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Hemati S, Mohammadi-Moghadam F. A systematic review on environmental perspectives of monkeypox virus. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:363-370. [PMID: 36593124 DOI: 10.1515/reveh-2022-0221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Monkeypox (MPX) is one of the common infections between humans and animals that caused by a virus belonging to the Orthopoxvirus genus. The Monkeypox virus (MPXV) outbreak is a global crisis triggered by environmental factors (virus, wastewater, surface, air) and amplified by the decisions of government officials and communities. The aim of this systematic review is to describe the environmental perspectives of MPXV with emphasis on risk assessment to prevent and control a new pandemic. Five online databases including Web of Science, PubMed, Scopus, Science Direct and Google Scholar were searched from 1990 to October 2022. Among 120 records, after the screening, four studies were included in the systematic review. The systematic review revealed that the possibility of MPXV transmission through wastewater, air, and the contaminated surfaces is a significant concern and its detection and destroying will play a major role in controlling the spread of the virus. Poxviruses have a high environmental stability, but are sensitive to all common chemical disinfectants. In conclusion, this study revealed that the environmental surveillance can be used as a complementary tool for detecting pathogens circulation in communities. This implies that the monitoring of environmental perspectives of MPXV can provide new awareness into virus transmission routes as well as the role of stakeholders and public health policies in MPXV risk management.
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Affiliation(s)
- Sara Hemati
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fazel Mohammadi-Moghadam
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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2
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Kuehn R, Fox T, Guyatt G, Lutje V, Gould S. Infection prevention and control measures to reduce the transmission of mpox: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002731. [PMID: 38236835 PMCID: PMC10796032 DOI: 10.1371/journal.pgph.0002731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To make inferences regarding the effectiveness of respiratory interventions and case isolation measures in reducing or preventing the transmission of mpox based on synthesis of available literature. METHODS The WHO Clinical Management and Infection Prevention and Control 2022 guideline and droplet precautions in healthcare facilities and home isolation infection prevention control measures for patients with mpox. We conducted a systematic review that included a broad search of five electronic databases. In a two-stage process, we initially sought only randomized controlled trials and observational comparative studies; when the search failed to yield eligible studies, the subsequent search included all study designs including clinical and environmental sampling studies. RESULTS No studies were identified that directly addressed airborne and droplet precautions and home isolation infection prevention control measures. To inform the review questions the review team synthesized route of transmission data in mpox. There were 2366/4309 (54.9%) cases in which investigators identified mpox infection occurring following transmission through direct physical sexual contact. There were no reported mpox cases in which investigators identified inhalation as a single route of transmission. There were 2/4309 cases in which investigators identified fomite as a single route of transmission. Clinical and environmental sampling studies isolated mpox virus in a minority of saliva, oropharangeal swabs, mpox skin lesions, and hospital room air. CONCLUSIONS Current findings provide compelling evidence that transmission of mpox occurs through direct physical contact. Because investigators have not reported any cases of transmission via inhalation alone, the impact of airborne and droplet infection prevention control measures in reducing transmission will be minimal. Avoiding physical contact with others, covering mpox lesions and wearing a medical mask is likely to reduce onward mpox transmission; there may be minimal reduction in transmission from additionally physically isolating patients with mild disease at home.
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Affiliation(s)
- Rebecca Kuehn
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Gordon Guyatt
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada
| | - Vittoria Lutje
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Susan Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Obermeier PE, Buder SC, Hillen U. Pockenvirusinfektionen in der Dermatologie: Poxvirus infections in dermatology - the neglected, the notable, and the notorious. J Dtsch Dermatol Ges 2024; 22:56-96. [PMID: 38212918 DOI: 10.1111/ddg.15257_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/20/2023] [Indexed: 01/13/2024]
Abstract
ZusammenfassungDie Familie Poxviridae umfasst derzeit 22 Gattungen, die Wirbeltiere infizieren können. Humanpathogene Pockenviren gehören den Gattungen Ortho‐, Para‐, Mollusci‐ und Yatapoxvirus an. Bis zur Eradikation der Variola vera im Jahr 1979 waren die Pocken, im Volksmund auch Blattern genannt, eine schwerwiegende Gesundheitsbedrohung für die Bevölkerung. Noch heute sind Dermatologen mit zahlreichen Pockenvirusinfektionen konfrontiert, wie den Bauernhofpocken, die als Zoonosen nach Tierkontakten in ländlichen Gebieten oder nach Massenversammlungen auftreten können. In den Tropen können Erkrankungen durch Tanapox‐ oder Vaccinia‐Viren zu den Differenzialdiagnosen gehören. Dellwarzen sind weltweit verbreitet und werden in bestimmten Fällen als sexuell übertragbare Pockenvirusinfektion angesehen. In jüngster Zeit hatten sich Mpox (Affenpocken) zu einer gesundheitlichen Notlage von internationaler Tragweite entwickelt, die eine rasche Identifizierung und angemessene Behandlung durch Dermatologen und Infektiologen erfordert. Fortschritte und neue Erkenntnisse über Epidemiologie, Diagnose, klinische Manifestationen und Komplikationen sowie Behandlung und Prävention von Pockenvirusinfektionen erfordern ein hohes Maß an Fachwissen und interdisziplinärer Zusammenarbeit in den Bereichen Virologie, Infektiologie und Dermatologie. Dieser CME‐Artikel bietet einen aktualisierten systematischen Überblick, um praktizierende Dermatologen bei der Identifizierung, Differenzialdiagnose und Behandlung klinisch relevanter Pockenvirusinfektionen zu unterstützen.
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Affiliation(s)
- Patrick E Obermeier
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Abteilung für Infektionskrankheiten, Vaccine Safety Initiative, Berlin, Deutschland
| | - Susanne C Buder
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Konsiliarlabor für Gonokokken, Fachgebiet Sexuell übertragbare bakterielle Krankheitserreger, Robert Koch-Institut, Berlin, Deutschland
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Obermeier PE, Buder SC, Hillen U. Poxvirus infections in dermatology - the neglected, the notable, and the notorious. J Dtsch Dermatol Ges 2024; 22:56-93. [PMID: 38085140 DOI: 10.1111/ddg.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/20/2023] [Indexed: 12/22/2023]
Abstract
The family Poxviridae currently comprises 22 genera that infect vertebrates. Of these, members of the Ortho-, Para-, Mollusci- and Yatapoxvirus genera have been associated with human diseases of high clinical relevance in dermatology. Historically, smallpox had been a notorious health threat until it was declared eradicated by the World Health Organization in 1979. Today, dermatologists are confronted with a variety of poxviral infections, such as farmyard pox, which occurs as a zoonotic infection after contact with animals. In the tropics, tanapox or vaccinia may be in the differential diagnosis as neglected tropical dermatoses. Molluscum contagiosum virus infection accounts for significant disease burden worldwide and is classified as a sexually transmitted infection in certain scenarios. Recently, mpox (monkeypox) has emerged as a public health emergency of international concern, requiring rapid recognition and appropriate management by dermatologists and infectious disease specialists. Advances and new insights into the epidemiology, diagnosis, clinical manifestations and complications, treatment, and prevention of poxviral infections require a high level of expertise and interdisciplinary skills from healthcare professionals linking virology, infectious diseases, and dermatology. This CME article provides a systematic overview and update to assist the practicing dermatologist in the identification, differential diagnosis, and management of poxviral infections.
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Affiliation(s)
- Patrick E Obermeier
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
- Department of Infectious Diseases, Vaccine Safety Initiative, Berlin, Germany
| | - Susanne C Buder
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
- German Reference Laboratory for Gonococci, Unit Sexually Transmitted Bacterial Pathogens, Department for Infectious Diseases, Robert Koch-Institute, Berlin, Germany
| | - Uwe Hillen
- Department of Dermatology and Venereology, Vivantes Hospital Neukölln, Berlin, Germany
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Wetsch WA, Heger E, Drinhaus H, Böttiger BW, Overbeek R, Lehmann C, Fätkenheuer G, Jung N, Fischer J, Kneifel J, Zweigner J, Klein F, Wieland U. Lack of monkeypox virus (MPXV) transmission despite occupational exposure of a large number of health care workers. J Med Virol 2024; 96:e29353. [PMID: 38178611 DOI: 10.1002/jmv.29353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Wolfgang A Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Eva Heger
- Institute of Virology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hendrik Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Remco Overbeek
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Julia Fischer
- Department I of Internal Medicine, University Hospital Cologne, Faculty of Medicine, University of Cologne, German Center for Infection Research Partner Side Köln-Bonn, University of Cologne, Cologne, Germany
| | - Jens Kneifel
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Florian Klein
- Institute of Virology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Ulrike Wieland
- Institute of Virology, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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Taha AM, Katamesh BE, Hassan AR, Abdelwahab OA, Rustagi S, Nguyen D, Silva-Cajaleon K, Rodriguez-Morales AJ, Mohanty A, Bonilla-Aldana DK, Sah R. Environmental detection and spreading of mpox in healthcare settings: a narrative review. Front Microbiol 2023; 14:1272498. [PMID: 38179458 PMCID: PMC10764434 DOI: 10.3389/fmicb.2023.1272498] [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: 08/04/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Monkeypox virus (MPXV), which causes Monkeypox (Mpox), has recently been found outside its usual geographic distribution and has spread to 117 different nations. The World Health Organization (WHO) designated the epidemic a Public Health Emergency of International Concern (PHEIC). Humans are at risk from MPXV's spread, which has raised concerns, particularly in the wake of the SARS-CoV-2 epidemic. The risk of virus transmission may rise due to the persistence of MPXV on surfaces or in wastewater. The risk of infection may also increase due to insufficient wastewater treatment allowing the virus to survive in the environment. To manage the infection cycle, it is essential to investigate the viral shedding from various lesions, the persistence of MPXV on multiple surfaces, and the length of surface contamination. Environmental contamination may contribute to virus persistence and future infection transmission. The best possible infection control and disinfection techniques depend on this knowledge. It is thought to spread mainly through intimate contact. However, the idea of virus transmission by environmental contamination creates great concern and discussion. There are more cases of environmental surfaces and wastewater contamination. We will talk about wastewater contamination, methods of disinfection, and the present wastewater treatment in this review as well as the persistence of MPXV on various environmental surfaces.
