Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries

Monkeypox: Prevention Strategies and Challenges: Updated Review

Background and Aims

The mpox virus, sometimes known as MPXV, is the cause of the disease mpox. The Monkeypox virus is a different Poxviridae family member from the orthopoxvirus (OPXV) group. Clades I and II are the two varieties of the Monkeypox virus. The mpox can spread from person to person through direct contact with infectious skin or other lesions, such as those on the mouth or genitalia. The mpox virus is spread from animal to people by bites or scratches, as well as through tasks including skinning, trapping, cooking, playing with carcasses, and eating animals. People with compromised immune systems, small children, those with a history of eczema, and pregnant women may be more susceptible to serious mpox illness. This review aimed to identify the challenges of mpox, treatment alternatives, and prevention modalities.

Methods

This review addressed mpox virus etiology, epidemiology, risk factors, clinical presentations, clinical evaluation techniques, currently available treatments, and preventative measures. An analysis of the narrative data was conducted instead of a pooled analysis. Complete data published in English was included in a comprehensive literature search conducted across relevant databases pertaining to the mpox.

Results

The recommended laboratory test for mpox is polymerase chain reaction detection of viral DNA. It is crucial to differentiate measles, scabies, herpes, syphilis, chickenpox, measles, bacterial skin infections, and allergies related to medications from mpox. The ability to distinguish between chickenpox and mpox is made by lymphadenopathy. The JYNNEOS vaccine, ACAM2000 vaccine, and MVABN also known as Imvamune vaccinations have now been investigated and authorized for usage during mpox epidemics in different locations. Tecovirimat, brincidofovir, and cidofovir which had previously shown promise against OPXV were used as antivirals during the 2022 outbreak.

Conclusion

This review provides a brief overview of current vaccinations and antiviral medications that have been assessed for their potential as treatments since the mpox threat came into existence will be provided. It is useful to increase awareness and recognize the common clinical manifestations of mpox, diagnose, and its prevention methods. To effectively reduce the global transmission of mpox, the WHO should prioritize strategies that enhance early detection of the illness, careful administration of antiviral treatments, and focused vaccination initiatives for high-risk groups or wider immunization in areas where the disease is common. Furthermore, it is crucial to establish preventive measures, conduct educational outreach, and implement robust healthcare policies.

A new STI in the city: MPOX in Barcelona. First outbreak (5/2022-5/2023) and subsequent resurgence

BACKGROUND

In May 2022, after the suspension of the mobility restrictions due to the COVID-19 pandemic, the first outbreak of MPOX virus, transmitted from human to human, was detected outside of Africa, affecting mostly sexually active men who have sex with men. Our aim is to report the first outbreak of MPOX in Barcelona city in the period from 5/2022 to 5/2023 and the subsequent surge of cases in 8/2023.

METHODS

We performed a descriptive study of all notified cases in city residents, obtained through epidemiological surveys. The analyses are presented for the hospitalized cases and the key population of men who have sex with men.

RESULTS

Of 2037 notified cases, 82.6% were confirmed. The cumulative incidence in the general population was 1.03 (95%CI 1.00-1.06) per 1000 inhabitants and 2.13 (2.01-2.17) per 1000 in men. Men were older than women, with a median age of 37 years (interquartile range 31-43). While 84.5% of men reported having sex with partners of the same gender, 70.9% of women only reported sex with partners of the opposite gender. Complications occurred in 4.1% of infected persons, 1.6% required hospitalization, and no deaths were registered. Georeferencing was highly associated with gay venues. Gay, bisexual and other men who have sex with men (GBMSM) accounted for most cases and severe cases, and were associated with attending public sex venues and not providing contact tracing information. Digital and printed prevention campaign materials were developed for GBMSM.

DISCUSSION

The 2022 MPOX outbreak posed a major challenge to surveillance and sexual health services worldwide. With new cases and re-infections on the rise, MPOX may become a regular infection to be incorporated in STI testing and management guidelines. Barcelona has some characteristics that may facilitate the occurrence and spread of emergencies related to sexual health.

