily spreads to humans through contact with infected wild animals, particularly rodents. Historically confined to Africa, the virus has expanded beyond endemic regions, with notable outbreaks in Europe and North America in 2022, especially among men who have sex with men (MSM). The World Health Organization (WHO) has declared the current Mpox outbreak a Public Health Emergency of International Concern. This review explores the epidemiology, pathophysiology, and clinical manifestations of MPXV, along with current treatment strategies and the role of mRNA vaccines. It emphasizes the importance of understanding the changing dynamics of Mpox transmission, which are influenced by factors such as waning immunity from smallpox vaccinations and increased global interconnectedness. The potential for developing multi-epitope vaccines that can stimulate robust immune responses is highlighted, showcasing how bioinformatics can facilitate the identification of immunogenic antigens. Continued research and investment in vaccine development are crucial to address the urgent need for effective candidates that can protect at-risk populations. In summary, this review underscores the necessity for proactive public health measures and collaborative efforts among healthcare authorities, researchers, and communities to mitigate the impact of Mpox and enhance global preparedness for future outbreaks.

Immunobiology of MPox Infection and Its Management: Experience From Developing Nations

PURPOSE

As humanity grapples with the COVID-19 pandemic caused by the novel SARS-CoV-2 virus, the rising threats of the MPox virus (MPXV) in 2022 and 2024 have shown signs of global transmission and the potential to spark another pandemic. Though MPXV has been present for over 5 decades, with cases traditionally confined to endemic regions in West and Central Africa, recent outbreaks have occurred in multiple non-endemic regions, declaring itself as a Public Health Emergency of International Concern. This study aims to examine the patterns of MPXV transmission, its zoonotic potential, associated complications, and viable strategies to control its spread.

METHODS

The study examines recent outbreak data, case reports, and literature on MPXV transmission, emphasising zoonotic pathways and healthcare-associated cases. A bibliometric analysis has also been performed to deepen the understanding and identify emerging research trends.

RESULTS

The findings suggest that while MPXV has traditionally been endemic in certain regions of Africa, recent outbreaks indicate an increased transmission risk in non-endemic countries, raising concerns about potential global spread. Data reveals that much of the transmission has occurred within healthcare settings. Additionally, global research on the outbreak remains limited and requires further exploration from various perspectives, emphasising the need for prompt intervention.

CONCLUSION

Containing MPXV's spread is essential to prevent another potential pandemic. Effective management and control strategies, including enhanced surveillance, public health interventions, and targeted education within at-risk communities, are critical to mitigate the spread and impact of MPXV globally. This study advocates for a proactive approach to MPXV control to avoid its escalation into a widespread health crisis.

Knowledge, concerns, and vaccine acceptance related to Mpox (Monkeypox) among university students in North and Northeast China: An online cross-sectional study

The growing number of Mpox cases in China has posed a challenge to public health. The prevalence of men who have sex with men behaviors among students has been consistently increasing each year in China, accompanied by a high frequency of unprotected anal sex. As crowded places, schools are highly likely to cause an Mpox outbreak among students through long-term close contact. Understanding university students' perceptions about Mpox and willingness to vaccinate play a vital role in implementing preventive measures in schools. This study aimed to assess knowledge, concerns, and vaccine acceptance toward Mpox among university students in North and Northeast China. A cross-sectional study was conducted among 3831 university students from seven universities in North and Northeast China between September 10 and September 25, 2023. This study found a relative insufficiency in Mpox knowledge among university students (71.60%), with less than half expressing concern about the Mpox outbreak (39.57%), and the majority exhibiting a positive attitude to vaccination (76.30%). Multivariate regression analysis revealed that a good knowledge level was associated with age, study discipline, education level, and a high level of concern about Mpox. Male, elderly, or highly educated participants had a low level of concern about Mpox. Participants with a high level of knowledge toward Mpox were more likely to have the vaccination willingness. This study might help governments and schools to understand students' Mpox perceptions and vaccination intentions, enabling them to implement effective measures in addressing the issue of inadequate understanding regarding Mpox among university students.

