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García-Hernández L, Hernández-Aceituno A, Moreno Saavedra RJ, Larumbe-Zabala E. Case report: clinical presentation of Monkeypox in pregnancy. Rev Clin Esp 2024; 224:245-247. [PMID: 38401666 DOI: 10.1016/j.rceng.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Affiliation(s)
- Laura García-Hernández
- Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Spain
| | - Ana Hernández-Aceituno
- Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
| | - Ricardo Jesus Moreno Saavedra
- Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eneko Larumbe-Zabala
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FCIISC), Servicio de Epidemiología y Prevención, Dirección General de Salud Pública, Islas Canarias, Spain
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2
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O'Shea JG, Bonacci RA, Cholli P, Kimball A, Brooks JT. HIV and mpox: a rapid review. AIDS 2023; 37:2105-2114. [PMID: 37877274 PMCID: PMC10962215 DOI: 10.1097/qad.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
In this review, we discuss the history and epidemiology of mpox, prevention strategies, clinical characteristics and management, severity of mpox among persons with advanced HIV, and areas for future research relevant to persons with HIV.
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Affiliation(s)
- Jesse G O'Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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3
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Coutinho C, Secco Torres Silva M, Torres TS, Peixoto E, Avelar Magalhães M, Wagner Cardoso S, Nazário G, Mendonça M, Menezes M, Almeida PM, Dias de Brito de Carvalho PR, Bia Bedin S, Almeida AM, Carvalho S, Gonçalves Veloso V, Grinsztejn B, Velasque L. Characteristics of women diagnosed with mpox infection compared to men: A case series from Brazil. Travel Med Infect Dis 2023; 56:102663. [PMID: 37949306 DOI: 10.1016/j.tmaid.2023.102663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cisgender men were mostly affected during the 2022 mpox multinational outbreak, with few cases reported in women. This study compares the characteristics of individuals diagnosed with mpox infection according to gender in Rio de Janeiro. METHODS We obtained surveillance data of mpox cases notified to Rio de Janeiro State Health Department (June 12 to December 15, 2022). We compared women (cisgender or transgender) to men (cisgender or transgender) using chi-squared, Fisher's exact, and Mood's median tests. RESULTS A total of 1306 mpox cases were reported; 1188 (91.0%) men (99.8% cisgender, 0.2% transgender), 108 (8.3%) women (87.0% cisgender, 13.0% transgender), and 10 (0.8%) non-binary persons. Compared to men, women were more frequently older (40+years: 34.3% vs. 25.1%; p < 0.001), reported more frequent non-sexual contact with a potential mpox case (21.4% vs. 9.8%; p = 0.004), fewer sexual partnerships (10.9 vs. 54.8%; p < 0.001), less sexual contact with a potential mpox case (18.5% vs. 43.0%; p < 0.001), fewer genital lesions (31.8% vs. 57.9%; p < 0.001), fewer systemic mpox signs/symptoms (38.0% vs. 50.1%; p = 0.015) and had a lower HIV prevalence (8.3% vs. 46.3%; p < 0.001), with all cases among transgender women. Eight women were hospitalized; no deaths occurred. The highest number of cases among women were notified in epidemiological week 34, when the number of cases among men started to decrease. CONCLUSIONS Women diagnosed with mpox presented differences in epidemiological, behavioral, and clinical characteristics compared to men. Health services should provide a comprehensive assessment that accounts for gender diversity.
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Affiliation(s)
- Carolina Coutinho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil.
