Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health

Mpox and the men who have sex with men (MSM) community in Nigeria: Exploratory insights from MSM and persons providing healthcare services to them

The current mpox outbreak has challenged previous understanding of the disease, with human-to-human transmission being a significant mode of transmission, particularly among gay, bisexual, and other men who have sex with men (GBMSM). A knowledge gap exists on MSM's mpox experiences in Nigeria's restrictive sociolegal context. This study explored mpox awareness, knowledge, and experiences among MSM in Lagos, Nigeria, through 28 in-depth interviews. We analysed the interview transcripts thematically. Findings showed low awareness and knowledge of mpox among MSM, who prefer seeking healthcare outside public health facilities due to stigma. Intimate contact during sexual intercourse is a likely source of infection among MSM. The Nigerian mpox response does not centre MSM, and centreing them may not be ideal due to potential stigma. MSM seek care through various means, including drugs, herbal remedies, and KP-friendly sexual and reproductive health (SRH) services, but face stressful care-seeking due to limited social support and stigma. The study shows that Nigeria's mpox situation differs from the situation in mpox non-endemic contexts. The homophobic legal and social environment and heterogenous spread require unique disease framing and context-sensitive response. The study concludes that further surveillance is needed to deepen understanding around mpox care seeking among MSM in Nigeria.

Phylogenetic analyses of the spread of Clade I MPOX in African and non-African nations

Recently, mpox has spread in some parts of Africa, such as Congo (DRC), Burundi, Rwanda, Uganda, and Kenya, worsening the situation in DRC and Burundi compared to the other parts of Africa due to the spread of the Clade Ib, with several confirmed and lethal cases. The study aims to analyze the broader molecular phylogenetics using greater complete genome sequences and molecular phylogenetics of Clade I (Clade Ia and Clade Ib), nucleotide diversity of the genome of Clade I, NGA/TCN context of G- > A/C- > T mutations, and epidemiology of the recent spread of mpox in the African countries. Overall molecular phylogenetics of mpox inform the divergence was noted between 0.00220 and 0.00265 and found Clade IIb has further subdivided into 37 sublineages. From our phylogenetic analysis and the tracking of recent mpox variants, we report the spread of Clade I (Clade Ib) of mpox, a virulent mpox, in the African continent, Thailand, Sweden, and USA. Furthermore, two Clades, Clade Ia and Clade Ib, have originated from Clade I. Recently, Clade Ib has expanded its region within African continent. We reported the mutation pattern in the genome. Epidemiological analysis indicates the most affected country is the Democratic Republic of the Congo (DRC). This work shows that mpox is steadily adapting as geographic area increases and can help the health authorities develop policies such as vaccinations, and travel restrictions to contain the spread of mpox.

Emergence and evolution of monkeypox virus: Epidemiology, pathology, clinical symptoms, preventative and treatment measures

As the COVID-19 pandemic situation was on an end, a new monkeypox menace has been discovered in several places of the world. The most comforting thing is that the fatality rate of monkeypox is unlike Covid-19. But the recent global outbreaks and the rise in the number of cases has drawn attention of world towards it. The number of cases in multiple countries have already surpassed 25,000, according to the WHO report released on July 25, 2022. The zoonotic disease monkey-pox virus causes a feverish sickness in humans, with characteristic skin rashes and is similar to smallpox in structure, clinical presentation, and response to antiviral medicine. This review offers important insights on the evolution of the monkeypox virus and its different modes of transmission. It also discusses epidemiology, clinical findings, management, challenges, and current strategies for the disease, as well as the implications of the current epidemic on public health. Comprehensive research on the pathophysiology and management of monkeypox is still lacking. In order to solve this problem, we reviewed the pathology and virology of monkeypox infection and provided an overview of the most recent developments in anti-monkeypox medications.

Strengthening Africa's resilience to Mpox: Preparedness and response initiatives of the Pasteur network

n/a

A review of epidemiology, diagnosis, and management of Mpox: The role of One Health

Human monkeypox (Mpox) is an emerging zoonotic disease. Its clinical features are similar to but less severe than those of smallpox. The etiology of this disease is the monkeypox virus. This virus is a double-stranded DNA virus that is classified into the genus Orthopoxvirus and the family Poxviridae. Human monkeypox was first identified in 1970 and mainly occurred in Central and Western Africa. In 2022, outbreaks of Mpox virus infection occurred in several non-endemic countries and caused a potential threat to humans. It is urgent to take immediate action to control and prevent the outbreak of the Mpox virus infection. This paper summarizes the current status of Mpox and generated strategies for managing the Mpox epidemic. Although progress in the diagnostic methods and treatment of Mpox produces better knowledge, we argue that the sensitive surveillance for animal and human Mpox virus infection and evidence-based response and management of Mpox outbreaks is critical. This study highlights the need for further research on preventive and control strategies for Mpox disease approached through the One Health concept.

Emergence and Global Spread of Mpox Clade Ib: Challenges and the Role of Wastewater and Environmental Surveillance

Several African countries, mainly the Democratic Republic of Congo, Burundi, and Uganda, are facing highly transmissible mpox clade Ib epidemics, prompting the World Health Organization to declare a Public Health Emergency of International Concern. It has spread to key travel hubs like Kinshasa, Bujumbura, and Kampala, increasing international spread risks. Current mitigation efforts focus mainly on medical care, diagnostics, vaccination, and infection prevention, but overlook wastewater and environmental surveillance (WES). WES can be effective in detecting hotspots and enabling rapid response through enhanced data collection and genomic sequencing. This perspective article reviews the latest outbreak situation and advocates integrating WES into response strategies.

Environmental, socioeconomic, and sociocultural drivers of monkeypox transmission in the Democratic Republic of the Congo: a One Health perspective

BACKGROUND

Monkeypox (mpox) is an emerging zoonotic disease that has persistently impacted public health in endemic regions of West and Central Africa for over half a century. The Democratic Republic of the Congo (DRC) remains one of the countries most affected. Understanding the risk factors for disease transmission from a One Health perspective is of great importance in the risk assessment, prevention, and control of zoonotic diseases. Therefore, this study aimed to investigate the risk factors for human mpox transmission at the human-animal-environment interface in the DRC.

METHODS

Epidemiological, environmental, socioeconomic, and sociocultural data from the DRC from 2000 to 2015 were obtained from publicly available dataset. Using these data, we applied negative binomial regression model, least absolute shrinkage and selection operator regression model, and principal component analysis (PCA) to identify key environmental, socioeconomic, and sociocultural factors contributing to mpox transmission. Moreover, a grey prediction model GM (1, n) was constructed to predict the epidemic trend of mpox post-2015 and validated using suspected mpox case data in the DRC from 2016 to 2021, sourced from the United States Centers for Disease Control and Prevention.

RESULTS

Between 2000 and 2021, a total of 43,628 suspected mpox cases were reported in the DRC, with a peak of 6216 cases in 2020. From 2016 to 2021, suspected cases accounted for over half (24,379/43,628, 55.9%) of the total reported during the 2000-2021 period. The proportion of primary forest [incidence rate ratio (IRR): 1.023, 95% confidence interval (CI): 1.018-1.027], index of economic well-being (IRR: 1.046, 95% CI: 1.039-1.052), and mean annual precipitation (IRR 1.040, 95% CI: 1.031-1.049) were positively associated with mpox incidence. PCA identified five principal components, explaining 69% of the variance in the environmental, socioeconomic, and sociocultural variables. The first component was characterized by socioeconomic factors. The GM (1, n) model, based on the proportion of primary forest, index of economic well-being, and mean annual precipitation, predicted the epidemic trend (revealed relative error: 2.69).