Quantifying the basic reproduction number and underestimated fraction of Mpox cases worldwide at the onset of the outbreak

In 2022, there was a global resurgence of mpox, with different clinical-epidemiological features compared with previous outbreaks. Sexual contact was hypothesized as the primary transmission route, and the community of men having sex with men (MSM) was disproportionately affected. Because of the stigma associated with sexually transmitted infections, the real burden of mpox could be masked. We quantified the basic reproduction number (R 0) and the underestimated fraction of mpox cases in 16 countries, from the onset of the outbreak until early September 2022, using Bayesian inference and a compartmentalized, risk-structured (high-/low-risk populations) and two-route (sexual/non-sexual transmission) mathematical model. Machine learning (ML) was harnessed to identify underestimation determinants. Estimated R 0 ranged between 1.37 (Canada) and 3.68 (Germany). The underestimation rates for the high- and low-risk populations varied between 25-93% and 65-85%, respectively. The estimated total number of mpox cases, relative to the reported cases, is highest in Colombia (3.60) and lowest in Canada (1.08). In the ML analysis, two clusters of countries could be identified, differing in terms of attitudes towards the 2SLGBTQIAP+ community and the importance of religion. Given the substantial mpox underestimation, surveillance should be enhanced, and country-specific campaigns against the stigmatization of MSM should be organized, leveraging community-based interventions.

A Review of Mpox Outbreak and Public Health Response in Spain

Objective

In May 2022, an unprecedented Mpox outbreak was reported in several non-endemic countries with unknown epidemiological links. Since May 2022, more than 20,000 cases have been reported in Europe. Spain has been the most affected country in Europe. We aim to describe the Mpox epidemiological profile in Spain, identify its outbreak risks, and describe public health interventions implemented by the Spanish authorities.

Methods

A literature review was conducted, using specific selection criteria to obtain relevant publications describing Mpox clinical presentation and risk factors and the public health response in Spain to the ongoing outbreak.

Results

63.1% of the cases presented an anogenital rash, considered a specific and early symptom in this outbreak. Low case fatality rate is observed, mainly in risk groups, such as the immunocompromised population. Patients evolution was generally favorable, although 3-8% required hospitalization and two deaths occurred; 40% of patients were previously diagnosed with HIV infection. Most of the cases were seen among young population and concentrated in men who had sex with other men, mainly with multiple sexual partners, who did not practice safe sex such as using condoms, and those attending mass event parties.

Conclusion

To date, the Mpox outbreak is not considered a public health emergency of international concern. The epidemiological trend of the virus in Spain shows that public health response interventions (health education, contact tracing, vaccination, etc.) have adequately controlled the epidemic curve in high-risk populations and avoided spreading the virus to other groups within the community.

Monkeypox Diagnosis in Clinical Settings: A Comprehensive Review of Best Laboratory Practices

An outbreak of monkeypox (Mpox) was reported in more than 40 countries in early 2022. Accurate diagnosis of Mpox can be challenging, but history, clinical findings, and laboratory diagnosis can establish the diagnosis. The pre-analytic phase of testing includes collecting, storing, and transporting specimens. It is advised to swab the lesion site with virus transport medium (VTM) containing Dacron or polyester flock swabs from two different sites. Blood, urine, and semen samples may also be used. Timely sampling is necessary to obtain a sufficient amount of virus or antibodies. The analytical phase of infectious disease control involves diagnostic tools to determine the presence of the virus. While polymerase chain reaction (PCR) is the gold standard for detecting Mpox, genome sequencing is for identifying new or modified viruses. As a complement to these methods, isothermal amplification methods have been designed. ELISA assays are also available for the determination of antibodies. Electron microscopy is another effective diagnostic method for tissue identification of the virus. Wastewater fingerprinting provides some of the most effective diagnostic methods for virus identification at the community level. The advantages and disadvantages of these methods are further discussed. Post-analytic phase requires proper interpretation of test results and the preparation of accurate patient reports that include relevant medical history, clinical guidelines, and recommendations for follow-up testing or treatment.

Retrospective testing for mpox virus in routine STI screens from men who have sex with men in England, August-October 2022

OBJECTIVES

A global outbreak of mpox (monkeypox) has been ongoing since 2022, with most cases in the UK detected in gay, bisexual and other men who have sex with men (GBMSM). Asymptomatic and pauci-symptomatic mpox infection has been reported outside of the UK. We aimed to investigate whether mpox could be detected in specimens from GBMSM in England who were attending sexual health services (SHSs) for asymptomatic sexually transmitted infection screening.

METHODS

Anonymised, residual clinical specimens from GBMSM undertaking routine asymptomatic screening for gonorrhoea (Neisseria gonorrhoeae (NG)) and chlamydia (Chlamydia trachomatis (CT)) infection were tested for the presence of mpox virus. Specimens were collected between 1 August and 7 October 2022 from three SHSs in high-mpox incidence areas in England. Testing was performed using a dual-clade, mpox virus-specific real-time PCR.