Knowledge about, attitudes toward and acceptance and predictors of intention to receive the mpox vaccine among cancer patients in China: A cross-sectional survey

This study aimed to investigate the knowledge about, attitudes toward, and acceptance and predictors of receiving the mpox vaccine among Chinese cancer patients. Patients were selected using a convenience sampling method. A web-based self-report questionnaire was developed to assess cancer patients' knowledge, attitudes, and acceptance regarding the mpox vaccine. Multivariate logistic regression analysis was used to determine predictors of acceptance of the mpox vaccine. A total of 805 cancer patients were included in this study, with a vaccine hesitancy rate of 27.08%. Approximately 66% of the patients' information about mpox and the vaccine came from the mass media, and there was a significant bias in the hesitant group's knowledge about mpox and the vaccine. Multivariable logistic regression analysis suggested that retirement; chemotherapy; the belief that the mpox vaccine could prevent disease, that vaccination should be compulsory when appropriate and that the mpox vaccine prevents mpox and reduces complications; the willingness to pay for the mpox vaccine; the willingness to recommend that friends and family receive the mpox vaccine; and the belief that the mpox vaccine should be distributed fairly and equitably were factors that promoted vaccination. The belief that mpox worsens tumor prognosis was a driving factor for vaccine hesitancy. This study investigated the knowledge of cancer patients about mpox and the vaccine, evaluated the acceptance and hesitancy rates of the mpox vaccine and examined the predictors of vaccination intention. We suggest that the government scientifically promote the vaccine and develop policies such as free vaccination and personalized vaccination to increase the awareness and acceptance rate of the mpox vaccine.

Comprehensive Insights into Monkeypox (mpox): Recent Advances in Epidemiology, Diagnostic Approaches and Therapeutic Strategies

Monkeypox (mpox) is a viral infection closely related to smallpox, manifesting as a milder febrile rash in affected individuals. Over the past two decades, the incidence of mpox has surged, possibly linked to a declining immunity against the smallpox vaccine worldwide. Recent outbreaks of mpox in multiple countries have sparked concerns regarding altered transmission patterns and the potential for a global menace. In this article, we present a multidimensional review encompassing the latest scientific discoveries, illuminating the intricate structure of the human mpox virus. Key findings include advancements in understanding the virus's molecular mechanisms, which highlight its genetic adaptability and potential for zoonotic spillover. Diagnostic innovations, such as improved molecular assays, have enhanced detection accuracy, while novel therapeutic strategies, including antiviral drugs and vaccines, show promise in mitigating outbreaks. Our conclusions emphasize the importance of robust surveillance systems, vaccination programs, and rapid response strategies to curb mpox's spread. Future recommendations include strengthening global collaboration for zoonotic disease surveillance, advancing the research on host-pathogen interactions, and developing next-generation therapeutics to address this emerging public health threat effectively.

Clade Ib: a new emerging threat in the Mpox outbreak

Monkeypox, a zoonotic virus in the Orthopoxvirus genus, has drawn global attention for its impact on public health. In the current Mpox outbreak, a novel clade, Ib, has emerged as a significant and potentially fatal threat. This review examines the dynamics of MPXV transmission, person-to-person spread, and infection mechanisms, highlighting key risk factors. We explore the clinical features of Mpox, focusing on symptomology, illness duration, and the distinguishing characteristics of clade Ib compared to other clades. A critical analysis addresses diagnostic techniques and emphasizes the need for robust surveillance, particularly for clade Ib detection. We review recent prevention and treatment strategies, including antiviral drugs and vaccines, with a focus on clade Ib containment. The conclusion underscores the urgency of global collaboration to prevent and prepare for emerging threats like clade Ib and identifies crucial research paths and knowledge gaps. This review offers a comprehensive overview of clade Ib, covering its emergence, genetic traits, epidemiological impact, transmission patterns, clinical features, the role of Artificial Intelligence (AI) in outbreak management, detection challenges, and implications for public health response.