CONCLUSIONS

Both socioeconomic and environmental factors play important roles in mpox transmission. Our study further highlighted the importance of considering the interconnectedness among humans, animals, and the environment, and treating these factors as a whole to explain the transmission and emergence of mpox outbreaks in the DRC according to the One Health concept.

From phytomedicine to conventional drug research, to look for new drug molecule against monkey pox virus; a molecular docking, virtual screening and ADME analysis

Globally, traditional and complementary therapies (such as homeopathy, phytotherapy and herbal medications) are becoming increasingly prevalent alongside modern medical care. The therapeutic substances used in homeopathy and other traditional complementary medicine disciplines are derived from these traditional applications. Numerous notable clinical and preclinical studies have shown their impact during COVID-19. This study aims to investigate the potential antiviral effects of medicinal alkaloids against the monkeypox virus in the current scenario. The structures of 47 known phytochemicals of commonly used medicines in CAM were obtained from PubChem in SDF format, minimized, and then docked against the 3D crystal structure of monkeypox virus methyltransferase VP39 (PDB: 8B07). The results were analyzed, and compounds with significant docking scores were further evaluated. The docking results showed that six compounds-Sarsaponin, Luteolin, Quercetin, Apigenin, and Ducimarine-had better docking scores than Tecovirimat, a standard drug used in managing monkeypox. Additionally, most compounds exhibited better docking scores than Cidofovir, another drug used against monkeypox. Interaction analysis revealed that hydrogen bonding, pi-pi T-shaped, and pi-alkyl interactions were responsible for the observed docking scores. Key amino acid residues involved in the interaction between the compounds and monkeypox virus methyltransferase VP39 included GLY 96, LEU 159, PHE 115, VAL 139, VAL 116, GLY 68, ARG 140, ILE 94, ASN 156, and ARG 156. Five phytochemicals-Luteolin, Quercetin, Apigenin, Sarsaponin, and Ducimarine-show strong potential as monkeypox virus methyltransferase inhibitors. Apigenin and Ducimarine are particularly promising due to their favorable profiles, including no PAINS alerts and good drug-like properties. Sarsaponin, while highly permeable, has high lipophilicity, which may limit its use. Luteolin and Quercetin also show potential but require further investigation due to PAINS alerts.

Intelligent skin disease prediction system using transfer learning and explainable artificial intelligence

Skin diseases impact millions of people around the world and pose a severe risk to public health. These diseases have a wide range of effects on the skin's structure, functionality, and appearance. Identifying and predicting skin diseases are laborious processes that require a complete physical examination, a review of the patient's medical history, and proper laboratory diagnostic testing. Additionally, it necessitates a significant number of histological and clinical characteristics for examination and subsequent treatment. As a disease's complexity and quantity of features grow, identifying and predicting it becomes more challenging. This research proposes a deep learning (DL) model utilizing transfer learning (TL) to quickly identify skin diseases like chickenpox, measles, and monkeypox. A pre-trained VGG16 is used for transfer learning. The VGG16 can identify and predict diseases more quickly by learning symptom patterns. Images of the skin from the four classes of chickenpox, measles, monkeypox, and normal are included in the dataset. The dataset is separated into training and testing. The experimental results performed on the dataset demonstrate that the VGG16 model can identify and predict skin diseases with 93.29% testing accuracy. However, the VGG16 model does not explain why and how the system operates because deep learning models are black boxes. Deep learning models' opacity stands in the way of their widespread application in the healthcare sector. In order to make this a valuable system for the health sector, this article employs layer-wise relevance propagation (LRP) to determine the relevance scores of each input. The identified symptoms provide valuable insights that could support timely diagnosis and treatment decisions for skin diseases.

Strengthening Africa's response to Mpox (monkeypox): insights from historical outbreaks and the present global spread

Mpox, formerly known as Monkeypox, is a viral zoonotic disease endemic to Central and West Africa that has posed significant public health challenges since its identification in 1970. Despite decades of experience in managing outbreaks, the 2022-2024 Mpox outbreaks exposed substantial gaps in global preparedness and response, leading the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC) in 2022. The resurgence of cases in Europe in 2022 and the more recent emergence of the virulent clade Ⅰb in the Democratic Republic of the Congo (DRC) in 2024 have highlighted a critical need for improved proactive and response strategies to curb the epidemic. This narrative review examines the historical and recent epidemiology of Mpox in Africa and explores the factors that have limited effective management. These include objective influences such as viral mutations, zoonotic transmission patterns, and environmental changes like deforestation, as well as subjective factors, including delayed responses, limited vaccine availability, cessation of smallpox vaccinations, and inequitable access to healthcare. In particular, the review emphasizes the ongoing disparities in global health equity, as wealthier nations have been able to secure vaccines and therapeutics quickly, while endemic regions in Africa continue to struggle with limited resources. The review also discusses how socio-economic and cultural factors, combined with weak public health infrastructure and inadequate surveillance systems, perpetuate cycles of outbreak in vulnerable populations. Furthermore, the emergence of clade Ⅰb in 2024, with its higher virulence and mortality rates among children, particularly in rural areas, underscores the urgency of addressing the evolving epidemiological landscape of Mpox. In response to these challenges, this review recommends strengthening healthcare infrastructure, enhancing surveillance systems, ensuring equitable access to vaccines and treatments, and integrating environmental management into public health strategies. Global collaboration remains essential to provide African countries with the resources and support needed to manage and prevent future outbreaks effectively. Without these measures, the world risks a prolonged public health crisis with far-reaching consequences for both Africa and the global community.

One Health Investigation into Mpox and Pets, United States

Monkeypox virus (MPXV) is zoonotic and capable of infecting many mammal species. However, whether common companion animals are susceptible to MPXV infection is unclear. During July 2022-March 2023, we collected animal and environmental swab samples within homes of confirmed human mpox case-patients and tested for MPXV and human DNA by PCR. We also used ELISA for orthopoxvirus antibody detection. Overall, 12% (22/191) of animal and 25% (14/56) of environmental swab samples from 4 households, including samples from 4 dogs and 1 cat, were positive for MPXV DNA, but we did not detect viable MPXV or orthopoxvirus antibodies. Among MPXV PCR-positive swab samples, 82% from animals and 93% from environment amplified human DNA with a statistically significant correlation in observed cycle threshold values. Our findings demonstrate likely DNA contamination from the human mpox cases. Despite the high likelihood for exposure, we found no indications that companion animals were infected with MPXV.

Mpox: what sexual health physicians need to know?

Monkeypox virus (MPXV) is another zoonotic virus spilled over to the man and resulted in pandemic. World Health Organization declared it as a 'Public Health Emergency of International Concern (PHEIC) on July 22, 2022. Mpox affected over 95226 individuals among them claimed the lives of 185. Despite the fact that Mpox is generally mild and self-limited, immunocompromised people with low CD4 counts may experience severe disease course. Management of Mpox patients has three pillars. First symptomatic approach includes pain management, prophylaxis for secondary infections and when needed effective treatment of superinfections. Second, vaccines developed against smallpox can be used in preexposure or postexposure prophylaxis strategies against Mpox. Third, current antiviral options include tecovirimat, cidofovir and birincidofovir all of which have been recommended relying on experience from animal studies, clinical case reports or case series. Results of well-planned randomized control trials are not available. Occupational exposure to MPXV is especially a manageable risk for health care workers. Prevention of Mpox also requires risk communication with vulnerable population and their involvement in mitigation efforts.