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Affiliation(s)
- Amira Mohamed Taha
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, United States
| | - Basant E. Katamesh
- Faculty of Medicine, Tanta University, Tanta, Egypt
- Mayo Clinic, Rochester, MN, United States
| | | | - Omar Ahmed Abdelwahab
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, United States
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
| | - Dang Nguyen
- Massachusetts General Hospital, Corrigan Minehan Heart Center and Harvard Medical School, Boston, MA, United States
| | | | - Alfonso J. Rodriguez-Morales
- Faculty of Environmental Sciences, Universidad Científica del Sur, Lima, Peru
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de lasAméricas-Institución Universitaria Visión de las Américas, Pereira, Colombia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Aroop Mohanty
- Department of Clinical Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | | | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Department of Clinical Microbiology, DY Patil Medical College, Hospital and Research Centre, DY Patil Vidyapeeth, Pune, India
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Guevara-Martínez J, La-Noire FP, Arteaga-Asensio P, Pascual-Miguelañez I, Moraes Souza R, Quiles M, Montes M, Fondevila C, Álvarez-Gallego M. Proctitis in patients with monkeypox infection: a single-center analysis of 42 consecutive cases from a multidisciplinary observational study on monkeypox proctitis. Tech Coloproctol 2023; 27:1211-1218. [PMID: 37086291 PMCID: PMC10638120 DOI: 10.1007/s10151-023-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The current monkeypox (MP) virus outbreak was declared an international emergency in July 2022. The aim of this report is to describe our initial experience with patients with MP, focusing on proctitis. METHODS We conducted an observational study between 20 May and 31 July 2022, on patients with MP at a reference tertiary center in Madrid, Spain. A descriptive analysis on MP was performed, focusing on its characteristics, symptoms, diagnosis, and outcomes. RESULTS A total of 143 positive MP cases were diagnosed in our center; 42 of them [all male, median age 39 years (range: 22-57 years)] had proctitis (29.37%), and 3 patients (2.09%/MP total cases and 7.14%/MP proctitis) required surgical drainage of a perianal abscess. CONCLUSIONS General and digestive surgeons must be aware of the presence of proctological impairment and complications due to MP virus.
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Affiliation(s)
- J Guevara-Martínez
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - F Prieto La-Noire
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
| | - P Arteaga-Asensio
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
| | - I Pascual-Miguelañez
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - R Moraes Souza
- Dermatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Quiles
- Microbiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - M Montes
- Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - C Fondevila
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain
| | - M Álvarez-Gallego
- General and Digestive Surgery, Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain.
- Instituto de Investigación, Hospital Universitario La Paz, Madrid, Spain.
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Mermel LA. Viable mpox in the inanimate environmental and risk of transmission. Infect Control Hosp Epidemiol 2023; 44:2102-2103. [PMID: 37665113 DOI: 10.1017/ice.2023.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Leonard A Mermel
- 1Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 2Department of Epidemiology & Infection Prevention, Lifespan Hospital System, Providence, Rhode Island
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Weber DJ, Rutala WA, Sickbert-Bennett E. Emerging infectious diseases, focus on infection prevention, environmental survival and germicide susceptibility: SARS-CoV-2, Mpox, and Candida auris. Am J Infect Control 2023; 51:A22-A34. [PMID: 37890950 DOI: 10.1016/j.ajic.2023.02.006] [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: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND New and emerging infectious diseases continue to represent a public health threat. Emerging infectious disease threats include pathogens increasing in range (eg, Mpox), zoonotic microbes jumping species lines to cause sustained infections in humans via person-to-person transmission (SARS-CoV-2) and multidrug-resistant pathogens (eg, Candida auris). MATERIALS AND METHODS We searched the published English literature and reviewed the selected articles on SARS-CoV-2, Mpox, and Candida auris with a focus on environmental survival, contamination of the patient's hospital environment, susceptibility of the pathogen to antiseptics and disinfectants and infection prevention recommendations. RESULTS All three pathogens (ie, SARS-CoV-2, Mpox, and Candida auris) can survive on surfaces for minutes to hours and for Mpox and C auris for days. Currently available antiseptics (eg, 70%-90% alcohol hand hygiene products) are active against SARS-CoV-2, Mpox and C auris. The U.S Environmental Protection Agency provides separate lists of surface disinfectants active against SARS-CoV-2, Mpox, and C auris. DISCUSSION The risk of environment-to-patient transmission of SARS-CoV-2, Mpox and Candida auris, is very low, low-moderate and high, respectively. In the absence of appropriate patient isolation and use of personal protection equipment, the risk of patient-to-health care provider transmission of SARS-CoV-2, Mpox, and C auris is high, moderate and low, respectively. CONCLUSIONS Appropriate patient isolation, use of personal protective equipment by health care personnel, hand hygiene, and surface disinfection can protect patients and health care personnel from acquiring SARS-CoV-2, Mpox, and C auris from infected patients.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Emily Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Hermanussen L, Brehm TT, Wolf T, Boesecke C, Schlabe S, Borgans F, Monin MB, Jensen BEO, Windhaber S, Scholten S, Jordan S, Lütgehetmann M, Wiesch JSZ, Addo MM, Mikolajewska A, Niebank M, Schmiedel S. Tecovirimat for the treatment of severe Mpox in Germany. Infection 2023; 51:1563-1568. [PMID: 37273167 PMCID: PMC10240449 DOI: 10.1007/s15010-023-02049-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND In May 2022, a multi-national mpox outbreak was reported in several non-endemic countries. The only licensed treatment for mpox in the European Union is the orally available small molecule tecovirimat, which in Orthopox viruses inhibits the function of a major envelope protein required for the production of extracellular virus. METHODS We identified presumably all patients with mpox that were treated with tecovirimat in Germany between the onset of the outbreak in May 2022 and March 2023 and obtained demographic and clinical characteristics by standardized case report forms. RESULTS A total of twelve patients with mpox were treated with tecovirimat in Germany in the study period. All but one patient identified as men who have sex with men (MSM) who were most likely infected with mpox virus (MPXV) through sexual contact. Eight of them were people living with HIV (PLWH), one of whom was newly diagnosed with HIV at the time of mpox, and four had CD4+ counts below 200/µl. Criteria for treatment with tecovirimat included severe immunosuppression, severe generalized and/or protracted symptoms, a high or increasing number of lesions, and the type and location of lesions (e.g., facial or oral soft tissue involvement, imminent epiglottitis, or tonsillar swelling). Patients were treated with tecovirimat for between six and 28 days. Therapy was generally well-tolerated, and all patients showed clinical resolution. CONCLUSIONS In this cohort of twelve patients with severe mpox, treatment with tecovirimat was well tolerated and all individuals showed clinical improvement.
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Affiliation(s)
- Lennart Hermanussen
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Thomas Theo Brehm
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner-Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Timo Wolf
- Internal Medicine II, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - Christoph Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Bonn, Germany
| | - Stefan Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - Frauke Borgans
- Internal Medicine II, Department of Infectious Diseases, University Hospital, Frankfurt, Germany
| | - Malte B Monin
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - Björn-Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Windhaber
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Scholten
- Praxis Hohenstaufenring in den RingColonnaden, Cologne, Germany
| | - Sabine Jordan
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner-Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Marylyn M Addo
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner-Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Agata Mikolajewska
- Centre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany
| | - Michaela Niebank
- Centre for Biological Threats and Special Pathogens (ZBS), Robert Koch Institute, Berlin, Germany
| | - Stefan Schmiedel
- Division of Infectious Diseases, I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Decousser JW, Romano-Bertrand S, Aho Glele LS, Baron R, Carre Y, Cassier P, Dananche C, Depaix-Champagnac F, Fournier S, Racaud J, Rogues AM, Tamames C, Keita-Perse O, Parneix P, Lavigne T. Healthcare worker protection against mpox contamination: position paper of the French Society for Hospital Hygiene. J Hosp Infect 2023; 140:156-164. [PMID: 37562588 DOI: 10.1016/j.jhin.2023.08.004] [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: 06/25/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
In the context of the recent re-emergence of mpox worldwide, the French Society for Hospital Hygiene (SF2H) performed a literature review of the transmission paths and proposed specific recommendations for healthcare workers (HCWs) caring for patients with suspected or confirmed MPXV. In developed countries, the risk of contamination among HCWs in healthcare facilities seemed to be very low, limited to contamination through needle stick injuries. Two additional contamination cases were reported and not fully explained. Beyond healthcare settings, the analysis of the literature highlighted (i) a main contamination route during sexual intercourse, mainly among men who have sex with men, and (ii) a very low secondary attack rate in other contexts, such as schools or jails. Numerous studies have reported molecular or virus identification on surfaces or in the air surrounding patients, without any association with the low secondary case incidence; moreover, the minimum infectious dose through air or mucosal exposure is still unknown. Owing to the lack of evidence of MPXV respiratory transmission in the healthcare setting, the SF2H recommends the implementation of standard and contact precautions combined with medical/surgical mask use. Owing to the lack of evidence of transcutaneous contamination, the SF2H recommends the use of gloves only if contact with cutaneous lesions or mucous membranes occurs. Regarding the risk of contamination from the environment in healthcare facilities, additional studies must be conducted to investigate this.