Bioinformatic Resources for Exploring Human-virus Protein-protein Interactions Based on Binding Modes

Historically, there have been many outbreaks of viral diseases that have continued to claim millions of lives. Research on human-virus protein-protein interactions (PPIs) is vital to understanding the principles of human-virus relationships, providing an essential foundation for developing virus control strategies to combat diseases. The rapidly accumulating data on human-virus PPIs offer unprecedented opportunities for bioinformatics research around human-virus PPIs. However, available detailed analyses and summaries to help use these resources systematically and efficiently are lacking. Here, we comprehensively review the bioinformatic resources used in human-virus PPI research, and discuss and compare their functions, performance, and limitations. This review aims to provide researchers with a bioinformatic toolbox that will hopefully better facilitate the exploration of human-virus PPIs based on binding modes.

Navigating monkeypox: identifying risks and implementing solutions

Monkeypox is a zoonotic disease caused by the orthopox virus, a double-stranded DNA virus that belongs the Poxviridae virus family. It is known to infect both animals (especially monkeys and rodents) and humans and causes a rash similar to smallpox. Humans can become infected with monkeypox virus (MPXV) when they get in close contact with infected animals (zoonotic transmission) or other infected people (human-human transmission) through their body fluids such as mucus, saliva, or even skin sores. Frequently observed symptoms of this disease include fever, headaches, muscle aches, and a rash that initially looks like a tiny bump before becoming a lump that is filled with fluid. Monkeypox symptoms also include an incubation period of 5-21 days, divided into prodromal and eruption phases. Several contributing factors, such as smallpox vaccine discontinuation, widespread intake of infected animal products as a source of protein, and high population density, amongst others, have been linked to an increase in the frequency of monkeypox outbreaks. The best course of action for diagnosing individuals who may be suffering from active monkeypox is to collect a sample of skin from the lesion and perform PCR molecular testing. Monkeypox does not presently have a specific therapy; however, supportive care can assist in managing symptoms, such as medication to lower body temperature and pain. Three major orthopoxvirus vaccines have been approved to serve as a preventive measure against monkeypox: LC16, JYNNEOS, and ACAM2000. The discovery that the monkeypox outbreak is communicable both among humans and within a population has sparked new public health worries on the possibility of the outbreak of another viral pandemic. Research and studies are still being conducted to gain a deeper understanding of this zoonotic viral disease. This review is therefore focused on deciphering monkeypox, its etiology, pathogenesis, transmission, risk factors, and control.

Nail Disorders in Patients Living with HIV Coinfected with Monkeypox: A Clinical Study in 69 Mexican Cases

Introduction

Several infectious diseases can present nail manifestations, which may be useful for diagnosis and prognosis, and only a few reports have been made regarding monkeypox (mpox). The objective of this study was to describe the clinical characteristics of nail alterations in patients living with HIV coinfected with mpox.

Methods

A prospective, cross-sectional study included patients living with HIV/AIDS, coinfected with mpox. We examined all 20 nails in search of nail plate alterations. Patients were divided into two groups, with and without nail disease, and the CD4 count was noted according to the Centers for Disease Control and Prevention (CDC) classification. A χ2 or Fisher's exact test for qualitative variables and Mann-Whitney U and Kruskal-Wallis tests with post hoc Bonferroni test for quantitative variables were used to compare them. Data were analyzed with the SPSS Statistics 25 software.

Results

Sixty-nine patients were included. The frequency of nail involvement was 58%. Papulonodular lesions were the most frequent type identified, with 21 cases (30.4%). A significant difference was observed between patients with nail disease versus median CD4 count (160 vs. 700/mm3; p = 0.002) and median HIV viral load (45,000 vs. 900/mL; p = 0.009). When comparing the characteristics of the nail lesions with the CDC Classification System for HIV infection by the CD4 count, a significant difference was observed in foot involvement, splinter hemorrhages, papulo-nodular lesions, anonychia, onychomadesis, acute paronychia, and nail bed ulcer-atrophy (p < 0.05).

Conclusions

The frequency of nail lesions is high in patients living with HIV coinfected with mpox. In addition, they tend to be more destructive in patients with lower CD4 counts and higher viral loads.

