Monkeypox fact sheets detail

Monkeypox fact sheets detail

Table of Contents

Monkeypox fact sheets detail

Key facts

  • Monkeypox fact sheets detail: Vaccines used during the smallpox eradication program also provided protection against Monkeypox. Newer vaccines have been developed, one of which has been approved to prevent Monkeypox.
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  • Monkeypox is caused by the Monkeypox virus, a member of the genus Orthopoxviral in the family Poxviridae.
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  • Monkeypox is usually a self-limiting disease with symptoms lasting 2 to 4 weeks. Severe cases can occur. Recently, the mortality rate has been around 3-6%.
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  • Monkeypox is transmitted to humans through close contact with an infected person or animal, or through material contaminated with the virus.
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  • Monkeypox is a viral zoonosis that occurs mainly in tropical forest areas of central and west Africa and is occasionally exported to other regions.
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  • The clinical presentation of Monkeypox is similar to that of smallpox, an infection caused by the orthopoxviral that was declared eradicated from the world in 1980.
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  • Monkeypox usually presents clinically with fever, rash, and swollen lymph nodes and can cause a variety of medical complications.

Introduction


Monkeypox is a viral zoonosis (a virus transmitted from animals to humans) with symptoms similar to those seen in smallpox patients in the past, although clinically less severe. With the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, Monkeypox became the most important public health orthopoxviral. Monkeypox occurs primarily in central and western Africa, often near tropical rainforests, and is increasingly found in urban areas. Animal hosts include a variety of rodents and non-human primates.

The causative agent / The pathogen


Monkeypox virus is an enveloped double-stranded DNA virus belonging to the genus Orth poxvirus of the family Poxviridae. There are two distinct genetic clades of Monkeypox virus: the Central African (Congo Basin) clade and the West African clade. Historically, the Congo Basin group caused more severe diseases and was considered more easily transmissible. The geographical separation between the two groups has so far been Cameroon, the only country where both virus groups have been found.

Monkeypox virus natural host

Several animal species have been identified as susceptible to the Monkeypox virus. These include rope squirrels, tree squirrels, Gambian rats, dormouse, non-human primates and other species. Uncertainty remains about the natural history of the Monkeypox virus, and further studies are needed to identify the exact reservoirs and how the virus is circulated in nature.

Outbreaks

Monkeypox in humans were first identified in 1970 in a 9-month-old child in the Democratic Republic of the Congo, in a region where smallpox was eradicated in 1968. Since then, most cases have been reported in rural and jungle regions of the Congo Basin, particularly in the Democratic Republic of the Congo, and increasing human cases have been reported in Central and West Africa.
Since 1970, human cases of monkeypox have been reported from 11 African countries: Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Gabon, Ivory Coast, Liberia, Nigeria, Republic of the Congo, Sierra Leone and South Sudan South. The true burden of monkeypox is unknown. For example, in 1996–97 an outbreak was reported in the Democratic Republic of the Congo with a lower than usual fatality rate and a higher rate of attacks.

A simultaneous outbreak of varicella (caused by non-orthopoxvirus varicella virus) and monkeypox was identified, which in this case could explain actual or apparent changes in transmission dynamics. Since 2017, Nigeria has experienced a major outbreak with more than 500 suspected cases and more than 200 confirmed cases and a fatality rate of around 3%. Cases are still being reported to this day.

Monkeypox is a disease of global public health concern, affecting not only West and Central African countries but the rest of the world. In 2003, the first outbreak of Monkeypox outside of Africa occurred in the United States and was linked to contact with infected prairie dogs. These pets were housed with Gambian rats and dormouse that had been imported into the country from Ghana. This outbreak caused more than 70 cases of monkeypox in the United States.

There were also reports of Monkeypox in travelers from Nigeria to Israel in September 2018, the UK in September 2018, December 2019, May 2021 and May 2022, Singapore in May 2019 and the United States of America. America in July and November. 2021. As of May 2022, multiple cases of monkeypox have been identified in several non-endemic countries. Studies are ongoing to better understand the epidemiology, sources of infection and transmission patterns.

Transmission

Animal-to-human transmission (zoonotic) can occur through direct contact with blood, body fluids, or skin or mucous membrane lesions of infected animals. Evidence of monkeypox virus infection has been found in many animals in Africa, including rope squirrels, tree squirrels, poached Gambian rats, dormouse, various species of monkeys, and others.

The natural reservoir for Monkeypox has not yet been identified, although rodents are the most likely. Eating undercooked meat and other animal products from infected animals is a possible risk factor. People living in or near forested areas may be slightly or indirectly exposed to infected animals.


Human-to-human transmission can occur through close contact with respiratory secretions, skin lesions from an infected person, or recently contaminated objects. Respiratory droplet transmission typically requires prolonged face-to-face contact, putting medical workers, household members and other close contacts of active cases at greater risk.

However, the longest documented chain of transmission in a community has increased from 6 to 9 consecutive human-to-human infections in recent years This may reflect reduced immunity across communities due to the cessation of vaccination against smallpox. Transmission can also occur across the placenta from mother to fetus (which can result in congenital Monkeypox) or through close contact during and after birth.

While close physical contact is a known risk factor for transmission, it is currently unclear whether Monkeypox can be transmitted specifically through sexual routes. Studies are needed to better understand this risk.

Signs and symptoms

The incubation period (interval from infection to onset of symptoms) for monkeypox is usually 6 to 13 days but can range from 5 to 21 days.