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Affiliation(s)
- J-W Decousser
- Equipe Opérationnelle d'Hygiène, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris, UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France.
| | - S Romano-Bertrand
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, Hospital Hygiene and Infection Control Department, University Hospital of Montpellier, Montpellier, France
| | - L S Aho Glele
- Epidémiologie et hygiène hospitalière, Centre Hospitalo-Universitaire de Dijon, hôpital d'enfants, Dijon, France
| | - R Baron
- Service Hygiène Hospitalière, Pôle Recherche et Santè Publique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Y Carre
- CHU de Bordeaux, Pôle de Santé Publique, Infection Control Unit, Bordeaux, France
| | - P Cassier
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Institut des Agents Infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - C Dananche
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, Service Hygiène, épidémiologie, infectiovigilance et prévention Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | | | - S Fournier
- Service Prévention du risque infectieux, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Racaud
- Service de lutte des infections nosocomiales, Centre Hospitalier Alpes-Leman, Contamine-sur-Arve, France
| | - A-M Rogues
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, CHU Bordeaux, Hygiene Hospitalière, Bordeaux, France
| | - C Tamames
- Service de Prévention et contrôle de l'infection, site Pitié Salpêtrière, Paris, France
| | - O Keita-Perse
- Service d'Epidémiologie et d'Hygiène Hospitalière, Centre Hospitalier Princesse Grace, Monaco
| | - P Parneix
- Nouvelle Aquitaine Healthcare-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - T Lavigne
- Service d'Hygiène Hospitalière, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Blacksell SD, Dhawan S, Kusumoto M, Khanh Le K, Summermatter K, O'Keefe J, Kozlovac J, Al Muhairi SS, Sendow I, Scheel CM, Ahumibe A, Masuku ZM, Bennett AM, Kojima K, Harper DR, Hamilton K. The Biosafety Research Road Map: The Search for Evidence to Support Practices in the Laboratory-Mpox/Monkeypox Virus. APPLIED BIOSAFETY 2023; 28:152-161. [PMID: 37736424 PMCID: PMC10510687 DOI: 10.1089/apb.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Introduction The virus formerly known as monkeypox virus, now called mpoxv, belongs to the Orthopoxvirus genus and can cause mpox disease through both animal-to-human and human-to-human transmission. The unexpected spread of mpoxv among humans has prompted the World Health Organization (WHO) to declare a Public Health Emergency of International Concern (PHEIC). Methods We conducted a literature search to identify the gaps in biosafety, focusing on five main areas: how the infection enters the body and spreads, how much of the virus is needed to cause infection, infections acquired in the lab, accidental release of the virus, and strategies for disinfecting and decontaminating the area. Discussion The recent PHEIC has shown that there are gaps in our knowledge of biosafety when it comes to mpoxv. We need to better understand where this virus might be found, how much of it can spread from person-to-person, what are the effective control measures, and how to safely clean up contaminated areas. By gathering more biosafety evidence, we can make better decisions to protect people from this zoonotic agent, which has recently become more common in the human population.
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Affiliation(s)
- Stuart D. Blacksell
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - Sandhya Dhawan
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Marina Kusumoto
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kim Khanh Le
- Mahidol-Oxford Tropical Research Medicine Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Joseph O'Keefe
- Ministry for Primary Industries, Wellington, New Zealand
| | - Joseph Kozlovac
- United States Department of Agriculture, Agricultural Research Service, Beltsville, Maryland, USA
| | | | - Indrawati Sendow
- Indonesian Research Center for Veterinary Science, National Research and Innovation Agency, Bogor, Indonesia
| | - Christina M. Scheel
- WHO Collaborating Center for Biosafety and Biosecurity, Office of the Associate Director for Laboratory Science, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anthony Ahumibe
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Zibusiso M. Masuku
- National Institute for Communicable Diseases of the National Health Laboratory Services, Johannesburg, South Africa
| | | | - Kazunobu Kojima
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization (WHO), Geneva, Switzerland
| | - David R. Harper
- The Royal Institute of International Affairs, London, United Kingdom
| | - Keith Hamilton
- World Organisation for Animal Health (OIE), Paris, France
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13
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Spencer A, Nicholls I, Onianwa O, Furneaux J, Grieves J, Pottage T, Gould S, Fletcher T, Dunning J, Bennett AM, Atkinson B. Mpox virus DNA contamination can still be detected by qPCR analysis after autoclaving. J Hosp Infect 2023; 139:217-219. [PMID: 37459916 DOI: 10.1016/j.jhin.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A Spencer
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK.
| | - I Nicholls
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - O Onianwa
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Furneaux
- Rare and Imported Pathogens Laboratory, UK Health Security Agency, Porton Down, Salisbury, UK
| | - J Grieves
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - T Pottage
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - S Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - T Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Dunning
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - A M Bennett
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
| | - B Atkinson
- Diagnostics and Pathogen Characterisation, UK Health Security Agency, Porton Down, Salisbury, UK
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14
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Maronese CA, Avallone G, Aromolo IF, Spigariolo CB, Quattri E, Ramoni S, Carrera CG, Marzano AV. Mpox: an updated review of dermatological manifestations in the current outbreak. Br J Dermatol 2023; 189:260-270. [PMID: 37146166 DOI: 10.1093/bjd/ljad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
Mpox is a disease caused by a double-stranded DNA orthopoxvirus discovered in 1958. In 2022, an outbreak on an unprecedented scale marked its transition from neglected, zoonotic disease circulating almost exclusively within African borders to sexually transmitted infection (STI) of international concern. Although phylogenetic evidence suggests progressive evolution from the strain associated with the 2018 outbreak in Nigeria, epidemiological links with previous cases have still not been completely elucidated. Clinically, mpox presents with systemic symptoms, such as fever, headache, malaise and a characteristic cutaneous eruption, similar to that of cognate viruses (e.g. smallpox). Mpox pseudopustules evolve through several stages, including umbilication and crusting, and resolve in the span of 2-3 weeks. The hallmarks that set the 2022 outbreak apart from classic mpox were a disproportionate number of cases occurring in men who have sex with men, an often localized cutaneous picture and a significant burden in terms of concomitant STIs. Investigations into the disease pathogenesis, related immune response, clinical and dermoscopic features, in addition to studies aimed at defining novel management strategies, have advanced mpox knowledge considerably. Herein, recent findings on mpox are reviewed, with a keen focus on dermatological manifestations and their implications in the current diagnostic scenario, reinforcing the pivotal role of dermatologists in managing suspect cases and preventing further spread of the contagion.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Gianluca Avallone
- Department of Medical Sciences, Dermatology Clinic, University of Turin, Turin, Italy
| | - Italo Francesco Aromolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Cristina Beatrice Spigariolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Eleonora Quattri
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Giovanni Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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15
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Elhusseiny SM, Bebawy AS, Saad BT, Aboshanab KM. Insights on monkeypox disease and its recent outbreak with evidence of nonsynonymous missense mutation. Future Sci OA 2023; 9:FSO877. [PMID: 37485445 PMCID: PMC10357398 DOI: 10.2144/fsoa-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023] Open
Abstract
The 2022 monkeypox outbreak has created a new global health threat and pandemic. Monkeypox virus is a descendant of the genus Orthopoxvirus, producing a febrile skin rash disease in humans. Monkeypox is zoonotic transmitted and transmitted from human to human in several ways. Even though this disease is self-limited, it creates important community health worries due to its inconvenience and widespread complications. Herein, we discussed the up-to-date current situation of monkeypox regarding its epidemiology, clinical manifestations, current in-use therapeutics, necessary protective measures, and response to potential occurrences considering the recent pandemic. Also, in this review, a comparative genomic analysis of the recent circulating strains that have been recovered from various countries including, Egypt, USA, Spain, Japan and South Africa has been investigated.
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Affiliation(s)
- Shaza M Elhusseiny
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ahram Canadian University (ACU), 4th Industrial Area, 6th of October City, Cairo, 12566, Egypt
| | - Abraam S Bebawy
- Department of Genomics, HITS Solutions Co., Cairo, 11765, Egypt
| | - Bishoy T Saad
- Department of Bioinformatics, HITS Solutions Co., Cairo, 11765, Egypt
| | - Khaled M Aboshanab
- Department of Microbiology & Immunology, Faculty of Pharmacy, Ain Shams University, Organization of African Unity St., Cairo, Abbassia, 11566, Egypt
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16
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Smoliga JM. Mpox and Monkeypox Virus: Special Considerations for Athletes in Contact Sports. Sports Med 2023; 53:1301-1313. [PMID: 36848020 PMCID: PMC9969948 DOI: 10.1007/s40279-023-01812-5] [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: 01/22/2023] [Indexed: 03/01/2023]
Abstract
Monkeypox virus infections (mpox) in humans have become increasingly common since the virus was first identified in 1970. Coverage of the ongoing mpox outbreak has emphasized the role of skin-to-skin contact in monkeypox virus transmission and has focused on the community of men who have sex with men. While close contact from sexual activity is currently the main mechanism of monkeypox virus transmission, the potential for contact sports to exacerbate the 2022 outbreak has largely been overlooked. Infectious diseases rapidly spread in sports with significant skin-to-skin contact (i.e., wrestling and other combat sports, American football, and rugby). Mpox has not yet reached the athletic community, but once it does, it may follow a similar pattern of other infectious skin diseases in sports. Thus, it is critical to initiate a discussion of the risk of mpox and potential preventive measures within a sports context. This Current Opinion aims to provide stakeholders within the sports community with a brief review of infectious skin diseases in athletes, an overview of mpox and why it is relevant to athletes, and recommendations to reduce the risk of monkeypox virus transmission within sports settings. Guidelines for sports participation in athletes exposed to mpox and those with suspected, probable, and confirmed cases of monkeypox are provided.
