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Lima MT, Kroon EG, Campos MA. Mpox and the impact on people with HIV. Curr Opin HIV AIDS 2025; 20:310-317. [PMID: 40018986 DOI: 10.1097/coh.0000000000000922] [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] [Indexed: 03/01/2025]
Abstract
PURPOSE OF REVIEW This review explores the intersection of Mpox and HIV, highlighting clinical manifestations, immune evasion mechanisms, epidemiological challenges, and prevention strategies. People with HIV (PWH), particularly those with low CD4 + cell count, face severe Mpox outcomes. Prevention relies on education, vaccination, and early detection. Integrating Mpox management into HIV care systems is vital. RECENT FINDINGS Since May 2022, Mpox caused by Orthopoxvirus monkeypox (MPV) Clade IIb, has affected 126 countries. In 2024, Clade Ib emerged in the Democratic Republic of Congo, leading to its declaration as a Public Health Emergency of International Concern (PHEIC). Research on MPV-HIV co-infections has provided genomic insights and protective strategies for PWH. Antivirals like tecovirimat show promise despite emerging resistance concerns. SUMMARY The global Mpox outbreak caused by Clade IIb and the emergence of Clade Ib underscores its growing threat. Mpox disproportionately impacts PWH, leading to severe outcomes and higher fatality rates. This review emphasizes clinical challenges, genomic advances, and prevention strategies. Enhanced surveillance, vaccination, and tailored therapies are essential to addressing this evolving health crisis.
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Affiliation(s)
- Mauricio Teixeira Lima
- Departamento de Microbiologia, Universidade Federal de Minas Gerais (UFMG)
- Laboratório Central de Saúde Pública do Estado de Minas Gerais, Fundação Ezequiel Dias (Funed)
| | | | - Marco Antônio Campos
- Instituto Rene Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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2
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de Meneses D, Stoffella-Dutra AG, Blaso VS, de Almeida IM, Dias KL, Domingos IJDS, Ribeiro GP, Coura-Vital W, Reis AB, Vieira TM, Trindade GDS. Domestic Dogs Exposed to Orthopoxvirus in Urban Areas of Brazil. Viruses 2025; 17:131. [PMID: 39861920 PMCID: PMC11768714 DOI: 10.3390/v17010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/10/2025] [Accepted: 01/15/2025] [Indexed: 01/27/2025] Open
Abstract
Domestic animals can share viral pathogens with humans, acting mainly as a bridge host. The Orthopoxvirus genus hosts important zoonotic species that have emerged in urban areas worldwide. Nevertheless, the role of companion animals, such as dogs and cats, in the circulation of orthopoxviruses in urban areas remains poorly understood. Therefore, the objective of this study was to evaluate the presence of neutralizing anti-orthopoxvirus antibodies in serum samples from owned dogs from three municipalities in Minas Gerais, as well as the presence of the C11R and A56R orthopoxviruses genes. The presence of neutralizing antibodies was detected in 14.3% of the animals investigated. However, no sample was positive for the presence of the genes investigated. Further study of the population of dogs in urban areas may prove a valuable tool for understanding the spread of orthopoxviruses in urbanized areas of Brazil.