| | - Mayara Secco Torres Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eduardo Peixoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil; Universidade Federal Do Estado Do Rio de Janeiro (UNIRIO), Departamento de Matemática e Estatística, Rio de Janeiro, RJ, Brazil
| | - Monica Avelar Magalhães
- Instituto de Comunicação e Informação Científica e Tecnológica Em Saúde, Fundação Oswaldo Cruz (ICICT-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Maíra Mendonça
- Secretaria de Estado de Saúde Do Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | - Valdilea Gonçalves Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Luciane Velasque
- Universidade Federal Do Estado Do Rio de Janeiro (UNIRIO), Departamento de Matemática e Estatística, Rio de Janeiro, RJ, Brazil; Secretaria de Estado de Saúde Do Rio de Janeiro, RJ, Brazil
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4
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Ubom AE, Oiwoh SO, Ajiboye AD, Nyeche S, Appiah-Kubi A, Sokunbi AE, Mbiiza CM, Olanrewaju FO, Ighorodje EE, Akinkugbe A, Okoeguale J, Ojo OD, Unwaha EA, Oriji PC, Adebawojo TO, Ekwebalam OP, Okwaraoha TI, Ijarotimi OA, Eifediyi RA, Okogbenin SA, Okwor T, Ikimalo JI, Kuti O, Fasubaa OB, Ogoina D. Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic. Int J Gynaecol Obstet 2023; 163:466-475. [PMID: 37128764 DOI: 10.1002/ijgo.14810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.
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Affiliation(s)
- Akaninyene Eseme Ubom
- Department of Obstetrics, Gynecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
- World Association of Trainees in Obstetrics and Gynecology (WATOG), Paris, France
- International Federation of Gynecology & Obstetrics (FIGO) Committee on Childbirth & Postpartum Haemorrhage, London, UK
| | - Sebastine Oseghae Oiwoh
- Dermatology and Venereology Unit, Department of Internal Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Akinyosoye Deji Ajiboye
- Department of Obstetrics, Gynecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Solomon Nyeche
- Department of Obstetrics and Gynecology, University of Port Harcourt/University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Adu Appiah-Kubi
- World Association of Trainees in Obstetrics and Gynecology (WATOG), Paris, France
- Department of Obstetrics and Gynecology, University of Health and Allied Sciences, Ho, Ghana
| | | | - Christabel Mweene Mbiiza
- World Association of Trainees in Obstetrics and Gynecology (WATOG), Paris, France
- University Teaching Hospital, Lusaka, Zambia
| | | | | | - Ayesha Akinkugbe
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Akoka, Lagos State, Nigeria
| | - Joseph Okoeguale
- Department of Obstetrics and Gynecology/Institute of Viral Hemorrhagic Fever and Emergent Pathogen, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Oluwaseun Dorcas Ojo
- Department of Obstetrics, Gynecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - Peter Chibuzor Oriji
- Department of Obstetrics and Gynecology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria
| | | | - Obinna Prince Ekwebalam
- Department of Obstetrics and Gynecology, Federal University Teaching Hospital, Imo State, Owerri, Nigeria
| | | | - Omotade Adebimpe Ijarotimi
- Department of Obstetrics, Gynecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
- Department of Obstetrics, Gynecology, and Perinatology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Reuben Agbons Eifediyi
- Department of Obstetrics and Gynecology/Institute of Viral Hemorrhagic Fever and Emergent Pathogen, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus Akhalufo Okogbenin
- Department of Obstetrics and Gynecology/Institute of Viral Hemorrhagic Fever and Emergent Pathogen, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Tochi Okwor
- Department of Prevention Programme and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - John Igemo Ikimalo
- Department of Obstetrics and Gynecology, University of Port Harcourt/University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Oluwafemi Kuti
- Department of Obstetrics, Gynecology, and Perinatology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
- Feto-Maternal Medicine Unit, Department of Obstetrics, Gynecology and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olusola Benjamin Fasubaa
- Department of Obstetrics, Gynecology, and Perinatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
- Department of Obstetrics, Gynecology, and Perinatology, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
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Low SJ, O'Neill MT, Kerry WJ, Krysiak M, Papadakis G, Whitehead LW, Savic I, Prestedge J, Williams L, Cooney JP, Tran T, Lim CK, Caly L, Towns JM, Bradshaw CS, Fairley C, Chow EPF, Chen MY, Pellegrini M, Pasricha S, Williamson DA. Rapid detection of monkeypox virus using a CRISPR-Cas12a mediated assay: a laboratory validation and evaluation study. THE LANCET. MICROBE 2023; 4:e800-e810. [PMID: 37722405 DOI: 10.1016/s2666-5247(23)00148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND The 2022 outbreak of mpox (formerly known as monkeypox) led to the spread of monkeypox virus (MPXV) in over 110 countries, demanding effective disease management and surveillance. As current diagnostics rely largely on centralised laboratory testing, our objective was to develop a simple rapid point-of-care assay to detect MPXV in clinical samples using isothermal amplification coupled