MPXV infection impairs IFN response but is partially sensitive to IFN-γ antiviral effect

The recent outbreak of monkeypox virus (MPXV) has caused global concern. How the virus evades the interferon (IFN) response is still poorly understood. We analyzed type I/II IFN (IFN-I/II) expression in clinical samples from MPXV-infected patients and measured IFN-I kinetics in MPXV-infected cells. We also evaluated the anti-MPXV activity of IFN-I/II in A549, HeLa and Vero-E6 cell lines. IFN-I/II mRNA expression was detected in skin lesions, anal swabs, nasopharyngeal samples and peripheral blood mononuclear cells (PBMC), with the highest levels in skin lesions (p < 0.05). High MPXV DNA levels in clinical samples were associated with increased IFN-I levels. In vitro, MPXV infection induced a peak of IFN-I between 48 and 72 h post-infection (p < 0.01). Pre-treatment of the A549, HeLa and Vero-E6 cells with high concentrations (≥ 100,000 International Unit, IU/ml) of IFN-α and IFN-ω did not inhibit or had little effect on MPXV replication, while IFN-β moderately reduced MPXV replication by 2.7-1.5 log10 at 100,000 IU/ml. In clinical samples there was a trend for elevated levels of IFN-γ in association with lower MPXV load and in vitro IFN-γ (3,600 IU/ml) strongly reduced viral titers by 3.4-1.6 log10. There were no significant differences in expression of select IFN-stimulated genes (ISGs) in MPXV infection in vitro. This study shows that MPXV delays IFN-I induction and inhibits expression of selected ISGs in vitro and is associated with an IFN-I resistance phenotype in vivo. However, MPXV is less resistant to IFN-γ in vivo and is sensitive to IFN-γ treatment in vitro, suggesting a potential therapeutic role for IFN-γ.

Different immunogens and prime-boost vaccination strategies affect the efficacy of recombinant candidate vaccines against pathogenic orthopoxviruses

Although not as lethal as variola virus (VARV), the cause of smallpox, monkeypox virus (MPXV) represents a threat to public health, with important infection rates and mortality in several African countries and signs of spreading worldwide. MPXV may establish new reservoirs in non-endemic countries and can be considered a possible biological weapon. Human-to-human MPXV transmission is increasing with a growing susceptibility, coincident with the declining herd immunity against smallpox. The emerging threat of MPXV highlights the urgent need for protection from new zoonotic infections, as mankind is completely unprepared for encounters with new viruses. Preventive vaccination remains the most effective control against orthopoxviruses (OPXVs) such as MPXV and prime-boost vaccination strategies can significantly influence vaccine efficacy and enhance immune responses. Our study aimed at characterizing potential vaccine candidates against OPXV infections in a murine model using DNA, viral and protein recombinant vaccines using different prime-boost regimens. The experiments employed Vaccinia virus (VACV) A33, B5, L1, and A27 envelope proteins as immunogens for both priming and boosting. Priming was carried out using a mixture of four plasmids (4pVAXmix), and boosts employed fowlpox (FWPV) recombinants (4FPmix) and/or the purified recombinant proteins (4protmix), all of them expressing the same antigens. One or two doses of the same immunogens were tested and identical protocols were also compared for intranasal (i.n.) or intramuscular (i.m.) viral administration, before challenge with the highly pathogenic VACV VVIHD-J strain. Our results show that a single dose of any combined immunogen elicited a very low antibody response. Protein mixtures administered twice boosted the humoral response of DNA immunizations by electroporation (e. p.), but did not protect from viral challenge. The antibody neutralizing titer was inversely correlated with animals' weight loss, which was initially similar in all of the groups after the challenge, but was then reversed in mice that had been primed twice with the DNA recombinants and boosted twice with the FWPV recombinants.

Mpox Resurgence: A Multifaceted Analysis for Global Preparedness

This study provides an in-depth analysis of mpox, encompassing its history, characteristics, epidemiology, diagnostics, treatment options, and the ongoing evolution of the virus and its transmission dynamics. Mpox, though once successfully eradicated, has re-emerged with new modes of transmission and a broader host range. Genomic analyses have revealed the virus's adaptability, posing challenges for diagnostics and vaccine efficacy. The epidemiology has shifted from sporadic zoonotic transmission in rural Africa to a significant presence in urban areas, particularly impacting high-risk populations. Advancements in diagnostics and therapeutics offer hope, but challenges persist. This work underscores the critical need for enhanced surveillance, vaccination strategies, and continued research to bolster global health systems and preparedness for future outbreaks.