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Affiliation(s)
- James M Smoliga
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, 27268, USA.
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17
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Saied AA, Chandran D, Chakraborty S, Emran TB, Dhama K. Mpox and healthcare workers — a minireview of our present knowledge. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:46. [DOI: 10.1186/s43162-023-00233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 09/01/2023] Open
Abstract
Abstract
Introduction
Workers in the healthcare industry form the backbone of health systems everywhere. In the face of global health crises like the current monkeypox (mpox) outbreak, healthcare workers like doctors, dentists, pharmacists, nurses, midwives, paramedics, administrators, support staff, laboratory technicians, and community health workers all play crucial roles in providing care and containing the spread of the disease.
Aim
Therefore, in the wake of concerns about mpox recurrence, we seek to shed light on the occupational transmission of mpox infection and the possible risk to healthcare personnel.
Results
Contamination of the environment of the household of cases of mpox and environment of the patient care units with the viral DNA has been reported besides asymptomatic cases and detection of viral DNA in air samples; therefore, more research on non-lesion-based testing for human mpox infection for screening asymptomatic people, particularly among populations at high risk of infection, in the event of asymptomatic transmission and potential transmission via aerosols is necessary. Monitoring efforts can be aided by incorporating mpox testing into locations where people are more likely to contract illnesses and seek medical attention. We must take a precautionary infection control approach to control the spread of the virus while completing urgent research to understand better the human-to-human mpox transmission process.
Conclusions
In this minireview, we discuss the potential routes of mpox transmission to healthcare and preventative strategies and measures that should be taken and considered.
Graphical Abstract
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18
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Saied AA. Mpox virus Clade IIb detection in the air. J Med Virol 2023; 95:e28775. [PMID: 37212310 DOI: 10.1002/jmv.28775] [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: 02/06/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Abstract
Mpox is a viral zoonotic disease endemic in Central and West Africa that is caused by the Mpox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. The clinical manifestations of mpox infection are milder than those of smallpox, and the incubation time of mpox varies from 5 to 21 days. Since May 2022, the mpox outbreak (formerly known as monkeypox) has suddenly and unexpectedly spread in non-endemic countries, suggesting that there may have been some undetected transmissions. Based on molecular analysis, there are two major genetic clades that represent the mpox virus: Clade I (formerly the Congo Basin clade OR the Central African clade) and Clade II (formerly the West African clade). It is believed that people who are asymptomatic or paucisymptomatic may spread the mpox virus. Infectious viruses cannot be distinguished by PCR testing; therefore, virus culture should be carried out. Recent evidence regarding the detection of the mpox virus (Clade IIb) in air samples collected from the patient's environment during the 2022 mpox outbreak was reviewed. Further studies are needed to evaluate the extent to which the presence of mpox virus DNA in the air could affect immunocompromised patients in healthcare facilities, and further epidemiological studies are crucial, especially in Africa.
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Affiliation(s)
- AbdulRahman A Saied
- National Food Safety Authority (NFSA), Aswan Branch, Aswan, Egypt
- Ministry of Tourism and Antiquities, Aswan Office, Aswan, Egypt
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19
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Sultan S, Zucker J, Weinberg DS. Mpox: What Practicing Gastroenterologists Need to Know. Gastroenterology 2023; 164:505-509. [PMID: 36539015 PMCID: PMC9774747 DOI: 10.1053/j.gastro.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York
| | - David S Weinberg
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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20
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Marimuthu K, Wong JCC, Lim PL, Octavia S, Huan X, Ng YK, Yang JJ, Sutjipto S, Linn KZ, Setoh YX, Ong CHC, Griffiths J, Farhanah S, Cheok TS, Sulaiman NAB, Congcong SB, Neves ES, Loo LH, Hakim L, Sim S, Lim M, Nazeem M, Vasoo S, Tham KW, Ng OT, Ng LC. Viable mpox virus in the environment of a patient room. Int J Infect Dis 2023; 131:40-45. [PMID: 36933611 PMCID: PMC10019930 DOI: 10.1016/j.ijid.2023.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
We conducted a prospective environmental surveillance study to investigate the air, surface, dust and water contamination of a room occupied by a patient infected with mpox virus (MPXV) at various stages of the illness. The patient tested positive for MPXV from a throat swab and skin lesions. Environmental sampling was conducted in a negative pressure room with 12 unidirectional HEPA air changes per hour and daily cleaning of the surfaces. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of illness. Among the days of sampling, air, surface, and dust contamination showed highest contamination rates on day 7 and 8 of illness, with a gradual decline to the lowest contamination level by day 21. Viable MPXV was isolated from surfaces and dust samples and no viable virus was isolated from the air and water samples.
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Affiliation(s)
- Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442; Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Drive, Singapore 117597.
| | - Judith Chui Ching Wong
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Poh Lian Lim
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442; Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 11 Mandalay Road, Singapore 308232
| | - Sophie Octavia
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667; School of Biotechnology and Biomolecular Sciences, University of New South Wales, Australia, University of NSW, Chancellery Walk, Kensington NSW 2033, Australia
| | - Xiaowei Huan
- Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Yi Kai Ng
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Jun Jing Yang
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Stephanie Sutjipto
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442; Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Kyaw Zaw Linn
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442
| | - Yin Xiang Setoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 10 Medical Drive, Singapore 117597; Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667; School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland, Australia, 68 Cooper Road, Brisbane City QLD 4072, Australia
| | | | - Jane Griffiths
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Sharifah Farhanah
- Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Thai Shawn Cheok
- Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433
| | | | - Sipaco Barbara Congcong
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442
| | - Erica Sena Neves
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Liang Hui Loo
- Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Luqman Hakim
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Shuzhen Sim
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Merrill Lim
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Mohammad Nazeem
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442; Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 11 Mandalay Road, Singapore 308232
| | - Kwok Wai Tham
- Department of the Built Environment, National University of Singapore, Singapore, 21 Lower Kent Ridge Road, Singapore 119077
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, 16 Jalan Tan Tock Seng, Singapore 308442; Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, Singapore 308433; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 11 Mandalay Road, Singapore 308232
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore, 11 Biopolis Way, Singapore 138667; School of Biological Sciences, Nanyang Technological University, 60 Nanyang Drive, Singapore 637551.
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21
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Szkiela M, Wiszniewska M, Lipińska-Ojrzanowska A. Monkeypox (Mpox) and Occupational Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5087. [PMID: 36981996 PMCID: PMC10049490 DOI: 10.3390/ijerph20065087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Recently, there has been a significant increase in interest in biological risk factors, which are increasingly perceived as an important problem in occupational medicine. Exposure to harmful biological agents may be associated with the deliberate use of microorganisms in the work process or with unintentional exposure resulting from the presence of biological risk factors in the work environment. Monkeypox (mpox) is a viral infectious disease that may afflict humans and non-human primates. Since May 2022, mpox has occurred in Europe, North and South America, Asia, Australia and Africa, with some 76,713 cases (75,822 in locations that have not historically reported mpox) and 29 total deaths reported to date. Between 2018 and 2021, several cases of mpox were reported worldwide in high-income countries (Israel, Singapore, United Kingdom, United States: Texas and Maryland). We conducted a literature search in PubMed and Google Scholar web databases for occupational exposure to mpox. The highest work-related risk for mpox transmission has been noted among healthcare professionals, people working with animals, and sex workers. There is general agreement that a paramount issue to avoid transmission of infection in occupational settings is an appropriate decontamination of often-touched surfaces and usage of appropriate personal protective equipment by the workers at high risk of infection. The group that should especially protect themselves and be educated in the field of early symptoms of the disease and prevention are dentists, who are often the first to detect the symptoms of the disease on the oral mucosa.
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22
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Cabanillas B, Murdaca G, Guemari A, Torres MJ, Azkur AK, Aksoy E, Vitte J, de Las Vecillas L, Giovannini M, Fernández-Santamaria R, Castagnoli R, Orsi A, Amato R, Giberti I, Català A, Ambrozej D, Schaub B, Tramper-Stranders GA, Novak N, Nadeau KC, Agache I, Akdis M, Akdis CA. A compilation answering 50 questions on monkeypox virus and the current monkeypox outbreak. Allergy 2023; 78:639-662. [PMID: 36587287 DOI: 10.1111/all.15633] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 01/02/2023]
Abstract
The current monkeypox disease (MPX) outbreak constitutes a new threat and challenge for our society. With more than 55,000 confirmed cases in 103 countries, World Health Organization declared the ongoing MPX outbreak a Public Health Emergency of International Concern (PHEIC) on July 23, 2022. The current MPX outbreak is the largest, most widespread, and most serious since the diagnosis of the first case of MPX in 1970 in the Democratic Republic of the Congo (DRC), a country where MPX is an endemic disease. Throughout history, there have only been sporadic and self-limiting outbreaks of MPX outside Africa, with a total of 58 cases described from 2003 to 2021. This figure contrasts with the current outbreak of 2022, in which more than 55,000 cases have been confirmed in just 4 months. MPX is, in most cases, self-limiting; however, severe clinical manifestations and complications have been reported. Complications are usually related to the extent of virus exposure and patient health status, generally affecting children, pregnant women, and immunocompromised patients. The expansive nature of the current outbreak leaves many questions that the scientific community should investigate and answer in order to understand this phenomenon better and prevent new threats in the future. In this review, 50 questions regarding monkeypox virus (MPXV) and the current MPX outbreak were answered in order to provide the most updated scientific information and to explore the potential causes and consequences of this new health threat.