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Affiliation(s)
- Débora de Meneses
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Ana G. Stoffella-Dutra
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Vicenzo S. Blaso
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Iara M. de Almeida
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Karolina L. Dias
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Iago José da S. Domingos
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Gabriela P. Ribeiro
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
| | - Wendel Coura-Vital
- Departamento de Análises Clínicas, Escola de Farmácia, Campus Morro do Cruzeiro, Universidade Federal de Ouro Preto, Morro do Cruzeiro, s/n, Ouro Preto 35402-163, Brazil
| | - Alexandre B. Reis
- Departamento de Análises Clínicas, Escola de Farmácia, Campus Morro do Cruzeiro, Universidade Federal de Ouro Preto, Morro do Cruzeiro, s/n, Ouro Preto 35402-163, Brazil
| | - Thallyta M. Vieira
- Departamento de Biologia Geral, Universidade Estadual de Montes Claros, Avenida Cula Mangabeira, Santo Expedito 39401-001, Brazil
| | - Giliane de S. Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Belo Horizonte 31270-901, Brazil
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Malka MS, Parkinson M, Zucker J, McLean JR, Pereira MR, Yin MT, Gunaratne SH. A Prolonged Case of Severe Mpox as an Opportunistic Infection in Advanced AIDS. Cureus 2024; 16:e59947. [PMID: 38854169 PMCID: PMC11161852 DOI: 10.7759/cureus.59947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
The case report discusses a 29-year-old male with advanced HIV who experienced one of the longest, confirmed cases of monkeypox (mpox) infection. Despite treatment with antivirals and supportive care, including intravenous tecovirimat and vaccinia immune globulin, the patient's condition worsened over a six-and-a-half-month period. He suffered from widespread ulcerative, necrotic lesions and multiple complications, including acute kidney injury, multi-drug resistant bacterial infections, and respiratory failure. Despite repeated treatments, including brincidofovir, the patient remained PCR-positive for monkeypox virus (MPXV) with low cycle threshold (Ct) values, indicating active infection. The case underscores the severity of mpox in immunocompromised individuals, particularly those with advanced HIV, and highlights the challenges in managing such cases. The patient's persistently low CD4 count and unsuppressed HIV viral load likely contributed to the inability to clear the virus. The report emphasizes the need for further research to optimize treatment strategies for MPXV infection, especially in people living with HIV.
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Affiliation(s)
| | | | - Jason Zucker
- Infectious Disease, Columbia University, New York, USA
| | | | | | - Michael T Yin
- Infectious Disease, Columbia University Irving Medical Center, New York, USA
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Wong M, Damon IK, Zucker J, Foote MMK, El-Sadr W. ART initiation for people living with HIV with severe mpox. Lancet 2023; 402:1750. [PMID: 37951687 DOI: 10.1016/s0140-6736(23)01674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/07/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Marcia Wong
- New York City Department of Health and Mental Hygiene, New York 11101, NY, USA.
| | | | - Jason Zucker
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Mary M K Foote
- New York City Department of Health and Mental Hygiene, New York 11101, NY, USA
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Carrubba S, Geevarghese A, Solli E, Guttha S, Sims J, Sperber L, Meehan S, Ostrovsky A. Novel severe oculocutaneous manifestations of human monkeypox virus infection and their historical analogues. THE LANCET. INFECTIOUS DISEASES 2023; 23:e190-e197. [PMID: 36702137 PMCID: PMC9870321 DOI: 10.1016/s1473-3099(22)00869-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Abstract
WHO has declared human mpox (formerly known as monkeypox) a global public health emergency since July, 2022. When case numbers were increasing, so did clinicians' exposures to new elements of the disease. Additionally, the burden of mpox is particularly apparent in immunocompromised patients, who can have more variable and severe manifestations of disease across organ systems. In this Grand Round, we report novel and severe oculocutaneous manifestations of mpox in this population, which are both sight and life threatening. Specifically, we highlight two patients with mpox and AIDS who had refractory skin necrosis that progressed to either ocular compromise or panfacial gangrene, or both. Both patients ultimately died due to systemic complications of their infections. Through clinical analogies, we show how past experiences with related orthopoxviruses, such as variola virus (smallpox) and vaccinia virus, can add useful context for understanding and treating these new disease states. We suspect that in patients who are immunocompromised, monkeypox virus can clinically evolve not only via viraemia but also through direct intradermal spread. We propose that intradermal spread occurs by a process clinically and immunologically analogous to progressive vaccinia, a complication previously seen after conventional smallpox vaccination. We share evidence in support of this theory and implications regarding early management and post-exposure prophylaxis for at-risk populations. Content note: this Grand Round contains graphic images of mpox lesions of the eyes and face.