Evolutionary Analysis and Antiviral Drug Prediction of Mpox Virus

The resurgence of mpox virus (MPXV) poses a significant challenge to global public health. Currently, there is a limited understanding of the evolutionary details of MPXV during its epidemics, and no specific drugs have been developed for it. Herein, analysis of mutations and positive selection sites (PSSs) within the MPXV genomes revealed 799 mutations and 40 PSSs. Visualization analysis indicated that these mutations and PSSs may affect protein structure. Additionally, a protein-protein interaction (PPI) network between human and MPXV was established, identifying 346 MPXV-interacting human proteins (MIHPs). An interaction network involving MIHPs and other viruses confirmed that these proteins can interact with various viruses that infect humans. Functional analysis of MIHPs suggested their enrichment in host immunity pathways. Lastly, two drugs targeting MIHPs and four compounds targeting MPXV proteins were screened as candidate antivirals against MPXV. These findings not only deepen our understanding of MPXV evolution but also aid in the development of anti-MPXV drugs.

CRISPR-based strategies for sample-to-answer monkeypox detection: current status and emerging opportunities

The global health threat posed by the Monkeypox virus (Mpox) requires swift, simple, and accurate detection methods for effective management, emphasizing the growing necessity for decentralized point-of-care (POC) diagnostic solutions. The clustered regularly interspaced short palindromic repeats (CRISPR), initially known for its effective nucleic acid detection abilities, presents itself as an attractive diagnostic strategy. CRISPR offers exceptional sensitivity, single-base specificity, and programmability. Here, we reviewed the latest developments in CRISPR-based POC devices and testing strategies for Mpox detection. We explored the crucial role of genetic sequencing in designing crRNA for CRISPR reaction and understanding Mpox transmission and mutations. Additionally, we showed the integration of CRISPR-Cas12 strategy with pre-amplification and amplification-free methods. Our study also focused on the significant role of Cas12 proteins and the effectiveness of Cas12 coupled with recombinase polymerase amplification (RPA) for Mpox detection. We envision the future prospects and challenges, positioning CRISPR-Cas12-based POC devices as a frontrunner in the next generation of molecular biosensing technologies.

Network-Based Drug Repurposing and Genomic Analysis to Unveil Potential Therapeutics for Monkeypox Virus

The emergence of the human monkeypox virus (MPXV) and the lack of effective medications have necessitated the exploration of various strategies to combat its infection. This study employs a network-based approach to drug discovery, utilizing the BLASTn and phylogenetic analysis to compare the MPXV genome with those of 18 related orthopoxviruses, revealing over 75 % genomic similarity. Through a literature review, 160 human-host proteins linked to MPXV and its relatives were identified, leading to the construction of a human-host protein interactome. Analysis of this interactome highlighted 39 central hub proteins, which were then examined for potential drug targets. The process successfully revealed 15 targets already approved for use with medications. Additionally, the functional enrichment analysis provided insights into potential pathways and disorders connected with these targets. Four medications, namely Baricitinib, Infliximab, Adalimumab, and Etanercept, have been identified as potential candidates for repurposing to combat MPXV. In addition, the pharmacophore-based screening identified a molecule that is comparable to Baricitinib and has the potential to be effective against MPXV. The findings of the study suggest that ZINC22060520 is a promising medication for treating MPXV infection and proposes these medications as potential options for additional experimental and clinical assessment in the battle against MPXV.