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Affiliation(s)
- Beatriz Cabanillas
- Department of Allergy, Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Giuseppe Murdaca
- Departments of Internal Medicine, University of Genova, Genova, Italy
| | - Amir Guemari
- Aix-Marseille Univ, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
| | - Maria Jose Torres
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Ahmet Kursat Azkur
- Department of Virology, Faculty of Veterinary Medicine, Kirikkale University, Kirikkale, Turkey
| | - Emel Aksoy
- Department of Virology, Faculty of Veterinary Medicine, Kirikkale University, Kirikkale, Turkey
| | - Joana Vitte
- Aix-Marseille Univ, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France.,Montpellier University, IDESP INSERM UMR UA 11, Montpellier, France
| | | | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Riccardo Castagnoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Rosa Amato
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Irene Giberti
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Alba Català
- Dermatology Department, Sexually Transmitted Diseases Clinic, Hospital Clinic, Barcelona, Spain
| | - Dominika Ambrozej
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.,Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany.,Member of German Center for Lung Research - DZL, LMU, Munich, Germany
| | | | - Natalija Novak
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California, USA
| | - Ioana Agache
- Transylvania University, Brasov, Romania.,Theramed Medical Center, Brasov, Romania
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
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23
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Clinical features and outcome of human Mpox (Monkeypox) in Saudi Arabia: An observational study of travel-related cases. J Infect Public Health 2023; 16:341-345. [PMID: 36680849 PMCID: PMC9838079 DOI: 10.1016/j.jiph.2023.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The 2022 Monkeypox virus (Mpox) outbreak had involved multiple countries around the globe. Here, we report clinical features and outcome of human Mpox of the first cases in Saudi Arabia. METHODS We obtained records of confirmed Mpox cases in Saudi Arabia from the public electronic health information system, Health Electronic Surveillance Network (HESN) and the healthcare providers completed a de-identified structured clinical data collection form. RESULTS The reported seven cases were travel-related and all were males between 24 and 41 years of age (mean age + SD) was 30.14 (+ 6.69) years. Of the cases, three (43 %) had heterosexual contact and the others had other intimate encounters while traveling abroad. They presented with skin lesions (100 %), fever (86 %), and lymphadenopathy (71 %). The illness was mild to moderate, did not require antiviral medications, and lasted 7-15 days. The mean duration of skin rash (+ SD) was 10 (+ 2.68) days. Routine laboratory tests (CBC, BUN, serum electrolytes, and liver enzymes) were within normal limits, and initial screening for HIV was negative. Expanded contact tracing did not reveal secondary cases of Mpox in the community or the healthcare setting. CONCLUSION The current study showed heterosexual transmission of Mpox and the clinical course was mild and non-complicated. Therefore, clinicians and public health professionals should consider Mpox among individuals presenting with skin rash especially in the context of the investigation of HIV and other sexually transmitted diseases.
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24
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Migaud P, Hosmann K, Drauz D, Mueller M, Haumann J, Stocker H. A case of occupational transmission of mpox. Infection 2023:10.1007/s15010-023-01989-x. [PMID: 36735196 PMCID: PMC9897149 DOI: 10.1007/s15010-023-01989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Between May 2022 and January 2023, a global mpox outbreak affected more than 84,000 patients across all continents. Transmission of mpox occurs through large respiratory droplets and direct contact with skin lesions. CASE PRESENTATION We present the case of a 31-year-old previously healthy male with mpox-Infection following occupational exposure to mpox from a needle stick injury with a sterile needle through a contaminated glove. The patient presented with a three-day history of fever, malaise, and an increasing erythema and swelling of one fingertip. The patient works as a medical doctor with regular exposure to patients infected with mpox. Mpox-PCR from a swab of the lesion and an oro-pharyngeal swab were positive. The lesion on his finger evolved into a necrotic skin lesion finally healing, leaving a scar. He did not develop any secondary pox on his skin and recovered fully. DISCUSSION Only a minority of patients with mpox infection develop illness with pronounced local complications as in this case. CONCLUSION Mpox can potentially be transmitted in an occupational context. Medical personnel should be informed about this possible route of transmission.
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Affiliation(s)
- Pascal Migaud
- Department of Infectious Diseases, St. Joseph Hospital, Berlin-Tempelhof, Germany.
| | - Kai Hosmann
- Department of Infectious Diseases, St. Joseph Hospital, Berlin-Tempelhof, Germany
| | - Daniela Drauz
- Department of Infectious Diseases, St. Joseph Hospital, Berlin-Tempelhof, Germany
| | - Markus Mueller
- Department of Infectious Diseases, St. Joseph Hospital, Berlin-Tempelhof, Germany
| | - Jonas Haumann
- Department of Gastroenterology, St. Joseph Hospital, Berlin-Tempelhof, Germany
| | - Hartmut Stocker
- Department of Infectious Diseases, St. Joseph Hospital, Berlin-Tempelhof, Germany
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25
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Pan D, Nazareth J, Sze S, Martin CA, Decker J, Fletcher E, Déirdre Hollingsworth T, Barer MR, Pareek M, Tang JW. Transmission of monkeypox/mpox virus: A narrative review of environmental, viral, host, and population factors in relation to the 2022 international outbreak. J Med Virol 2023; 95:e28534. [PMID: 36708091 PMCID: PMC10107822 DOI: 10.1002/jmv.28534] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/05/2022] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
Monkeypox virus (MPXV) has spread globally. Emerging studies have now provided evidence regarding MPXV transmission, that can inform rational evidence-based policies and reduce misinformation on this topic. We aimed to review the evidence on transmission of the virus. Real-world studies have isolated viable viruses from high-touch surfaces for as long as 15 days. Strong evidence suggests that the current circulating monkeypox (mpox) has evolved from previous outbreaks outside of Africa, but it is yet unknown whether these mutations may lead to an inherently increased infectivity of the virus. Strong evidence also suggests that the main route of current MPXV transmission is sexual; through either close contact or directly, with detection of culturable virus in saliva, nasopharynx, and sperm for prolonged periods and the presence of rashes mainly in genital areas. The milder clinical presentations and the potential presence of presymptomatic transmission in the current circulating variant compared to previous clades, as well as the dominance of spread amongst men who have sex with men (MSMs) suggests that mpox has a developed distinct clinical phenotype that has increased its transmissibility. Increased public awareness of MPXV transmission modalities may lead to earlier detection of the spillover of new cases into other groups.
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Affiliation(s)
- Daniel Pan
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- Li Ka Shing Centre for Health Information and Discovery, Big Data InstituteUniversity of OxfordOxfordUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Joshua Nazareth
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Shirley Sze
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Christopher A. Martin
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Jonathan Decker
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Eve Fletcher
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - T. Déirdre Hollingsworth
- Li Ka Shing Centre for Health Information and Discovery, Big Data InstituteUniversity of OxfordOxfordUK
| | - Michael R. Barer
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Clinical MicrobiologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Manish Pareek
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of Infectious Diseases and HIV MedicineUniversity Hospitals of Leicester NHS TrustLeicesterUK
- NIHR Leicester Biomedical Research CentreLiecesterUK
| | - Julian W. Tang
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
- Department of VirologyUniversity Hospitals of Leicester NHS TrustLeicesterUK
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26
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Sawal I, Tariq R, Bint‐e‐Shuaib S, Khan AA, Ullah I, Nashwan AJ. Monkeypox: Is it the new pandemic? Health Sci Rep 2023; 6:e963. [DOI: 10.1002/hsr2.963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
| | - Rabbia Tariq
- Dow University of Health Sciences Karachi Pakistan
| | | | - Asad Ali Khan
- Internal Medicine, Hayatabad Medical Complex Peshawar Pakistan
| | - Irfan Ullah
- Kabir Medical College Gandhara University Peshawar Pakistan
- Institute of Public Health and Social Science (IPH&SS) Khyber Medical University Peshawar Pakistan
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27
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Hernaez B, Muñoz-Gómez A, Sanchiz A, Orviz E, Valls-Carbo A, Sagastagoitia I, Ayerdi O, Martín R, Puerta T, Vera M, Cabello N, Vergas J, Prieto C, Pardo-Figuerez M, Negredo A, Lagarón JM, del Romero J, Estrada V, Alcamí A. Monitoring monkeypox virus in saliva and air samples in Spain: a cross-sectional study. THE LANCET. MICROBE 2023; 4:e21-e28. [PMID: 36436538 PMCID: PMC9691259 DOI: 10.1016/s2666-5247(22)00291-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The transmission of monkeypox virus occurs through direct contact, but transmission through saliva or exhaled droplets and aerosols has not yet been investigated. We aimed to assess the presence of monkeypox virus DNA and infectious virus in saliva samples and droplets and aerosols exhaled from patients infected with monkeypox virus. METHODS We did a cross-sectional study in patients with monkeypox confirmed by PCR who attended two health centres in Madrid, Spain. For each patient, we collected samples of saliva, exhaled droplets within a mask, and aerosols captured by air filtration through newly developed nanofiber filters. We evaluated the presence of monkeypox virus in the samples by viral DNA detection by quantitative PCR (qPCR) and isolation of infectious viruses in cell cultures. FINDINGS Between May 18 and July 15, 2022, 44 patients with symptomatic monkeypox attended two health centres in Madrid and were included in the study. All were cisgender men, with a median age of 35·0 years (IQR 11·3). We identified high loads of monkeypox virus DNA by qPCR in 35 (85%) of 41 saliva samples. Infectious monkeypox virus was recovered from 22 (67%) of 33 saliva samples positive for monkeypox virus DNA. We also found a significant association between the number of affected cutaneous areas or general symptoms and the viral load present in saliva samples. Droplets exhaled from patients with monkeypox, detected inside a mask, contained monkeypox virus DNA in 32 (71%) of 45 samples, with two of the 32 positive samples showing the presence of the infectious virus. Monkeypox virus DNA in aerosols, collected from the medical consultation room, were detected in 27 (64%) of 42 samples, despite patients wearing an FFP2 mask during the visit. Infectious virus was not recovered from aerosol samples. High levels of monkeypox virus DNA were identified in aerosols collected from a hospital isolation room housing a patient with monkeypox. INTERPRETATION The identification of high viable monkeypox virus loads in saliva in most patients with monkeypox and the finding of monkeypox virus DNA in droplets and aerosols warrants further epidemiological studies to evaluate the potential relevance of the respiratory route of infection in the 2022 monkeypox virus outbreak. FUNDING EU, Consejo Superior de Investigaciones Científicas, and Ciberinfec.