The Re-Emergence of Mpox: Old Illness, Modern Challenges

The Mpox virus (MPXV) is known to cause zoonotic disease in humans. The virus belongs to the genus Orthopoxvirus, of the family Poxviridae, and was first reported in monkeys in 1959 in Denmark and in humans in 1970 in the Congo. MPXV first appeared in the U.S. in 2003, re-emerged in 2017, and spread globally within a few years. Wild African rodents are thought to be the reservoir of MPXV. The exotic trade of animals and international travel can contribute to the spread of the Mpox virus. A phylogenetic analysis of MPXV revealed two distinct clades (Central African clade and West African clade). The smallpox vaccine shows cross-protection against MPXV infections in humans. Those who have not previously been exposed to Orthopoxvirus infections are more vulnerable to MPXV infections. Clinical manifestations in humans include fever, muscle pain, headache, and vesicle formation on the skin of infected individuals. Pathognomonic lesions include ballooning degenerations with Guarnieri-like inclusions in vesicular epithelial cells. Alterations in viral genome through genetic mutations might favor the re-emergence of a version of MPXV with enhanced virulence. As of November 2023, 92,783 cases and 171 deaths have been reported in 116 countries, representing a global public health concern. Here, we provide insights on the re-emergence of MPXV in humans. This review covers the origin, emergence, re-emergence, transmission, pathology, diagnosis, control measures, and immunomodulation of the virus, as well as clinical manifestations. Concerted efforts of health professionals and scientists are needed to prevent the disease and stop its transmission in vulnerable populations.

Molecular epidemiology of recurrent zoonotic transmission of mpox virus in West Africa

Nigeria and Cameroon reported their first mpox cases in over three decades in 2017 and 2018 respectively. The outbreak in Nigeria is recognised as an ongoing human epidemic. However, owing to sparse surveillance and genomic data, it is not known whether the increase in cases in Cameroon is driven by zoonotic or sustained human transmission. Notably, the frequency of zoonotic transmission remains unknown in both Cameroon and Nigeria. To address these uncertainties, we investigated the zoonotic transmission dynamics of the mpox virus (MPXV) in Cameroon and Nigeria, with a particular focus on the border regions. We show that in these regions mpox cases are still driven by zoonotic transmission of a newly identified Clade IIb.1. We identify two distinct zoonotic lineages that circulate across the Nigeria-Cameroon border, with evidence of recent and historic cross border dissemination. Our findings support that the complex cross-border forest ecosystems likely hosts shared animal populations that drive cross-border viral spread, which is likely where extant Clade IIb originated. We identify that the closest zoonotic outgroup to the human epidemic circulated in southern Nigeria in October 2013. We also show that the zoonotic precursor lineage circulated in an animal population in southern Nigeria for more than 45 years. This supports findings that southern Nigeria was the origin of the human epidemic. Our study highlights the ongoing MPXV zoonotic transmission in Cameroon and Nigeria, underscoring the continuous risk of MPXV (re)emergence.

Understanding the biology of monkeypox virus to prevent future outbreaks

Historically, monkeypox (mpox) was a zoonotic disease endemic in Africa. However, in 2022, a global outbreak occurred following a substantial increase in cases in Africa, coupled with spread by international travellers to other continents. Between January 2022 and October 2023, about 91,000 confirmed cases from 115 countries were reported, leading the World Health Organization to declare a public health emergency. The basic biology of monkeypox virus (MPXV) can be inferred from other poxviruses, such as vaccinia virus, and confirmed by genome sequencing. Here the biology of MPXV is reviewed, together with a discussion of adaptive changes during MPXV evolution and implications for transmission. Studying MPXV biology is important to inform specific host interactions, to aid in ongoing outbreaks and to predict those in the future.

Orally available nucleoside analog UMM-766 provides protection in a murine model of orthopox disease

Although smallpox has been eradicated, other orthopoxviruses continue to be a public health concern as exemplified by the ongoing Mpox (formerly monkeypox) global outbreak. While medical countermeasures (MCMs) previously approved by the Food and Drug Administration for the treatment of smallpox have been adopted for Mpox, previously described vulnerabilities coupled with the questionable benefit of at least one of the therapeutics during the 2022 Mpox outbreak reinforce the need for identifying and developing other MCMs against orthopoxviruses. Here, we screened a panel of Merck proprietary small molecules and identified a novel nucleoside inhibitor with potent broad-spectrum antiviral activity against multiple orthopoxviruses. Efficacy testing of a 7-day dosing regimen of the orally administered nucleoside in a murine model of severe orthopoxvirus infection yielded a dose-dependent increase in survival. Treated animals had greatly reduced lesions in the lung and nasal cavity, particularly in the 10 µg/mL dosing group. Viral levels were also markedly lower in the UMM-766-treated animals. This work demonstrates that this nucleoside analog has anti-orthopoxvirus efficacy and can protect against severe disease in a murine orthopox model.IMPORTANCEThe recent monkeypox virus pandemic demonstrates that members of the orthopoxvirus, which also includes variola virus, which causes smallpox, remain a public health issue. While currently FDA-approved treatment options exist, risks that resistant strains of orthopoxviruses may arise are a great concern. Thus, continued exploration of anti-poxvirus treatments is warranted. Here, we developed a template for a high-throughput screening assay to identify anti-poxvirus small-molecule drugs. By screening available drug libraries, we identified a compound that inhibited orthopoxvirus replication in cell culture. We then showed that this drug can protect animals against severe disease. Our findings here support the use of existing drug libraries to identify orthopoxvirus-targeting drugs that may serve as human-safe products to thwart future outbreaks.

Cross-species transmission and host range genes in poxviruses

The persistent epidemic of human mpox, caused by mpox virus (MPXV), raises concerns about the future spread of MPXV and other poxviruses. MPXV is a typical zoonotic virus which can infect human and cause smallpox-like symptoms. MPXV belongs to the Poxviridae family, which has a relatively broad host range from arthropods to vertebrates. Cross-species transmission of poxviruses among different hosts has been frequently reported and resulted in numerous epidemics. Poxviruses have a complex linear double-strand DNA genome that encodes hundreds of proteins. Genes related to the host range of poxvirus are called host range genes (HRGs). This review briefly introduces the taxonomy, phylogeny and hosts of poxviruses, and then comprehensively summarizes the current knowledge about the cross-species transmission of poxviruses. In particular, the HRGs of poxvirus are described and their impacts on viral host range are discussed in depth. We hope that this review will provide a comprehensive perspective about the current progress of researches on cross-species transmission and HRG variation of poxviruses, serving as a valuable reference for academic studies and disease control in the future.