RESULTS

During the collection period, 2927 clinical specimens (951 pharyngeal swabs, 1022 urine specimens and 954 rectal swabs) were obtained from 1159 GBMSM. Mpox virus was detected in four specimens from two participants who attended the same SHS at different times (the first during the week 8-12 of August, the second during the week 19-23 of September). One participant was positive in the urine specimen only, while the other tested positive at all three sites.

CONCLUSIONS

A very low prevalence (2 of 1159, 0.17%) of mpox infection was detected in GBMSM attending SHS in England for asymptomatic NG/CT screening, suggesting that undetected infection in this population was unlikely to be a main driver of transmission. Confirmed mpox cases in the UK declined from over 1100 per month in June and July to 764 cumulatively during the collection period. These data give reassurance that the observed reduction in cases during the collection period was not due to undetected infection or changes in presentation among SHS attendees. Currently, there is insufficient evidence to support routine testing of asymptomatic GBMSM for mpox infection in England.

Mapping the Landscape of Health Research Priorities for Effective Pandemic Preparedness in Human Mpox Virus Disease

The global re-emergence of monkeypox (Mpox) in non-endemic regions in 2022 has highlighted the critical importance of timely virus detection and robust public health surveillance in assessing outbreaks and their impact. Despite significant Mpox research being conducted worldwide, there is an urgent need to identify knowledge gaps and prioritize key research areas in order to create a roadmap that maximizes the utilization of available resources. The present research article provides a comprehensive mapping of health research priorities aimed at advancing our understanding of Mpox and developing effective interventions for managing its outbreaks, and, as evidenced by the fact that achieving this objective requires close interdisciplinary collaboration. The key research priorities observed were identifying variants responsible for outbreaks; discovering novel biomarkers for diagnostics; establishing suitable animal models; investigating reservoirs and transmission routes; promoting the One Health approach; identifying targets for vaccination; gaining insight into the attitudes, experiences, and practices of key communities, including stigma; and ensuring equity during public health emergencies. The findings of this study hold significant implications for decision making by multilateral partners, including research funders, public health practitioners, policy makers, clinicians, and civil society, which will facilitate the development of a comprehensive plan not only for Mpox but also for other similar life-threatening viral infections.

Antivirals against Monkeypox (Mpox) in Humans: An Updated Narrative Review

As of 29 August 2023, a total of 89,596 confirmed cases of Mpox (monkeypox) have been documented across 114 countries worldwide, with 157 reported fatalities. The Mpox outbreak that transpired in 2022 predominantly affected young men who have sex with men (MSM). While most cases exhibited a mild clinical course, individuals with compromised immune systems, particularly those living with HIV infection and possessing a CD4 count below 200 cells/mm3, experienced a more severe clinical trajectory marked by heightened morbidity and mortality. The approach to managing Mpox is primarily symptomatic and supportive. However, in instances characterized by severe or complicated manifestations, the utilization of antiviral medications becomes necessary. Despite tecovirimat's lack of official approval by the FDA for treating Mpox in humans, a wealth of positive clinical experiences exists, pending the outcomes of ongoing clinical trials. Brincidofovir and cidofovir have also been administered in select cases due to the unavailability of tecovirimat. Within the scope of this narrative review, our objective was to delve into the clinical attributes of Mpox and explore observational studies that shed light on the utilization of these antiviral agents.

Mpox (Monkeypox) in Pregnancy: Viral Clade Differences and Their Associations with Varying Obstetrical and Fetal Outcomes

In African countries where mpox (monkeypox) is endemic, infection is caused by two genetically related clades-Clade I (formerly Congo Basin), and Clade IIa (formerly West Africa), both of which are potentially life-threatening infections. Prior to the 2022-2023 global outbreak, mpox infections among pregnant women caused by Clade I were reported to have a 75% perinatal case fatality rate in the Democratic Republic of Congo, including the only documented case of placental infection and stillbirth from the Congenital Mpox Syndrome, and the Clade IIa mpox infection was associated with stillbirths in Nigeria. The 2022-2023 global mpox outbreak, caused by a genetically distinct strain, Clade IIb, has focused attention on the effects of mpox on pregnant women and fetal outcomes. There have been at least 58 cases of mpox infection occurring in pregnant women during the 2022-2023 outbreak. No confirmed cases of adverse perinatal outcome, including stillbirth, have been reported. The absence of perinatal morbidity and mortality from Clade IIb corresponds to the overall case fatality rate among non-pregnant women of <0.1%, as this clade has been demonstrated to produce a less-severe disease than the mpox Clade I or IIa variants. Thus, there are apparently important differences between mpox clades affecting pregnant women and perinatal outcomes.