Useful public health countermeasures to control the current multicountry outbreak of Monkeypox disease

Monkeypox Vaccine Hesitancy Among Healthcare Workers in Pakistan

Objective

This study aimed to investigate healthcare workers (HCWs) acceptance of the HMPXV vaccine in Pakistan and identify influencing factors.

Methods

A cross-sectional survey of 4257 HCWs assessed vaccine acceptance across demographics, ethnicity, marital status, specialty, medical conditions, and education. Logistic regression identified predictors of acceptance.

Results

The overall HMPXV vaccine acceptance among HCWs was 73.1%. The gender distribution shows that a majority of participants are female (56.60%) while males constitute 43.40% of the sample. Interestingly, vaccine acceptance is higher among females (68.43%) compared to males (31.57%). Ethnicity in the sample reveals that Punjabi participants are the most common at 45.25%, followed by Pashtun (26.06%), Sindhi (14.41%), Balochi (12.72%), and Other (1.46%). Age categories are compared to the 18-30 age group. The odds of vaccine acceptance are lower for individuals aged 31-40 (OR 0.48, 95% CI 0.19-1.25) and for those over 60 (OR 0.80, 95% CI 0.41-0.97). Conversely, the odds are higher for those aged 41-50 (OR 1.93, 95% CI 0.27-3.01) and 51-60 (OR 0.54, 95% CI 0.19-1.67). Gender comparison reveals that females have higher odds of vaccine acceptance (OR 0.26, 95% CI 0.21-1.24) than males. Among ethnicities, Sindhi participants (OR 1.21, 95% CI 0.23-1.88) have slightly higher odds of vaccine acceptance than Punjabi participants. Marital status doesn't significantly influence vaccine acceptance, but married individuals have slightly higher odds (OR 1.75, 95% CI 0.87-5.06). In terms of specialty, Surgery/Allied professionals have lower odds of vaccine acceptance (OR 0.48, 95% CI 0.13-1.70) compared to Medicine/Allied professionals.

Conclusion

Strategies addressing demographic disparities and countering misinformation are crucial for enhancing HMPXV vaccine uptake among HCWs. Targeted interventions are necessary for effective vaccination coverage in healthcare settings.

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

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

The Feasibility of Elimination of Monkeypox Virus in Nigeria: A Systematic Review

Monkeypox is a zoonotic virus with an increasing incidence in Nigeria, posing significant public health challenges. The virus, related to smallpox, primarily spreads through direct contact with infected animals or humans and has been noted for its potential for wider transmission due to changing ecological and social dynamics. This research aims to evaluate the feasibility of eliminating monkeypox in Nigeria through integrated approaches involving vaccination, public health strategies, and ecological management. Additionally, it seeks to propose a unified public health strategy, incorporating One Health principles, to achieve the elimination of monkeypox in Nigeria. A review of the feasibility of eliminating the monkeypox virus in Nigeria was conducted using databases like Science Direct, Cochrane, PubMed, and Medline. The search was guided by the methodologies and reporting guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The initial search yielded 89 publications, but the number of articles that required examination was reduced after applying selected keywords and evaluating abstracts. We deemed 32 articles relevant to the subject after applying inclusion and exclusion criteria. The findings are analyzed, highlighting their limitations and strengths and discussing practical implications, knowledge gaps, and recommendations for future research. This study provides evidence supporting the feasibility of the elimination of the monkeypox virus in Nigeria. Strategic recommendations for a sustainable public health approach to eliminating monkeypox emphasize preventive measures, community engagement, and ecological preservation. This study will provide critical insights into the feasibility of eliminating monkeypox in Nigeria, offering a model that can be adapted for other regions facing similar challenges. The integration of health, ecological, and community-focused strategies is expected to contribute significantly to global efforts to control and potentially eradicate monkeypox. This research could serve as a foundational study for public health authorities in Nigeria and internationally, informing policy and operational decisions to control and eliminate monkeypox as a public health threat. The monkeypox virus reemerges in Nigeria, increasing mortality rates. Awareness programs should be conducted on its danger, transmission mode, and potential human transmission. Public education on the lack of treatment and vaccines is crucial. Meat inspection laws should be enforced to ensure safe animal consumption.

Plausible reasons for the resurgence of Mpox (formerly Monkeypox): an overview

Poxviruses are large and diversified viruses that cause an emerging zoonotic disease known as monkeypox (mpox). In the past, mpox predominated primarily in the rural rainforests of Central and West Africa. Recently, the exportation of mpoxv from Africa to other continents has been progressively reported. However, the lack of travel history to Africa in most of the currently reported cases in 2022 promotes the sign of changing epidemiology of this disease. Concerns over the geographic distribution and continued resurgence of mpox is growing. In this review, we addressed the geographic distribution, transmission, reasons for the resurgence of mpox, and vaccination. Although the precise cause of the resurgence in mpox cases is mostly unknown, several suggested factors are believed to be waning immunity, accumulation of unvaccinated people, ecological conditions, risk behaviors of men who have sex with men, and genetic evolution.

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

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