Clinical Manifestations of an Outbreak of Monkeypox Virus in Captive Chimpanzees in Cameroon, 2016

Monkeypox virus (MPXV) is a reemerging virus of global concern. An outbreak of clade I MPXV affected 20 captive chimpanzees in Cameroon in 2016. We describe the epidemiology, virology, phylogenetics, and clinical progression of this outbreak. Clinical signs included exanthema, facial swelling, perilaryngeal swelling, and eschar. Mpox can be lethal in captive chimpanzees, with death likely resulting from respiratory complications. We advise avoiding anesthesia in animals with respiratory signs to reduce the likelihood of death. This outbreak presented a risk to animal care staff. There is a need for increased awareness and a One Health approach to preparation for outbreaks in wildlife rescue centers in primate range states where MPXV occurs. Control measures should include quarantining affected animals, limiting human contacts, surveillance of humans and animals, use of personal protective equipment, and regular decontamination of enclosures.

Concurrent Clade I and Clade II Monkeypox Virus Circulation, Cameroon, 1979-2022

During 1979-2022, Cameroon recorded 32 laboratory-confirmed mpox cases among 137 suspected mpox cases identified by the national surveillance network. The highest positivity rate occurred in 2022, indicating potential mpox re-emergence in Cameroon. Both clade I (n = 12) and clade II (n = 18) monkeypox virus (MPXV) were reported, a unique feature of mpox in Cameroon. The overall case-fatality ratio of 2.2% was associated with clade II. We found mpox occurred only in the forested southern part of the country, and MPXV phylogeographic structure revealed a clear geographic separation among concurrent circulating clades. Clade I originated from eastern regions close to neighboring mpox-endemic countries in Central Africa; clade II was prevalent in western regions close to West Africa. Our findings suggest that MPXV re-emerged after a 30-year lapse and might arise from different viral reservoirs unique to ecosystems in eastern and western rainforests of Cameroon.

The One Health Concept

The concept of One Health has been developed as the appreciation that human health is intricately connected to those of other animals and the environment that they inhabit. In recent years, the COVID-19 pandemic and noticeable effects of climate change have encouraged national and international cooperation to apply One Health strategies to address key issues of health and welfare. The United Nations (UN) Sustainable Development Goals have established targets for health and wellbeing, clean water and sanitation, climate action, as well as sustainability in marine and terrestrial ecosystems. The One Health Quadripartite comprises the World Health Organization (WHO), the World Organization for Animal Health (WOAH-formerly OIE), the United Nations Food and Agriculture Organization (FAO) and the United Nations Environment Programme (UNEP). There are six areas of focus which are Laboratory services, Control of zoonotic diseases, Neglected tropical diseases, Antimicrobial resistance, Food safety and Environmental health. This article discusses the concept of One Health by considering examples of infectious diseases and environmental issues under each of those six headings. Biomedical Scientists, Clinical Scientists and their colleagues working in diagnostic and research laboratories have a key role to play in applying the One Health approach to key areas of healthcare in the 21st Century.

Biological Characteristics and Pathogenesis of Monkeypox Virus: An Overview

Although the smallpox virus has been eradicated worldwide, the World Health Organization (WHO) has issued a warning about the virus's potential to propagate globally. The WHO labeled monkeypox a world public health emergency in July 2022, requiring urgent prevention and treatment. The monkeypox virus is a part of the Poxviridae family, Orthopoxvirus genus, and is accountable for smallpox, which has killed over a million people in the past. Natural hosts of the virus include squirrels, Gambian rodents, chimpanzees, and other monkeys. The monkeypox virus has transmitted to humans through primary vectors (various animal species) and secondary vectors, including direct touch with lesions, breathing particles from body fluids, and infected bedding. The viral particles are ovoid or brick-shaped, 200-250 nm in diameter, contain a single double-stranded DNA molecule, and reproduce only in the cytoplasm of infected cells. Monkeypox causes fever, cold, muscle pains, headache, fatigue, and backache. The phylogenetic investigation distinguished between two genetic clades of monkeypox: the more pathogenic Congo Basin clade and the West Africa clade. In recent years, the geographical spread of the human monkeypox virus has accelerated despite a paucity of information regarding the disease's emergence, ecology, and epidemiology. Using lesion samples and polymerase chain reaction (PCR), the monkeypox virus was diagnosed. In the USA, the improved Ankara vaccine can now be used to protect people who are at a higher risk of getting monkeypox. Antivirals that we have now work well against smallpox and may stop the spread of monkeypox, but there is no particular therapy for monkeypox.

Monkeypox: Past, Present, and Future

Monkeypox (Mpox) is a zoonotic disease caused by a virus (monkeypox virus-MPV) belonging to the Poxviridae family. In humans, the disease has an incubation period of 5-21 days and then progresses in two phases, the prodromal phase and the rash phase. The prodromal phase is characterized by non-specific symptoms such as fever, muscle pain, malaise, lymphadenopathy, headache, and chills. Skin lesions appear in the rash phase of the disease. These lesions progress through different stages (macules, papules, vesicles, and pustules). In May 2022, WHO reported an outbreak of human Mpox in several countries which were previously Mpox-free. As per the CDC report of March 01, 2023, a total of 86,231 confirmed cases of Mpox and 105 deaths have been reported from 110 countries and territories across the globe. Notably, more than 90% of these countries were reporting Mpox for the first time. The phylogenetic analysis revealed that this outbreak was associated with the virus from the West African clade. However, most of the cases in this outbreak had no evidence of travel histories to MPV-endemic countries in Central or West Africa. This outbreak was primarily driven by the transmission of the virus via intimate contact in men who have sex with men (MSM). The changing epidemiology of Mpox raised concerns about the increasing spread of the disease in non-endemic countries and the urgent need to control and prevent it. In this chapter, we present all the documented cases of Mpox from 1970 to 2023 and discuss the past, present, and future of MPV.

Pathogenicity and virulence of monkeypox at the human-animal-ecology interface

Monkeypox (Mpox) was mostly limited to Central and Western Africa, but recently it has been reported globally. The current review presents an update on the virus, including ecology and evolution, possible drivers of transmission, clinical features and management, knowledge gaps, and research priorities to reduce the disease transmission. The origin, reservoir(s) and the sylvatic cycle of the virus in the natural ecosystem are yet to be confirmed. Humans acquire the infection through contact with infected animals, humans, and natural hosts. The major drivers of disease transmission include trapping, hunting, bushmeat consumption, animal trade, and travel to endemic countries. However, in the 2022 epidemic, the majority of the infected humans in non-endemic countries had a history of direct contact with clinical or asymptomatic persons through sexual activity. The prevention and control strategies should include deterring misinformation and stigma, promoting appropriate social and behavioural changes, including healthy life practices, instituting contact tracing and management, and using the smallpox vaccine for high-risk people. Additionally, longer-term preparedness should be emphasized using the One Health approach, such as systems strengthening, surveillance and detection of the virus across regions, early case detection, and integrating measures to mitigate the socio-economic effects of outbreaks.

Driving effect of multiplex factors on Mpox in global high-risk region, implication for Mpox based on one health concept

Mpox is an ongoing viral zoonotic disease epidemic worldwide. Being different from conventional animal-to-human transmission, the present outbreak is mainly caused by human-to-human transmission of Mpox virus, putting forward the risk of worldwide epidemic. The current spatial distribution characteristics and risk area prediction are urgently needed for preparedness for prevention and control of the disease based on the One Health strategy. In the present study, the global outbreak point of Mpox virus were collected and used to predict potential global risk of Mpox virus with ecological niche model constructed with a combination of eco-geographical, anthropoid, meteorological, and host variables. The results showed that human factors are the key to the risk and prevalence of Mpox. The risk map indicated that Mpox may affect extensive areas worldwide. Europe and North America have the highest risk of Mpox. Although most areas have never recorded Mpox before, there are some high-risk areas in Asia. Our findings highlight population density is the most important contributing factor for high-risk area. Many large cities with dense populations, developed transportation, and high migration rate in the world, are in high risks. At present, the spread of Mpox is highly valued in the world and strict prevention and control measures have been taken. However, under the influence of human factors, Mpox has the potential of a global pandemic. The risk area prediction and main risk factors provide key information for targeted preparedness for prevention and control of Mpox outbreak and avoiding potential global epidemic through the One Health approach.