with CRISPR and CRISPR-associated protein (Cas) technology. METHODS In this proof-of-concept study, we developed a portable isothermal amplification CRISPR-Cas12a-based assay for the detection of MPXV. We designed a panel of 22 primer-guide RNA sets using pangenome and gene-agnostic approaches, and subsequently shortlisted the three sets producing the strongest signals for evaluation of analytical sensitivity and specificity using a fluorescence-based readout. The set displaying 100% specificity and the lowest limit of detection (LOD) was selected for further assay validation using both a fluorescence-based and lateral-flow readout. Assay specificity was confirmed using a panel of viral and bacterial pathogens. Finally, we did a blind concordance study on genomic DNA extracted from 185 clinical samples, comparing assay results with a gold-standard quantitative PCR (qPCR) assay. We identified the optimal time to detection and analysed the performance of the assay relative to qPCR using receiver operating characteristic (ROC) curves. We also assessed the compatibility with lateral-flow strips, both visually and computationally, where strips were interpreted blinded to the fluorescence results on the basis of the presence or absence of test bands. FINDINGS With an optimal run duration of approximately 45 min from isothermal amplification to CRISPR-assay readout, the MPXV recombinase polymerase amplification CRISPR-Cas12a-based assay with the selected primer-guide set had an LOD of 1 copy per μL and 100% specificity against tested viral pathogens. Blinded concordance testing of 185 clinical samples resulted in 100% sensitivity (95% CI 89·3-100) and 99·3% specificity (95% CI 95·7-100) using the fluorescence readout. For optimal time to detection by fluorescence readout, we estimated the areas under the ROC curve to be 0·98 at 2 min and 0·99 at 4 min. Lateral-flow strips had 100% sensitivity (89·3-100) and 98·6% specificity (94·7-100) with both visual and computational assessment. Overall, lateral-flow results were highly concordant with fluorescence-based readouts (179 of 185 tests, 96·8% concordant), with discrepancies associated with low viral load samples. INTERPRETATION Our assay for the diagnosis of mpox displayed good performance characteristics compared with qPCR. Although optimisation of the assay will be required before deployment, its usability and versatility present a potential solution to MPXV detection in low-resource and remote settings, as well as a means of community-based, on-site testing. FUNDING Victorian Medical Research Accelerator Fund and the Australian Government Department of Health.
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Affiliation(s)
- Soo Jen Low
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Matthew T O'Neill
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - William J Kerry
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Marcelina Krysiak
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Georgina Papadakis
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Lachlan W Whitehead
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Ivana Savic
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jacqueline Prestedge
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Lewis Williams
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - James P Cooney
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Chuan K Lim
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Leon Caly
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Janet M Towns
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Christopher Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Marc Pellegrini
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Shivani Pasricha
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia; Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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6
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Yao L, Chemaitelly H, Goldman E, Gudina EK, Khalil A, Ahmed R, James AB, Roca A, Fallah MP, Macnab A, Cho WC, Eikelboom J, Qamar FN, Kremsner P, Oliu-Barton M, Sisa I, Tadesse BT, Marks F, Wang L, Kim JH, Meng X, Wang Y, Fly AD, Wang CY, Day SW, Howard SC, Graff JC, Maida M, Ray K, Franco-Paredes C, Mashe T, Ngongo N, Kaseya J, Ndembi N, Hu Y, Bottazzi ME, Hotez PJ, Ishii KJ, Wang G, Sun D, Aleya L, Gu W. Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view. EClinicalMedicine 2023; 64:102222. [PMID: 37811488 PMCID: PMC10550631 DOI: 10.1016/j.eclinm.2023.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
In counteracting highly infectious and disruptive respiratory diseases such as COVID-19, vaccination remains the primary and safest way to prevent disease, reduce the severity of illness, and save lives. Unfortunately, vaccination is often not the first intervention deployed for a new pandemic, as it takes time to develop and test vaccines, and confirmation of safety requires a period of observation after vaccination to detect potential late-onset vaccine-associated adverse events. In the meantime, nonpharmacologic public health interventions such as mask-wearing and social distancing can provide some degree of protection. As climate change, with its environmental impacts on pathogen evolution and international mobility continue to rise, highly infectious respiratory diseases will likely emerge more frequently and their impact is expected to be substantial. How quickly a safe and efficacious vaccine