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Affiliation(s)
- Bruno Hernaez
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Ana Muñoz-Gómez
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | - Africa Sanchiz
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Eva Orviz
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | | | - Iñigo Sagastagoitia
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain,Ciber de Enfermedades Infecciosas, Madrid, Spain
| | - Oskar Ayerdi
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | - Rocío Martín
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain
| | - Teresa Puerta
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | - Mar Vera
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | - Noemi Cabello
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain,Ciber de Enfermedades Infecciosas, Madrid, Spain
| | - Jorge Vergas
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | - Cristina Prieto
- Instituto de Agroquímica y Tecnología de Alimentos, Valencia, Spain
| | | | - Anabel Negredo
- Ciber de Enfermedades Infecciosas, Madrid, Spain,Laboratorio de Arbovirus y Enfermedades Víricas Importadas, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jorge del Romero
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain
| | - Vicente Estrada
- Centro Sandoval and Hospital Universitario Clínico de San Carlos, IdISSC, Madrid, Spain; Ciber de Enfermedades Infecciosas, Madrid, Spain.
| | - Antonio Alcamí
- Centro de Biología Molecular Severo Ochoa (Consejo Superior de Investigaciones Científicas and Universidad Autónoma de Madrid), Madrid, Spain.
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28
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Karbalaei M, Keikha M. Hospitalization records during monkeypox outbreaks: a scientific report from the available documents. Int J Surg 2023; 109:39-40. [PMID: 36799787 PMCID: PMC10389579 DOI: 10.1097/js9.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/18/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Mohsen Karbalaei
- Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft
| | - Masoud Keikha
- Department of Microbiology and Virology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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29
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Transmission characteristics, replication patterns and clinical manifestations of human monkeypox virus-an in-depth analysis of four cases from Germany. Clin Microbiol Infect 2023; 29:112.e5-112.e9. [PMID: 36155255 PMCID: PMC9534158 DOI: 10.1016/j.cmi.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Since April 2022, increasing numbers of monkeypox (MPX) cases have been reported outside endemic areas as part of an international outbreak. Our study shows aspects of clinical manifestations as well as epidemiological and virological features impacting transmission, for which only scarce data are available so far. METHODS We present a descriptive study consisting of epidemiological, clinical and virological data of four patients with confirmed MPX diagnosis. Follow-up examinations included in-depth virological investigations, including MPX virus-specific quantitative PCR and virus isolation. RESULTS Between 22 May 2022, and 21 June 2022, four patients with MPX were evaluated. The number of lesions ranged between one and more than 30, with asynchronous eruptions. The periorificial distribution of initial lesions together with the case histories strongly suggest human-to-human transmission during intimate contacts in sexual activities. None of the patients reported about memorable lesions on the skin of potential risk contacts. Virological sampling showed positive MPX virus-specific quantitative PCR results from swabs of the primary lesions (until day 22 after symptom onset), pharyngeal and anal mucosa, urine, seminal fluid, blood and samples of non-affected skin. Virus isolation was positive in 6/14 samples (lesional skin, anal and pharyngeal mucosa). One patient required inpatient treatment for bacterial superinfection; in another patient, three sexually transmitted co-infections were present. CONCLUSIONS Our report demonstrates asynchronous multiple-site lesions of MPX with prolonged PCR positivity in mucosal swabs, swabs of non-affected skin, urine and seminal fluid. In addition, infectious virus was confirmed on lesional skin and mucosal swabs. The observed virological kinetics together with the suspected pre-symptomatic transmission may lead to effective and sustained human-to-human transmission, particularly in sexual networks. Preventive measures such as vaccination and post-exposure prophylaxis may become important for MPX control in vulnerable groups.
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30
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Hermanussen L, Grewe I, Tang HT, Nörz D, Bal LC, Pfefferle S, Unger S, Hoffmann C, Berzow D, Kohsar M, Aepfelbacher M, Lohse AW, Addo MM, Lütgehetmann M, Schulze Zur Wiesch J, Schmiedel S. Tecovirimat therapy for severe monkeypox infection: Longitudinal assessment of viral titers and clinical response pattern-A first case-series experience. J Med Virol 2023; 95:e28181. [PMID: 36177717 DOI: 10.1002/jmv.28181] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Lennart Hermanussen
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilka Grewe
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hui Ting Tang
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dominik Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Lukas C Bal
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Pfefferle
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Stefan Unger
- Institute for interdisciplinary medicine (ifi), Hamburg, Germany
| | | | | | - Matin Kohsar
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Tropical Medicine Berhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ansgar W Lohse
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lubeck-Borstel-Riems, Hamburg, Germany
| | - Marylyn M Addo
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lubeck-Borstel-Riems, Hamburg, Germany.,Institute for Infection research and Vaccine development (IIRVD), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,German Center for Infection Research, Hamburg-Lubeck-Borstel-Riems, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lubeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Schmiedel
- Department of Internal Medicine, Gastroenterology and Hepatology, Sections of Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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31
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Knobloch JK, Pfefferle S, Lütgehetmann M, Nörz D, Klupp EM, Belmar Campos CE, Kluge S, Aepfelbacher M, Knobling B, Franke G. Infectivity of SARS-CoV-2 on Inanimate Surfaces: Don't Trust Ct Value. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17074. [PMID: 36554950 PMCID: PMC9779331 DOI: 10.3390/ijerph192417074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
SARS-CoV-2 RNA is frequently identified in patient rooms and it was speculated that the viral load quantified by PCR might correlate with infectivity of surfaces. To evaluate Ct values for the prediction of infectivity, we investigated contaminated surfaces and Ct-value changes after disinfection. Viral RNA was detected on 37 of 143 investigated surfaces of an ICU. However, virus isolation failed for surfaces with a high viral RNA load. Also, SARS-CoV-2 could not be cultivated from surfaces artificially contaminated with patient specimens. In order to evaluate the significance of Ct values more precisely, we used surrogate enveloped bacteriophage Φ6. A strong reduction in Φ6 was achieved by three different disinfection methods. Despite a strong reduction in viability almost no change in the Ct values was observed for UV-C and alcoholic surface disinfectant. Disinfection using ozone resulted in a lack of Φ6 recovery as well as a detectable shift in Ct values indicating strong degradation of the viral RNA. The observed lack of significant effects on the detectable viral RNA after effective disinfection suggest that quantitative PCR is not suitable for predicting the infectivity of SARS-CoV-2 on inanimate surfaces. Ct values should therefore not be considered as markers for infectivity in this context.
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Affiliation(s)
- Johannes K. Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Susanne Pfefferle
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Dominik Nörz
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Eva M. Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Cristina E. Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Martin Aepfelbacher
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Birte Knobling
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gefion Franke
- Institute for Medical Microbiology, Virology and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Gould S, Atkinson B, Onianwa O, Spencer A, Furneaux J, Grieves J, Taylor C, Milligan I, Bennett A, Fletcher T, Dunning J. Air and surface sampling for monkeypox virus in a UK hospital: an observational study. THE LANCET. MICROBE 2022; 3:e904-e911. [PMID: 36215984 PMCID: PMC9546519 DOI: 10.1016/s2666-5247(22)00257-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND An outbreak of monkeypox virus infections in non-endemic countries was recognised on May 12, 2022. As of September 29, more than 67 000 infections have been reported globally, with more than 3400 confirmed cases in the UK by September 26. Monkeypox virus is believed to be predominantly transmitted through direct contact with lesions or infected body fluids, with possible involvement of fomites and large respiratory droplets. A case of monkeypox in a health-care worker in the UK in 2018 was suspected to be due to virus exposure while changing bedding. We aimed to measure the extent of environmental contamination in the isolation rooms of patients with symptomatic monkeypox. METHODS We investigated environmental contamination with monkeypox virus from infected patients admitted to isolation rooms at the Royal Free Hospital (London, UK) between May 24 and June 17, 2022. Surface swabs of high-touch areas in five isolation rooms, of the personal protective equipment (PPE) of health-care workers in doffing areas in three rooms, and from air samples collected before and during bedding changes in five rooms were analysed using quantitative PCR to assess monkeypox virus contamination levels. Virus isolation was performed to confirm presence of infectious virus in selected positive samples. FINDINGS We identified widespread surface contamination (56 [93%] of 60 samples were positive) in occupied patient rooms (monkeypox DNA cycle threshold [Ct] values 24·7-37·4), on health-care worker PPE after use (Ct 26·1-35·6), and in PPE doffing areas (Ct 26·3-36·8). Of 20 air samples taken, five (25%) were positive. Three (75%) of four air samples collected before and during a bedding change in one patient's room were positive (Ct 32·7-36·2). Replication-competent virus was identified in two (50%) of four samples selected for viral isolation, including from air samples collected during bedding change. INTERPRETATION These data show contamination in isolation facilities and potential for suspension of monkeypox virus into the air during specific activities. PPE contamination was observed after clinical contact and changing of bedding. Contamination of hard surfaces in doffing areas supports the importance of cleaning protocols, PPE use, and doffing procedures. FUNDING None.