Monkeypox Virus Immune Evasion and Eye Manifestation: Beyond Eyelid Implications

Monkeypox virus (MPXV), belonging to the Poxviridae family and Orthopoxvirus genus, is closely related to the smallpox virus. Initial prodromal symptoms typically include headache, fever, and lymphadenopathy. This review aims to detail various ocular manifestations and immune evasion associated with the monkeypox viral infection and its complications, making it appropriate as a narrative review. Common external ocular manifestations of MPXV typically involve a generalized pustular rash, keratitis, discharges, and dried secretions related to conjunctival pustules, photophobia, and lacrimation. Orthopoxviruses can evade host immune responses by secreting proteins that antagonize the functions of host IFNγ, CC and CXC chemokines, IL-1β, and the complement system. One of the most important transcription factors downstream of pattern recognition receptors binding is IRF3, which controls the expression of the crucial antiviral molecules IFNα and IFNβ. We strongly recommend that ophthalmologists include MPXV as part of their differential diagnosis when they encounter similar cases presenting with ophthalmic manifestations such as conjunctivitis, blepharitis, or corneal lesions. Furthermore, because non-vaccinated individuals are more likely to exhibit these symptoms, it is recommended that healthcare administrators prioritize smallpox vaccination for at-risk groups, including very young children, pregnant women, older adults, and immunocompromised individuals, especially those in close contact with MPXV cases.

Mpox global outbreak: update in epidemiology, clinical spectrum and considerations in prevention and treatment

Mpox is the most prevalent Orthopoxvirus infection in humans. Several clinical characteristics of mpox distinguish this disease from other rash illnesses. Complications are not uncommon. New therapeutics and vaccines are likely to change the course of the disease, especially in immunocompromised individuals. Clinicians must ensure that access to treatment and prevention measures are guaranteed especially in this particular population. This review exposes the epidemiology, clinical spectrum and updated considerations in treatment and prevention within the mpox global outbreak.

The use of Xuanbai Chengqi decoction on monkeypox disease through the estrone-target AR interaction

Introduction

After COVID-19, there was an outbreak of a new infectious disease caused by monkeypox virus. So far, no specific drug has been found to treat it. Xuanbai Chengqi decoction (XBCQD) has shown effects against a variety of viruses in China.

Methods

We searched for the active compounds and potential targets for XBCQD from multiple open databases and literature. Monkeypox related targets were searched out from the OMIM and GeneCards databases. After determining the assumed targets of XBCQD for monkeypox treatment, we built the PPI network and used R for GO enrichment and KEGG pathway analysis. The interactions between the active compounds and the hub targets were investigated by molecular docking and molecular dynamics (MD) simulations.

Results

In total, 5 active compounds and 10 hub targets of XBCQD were screened out. GO enrichment and KEGG analysis demonstrated that XBCQD plays a therapeutic role in monkeypox mainly by regulating signaling pathways related to viral infection and inflammatory response. The main active compound estrone binding to target AR was confirmed to be the best therapy choice for monkeypox.

Discussion

This study systematically explored the interactions between the bioactive compounds of XBCQD and the monkeypox-specific XBCQD targets using network pharmacological methods, bioinformatics analyses and molecular simulations, suggesting that XBCQD could have a beneficial therapeutic effect on monkeypox by reducing the inflammatory damage and viral replication via multiple pathways. The use of XBCQD on monkeypox disease was confirmed to be best worked through the estrone-target AR interaction. Our work could provide evidence and guidance for further research on the treatment of monkeypox disease.

The Changing Global Epidemiology of Re-emerging Human Monkeypox Virus Infection: A Systematic Review

Human monkeypox virus (MPVX) infection represents an emerging zoonotic disease caused by an orthopoxvirus, resulting in a condition reminiscent of smallpox. More recent developments have witnessed a notable surge in global MPVX outbreaks, eliciting significant concerns. We aimed to investigate the epidemiological factors of the emerging human monkeypox virus infection, including the number of suspected, confirmed, and fatal cases, as well as the risk factors for contracting monkeypox infection. We performed a systematic review of peer-reviewed literature by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic database search (PubMed, Wiley Online Library, and Science Direct) was undertaken. For monkeypox-related studies, we included 25 peer-reviewed articles from 2018 and 2022, and data were extracted on the current evidence on the cases and the risk factors for MPVX infection, to develop public health advisories. Our reports show a rapid rise of MPVX cases in the highly endemic African regions after the 1970s, spread to other countries, and an increase in the median age from young children to young adults. The cessation of smallpox vaccination might have been one of the factors responsible for these findings. As of 2022, the genomic sequences of ten MPVX strains associated with the recent countrywide outbreak have been determined. While the West African Clade has been primarily implicated in the recent viral surge, data were insufficient to determine which mutation contributed to increased transmissibility. In the Democratic Republic of the Congo (DRC), sleeping on the floor was significantly associated with contracting MPVX, while eating or processing of animal foods was not a significant risk factor. In the United States, cleaning the cages and bedding of sick animals, touching infected animals, and daily exposure to sick animals were associated with an increased probability of contracting the MPVX infection. Recent global outbreaks and the rising incidence of MPVX infections among young adults in the endemic zones might be a result of the cessation of the smallpox vaccine. The increased risk associated with exposure to sick animals or sleeping on the floor suggests high infectivity from animal excretions. Increasing awareness, strict surveillance, and contact tracing can help contain global outbreaks. The ring vaccination approach for exposed individuals is another potential disease containment strategy. Future studies should investigate measures for rapid laboratory diagnosis, maintaining lab safety, and transmissibility.

One Health in a Digital World: Technology, Data, Information and Knowledge

OBJECTIVES

To describe the origins and growth of the One Health concept and its recent application in One Digital Health.

METHODS

Bibliometric review and critical discussion of emergent themes derived from co-occurrence of MeSH keywords.

RESULTS

The fundamental interrelationship between human health, animal health and the wider environment has been recognized since ancient times. One Health as a distinct term originated in 2004 and has been a rapidly growing concept of interest in the biomedical literature since 2017. One Digital Health has quickly established itself as a unifying construct that highlights the critical role of technology, data, information and knowledge to facilitate the interdisciplinary collaboration that One Health requires. The principal application domains of One Digital Health to date are in FAIR data integration and analysis, disease surveillance, antimicrobial stewardship and environmental monitoring.

CONCLUSIONS

One Health and One Digital Health offer powerful lenses to examine and address crises in our living world. We propose thinking in terms of Learning One Health Systems that can dynamically capture, integrate, analyse and monitor application of data across the biosphere.