Advancements in monkeypox vaccines development: a critical review of emerging technologies

Monkeypox (mpox) is a zoonotic illness caused by the monkeypox virus (MPXV), with higher health concerns among people who are pregnant, children, and persons who are immunocompromised, including people with untreated and advanced HIV disease. Significant progress has been made in developing vaccines against mpox, yet critical challenges and limitations persist in ensuring their effectiveness, safety, and accessibility. The pertinence of this review is highlighted by the World Health Organization's declaration of a global health emergency on August 14, 2024, due to the recent mpox outbreak, underscoring the critical necessity for effective vaccine solutions in the face of a rapidly evolving virus. Here, we comprehensively analyze various vaccine platforms utilized in mpox prevention, including attenuated and non-replicating virus vaccines, viral vector-based vaccines, recombinant protein vaccines, and DNA and mRNA vaccines. We evaluate the advantages and limitations of each platform, highlighting the urgent need for ongoing research and innovation to enhance vaccine efficacy and safety. Recent advancements, such as incorporating immunostimulatory sequences, improved delivery systems, and developing polyvalent vaccines, are explored for their potential to offer broader protection against diverse orthopoxvirus strains. This work underscores the need to optimize currently available vaccines and investigate novel vaccination strategies to address future public health emergencies effectively. By focusing on these advanced methodologies, we aim to contribute to the development of robust and adaptable vaccine solutions for mpox and other related viral threats.

Assessment of oral tissue alterations in patients diagnosed with SARS-CoV-2

BACKGROUND

The aim of this study was to investigate oral mucosal changes in patients with confirmed moderate-scale severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

METHODS

We analyzed 85 COVID-19 patients (50 males, 35 females) with an average age of 53.6 years, treated at the prehospital infectious disease center and Aldent University Clinic in Tirana, Albania, from May 2021 to June 2022.

RESULTS

Elevated C-reactive protein levels were observed in 82 patients (±44.20), with 20 patients showing significant fibrinogen increase (mean ± 5.85 g/L), and 22 patients having elevated D-Dimer (mean ± 336.6 mg/mL). Despite the absence of anticoagulant history, 13 patients exhibited bleeding. Xerodermia, xerostomia, and angular cheilitis were noted, with 41 patients displaying angular cheilitis. In 82 patients, oral mucosal and tongue examinations revealed color changes from white to bright yellow, with brown edema. Pigmentation in the fixed gingiva of upper and lower front teeth was observed in 35 patients.

CONCLUSIONS

Oral mucosal changes during COVID-19 appear more influenced by drug treatment and disease progression than the infection itself, suggesting that secondary factors play a significant role. Despite the oral cavity's potential for viral entry, these changes seem connected to other underlying causes.

The monkeypox virus-host interplays

Monkeypox virus (MPXV) is a DNA virus belonging to the Orthopoxvirus genus within the Poxviridae family which can cause a zoonotic infection. The unexpected non-endemic outbreak of mpox in 2022 is considered as a new global threat. It is imperative to take proactive measures, including enhancing our understanding of MPXV's biology and pathogenesis, and developing novel antiviral strategies. The host immune responses play critical roles in defensing against MPXV infection while the virus has also evolved multiple strategies for immune escape. This review summarizes the biological features, antiviral immunity, immune evasion mechanisms, pathogenicity, and prevention strategies for MPXV.

Monkeypox: A Comprehensive Review of Virology, Epidemiology, Transmission, Diagnosis, Prevention, Treatment, and Artificial Intelligence Applications

Monkeypox (Mpox), an uncommon zoonotic Orthopoxvirus, is commonly manifested by blisters on the skin and has a mortality rate of approximately 0-10%. Approximately two decades after the cessation of global smallpox vaccination, the number of confirmed cases of Mpox has been growing, making it the most common Orthopoxvirus infection. Therefore, in this narrative review, we aimed to shed light on recent advancements in the pathophysiology, transmission routes, epidemiology, manifestations, diagnosis, prevention, and treatment of Mpox, as well as the application of artificial intelligence (AI) methods for predicting this disease. The clinical manifestations of Mpox, including the onset of symptoms and dermatologic characteristics, are similar to those of the infamous smallpox, but Mpox is clinically milder. Notably, a key difference between smallpox and Mpox is the high prevalence of lymphadenopathy. Human-to-human, animal-to-human, and animal-to-animal transmission are the three main pathways of Mpox spread that must be considered for effective prevention, particularly during outbreaks. PCR testing, as the preferred method for diagnosing Mpox infection, can enhance early detection of new cases and thereby improve infection control measures. JYNNEOS and ACAM2000 are among the vaccines most commonly recommended for the prevention of Mpox. Brincidofovir, Cidofovir, and Tecovirimat are the primary treatments for Mpox cases. Similar to other viral infections, the best approach to managing Mpox is prevention. This can, in part, be achieved through measures such as reducing contact with individuals displaying symptoms, maintaining personal safety, and adhering to practices commonly used to prevent sexually transmitted infections.