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Affiliation(s)
- Susan Gould
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK,Correspondence to: Dr Susan Gould, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | | | | | | | | | | | - Caroline Taylor
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Iain Milligan
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | | | - Tom Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK,Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jake Dunning
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Guelbert C. Monkeypox: What nurse leaders need to know. Nurs Manag (Harrow) 2022; 53:20-25. [PMID: 36449704 DOI: 10.1097/01.numa.0000897484.28335.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Christopher Guelbert
- Christopher Guelbert is an associate professor of nursing at Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Mo
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Ogoina D, Ogunsola FT. Monkeypox and the health-care environment. THE LANCET. MICROBE 2022; 3:e889-e890. [PMID: 36215985 PMCID: PMC9546517 DOI: 10.1016/s2666-5247(22)00286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Bayelsa PMB 100, Nigeria
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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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Beig M, Mohammadi M, Nafe Monfared F, Nasereslami S. Monkeypox: An emerging zoonotic pathogen. World J Virol 2022; 11:426-434. [PMID: 36483104 PMCID: PMC9724206 DOI: 10.5501/wjv.v11.i6.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/22/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Monkeypox virus (MPXV), which belongs to the orthopoxvirus genus, causes zoonotic viral disease. This review discusses the biology, epidemiology, and evolution of MPXV infection, particularly cellular, human, and viral factors, virus transmission dynamics, infection, and persistence in nature. This review also describes the role of recombination, gene loss, and gene gain in MPXV evol-vement and the role of signal transduction in MPXV infection and provides an overview of the current access to therapeutic options for the treatment and prevention of MPXV. Finally, this review highlighted gaps in knowledge and proposed future research endeavors to address the unresolved questions.
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Affiliation(s)
- Masoumeh Beig
- Department of Microbiology, Pasteur Institute of Iran, Tehran 5423566512, Iran
| | - Mehrdad Mohammadi
- Department of Immunology and Microbiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan 8715973449, Iran
| | - Fatemeh Nafe Monfared
- Department of Virology, Tehran University of Medical Sciences, Tehran 5151561892, Iran
| | - Somaieh Nasereslami
- Department of Virology, Faculty of Medicine, Tarbiat Modares University, Tehran 5214632542, Iran
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Thakur N. MonkeyPox2022Tweets: A Large-Scale Twitter Dataset on the 2022 Monkeypox Outbreak, Findings from Analysis of Tweets, and Open Research Questions. Infect Dis Rep 2022; 14:855-883. [PMID: 36412745 PMCID: PMC9680479 DOI: 10.3390/idr14060087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
The mining of Tweets to develop datasets on recent issues, global challenges, pandemics, virus outbreaks, emerging technologies, and trending matters has been of significant interest to the scientific community in the recent past, as such datasets serve as a rich data resource for the investigation of different research questions. Furthermore, the virus outbreaks of the past, such as COVID-19, Ebola, Zika virus, and flu, just to name a few, were associated with various works related to the analysis of the multimodal components of Tweets to infer the different characteristics of conversations on Twitter related to these respective outbreaks. The ongoing outbreak of the monkeypox virus, declared a Global Public Health Emergency (GPHE) by the World Health Organization (WHO), has resulted in a surge of conversations about this outbreak on Twitter, which is resulting in the generation of tremendous amounts of Big Data. There has been no prior work in this field thus far that has focused on mining such conversations to develop a Twitter dataset. Furthermore, no prior work has focused on performing a comprehensive analysis of Tweets about this ongoing outbreak. To address these challenges, this work makes three scientific contributions to this field. First, it presents an open-access dataset of 556,427 Tweets about monkeypox that have been posted on Twitter since the first detected case of this outbreak. A comparative study is also presented that compares this dataset with 36 prior works in this field that focused on the development of Twitter datasets to further uphold the novelty, relevance, and usefulness of this dataset. Second, the paper reports the results of a comprehensive analysis of the Tweets of this dataset. This analysis presents several novel findings; for instance, out of all the 34 languages supported by Twitter, English has been the most used language to post Tweets about monkeypox, about 40,000 Tweets related to monkeypox were posted on the day WHO declared monkeypox as a GPHE, a total of 5470 distinct hashtags have been used on Twitter about this outbreak out of which #monkeypox is the most used hashtag, and Twitter for iPhone has been the leading source of Tweets about the outbreak. The sentiment analysis of the Tweets was also performed, and the results show that despite a lot of discussions, debate, opinions, information, and misinformation, on Twitter on various topics in this regard, such as monkeypox and the LGBTQI+ community, monkeypox and COVID-19, vaccines for monkeypox, etc., "neutral" sentiment was present in most of the Tweets. It was followed by "negative" and "positive" sentiments, respectively. Finally, to support research and development in this field, the paper presents a list of 50 open research questions related to the outbreak in the areas of Big Data, Data Mining, Natural Language Processing, and Machine Learning that may be investigated based on this dataset.
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Affiliation(s)
- Nirmalya Thakur
- Department of Computer Science, Emory University, Atlanta, GA 30322, USA
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38
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Wang F, Zhang J, Wang Y, Chen Y, Han D. Viral tropism for the testis and sexual transmission. Front Immunol 2022; 13:1040172. [PMID: 36439102 PMCID: PMC9682072 DOI: 10.3389/fimmu.2022.1040172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/24/2022] [Indexed: 10/17/2023] Open
Abstract
The mammalian testis adopts an immune privileged environment to protect male germ cells from adverse autoimmune reaction. The testicular immune privileged status can be also hijacked by various microbial pathogens as a sanctuary to escape systemic immune surveillance. In particular, several viruses have a tropism for the testis. To overcome the immune privileged status and mount an effective local defense against invading viruses, testicular cells are well equipped with innate antiviral machinery. However, several viruses may persist an elongated duration in the testis and disrupt the local immune homeostasis, thereby impairing testicular functions and male fertility. Moreover, the viruses in the testis, as well as other organs of the male reproductive system, can shed to the semen, thus allowing sexual transmission to partners. Viral infection in the testis, which can impair male fertility and lead to sexual transmission, is a serious concern in research on known and on new emerging viruses. To provide references for our scientific peers, this article reviews research achievements and suggests future research focuses in the field.
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Affiliation(s)
| | | | | | - Yongmei Chen
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Daishu Han
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
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Eggers M, Exner M, Gebel J, Ilschner C, Rabenau HF, Schwebke I. Hygiene and disinfection measures for monkeypox virus infections. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc18. [PMID: 36531784 PMCID: PMC9727782 DOI: 10.3205/dgkh000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In Germany, recommendations on infection prevention and control of current virus outbreaks are given as communications by the Association for Applied Hygiene e.V. (VAH) together with the joint Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV) and the Society of Virology* (GfV). The DVV was founded in 1954 in response to the ongoing threat to the population from polio and was given its current name in 1977. The DVV is supported by the Federal Ministry of Health, the Ministries of Health of the Federal States, scientific societies, as well as social foundations and organisations. Private individuals cannot be members of the DVV. The Society of Virology e.V. (GfV) is a scientific society for all virological fields in Germany, Austria and Switzerland, and is thus the largest virological society in Europe. With numerous commissions, guidelines and statements, it is the authoritative contact for research, healthcare and politics. The joint commission "Virus Disinfection" of these scientific societies focuses on the efficacy of chemical disinfection procedures against viruses. The VAH bundles the expertise of scientific societies and experts on infection prevention and is particularly committed to the quality assurance of hygiene measures. With the VAH disinfectant list, the association provides the standard reference for the selection of high-quality disinfection procedures. This disinfectant list has a tradition of more than 60 years in Germany. The original German version of this document was published in August 2022 and has now been made available to the international professional public in English. The document contains recommendations on hygiene and disinfection measures for monkeypox virus infections. Disinfectants against monkeypox must have at least proven efficacy against enveloped viruses (active against enveloped viruses); products with the efficacy ranges "limited virucidal activity" and "virucidal" can also be used. The disinfectant list of the VAH or the disinfectant list of the Robert Koch Institute are available for the selection of products. Especially in the case of contamination with crust or scab material, it should be noted that protein contamination can have a protective or stabilising effect on monkeypox. Therefore, cleaning - before disinfection - should always be carried out in this situation. Preventive measures such as vaccination and hygiene in the vicinity of people with monkeypox must be taken to prevent transmission to small children, pregnant women or people with a pronounced immune deficiency.