Human monkeypox: history, presentations, transmission, epidemiology, diagnosis, treatment, and prevention

Human monkeypox is a zoonotic infection that is similar to the diseases caused by other poxviruses. It is endemic among wild rodents in the rainforests of Central and Western Africa, and can be transmitted via direct skin contact or mucosal exposure to infected animals. The initial symptoms include fever, headache, myalgia, fatigue, and lymphadenopathy, the last of which is the main symptom that distinguishes it from smallpox. In order to prevent and manage the disease, those who are infected must be rapidly diagnosed and isolated. Several vaccines have already been developed (e.g., JYNNEOS, ACAM2000 and ACAM3000) and antiviral drugs (e.g., cidofovir and tecovirimat) can also be used to treat the disease. In the present study, we reviewed the history, morphology, clinical presentations, transmission routes, diagnosis, prevention, and potential treatment strategies for monkeypox, in order to enable health authorities and physicians to better deal with this emerging crisis.

A Comprehensive Review on Monkeypox Viral Disease with Potential Diagnostics and Therapeutic Options

The purpose of this review is to give an up-to-date, thorough, and timely overview of monkeypox (Mpox), a severe infectious viral disease. Furthermore, this review provides an up-to-date treatment option for Mpox. The monkeypox virus (MPXV) has remained the most virulent poxvirus for humans since the elimination of smallpox approximately 41 years ago, with distribution mainly in central and west Africa. Mpox in humans is a zoonotically transferred disease that results in symptoms like those of smallpox. It had spread throughout west and central Africa when it was first diagnosed in the Republic of Congo in 1970. Mpox has become a major threat to global health security, necessitating a quick response by virologists, veterinarians, public health professionals, doctors, and researchers to create high-efficiency diagnostic tests, vaccinations, antivirals, and other infection control techniques. The emergence of epidemics outside of Africa emphasizes the disease's global significance. A better understanding of Mpox's dynamic epidemiology may be attained by increased surveillance and identification of cases.

Challenges in the treatment and prevention of Monkeypox infection; a comprehensive review

Human monkeypox (HMPX) is a zoonotic disease, literally meaning that it can be passed on from animals (non-primate) to human (primate). All the reported and recorded cases have been traced back either to international travel or import of African animals. In the Unites states, sporadic monkeypox cases have been reported in specific over the past 50 years, starting its first identification in the Democratic Republic of the Congo (D.R.C.) in 1970. Due to its extreme versatility, this disease poses threat as a serious public health issue that needs to be monitored, researched and prevented. Data indicate that prior immunization with the smallpox vaccine is beneficial and may provide protection against the monkeypox virus. JYNNEOSTM is a live viral vaccine that has been approved to improve clinical manifestations of the infection. On the other hand, public ignorance about safety precaution towards monkeypox post-COVID is another challenge that needs to be overcome in tackling HMPX as a possible re-emergent infection. This review is a collation of the epidemiology, etiology, transmission, clinical features and treatment of human monkeypox (HMPX).

Monkeypox: A comprehensive review of a multifaceted virus

In May 2022, the world witnessed the re-emergence of the zoonotic disease monkeypox. While this was not the first epidemic of this disease, what differentiated the outbreak was the rapid global spread and increase of cases, which led the WHO to declare monkeypox a global health emergency. Although the disease spreads mainly through inadequately cooked meat of various rodent species, this virus also shows droplet, respiratory, sexual, and even vertical transmission. Monkeypox further multiplies in lymphoproliferative organs and presents with a classical smallpox-like rash, fever, headache, and muscle aches. Diagnosis is confirmed with a polymerase-chain-reaction test and is managed largely supportively with possible usage of some antivirals and immunoglobulins. Moreover, some pre-exposure and postexposure prophylactic vaccines have been developed. This paper aims to conduct an in-depth review of the historical epidemics, transmission, pathophysiology, clinical presentation, and management of the monkeypox disease.

Monkeypox: a review of epidemiological modelling studies and how modelling has led to mechanistic insight

Human monkeypox (mpox) virus is a viral zoonosis that belongs to the Orthopoxvirus genus of the Poxviridae family, which presents with similar symptoms as those seen in human smallpox patients. Mpox is an increasing concern globally, with over 80,000 cases in non-endemic countries as of December 2022. In this review, we provide a brief history and ecology of mpox, its basic virology, and the key differences in mpox viral fitness traits before and after 2022. We summarize and critique current knowledge from epidemiological mathematical models, within-host models, and between-host transmission models using the One Health approach, where we distinguish between models that focus on immunity from vaccination, geography, climatic variables, as well as animal models. We report various epidemiological parameters, such as the reproduction number, R0, in a condensed format to facilitate comparison between studies. We focus on how mathematical modelling studies have led to novel mechanistic insight into mpox transmission and pathogenesis. As mpox is predicted to lead to further infection peaks in many historically non-endemic countries, mathematical modelling studies of mpox can provide rapid actionable insights into viral dynamics to guide public health measures and mitigation strategies.

Preventing and fighting stigma: a lesson from the first Mpox in Veneto region of Northeast Italy-A case report

Since the 1970s, human monkeypox (Mpox) has been referred to as a zoonotic endemic disease of specific regions of Africa until early 2022, when a worldwide epidemic outbreak developed. There are many hypotheses on how Mpox could spread to non-endemic regions; the dominant theory is that it spread from the UK and Spain among men who have sex with men (MSM). Therefore, the first clinical case in the Veneto region (Northeast of Italy) was analyzed-which represented a typical case report of the ongoing outbreak-with lesions located mainly in the areas associated with sexual behaviors (genital and oral). This case report highlights the new challenges of Mpox, as it seems to differ from the previous classic manifestation. Indeed, although the patient achieved restitution ad integrum of lesions and complete recovery from the disease, it is deemed necessary to offer communication strategies to involve a heterogeneous audience based on different risks of exposure but without stigmatizing attitudes, avoiding the mistakes made with HIV. The need for broad public involvement is demonstrated by identifying Mpox even in "anomalous cases." Stigma could be an obstacle in engaging patients in proper care and in getting honest answers while contact tracing, as happened in our patient's case; thus, WHO recently renamed monkeypox as Mpox. Abnormal outbreaks in non-endemic countries, with no causal links, must become a warning signal for governments and health policies to design national plans for managing unexpected outbreaks. For an effective public health response, health institutions must communicate effectively, focus on changes and prevention measures, and formulate a plan based on equity and inclusion of the most vulnerable groups.

Mpox Virus: Its Molecular Evolution and Potential Impact on Viral Epidemiology

Mpox (previously known as monkeypox) is an infectious viral illness caused by the mpox virus (MPXV), an orthopoxvirus that belongs to the family Poxviridae. The symptoms of mpox in humans are similar to those of smallpox, although the mortality rate is lower. In recent years, the concern over a potential global pandemic has increased due to reports of mpox spreading across Africa and other parts of the world. Prior to this discovery, mpox was a rare zoonotic disease restricted to endemic regions of Western and Central Africa. The sudden emergence of MPXV cases in multiple regions has raised concerns about its natural evolution. This review aims to provide an overview of previously available information about MPXV, including its genome, morphology, hosts and reservoirs, and virus-host interaction and immunology, as well as to perform phylogenetic analysis on available MPXV genomes, with an emphasis on the evolution of the genome in humans as new cases emerge.