can be deployed against rising infectious respiratory diseases may be the most important challenge that humanity will face in the near future. While some organizations are engaged in addressing the World Health Organization's "blueprint for priority diseases", the lack of worldwide preparedness, and the uncertainty around universal vaccine availability, remain major concerns. We therefore propose the establishment of an international candidate vaccine pool repository for potential respiratory diseases, supported by multiple stakeholders and countries that contribute facilities, technologies, and other medical and financial resources. The types and categories of candidate vaccines can be determined based on information from previous pandemics and epidemics. Each participant country or region can focus on developing one or a few vaccine types or categories, together covering most if not all possible potential infectious diseases. The safety of these vaccines can be tested using animal models. Information for effective candidates that can be potentially applied to humans will then be shared across all participants. When a new pandemic arises, these pre-selected and tested vaccines can be quickly tested in RCTs for human populations.
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Affiliation(s)
- Lan Yao
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Emanuel Goldman
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
| | - Asma Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Rahaman Ahmed
- Cell Biology and Genetics Department, University of Lagos, Lagos 101017, Nigeria
- Centre for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Ayorinde Babatunde James
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Mosoka Papa Fallah
- Refuge Place International, Monrovia, Liberia
- Centre for Emerging Infectious Diseases Policy and Research, Boston University, Boston, MA, USA
- Africa Centre for Disease Control, Addis Ababa, Ethiopia
| | - Andrew Macnab
- The Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, South Africa
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - John Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Karachi, Sindh 74800, Pakistan
| | - Peter Kremsner
- Institut für Tropenmedizin, Universität Tübingen, Germany
- Centre de Recherches Medicales de Lambarene, Gabon
| | - Miquel Oliu-Barton
- Université Paris Dauphine – PSL, Pl. du Maréchal de Lattre de Tassigny, Paris 75016, France
- Bruegel, Rue de la Charité 33, Brussels 1210, Belgium
| | - Ivan Sisa
- College of Health Sciences, Universidad San Francisco de Quito, Quito 170901, Ecuador
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| | - Lishi Wang
- Department of Basic Medicine, Inner Mongolia Medical University, Jinshan Development Zone, Huhhot, China
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Alyce D. Fly
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA
| | - Cong-Yi Wang
- NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, The Centre for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sara W. Day
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Scott C. Howard
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Kunal Ray
- School of Biological Science, Ramkrishna Mission Vivekananda Education & Research Institute, Narendrapur 700103, West Bengal, India
| | - Carlos Franco-Paredes
- Hospital Infantil de Mexico, Federico Gomez, Mexico
- Department of Microbiology, Immunology, and Pathology, Colorado State University, USA
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe
- World Health Organization, Harare, Zimbabwe
| | | | | | | | - Yu Hu
- Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Hubei Clinical and Research Centre of Thrombosis and Hemostasis, Wuhan, China
| | - Maria Elena Bottazzi
- Department of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J. Hotez
- Department of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Ken J. Ishii
- Division of Vaccine Science, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- International Vaccine Design Centre, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Centre for Vaccine Adjuvant Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Gang Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dianjun Sun
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health 23618104, 157 Baojian Road, Harbin, Heilongjiang 150081, China
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex F-25030, France
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA
- Research Service, Memphis VA Medical Centre, 1030 Jefferson Avenue, Memphis, TN 38104, USA
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7
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Sharma E, Malhotra S, Kaul S, Jain N, Nagaich U. Unveiling the Mpox menace: exploring the intricacies of a zoonotic virus and clinical implications. Diagn Microbiol Infect Dis 2023; 107:116024. [PMID: 37481798 DOI: 10.1016/j.diagmicrobio.2023.116024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/28/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