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Affiliation(s)
- Maren Eggers
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,Society of Virology (GfV), Heidelberg, Germany,Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV), Kiel, Germany,Labor Prof. Gisela Enders MVZ GbR, Stuttgart, Germany,*To whom correspondence should be addressed: Maren Eggers, Labor Prof. Gisela Enders MVZ GbR, Head of VirologyRosenbergstr. 85, 70193, Stuttgart, Germany, E-mail:
| | - Martin Exner
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,German Society of Hospital Hygiene (DGKH), Berlin, Germany,University Hospital Bonn, Bonn, Germany
| | - Jürgen Gebel
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,University Hospital Bonn, Bonn, Germany
| | - Carola Ilschner
- Association for Applied Hygiene e.V. (VAH), Bonn, Germany,University Hospital Bonn, Bonn, Germany
| | - Holger F. Rabenau
- Society of Virology (GfV), Heidelberg, Germany,Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV), Kiel, Germany,University Hospital Frankfurt, Germany
| | - Ingeborg Schwebke
- Society of Virology (GfV), Heidelberg, Germany,Disinfectant Commission of the German Association for the Control of Virus Diseases e.V. (DVV), Kiel, Germany
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Nörz D, Brehm TT, Tang HT, Grewe I, Hermanussen L, Matthews H, Pestel J, Degen O, Günther T, Grundhoff A, Fischer N, Addo MM, Jordan S, Hertling S, Unger S, Schäfer G, Schewe K, Hoffmann C, Aepfelbacher M, Pfefferle S, Schulze zur Wiesch J, Schmiedel S, Lütgehetmann M. Clinical characteristics and comparison of longitudinal qPCR results from different specimen types in a cohort of ambulatory and hospitalized patients infected with monkeypox virus. J Clin Virol 2022; 155:105254. [PMID: 36057206 PMCID: PMC9528238 DOI: 10.1016/j.jcv.2022.105254] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 01/18/2023]
Abstract
Background The ongoing monkeypox virus outbreak includes at least 7553 confirmed cases in previously non-endemic countries worldwide as of July 2022. Clinical presentation has been reported as highly variable, sometimes lacking classically described systemic symptoms, and only small numbers of cutaneous lesions in most patients. The aim of this study was to compare clinical data with longitudinal qPCR results from lesion swabs, oropharyngeal swabs and blood in a well characterized patient cohort. Methods 16 male patients (5 hospitalized, 11 outpatients) were included in the study cohort and serial testing for monkeypox virus-DNA carried out in various materials throughout the course of disease. Laboratory analysis included quantitative PCR, next-generation sequencing, immunofluorescence tests and virus isolation in cell culture. Results All patients were male, between age 20 and 60, and self-identified as men having sex with men. Two had a known HIV infection, coinciding with an increased number of lesions and viral DNA detectable in blood. In initial- and serial testing, lesion swabs yielded viral DNA-loads at, or above 106 cp/ml and only declined during the third week. Oropharyngeal swabs featured lower viral loads and returned repeatedly negative in some cases. Viral culture was successful only from lesion swabs but not from oropharyngeal swabs or plasma. Discussion The data presented underscore the reliability of lesion swabs for monkeypox virus-detection, even in later stages of the disease. Oropharyngeal swabs and blood samples alone carry the risk of false negative results, but may hold value in pre-/asymptomatic cases or viral load monitoring, respectively.
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Spath T, Brunner-Ziegler S, Stamm T, Thalhammer F, Kundi M, Purkhauser K, Handisurya A. Modelling the protective effect of previous compulsory smallpox vaccination against human monkeypox infection: from hypothesis to a worst case scenario. Int J Infect Dis 2022; 124:107-112. [PMID: 36126863 PMCID: PMC9547495 DOI: 10.1016/j.ijid.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Human monkeypox (MPX) cases are escalating worldwide. Smallpox vaccination, which was compulsory in Austria until 1981, was reported to confer 85% cross-protection against MPX. Methods To assess the impact of smallpox vaccine-induced protection, the age-dependent vaccine-induced immunity against human MPX and the probability of infection according to age in the general population of Vienna, Austria, were determined using a modified susceptible-infected-removed model. Results Within the population born before 1981, the average vaccine-induced protective effect was calculated at 50.4%, whereas in the population born thereafter, protection was lacking. The overall probability of infection after exposure to an infected patient was calculated at 73.8%, which exceeds the threshold value of 46.9% for an index patient to infect at least one other person (R ≥1.0). Conclusion Our model shows that if no additional interventions are taken, the collective immunization status of the population alone will not suffice to contain human MPX. Although the majority of cases have occurred in a subpopulation, given the steadily increasing incidence, dissemination into the general population remains possible, as observed before with HIV. Our model emphasizes the need for adequate containment measures and may aid in specific risk assessment because it can easily be adapted to other populations and cohorts worldwide.
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Affiliation(s)
- Tibor Spath
- Medical University of Vienna, Department of Hospital Epidemiology and Infection Control, Vienna, Austria
| | - Sophie Brunner-Ziegler
- Medical University of Vienna, Department of Medicine II, Division of Angiology, Vienna, Austria
| | - Tanja Stamm
- Medical University of Vienna, Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Outcomes Research, Vienna, Austria
| | | | - Michael Kundi
- Medical University of Vienna, Center of Public Health, Vienna, Austria
| | - Kim Purkhauser
- Medical University of Vienna, Department of Dermatology, Vienna, Austria
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Advancing surgical setting: A paradigm for healthcare workers during the monkeypox outbreak. Ann Med Surg (Lond) 2022; 81:104343. [PMID: 36035596 PMCID: PMC9399141 DOI: 10.1016/j.amsu.2022.104343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
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Lai CC, Hsu CK, Yen MY, Lee PI, Ko WC, Hsueh PR. Monkeypox: An emerging global threat during the COVID-19 pandemic. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:787-794. [PMID: 35970757 PMCID: PMC9352646 DOI: 10.1016/j.jmii.2022.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2022]
Abstract
The emergence of the monkeypox outbreak in early 2022 has posed a new global health threat. As of July 8, 2022, 9069 laboratory-confirmed cases have been reported, and most of them are from non-endemic countries. The monkeypox virus is an enveloped double-stranded DNA virus, and preliminary genetic data suggest that the 2022 monkeypox virus belongs to the West African clade. In the current outbreak, human-to-human transmission has been the primary transmission mode. Although direct skin-to-skin contact with lesions during sexual activities can spread the virus, it remains unclear whether monkeypox can spread through sexual contact, specifically through contaminated body fluids. The typical presentation of monkeypox includes prodromal symptoms, followed by a rash that usually begins within 1–3 days of symptom onset, and the skin lesions can last for 2–4 weeks and then gradually resolve. However, the monkeypox outbreak in 2022 may exhibit atypical features. A definite diagnosis of monkeypox virus infection requires nucleic acid amplification testing via the polymerase chain reaction method. Supportive care is essential, and antiviral therapy is not considered for all affected patients, but recommended for those at highrisk for severe diseases. The mitigation of monkeypox outbreaks include enhanced case detection, case isolation, contact tracing, and post-exposure vaccination. In conclusion, the current monkeypox outbreak is a new threat during the COVID-19 pandemic. Clinicians should be aware of this new situation, which presents a different scenario from those of prior outbreaks. Global health systems should develop effective strategies to mitigate the spread of monkeypox.
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Affiliation(s)
- Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chi-Kuei Hsu
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Muh-Yong Yen
- Division of Infectious Diseases, Cheng Hsin General Hospital, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Xia J, Huang CL, Chu P, Kroshinsky D. Eczema Monkeypoxicum: Report of Monkeypox Transmission in Atopic Dermatitis. JAAD Case Rep 2022; 29:95-99. [PMID: 36212897 PMCID: PMC9534102 DOI: 10.1016/j.jdcr.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Schrarstzhaupt IN, Fontes-Dutra M, Diaz-Quijano FA. Early estimates of the incidence trend and the reproductive number of the monkeypox epidemic in Brazil. Travel Med Infect Dis 2022; 50:102484. [PMID: 36342036 PMCID: PMC9617678 DOI: 10.1016/j.tmaid.2022.102484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Background We aimed to calculate the weekly growth of the incidence and the effective reproductive number (Rt) of the 2022 Monkeypox epidemic during its introduction in Brazil. Method We described the case distribution in the country and calculated the incidence trend and the Rt in the four geographical states with the highest case reports. By using two regression approaches, count model and the Prais-Winsten, we calculated the relative incidence increase. Moreover, we estimated the Rt for the period between the 24th and the 50th days after the first official report, using a serial interval reported in another population and two alternative values (± 3 days). Results Up to August 22, 3.896 Monkeypox cases were confirmed in Brazil. The weekly incidence increases were between 37.5% (95% CI: 20.7% - 56,6%) and 82.1% (95% CI: 59.5%–107.8%), and all estimates of Rt were significantly higher than 1 in the four states analyzed. Conclusions The Monkeypox outbreak in Brazil is a significant public health emergency that requires coordinated public health strategies such as testing, contact tracing, and vaccination.
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Affiliation(s)
- Isaac N. Schrarstzhaupt
- Capixaba Health Teaching, Research, and Innovation Institute (ICEPi), Brazil,Corresponding author. 27 Alcides Sartor, Apt 102, Caxias do Sul, RS, 95060705, Brazil
| | - Mellanie Fontes-Dutra
- University of Vale do Rio dos Sinos (UNISINOS), School of Health, Rio Grande do Sul, RS, Brazil
| | - Fredi Alexander Diaz-Quijano
- University of São Paulo, School of Public Health, Department of Epidemiology - Laboratory of Causal Inference in Epidemiology (LINCE-USP), São Paulo, SP, Brazil
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