Public Health Challenges in the Context of the Global Spread of Mpox Infections

The declaration of the ongoing mpox (formerly monkeypox) outbreak by the WHO as a public health emergency of international concern has put global attention on mpox disease. As of December 4, 2022, a total of 80,221 mpox cases had been confirmed from 110 countries, with a major proportion of cases being reported from previously non-endemic countries. The current global emergence and spread of the disease has highlighted the challenges and the need for efficient public health preparedness and response. There are several challenges posed in the current mpox outbreak, ranging from epidemiological factors to diagnostic and socio-ethnic issues. These challenges may be circumvented with proper intervention measures such as strengthening surveillance, robust diagnostics, clinical management plans, intersectoral collaboration, firm prevention plans, capacity building, addressing stigma and discrimination against vulnerable groups, and ensuring equitable access to treatments and vaccines. To address the above challenges in the wake of the current outbreak, it is essential to understand the gaps and plug them with effective countermeasures.

Monkeypox Virus in Animals: Current Knowledge of Viral Transmission and Pathogenesis in Wild Animal Reservoirs and Captive Animal Models

Mpox, formerly called monkeypox, is now the most serious orthopoxvirus (OPXV) infection in humans. This zoonotic disease has been gradually re-emerging in humans with an increasing frequency of cases found in endemic areas, as well as an escalating frequency and size of epidemics outside of endemic areas in Africa. Currently, the largest known mpox epidemic is spreading throughout the world, with over 85,650 cases to date, mostly in Europe and North America. These increased endemic cases and epidemics are likely driven primarily by decreasing global immunity to OPXVs, along with other possible causes. The current unprecedented global outbreak of mpox has demonstrated higher numbers of human cases and greater human-to-human transmission than previously documented, necessitating an urgent need to better understand this disease in humans and animals. Monkeypox virus (MPXV) infections in animals, both naturally occurring and experimental, have provided critical information about the routes of transmission; the viral pathogenicity factors; the methods of control, such as vaccination and antivirals; the disease ecology in reservoir host species; and the conservation impacts on wildlife species. This review briefly described the epidemiology and transmission of MPXV between animals and humans and summarizes past studies on the ecology of MPXV in wild animals and experimental studies in captive animal models, with a focus on how animal infections have informed knowledge concerning various aspects of this pathogen. Knowledge gaps were highlighted in areas where future research, both in captive and free-ranging animals, could inform efforts to understand and control this disease in both humans and animals.

Can Acanthamoeba Harbor Monkeypox Virus?

Acanthamoeba is well known to host a variety of microorganisms such as viruses, bacteria, protozoa, and yeast. Given the recent number of cases of monkeypox infection, we speculate that amoebae may be aiding viral transmission to the susceptible hosts. Although there is no confirmatory evidence to suggest that Acanthamoeba is a host to monkeypox (a double-stranded DNA virus), the recent discovery of mimivirus (another double-stranded DNA virus) from Acanthamoeba, suggests that amoebae may shelter monkeypox virus. Furthermore, given the possible spread of monkeypox virus from animals to humans during an earlier outbreak, which came about after patients came in contact with prairie dogs, it is likely that animals may also act as mixing vessel between ubiquitously distributed Acanthamoeba and monkeypox virus, in addition to the environmental habitat that acts as an interface in complex interactions between diverse microorganisms and the host.

AI-driven drug repurposing and binding pose meta dynamics identifies novel targets for Monkeypox virus

Monkeypox virus (MPXV) was confirmed in May 2022 and designated a global health emergency by WHO in July 2022. MPX virions are big, enclosed, brick-shaped, and contain a linear, double-stranded DNA genome as well as enzymes. MPXV particles bind to the host cell membrane via a variety of viral-host protein interactions. As a result, the wrapped structure is a potential therapeutic target. DeepRepurpose, an artificial intelligence-based compound-viral proteins interaction framework, was used via a transfer learning setting to prioritize a set of FDA approved and investigational drugs which can potentially inhibit MPXV viral proteins. To filter and narrow down the lead compounds from curated collections of pharmaceutical compounds, we used a rigorous computational framework that included homology modeling, molecular docking, dynamic simulations, binding free energy calculations, and binding pose metadynamics. We identified Elvitegravir as a potential inhibitor of MPXV virus using our comprehensive pipeline.

Monkeypox (hMPXV Infection): A Practical Review

Monkeypox, a neglected disease previously confined to Africa, is causing a worldwide outbreak affecting predominantly males who have sex with males, especially those who are infected with HIV. The clinical presentation during the current outbreak differs from endemic cases. Treatment with tecovirimat and other antivirals is available. Immunization may be used as preexposure and postexposure prophylaxis.

Overview of the regulatory approval of tecovirimat intravenous formulation for treatment of smallpox: potential impact on smallpox outbreak response capabilities, and future tecovirimat development potential

INTRODUCTION

Tecovirimat oral capsule formulation is approved in the US and Canada for treatment of smallpox and in the United Kingdom (UK) and European Union (EU) for treatment of multiple human orthopoxvirus diseases, including mpox. Smallpox is considered a serious threat, and there is currently an unprecedented global mpox outbreak.

AREAS COVERED

A brief summary of the threat of smallpox, the threat of increasing mpox spread in endemic regions, and the unprecedented emergence of mpox into non-endemic regions is presented. The tecovirimat intravenous formulation clinical development program leading to USFDA approval for smallpox treatment is discussed.

EXPERT OPINION

As of January 2023 tecovirimat is approved to treat mpox in the UK and EU. However, published clinical trial data evaluating tecovirimat efficacy and safety in mpox patients is pending. Increasing global prevalence of mpox highlights the potential benefits of a well-characterized, effective, and safe antiviral treatment for mpox infection. Ongoing trials in mpox patients may provide results supporting the use of tecovirimat to treat this disease. USFDA approval of tecovirimat for post-exposure prophylaxis in the event of a smallpox release, and the development of pediatric liquid formulations for patients under 13 kg, could provide additional public health benefits.

Monkeypox virus: past and present

BACKGROUND

The objective of this paper is to analyze the current status of monkeypox worldwide. In the face of this public health threat, our purpose is to elucidate the clinical characteristics and epidemiology of monkeypox, the developmental progress of monkeypox-related drugs and the vaccines available.

DATA SOURCES

The literature review was performed in databases including PubMed, Science Direct and Google Scholar up to July 2022.

RESULTS

Since May 2022, the World Health Organization has reported more than 45,000 confirmed cases from 92 nonendemic countries, including nine deaths. Although some women and children have been infected so far, most cases have occurred among men who have sex with other men, especially those with multiple sexual partners or anonymous sex.

CONCLUSIONS

Pediatric monkeypox infection has been associated with a higher likelihood of severe illness and mortality than in adults. Severe monkeypox illness in pediatrics often requires adjunctive antiviral therapy. It is crucial for all countries to establish sound monitoring and testing systems and be prepared with emergency preparedness.

Orthopoxvirus Zoonoses—Do We Still Remember and Are Ready to Fight?