Mpox (formerly known as monkeypox) is an orthopoxvirus based zoonotic infection that induces a smallpox-like human illness. Since the Democratic Republic of the Congo reported the first human case of mpox in 1970, the disease has proliferated to other areas of Africa, predominantly the West, and Central, with instances recently confirmed outside of Africa. Reports of cases of mpox in 2022 have brought into light its re-emergence. Even though the smallpox vaccine protects against the mpox virus, new nonimmune generations contribute to the rising prevalence of the cases. People are coming into contact with potential hosts as a result of environmental factors, raising the probability of animal-to-human transmission. Mpox poses a more serious threat to previously unaffected nations as it is showing up in data provided by governmental bodies due to increased transmission risk brought on by globalization, armed conflict, and environmental factors. In this article, we have extensively covered the virology, etiology, and epidemiology of the disease. Various gene studies, recent drugs studied, and clinical trials pertaining to mpox have been incorporated in this review. Additionally, we have compiled a comprehensive analysis of various systematic reviews and meta-analyses concerning pregnancies complicated by mpox, retrospective studies examining mpox and HIV-coinfection, mpox in conjuction with SARS-CoV-2, and HIV coinfection, as well as case studies exploring the implications of mpox manifestations in conjunction with syphilis, gonorrhoea, myocarditis, and neuroinflammatory implications.
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Affiliation(s)
- Eshita Sharma
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
| | - Sakshi Malhotra
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
| | - Shreya Kaul
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India.
| | - Neha Jain
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
| | - Upendra Nagaich
- Department of Pharmaceutics, Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh, India
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Renfro ZT, Contag CA, Lu J, Solis D, Huang C, Sahoo MK, Yamamoto F, Mah J, Jones MS, Lin J, Levy V, Pinsky BA. Two cases of MPXV infection during pregnancy in heterosexual cisgender women without classic cutaneous lesions, Northern California, 2022. IDCases 2023; 33:e01881. [PMID: 37680215 PMCID: PMC10480306 DOI: 10.1016/j.idcr.2023.e01881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023] Open
Abstract
As part of an epidemiologic survey, we screened remnant samples collected for STI testing for mpox virus. We identified two cases of presumed MPXV infection in pregnant, heterosexual cisgender women. Here, we describe their pregnancy and birth outcomes. Both patients required induction of labor and experienced labor complicated by chorioamnionitis.
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Affiliation(s)
- Zachary T. Renfro
- Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Caitlin A. Contag
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jacky Lu
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Daniel Solis
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Malaya K. Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Fumiko Yamamoto
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Jordan Mah
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Morris S. Jones
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
- San Mateo County Health, Public Health Laboratory, San Mateo, CA, United States of America
| | - Jennifer Lin
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Infectious Diseases, San Mateo County Health, San Mateo Medical Center, San Mateo, CA, United States of America
| | - Vivian Levy
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Infectious Diseases, San Mateo County Health, San Mateo Medical Center, San Mateo, CA, United States of America
| | - Benjamin A. Pinsky
- Stanford University School of Medicine, Stanford, CA, United States of America
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
- Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States of America
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9
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Schwartz DA, Pittman PR. Mpox (Monkeypox) in Pregnancy: Viral Clade Differences and Their Associations with Varying Obstetrical and Fetal Outcomes. Viruses 2023; 15:1649. [PMID: 37631992 PMCID: PMC10458075 DOI: 10.3390/v15081649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
In African countries where mpox (monkeypox) is endemic, infection is caused by two genetically related clades-Clade I (formerly Congo Basin), and Clade IIa (formerly West Africa), both of which are potentially life-threatening infections. Prior to the 2022-2023 global outbreak, mpox infections among pregnant women caused by Clade I were reported to have a 75% perinatal case fatality rate in the Democratic Republic of Congo, including the only documented case of placental infection and stillbirth from the Congenital Mpox Syndrome, and the Clade IIa mpox infection was associated with stillbirths in Nigeria. The 2022-2023 global mpox outbreak, caused by a genetically distinct strain, Clade IIb, has focused attention on the effects of mpox on pregnant women and fetal outcomes. There have been at least 58 cases of mpox infection occurring in pregnant women during the 2022-2023 outbreak. No confirmed cases of adverse perinatal outcome, including stillbirth, have been reported. The absence of perinatal morbidity and mortality from Clade IIb corresponds to the overall case fatality rate among non-pregnant women of <0.1%, as this clade has been demonstrated to produce a less-severe disease than the mpox Clade I or IIa variants. Thus, there are apparently important differences between mpox clades affecting pregnant women and perinatal outcomes.