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Affiliation(s)
- Steven Carrubba
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Alexi Geevarghese
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Elena Solli
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Samyuktha Guttha
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Jeffrey Sims
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Laurence Sperber
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Shane Meehan
- Department of Dermatology, NYU Langone Medical Center, New York, NY, USA
| | - Ann Ostrovsky
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA,Correspondence to: Dr Ann Ostrovsky, New York, NY 10017, USA
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MacNeill AL. Comparative Pathology of Zoonotic Orthopoxviruses. Pathogens 2022; 11:pathogens11080892. [PMID: 36015017 PMCID: PMC9412692 DOI: 10.3390/pathogens11080892] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
This review provides a brief history of the impacts that a human-specific Orthopoxvirus (OPXV), Variola virus, had on mankind, recalls how critical vaccination was for the eradication of this disease, and discusses the consequences of discontinuing vaccination against OPXV. One of these consequences is the emergence of zoonotic OPXV diseases, including Monkeypox virus (MPXV). The focus of this manuscript is to compare pathology associated with zoonotic OPXV infection in veterinary species and in humans. Efficient recognition of poxvirus lesions and other, more subtle signs of disease in multiple species is critical to prevent further spread of poxvirus infections. Additionally included are a synopsis of the pathology observed in animal models of MPXV infection, the recent spread of MPXV among humans, and a discussion of the potential for this virus to persist in Europe and the Americas.
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Affiliation(s)
- Amy L MacNeill
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Barbosa Costa G, Silva de Oliveira J, Townsend MB, Carson WC, Borges IA, McCollum AM, Kroon EG, Satheshkumar PS, Reynolds MG, Nakazawa YJ, de Souza Trindade G. Educational Approach to Prevent the Burden of Vaccinia Virus Infections in a Bovine Vaccinia Endemic Area in Brazil. Pathogens 2021; 10:pathogens10050511. [PMID: 33922509 PMCID: PMC8145679 DOI: 10.3390/pathogens10050511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
Bovine vaccinia (BV), caused by Vaccinia virus (VACV), is a zoonotic disease characterized by exanthematous lesions on the teats of dairy cows and the hands of milkers, and is an important public health issue in Brazil and South America. BV also results in economic losses to the dairy industry, being a burden to the regions involved in milk production. In the past 20 years, much effort has been made to increase the knowledge regarding BV epidemiology, etiologic agents, and interactions with the hosts and the environment. In the present study, we evaluated milking practices that could be associated with VACV infections in an endemic area in Brazil and proposed an educational tool to help prevent VACV infections. In our survey, 124 individuals (51.7%) from a total of 240 had previously heard of BV, 94 of which knew about it through BV outbreaks. Although most individuals involved in dairy activities (n = 85/91) reported having good hygiene practices, only 29.7% used adequate disinfecting products to clean their hands and 39.5% disinfected cows’ teats before and after milking. Furthermore, 46.7% of individuals reported having contact with other farm and domestic animals besides dairy cattle. We also evaluated the presence of IgG and IgM antibodies in the surveyed population. Overall, 6.1% of likely unvaccinated individuals were positive for anti-Orthopoxvirus IgG antibodies, and 1.7% of all individuals were positive for IgM antibodies. Based on our findings, we proposed educational materials which target individuals with permanent residence in rural areas (mainly farmers and milkers), providing an overview and basic information about preventive measures against VACV infections that could enhance BV control and prevention efforts, especially for vulnerable populations located in endemic areas.
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Affiliation(s)
- Galileu Barbosa Costa
- Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília 70723-040, Brazil
- Correspondence: or (G.B.C.); (G.d.S.T.); Tel.: +55-61-3315-7708 (G.B.C.); +55-31-3409-2747 (G.d.S.T.)
| | - Jaqueline Silva de Oliveira
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
| | - Michael B. Townsend
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - William C. Carson
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Iara Apolinário Borges
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
| | - Panayampalli Subbian Satheshkumar
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Yoshinori J. Nakazawa
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (M.B.T.); (W.C.C.); (A.M.M.); (P.S.S.); (M.G.R.); (Y.J.N.)
| | - Giliane de Souza Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil; (J.S.d.O.); (I.A.B.); (E.G.K.)