Salsoline derivatives, genistein, semisynthetic derivative of kojic acid, and naringenin as inhibitors of A42R profilin-like protein of monkeypox virus: in silico studies

Monkeypox virus (MPV) infection has developed into a re-emerging disease, and despite the potential of tecovirimat and cidofovir drugs, there is currently no conclusive treatment. The treatment's effectiveness and cost challenges motivate us to use In Silico approaches to seek natural compounds as candidate antiviral inhibitors. Using Maestro 11.5 in Schrodinger suite 2018, available natural molecules with validated chemical structures collected from Eximed Laboratory were subjected to molecular docking and ADMET analysis against the highly conserved A42R Profilin-like Protein of Monkeypox Virus Zaire-96-I-16 (PDB: 4QWO) with resolution of 1.52 Å solved 3D structure. Compared to the FDA-approved Tecovirimat, molecular docking revealed that Salsoline derivatives, Genistein, Semisynthetic derivative of kojic acid, and Naringenin had strengthened affinity (-8.9 to -10 kcal/mol) to 4QWO, and the molecular dynamic's simulation confirmed their high binding stability. In support of these results, the hydrogen bond analysis indicated that the Salsoline derivative had the most robust interaction with the binding pockets of 4QWO among the four molecules. Moreover, the comparative free energy analyses using MM-PBSA revealed an average binding free energy of the complexes of Salsoline derivative, Genistein, Semisynthetic derivative of kojic acid, Naringenin, of -106.418, -46.808, -50.770, and -63.319 kJ/mol, respectively which are lower than -33.855 kJ/mol of the Tecovirimat complex. Interestingly, these results and the ADMET predictions suggest that the four compounds are promising inhibitors of 4QWO, which agrees with previous results showing their antiviral activities against other viruses.

A Severe and Prolonged Case of Ocular Monkeypox Without Systemic Manifestations

PURPOSE

The objective of this study was to present a rare case of prolonged and severe ocular monkeypox virus infection in the absence of systemic manifestations.

METHODS

This was a single case report.

RESULTS

A 60-year-old man, having been symptomatic for 9 days, presented with several umbilicated, ulcerated papules on the left cheek, left side of the nose, and left upper eyelid, along with marked follicular conjunctivitis and multiple conjunctival ulcerations. Two weeks after presentation, he developed an irregular, 360° circumferential opacity in the peripheral cornea that progressed to a large epithelial defect with corneal thinning. Although the initial eyelid lesions and conjunctivitis quickly resolved, the patient experienced nonresolving corneal inflammation manifest with peripheral corneal thinning, epithelial defects, and stromal keratitis. Four months after presentation, with the presumptive diagnosis of peripheral ulcerative keratitis, the patient was treated with intravenous steroids and immunosuppressive treatment, after which the ocular surface inflammation improved. However, the inflammation recurred 12 weeks later, and the patient developed severe perilimbal necrotizing conjunctivitis, followed by recurrence of ulcerated nodular eyelid lesions. Eight months after presentation, nucleic acid amplification tests from eyelid lesion swabs returned positive for nonvariola Orthopoxviruses , which led to the diagnosis of mpox. Within 2 weeks of beginning antiviral treatment with systemic tecovirimat and cidofovir and topical trifluridine, the eyelid lesions, conjunctivitis, and corneal inflammation resolved.

CONCLUSIONS

We present an unusual and challenging case of ocular mpox with severe ocular surface inflammation including peripheral corneal thinning and epithelial defects, without systemic disease. Initiation of antiviral treatment resulted in a quick resolution of the ocular disease.

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

BACKGROUND

In July 2022, the world health organization (WHO) announced the monkeypox virus (MPXV) as a public health emergency of international concern, due to the unprecedented global transmission of the disease beyond previously endemic countries in Africa.