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Affiliation(s)
| | - Phillip R. Pittman
- Division of Medicine, U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD 21702, USA;
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10
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Schwartz DA, Ha S, Dashraath P, Baud D, Pittman PR, Adams Waldorf K. Mpox Virus in Pregnancy, the Placenta, and Newborn. Arch Pathol Lab Med 2023; 147:746-757. [PMID: 36857117 DOI: 10.5858/arpa.2022-0520-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
CONTEXT.— Before its eradication, the smallpox virus was a significant cause of poor obstetric outcomes, including maternal and fetal morbidity and mortality. The mpox (monkeypox) virus is now the most pathogenic member of the Orthopoxvirus genus infecting humans. The 2022 global mpox outbreak has focused attention on its potential effects during pregnancy. OBJECTIVE.— To understand the comparative effects of different poxvirus infections on pregnancy, including mpox virus, variola virus, vaccinia virus, and cowpox virus. The impact on the pregnant individual, fetus, and placenta will be examined, with particular attention to the occurrence of intrauterine vertical transmission and congenital infection. DATA SOURCES.— The data are obtained from the authors' cases and from various published sources, including early historical information and contemporary publications. CONCLUSIONS.— Smallpox caused maternal and perinatal death, with numerous cases reported of intrauterine transmission. In endemic African countries, mpox has also affected pregnant individuals, with up to a 75% perinatal case fatality rate. Since the start of the 2022 mpox outbreak, increasing numbers of pregnant women have been infected with the virus. A detailed description is given of the congenital mpox syndrome in a stillborn fetus, resulting from maternal-fetal transmission and placental infection, and the potential mechanisms of intrauterine infection are discussed. Other poxviruses, notably vaccinia virus and, in 1 case, cowpox virus, can also cause perinatal infection. Based on the historical evidence of poxvirus infections, mpox remains a threat to the pregnant population, and it can be expected that additional cases will occur in the future.
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Affiliation(s)
- David A Schwartz
- From Perinatal Pathology Consulting, Atlanta, Georgia (Schwartz)
| | - Sandy Ha
- The Department of Obstetrics and Gynecology, University of Washington, Seattle (Ha)
| | - Pradip Dashraath
- The Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Dashraath)
| | - David Baud
- Materno-Fetal and Obstetrics Research Unit, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland (Baud)
| | - Phillip R Pittman
- The Department of Clinical Research, US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Maryland (Pittman)
| | - Kristina Adams Waldorf
- The Departments of Obstetrics and Gynecology and Global Health, University of Washington School of Medicine, Seattle (Adams Waldorf)
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Human Monkeypox Experience in a Tertiary Level Hospital in Milan, Italy, between May and October 2022: Epidemiological Features and Clinical Characteristics. Viruses 2023; 15:v15030667. [PMID: 36992376 PMCID: PMC10051371 DOI: 10.3390/v15030667] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Monkeypox virus (mpxv) started to spread to Europe and North America at the beginning of the current outbreak in May 2022, and the World Health Organization (WHO) declared Human Monkeypox (mpox) as a public health emergency of international concern (PHEIC) in July 2022. The aim of this observational analysis is to describe demographical data, symptoms presentation and clinical course till outcome of individuals diagnosed with mpox, between May and October 2022, at our open-access Sexual Health Clinic in IRCCS San Raffaele Hospital in Milan, Italy. Methods: Among people who accessed our Sexual Health Clinic, we considered, as suspected diagnosis of mpox, individuals with consistent symptoms and epidemiological criteria. Following the physical examination, oropharyngeal, anal, genital and cutaneous swabs, plus plasma, urine and seminal fluid were collected as biological materials to detect mpxv DNA. We also performed a screening for sexually transmitted infections (STIs). Results: Overall, 140 individuals with mpox were included in this study. Median age was 37 (interquartile, IQR 33, 43) years old. Males were 137 (98%) and men who have sex with men (MSM) were 134 (96%). As risk factors, we detected travels abroad in 35 (25%) individuals and close contact with mpox cases in 49 (35%). There were 66 (47%) people living with HIV (PLWH). Most frequent symptoms were fever (59%), lymphadenopathy (57%), cutaneous (77%), genital (42%), anal (34%) and oral (26%) lesions, proctitis (39%), sore throat (22%) and generalized rash (5%). At mpox diagnosis, we also observed N. gonorrhoeae in 18 (13%) cases, syphilis in 14 (10%) and C. trachomatis in 12 (9%). Two (1%) people received a concomitant diagnosis of HIV infection. We attended to 21 (15%) complications, with nine (6%) cases of hospitalization including six (IQR 3,7) median hospital days. Forty-five (32%) patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs), 37 (26%) with antibiotics and eight (6%) with antiviral drugs. Conclusions: Similarly to other international cohorts, sexual transmission was most frequently present, and concomitant STIs were common. Symptoms were heterogenous, self-resolving and responsive to therapy. Hospitalization was necessary in few patients. There is uncertainty about the future development of mpox and further studies (e.g., potential disease reservoirs, other possible means of transmission, predictors of severe disease) are still needed.
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D'Antonio F, Buca D, Khalil A. Reply to the Letter to Editor 'Monkeypox virus in pregnancy, do we have sufficient evidence?'. Am J Obstet Gynecol MFM 2023; 5:100807. [PMID: 36371034 PMCID: PMC9870765 DOI: 10.1016/j.ajogmf.2022.100807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Francesco D'Antonio
- Center for Fetal Care and High-Risk pregnancy, University of Chieti, Chieti, Italy.
| | - Danilo Buca
- Center for Fetal Care and High-Risk pregnancy, University of Chieti, Chieti, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George Hospital, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom; Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, United Kingdom
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13
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Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, Orkin CM. Monkeypox. Lancet 2023; 401:60-74. [PMID: 36403582 PMCID: PMC9671644 DOI: 10.1016/s0140-6736(22)02075-x] [Citation(s) in RCA: 120] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
Abstract
Monkeypox is a zoonotic illness caused by the monkeypox virus, an Orthopoxvirus in the same genus as the variola, vaccinia, and cowpox viruses. Since the detection of the first human case in the Democratic Republic of the Congo in 1970, the disease has caused sporadic infections and outbreaks, mainly restricted to some countries in west and central Africa. In July, 2022, WHO declared monkeypox a Public Health Emergency of International Concern, on account of the unprecedented global spread of the disease outside previously endemic countries in Africa and the need for global solidarity to address this previously neglected disease. The 2022 outbreak has been primarily associated with close intimate contact (including sexual activity) and most cases have been diagnosed among men who have sex with men, who often present with novel epidemiological and clinical characteristics. In the 2022 outbreak, the incubation period ranges from 7 days to 10 days and most patients present with a systemic illness that includes fever and myalgia and a characteristic rash, with papules that evolve to vesicles, pustules, and crusts in the genital, anal, or oral regions and often involve the mucosa. Complications that require medical treatment (eg, antiviral therapy, antibacterials, and pain control) occur in up to 40% of patients and include rectal pain, odynophagia, penile oedema, and skin and anorectal abscesses. Most patients have a self-limited illness; between 1% and 13% require hospital admission (for treatment or isolation), and the case-fatality rate is less than 0·1%. A diagnosis can be made through the presence of Orthopoxvirus DNA in PCRs from lesion swabs or body fluids. Patients with severe manifestations and people at risk of severe disease (eg, immunosuppressed people) could benefit from antiviral treatment (eg, tecovirimat). The current strategy for post-exposure prophylaxis or pre-exposure prophylaxis for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain; Fight Infectious Diseases Foundation, Badalona, Spain; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
| | - Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University and Niger Delta University Teaching Hospital, Bayelsa, Nigeria
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Medecins du Cameroun (Medcamer), Yaoundé, Cameroon
| | | | - Jean-Jacques Muyembe
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Michael Marks