- Correspondence: or (G.B.C.); (G.d.S.T.); Tel.: +55-61-3315-7708 (G.B.C.); +55-31-3409-2747 (G.d.S.T.)
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José da Silva Domingos I, Silva de Oliveira J, Lorene Soares Rocha K, Bretas de Oliveira D, Geessien Kroon E, Barbosa Costa G, de Souza Trindade G. Twenty Years after Bovine Vaccinia in Brazil: Where We Are and Where Are We Going? Pathogens 2021; 10:406. [PMID: 33807254 PMCID: PMC8065508 DOI: 10.3390/pathogens10040406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 01/31/2023] Open
Abstract
Orthopoxvirus (OPV) infections have been present in human life for hundreds of years. It is known that Variola virus (VARV) killed over 300 million people in the past; however, it had an end thanks to the physician Edward Jenner (who developed the first vaccine in history) and also thanks to a massive vaccination program in the 20th century all over the world. Although the first vaccine was created using the Cowpox virus (CPXV), it turned out later that the Vaccinia virus was the one used during the vaccination program. VACV is the etiological agent of bovine vaccinia (BV), a zoonotic disease that has emerged in Brazil and South America in the last 20 years. BV has a great impact on local dairy economies and is also a burden to public health. In this review, we described the main events related to VACV and BV emergence in Brazil and South America, the increase of related scientific studies, and the issues that science, human and animal medicine are going to face if we do not be on guard to this virus and its disease.
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Affiliation(s)
- Iago José da Silva Domingos
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil; (I.J.d.S.D.); (J.S.d.O.); (E.G.K.)
| | - Jaqueline Silva de Oliveira
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil; (I.J.d.S.D.); (J.S.d.O.); (E.G.K.)
| | - Kamila Lorene Soares Rocha
- Laboratório de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG 39100-000, Brazil; (K.L.S.R.); (D.B.d.O.)
| | - Danilo Bretas de Oliveira
- Laboratório de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG 39100-000, Brazil; (K.L.S.R.); (D.B.d.O.)
| | - Erna Geessien Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil; (I.J.d.S.D.); (J.S.d.O.); (E.G.K.)
| | - Galileu Barbosa Costa
- Departamento de Análise em Saúde e Vigilância de Doenças Não-Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF 70719-040, Brazil
| | - Giliane de Souza Trindade
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG 31270-901, Brazil; (I.J.d.S.D.); (J.S.d.O.); (E.G.K.)
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Silva NIO, de Oliveira JS, Kroon EG, Trindade GDS, Drumond BP. Here, There, and Everywhere: The Wide Host Range and Geographic Distribution of Zoonotic Orthopoxviruses. Viruses 2020; 13:E43. [PMID: 33396609 PMCID: PMC7823380 DOI: 10.3390/v13010043] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 01/05/2023] Open
Abstract
The global emergence of zoonotic viruses, including poxviruses, poses one of the greatest threats to human and animal health. Forty years after the eradication of smallpox, emerging zoonotic orthopoxviruses, such as monkeypox, cowpox, and vaccinia viruses continue to infect humans as well as wild and domestic animals. Currently, the geographical distribution of poxviruses in a broad range of hosts worldwide raises concerns regarding the possibility of outbreaks or viral dissemination to new geographical regions. Here, we review the global host ranges and current epidemiological understanding of zoonotic orthopoxviruses while focusing on orthopoxviruses with epidemic potential, including monkeypox, cowpox, and vaccinia viruses.
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Affiliation(s)
| | | | | | | | - Betânia Paiva Drumond
- Laboratório de Vírus, Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais: Belo Horizonte, Minas Gerais 31270-901, Brazil; (N.I.O.S.); (J.S.d.O.); (E.G.K.); (G.d.S.T.)
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