METHODS

For this systematic review, the author searched the "web of science" (WoS) database, which retrieves 138 articles on MPXV, published between 01-04-2022 and 22-09-2022. This period witnessed the maximum cases of infection as confirmed by the WHO. Seventy articles were used for in-depth analysis, after excluding papers not highly relevant to the topic.

RESULTS AND CONCLUSIONS

The current review demonstrates different types of MPXV identification analysis, transmission of MPXV, clinical features, immune responses against MPXV, the mutations, and phylogenetic analysis. It also identifies the patients with high-risk complications and determines the other diseases related to MPXV. This paper provides suggestions for the suitable usage of vaccines or antiviral drugs as a procedure to control the outbreak and preventive strategies related to the humans. This research discusses significant implications and recommendations to contribute in reducing the spread of MPXV and presents avenues for upcoming MPXV research.

Inhibition of Monkeypox Virus DNA Polymerase Using Moringa oleifera Phytochemicals: Computational Studies of Drug-Likeness, Molecular Docking, Molecular Dynamics Simulation and Density Functional Theory

The emergence of zoonotic monkeypox (MPX) disease, caused by the double-stranded DNA monkeypox virus (MPXV), has become a global threat. Due to unavailability of a specific small molecule drug for MPX, this study investigated Moringa oleifera phytochemicals to find potent and safe inhibitors of DNA Polymerase (DNA Pol), a poxvirus drug target due to its role in the viral life cycle. For that, 146 phytochemicals were screened through drug-likeness and molecular docking analyses. Among these, 136 compounds exhibited drug-like properties, with Gossypetin showing the highest binding affinity (- 7.8 kcal/mol), followed by Riboflavin (- 7.6 kcal/mol) and Ellagic acid (- 7.6 kcal/mol). In comparison, the control drugs Cidofovir and Brincidofovir displayed lower binding affinities, with binding energies of - 6.0 kcal/mol and - 5.1 kcal/mol, respectively. Hydrogen bonds, electrostatic and hydrophobic interactions were the main non-bond interactions between inhibitors and protein active site. The identified compounds were further evaluated using molecular dynamics simulation, density functional theory analysis and ADMET analysis. Molecular dynamics simulations conducted over 200 ns revealed that DNA Pol-Gossypetin complex was not stable, however, Riboflavin and Ellagic acid complexes showed excellent stability indicating them as better DNA Pol inhibitors. The density functional theory analysis exhibited the chemical reactivity of these inhibitor compounds. The ADMET analysis suggested that the top phytochemicals were safe and showed no toxicity. In conclusion, this study has identified Riboflavin and Ellagic acid as potential DNA Pol inhibitors to control MPXV. Further experimental assays and clinical trials are needed to confirm their activity against the disease.

Graphical Abstract

Surveillance Metrics and History of the COVID-19 Pandemic in Central Asia: Updated Epidemiological Assessment

BACKGROUND

This study updates the COVID-19 pandemic surveillance in Central Asia we conducted during the first year of the pandemic by providing 2 additional years of data for the region. The historical context provided through additional data can inform regional preparedness and early responses to infectious outbreaks of either the SARS-CoV-2 virus or future pathogens in Central Asia.

OBJECTIVE

First, we aim to measure whether there was an expansion or contraction in the pandemic in Central Asia when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in Central Asia.

METHODS

Traditional surveillance metrics, including counts and rates of COVID-19 transmissions and deaths, and enhanced surveillance indicators, including speed, acceleration, jerk, and persistence, were used to measure shifts in the pandemic. To identify the appearance and duration of variants of concern, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period.

RESULTS

Speed for the region had remained below the outbreak threshold for 7 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant, the coefficients were relatively small in magnitude (0.125 and 0.347, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, were both significant and negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became entirely insignificant for the first time in March 2023.

CONCLUSIONS

Although COVID-19 continues to circulate in Central Asia, the rate of transmission remained well below the threshold of an outbreak for 7 months ahead of the WHO declaration. COVID-19 appeared to be endemic in the region and no longer reached the threshold of a pandemic. Both standard and enhanced surveillance metrics suggest the pandemic had ended by the time of the WHO declaration.