The eradication of smallpox was an enormous achievement due to the global vaccination program launched by World Health Organization. The cessation of the vaccination program led to steadily declining herd immunity against smallpox, causing a health emergency of global concern. The smallpox vaccines induced strong, humoral, and cell-mediated immune responses, protecting for decades after immunization, not only against smallpox but also against other zoonotic orthopoxviruses that now represent a significant threat to public health. Here we review the major aspects regarding orthopoxviruses’ zoonotic infections, factors responsible for viral transmissions, as well as the emerging problem of the increased number of monkeypox cases recently reported. The development of prophylactic measures against poxvirus infections, especially the current threat caused by the monkeypox virus, requires a profound understanding of poxvirus immunobiology. The utilization of animal and cell line models has provided good insight into host antiviral defenses as well as orthopoxvirus evasion mechanisms. To survive within a host, orthopoxviruses encode a large number of proteins that subvert inflammatory and immune pathways. The circumvention of viral evasion strategies and the enhancement of major host defenses are key in designing novel, safer vaccines, and should become the targets of antiviral therapies in treating poxvirus infections.

Mathematical epidemiological modeling and analysis of monkeypox dynamism with non-pharmaceutical intervention using real data from United Kingdom

In this study, a mathematical model for studying the dynamics of monkeypox virus transmission with non-pharmaceutical intervention is created, examined, and simulated using real-time data. Positiveness, invariance, and boundedness of the solutions are thus examined as fundamental features of mathematical models. The equilibrium points and the prerequisites for their stability are achieved. The basic reproduction number and thus the virus transmission coefficient ℜ0 were determined and quantitatively used to study the global stability of the model's steady state. Furthermore, this study considered the sensitivity analysis of the parameters according to ℜ0. The most sensitive variables that are important for infection control are determined using the normalized forward sensitivity index. Data from the United Kingdom collected between May and August 2022, which also aid in demonstrating the usefulness and practical application of the model to the spread of the disease in the United Kingdom, were used. In addition, using the Caputo-Fabrizio operator, Krasnoselskii's fixed point theorem has been used to analyze the existence and uniqueness of the solutions to the suggested model. The numerical simulations are presented to assess the system dynamic behavior. More vulnerability was observed when monkeypox virus cases first appeared recently as a result of numerical calculations. We advise the policymakers to consider these elements to control monkeypox transmission. Based on these findings, we hypothesized that another control parameter could be the memory index or fractional order.

Nanomedicine as a Potential Tool against Monkeypox

Human monkeypox is a rare viral zoonosis that was first identified in 1970; since then, this infectious disease has been marked as endemic in central and western Africa. The disease has always been considered rare and self-limiting; however, recent worldwide reports of several cases suggest otherwise. Especially with monkeypox being recognized as the most important orthopoxvirus infection in humans in the smallpox post-eradication era, its spread across the globe marks a new epidemic. Currently, there is no proven treatment for human monkeypox, and questions about the necessity of developing a vaccine persist. Notably, if we are to take lessons from the COVID-19 pandemic, developing a nanomedicine-based preventative strategy might be prudent, particularly with the rapid growth of the use of nanotechnology and nanomaterials in medical research. Unfortunately, the collected data in this area is limited, dispersed, and often incomplete. Therefore, this review aims to trace all reported nanomedicine approaches made in the monkeypox area and to suggest possible directions that could be further investigated to develop a counteractive strategy against emerging and existing viruses that could diminish this epidemic and prevent it from becoming a potential pandemic, especially with the world still recovering from the COVID-19 pandemic.

The monkeypox diagnosis, treatments and prevention: A review

The world is currently dealing with a second viral outbreak, monkeypox, which has the potential to become an epidemic after the COVID-19 pandemic. People who reside in or close to forest might be exposed indirectly or at a low level, resulting in subclinical disease. However, the disease has lately emerged in shipped African wild mice in the United States. Smallpox can cause similar signs and symptoms to monkeypox, such as malaise, fever, flu-like signs, headache, distinctive rash, and back pain. Because Smallpox has been eliminated, similar symptoms in a monkeypox endemic zone should be treated cautiously. Monkeypox is transmitted to humans primarily via interaction with diseased animals. Infection through inoculation via interaction with skin or scratches and mucosal lesions on the animals is conceivable significantly once the skin barrier is disrupted by scratches, bites, or other disturbances or trauma. Even though it is clinically unclear from other pox-like infections, laboratory diagnosis is essential. There is no approved treatment for human monkeypox virus infection, however, smallpox vaccination can defend counter to the disease. Human sensitivity to monkeypox virus infection has grown after mass vaccination was discontinued in the 1980s. Infection may be prevented by reducing interaction with sick patients or animals and reducing respiratory exposure among people who are infected.

Potential Inhibitors of Monkeypox Virus Revealed by Molecular Modeling Approach to Viral DNA Topoisomerase I

The monkeypox outbreak has become a global public health emergency. The lack of valid and safe medicine is a crucial obstacle hindering the extermination of orthopoxvirus infections. The identification of potential inhibitors from natural products, including Traditional Chinese Medicine (TCM), by molecular modeling could expand the arsenal of antiviral chemotherapeutic agents. Monkeypox DNA topoisomerase I (TOP1) is a highly conserved viral DNA repair enzyme with a small size and low homology to human proteins. The protein model of viral DNA TOP1 was obtained by homology modeling. The reliability of the TOP1 model was validated by analyzing its Ramachandran plot and by determining the compatibility of the 3D model with its sequence using the Verify 3D and PROCHECK services. In order to identify potential inhibitors of TOP1, an integrated library of 4103 natural products was screened via Glide docking. Surface Plasmon Resonance (SPR) was further implemented to assay the complex binding affinity. Molecular dynamics simulations (100 ns) were combined with molecular mechanics Poisson-Boltzmann surface area (MM/PBSA) computations to reveal the binding mechanisms of the complex. As a result, three natural compounds were highlighted as potential inhibitors via docking-based virtual screening. Rosmarinic acid, myricitrin, quercitrin, and ofloxacin can bind TOP1 with KD values of 2.16 μM, 3.54 μM, 4.77 μM, and 5.46 μM, respectively, indicating a good inhibitory effect against MPXV. The MM/PBSA calculations revealed that rosmarinic acid had the lowest binding free energy at -16.18 kcal/mol. Myricitrin had a binding free energy of -13.87 kcal/mol, quercitrin had a binding free energy of -9.40 kcal/mol, and ofloxacin had a binding free energy of -9.64 kcal/mol. The outputs (RMSD/RMSF/Rg/SASA) also indicated that the systems were well-behaved towards the complex. The selected compounds formed several key hydrogen bonds with TOP1 residues (TYR274, LYS167, GLY132, LYS133, etc.) via the binding mode analysis. TYR274 was predicted to be a pivotal residue for compound interactions in the binding pocket of TOP1. The results of the enrichment analyses illustrated the potential pharmacological networks of rosmarinic acid. The molecular modeling approach may be acceptable for the identification and design of novel poxvirus inhibitors; however, further studies are warranted to evaluate their therapeutic potential.

What Do We Know About the Smallpox Virus? A Journey Between Clinic and Therapy

PURPOSE

Modern research is increasingly focusing on the study of new viruses and the re-emergence of past microbes, such as Coronaviruses, particularly Sars-Cov2 that was responsible for the very recent pandemic.

METHODS AND RESULTS

This infection manifested itself and still continues to manifest as a severe respiratory syndrome. The main discriminator of whether or not one succeeds in overcoming this infection may depend on a great many factors, but the main one is definitely determined by vaccination, which has minimized hospitalizations and more severe syndromes.

CONCLUSION

Recently, a new virus, the monkeypox virus, which was previously confined to Central and West Africa but is now gradually spreading to more than 30 countries including the United States of America, where such an infection is not endemic, is coming forward again.