- London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunology, University College London, London, UK
| | - Chloe M Orkin
- Centre for Immunobiology, Blizard Institute, Queen Mary University, London, UK
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Vallée A, Chatelain A, Carbonnel M, Racowsky C, Fourn E, Zucman D, Ayoubi JM. Monkeypox Virus Infection in 18-Year-Old Woman after Sexual Intercourse, France, September 2022. Emerg Infect Dis 2023; 29:219-222. [PMID: 36355630 PMCID: PMC9796185 DOI: 10.3201/eid2901.221643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A monkeypox virus outbreak has spread worldwide since April 2022. We report a young woman in France positive for monkeypox virus transmitted through oral and vaginal sex. Ulceronecrotic lesions developed intravaginally and around her vulva. Health professionals should become familiar with all aspects of infection from this virus, including possible vertical transmission.
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15
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Monkeypox Infection 2022: An Updated Narrative Review Focusing on the Neonatal and Pediatric Population. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121832. [PMID: 36553276 PMCID: PMC9776986 DOI: 10.3390/children9121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Monkeypox disease has been endemic in sub-Saharan Africa for decades, attracting remarkable attention only i23n 2022 through the occurrence of a multi-country outbreak. The latter has raised serious public health concerns and is considered a public health emergency by the World Health Organization. Although the disease is usually self-limiting, it can cause severe illness in individuals with compromised immune systems, in children, and/or the pregnant woman-fetus dyad. Patients generally present with fever, lymphadenopathy, and a vesicular rash suggestive of mild smallpox. Serious eye, lung and brain complications, and sepsis can occur. However, cases with subtler clinical presentations have been reported in the recent outbreak. A supportive care system is usually sufficient; otherwise, treatment options are needed in patients who are immunocompromised or with comorbidities. A replication-deficient modified and a live infectious vaccinia virus vaccine can be used both before and after exposure. Due to the persistent spread of monkeypox, it is necessary to focus on the pediatric population, pregnant women, and newborns, who represent fragile contagion groups. Here we assess and summarize the available up-to-date information, focusing on available therapeutic options, with insights into social and school management, breastfeeding, and prevention that will be useful for the scientific community and in particular neonatal and pediatric health professionals.
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Cuérel A, Favre G, Vouga M, Pomar L. Monkeypox and Pregnancy: Latest Updates. Viruses 2022; 14:v14112520. [PMID: 36423129 PMCID: PMC9693336 DOI: 10.3390/v14112520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Monkeypox virus (MPXV) has emerged as a threatening zoonosis. Its spread around the world has been growing fast over the last 2 years, particularly in 2022. The reasons for this sudden spread are probably multifactorial. The R0 values of the two MPXV clades are rather low, and a massive pandemic is considered unlikely, although the increase in the number of single-nucleotide polymorphisms found in the 2022 MPXV strain could indicate an accelerated human adaptation. Very little is known about the risks of an infection during pregnancy for both the mother and the fetus. Further observations must be made to create clear, adapted, evidence-based guidelines. This article summarizes the current knowledge about MPXV infections and similar pregnancy virus infections.
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Affiliation(s)
- Alexandre Cuérel
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Correspondence:
| | - Guillaume Favre
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Manon Vouga
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Léo Pomar
- Department Woman-Mother-Child, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, 1011 Lausanne, Switzerland
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Kumar J, Meena J. Mpox infection in neonates: what we know so far? Paediatr Int Child Health 2022; 42:173-174. [PMID: 36871266 DOI: 10.1080/20469047.2023.2186077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Jogender Kumar
- Division of Neonatology, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Meena
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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