The infection can be divided into two periods:


  • >The invasive phase (between 0 and 5 days) characterized by fever, severe headache, lymphadenopathy (swollen lymph nodes), back pain, myalgia (muscle pain) and severe asthenia (lack of energy). Lymphadenopathy is a distinguishing feature of monkeypox compared to other diseases that may at first appear similar (varicella, measles, smallpox).

>The rash usually begins within 1 to 3 days of the onset of the fever. The rash is concentrated on the face and extremities rather than the trunk. It affects the face (95% of the time) and the palms and soles (75% of the time). The oral mucosa (in 70% of cases), the genitals (30%) and the conjunctiva (20%) are also affected, as is the cornea. The rash progresses sequentially from patches (flat-based lesions) to papules (firm, slightly raised lesions), vesicles (clear, fluid-filled lesions), pustules (yellowish, fluid-filled lesions), and scabs that dry and fall off. The number of injured varies between a few and several thousand. In severe cases, the lesions can grow together until large areas of skin are shed.


Monkeypox is usually a self-limiting disease with symptoms lasting 2 to 4 weeks. Severe cases are more common in children and are related to the level of exposure to the virus, the patient’s medical condition, and the nature of the complications. Underlying immune deficiencies can lead to worse outcomes. Although smallpox vaccination was protective in the past, people under the age of 40 to 50 (depending on the country) may be more susceptible to monkeypox today, since smallpox vaccination campaigns worldwide were discontinued after the disease was eradicated.

Complications of Monkeypox can include secondary infections, bronchopneumonia, sepsis, encephalitis, and corneal infection with subsequent vision loss.The extent to which asymptomatic infection can occur is unknown.


Historically, mortality rates from Monkeypox ranged from 0% to 11% in the general population and were higher in young children. Recently, the mortality rate has been around 3-6%.

Monkeypox/Milao Haath

Diagnosis

Clinical differential diagnoses to consider include other rash diseases such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and drug allergies. Lymphadenopathy during the prodromal stage of the disease may be a clinical feature to distinguish monkeypox from varicella or smallpox.

If monkeypox is suspected, health workers should collect an appropriate sample and transport it safely to a laboratory with sufficient capacity. Confirmation of monkeypox depends on the type and quality of the specimen and the type of laboratory test. Therefore, samples must be packaged and shipped according to national and international requirements. The polymerase chain reaction (PCR) is the preferred laboratory test due to its accuracy and sensitivity.

this, the optimal diagnostic specimens for monkeypox skin lesions are: the roof or fluid of vesicles and pustules and dry scabs. If possible, a biopsy is an option. Lesion specimens should be stored in a dry, sterile tube (no viral transport media) and kept refrigerated. PCR blood tests are generally inconclusive due to the short duration of viraemia compared to when the sample was collected after onset of symptoms and should not be routinely drawn from patients.

Because orthopoxviruses are serologically reactive, antigen and antibody detection methods do not provide specific confirmation of monkeypox. Therefore, serology and antigen detection methods are not recommended for diagnosis or case investigation when resources are limited. In addition, recent or remote vaccination with a vaccinia-based vaccine (e.g., people who were vaccinated before smallpox was eradicated or who were recently vaccinated because of increased risk, such as orthopoxvirus laboratory workers) could produce false positive results to lead.

In order to interpret the test results, it is important that patient information is provided with the specimens, including: a) date of onset of fever, b) date of onset of rash, c) date of specimen collection, specimen, d) current condition of specimen individual (eruption stage) and e) age.

Therapeutics

Clinical care for monkeypox needs to be fully optimized to alleviate symptoms, manage complications, and prevent long-term sequelae. Patients should be offered fluids and food to maintain an adequate nutritional status.

Secondary bacterial infections should be treated as indicated. An antiviral called tecovirimat, developed to treat smallpox, was approved for monkeypox in 2022 by the European Medicines Agency (EMA) based on data from animal and human studies.

It is not yet widely available. When used in patient care, tecovirimate should ideally be monitored as part of a clinical investigation with prospective data collection.

Vaccination

Monkeypox/Milao Haath Monkeypox/Milao Haath
 

Several observational studies have shown that smallpox vaccination is approximately 85% effective in preventing monkeypox. Therefore, prior smallpox vaccination may result in a milder disease. Signs of a previous smallpox vaccination are usually found as a scar on the upper arm. Currently, the original smallpox vaccines (first generation) are no longer available to the general public.

Some laboratory workers or healthcare workers may have received a newer smallpox vaccine to protect them from exposure to orthopoxviruses in the workplace. An even newer vaccine based on a modified attenuated vaccinia virus (Ankara strain) was approved in 2019 for the prevention of monkeypox. It is a two-dose vaccine and availability remains limited. Smallpox and monkeypox vaccines are being developed in vaccinia virus-based formulations because cross-protection is provided by the immune response to orthopoxviruses.

Reducing the risk of human-to-human transmission

Monitoring and rapid identification of new cases are critical to containing the outbreak. In human outbreaks of monkeypox, close contact with infected individuals is the most important risk factor for infection with the monkeypox virus. Healthcare workers and household members are at higher risk of infection.

Healthcare workers who care for patients with confirmed or suspected monkeypox infection or who handle samples from them should use standard infection control precautions. If possible, smallpox vaccinees should be selected beforehand to care for the patient.

Specimens from humans and animals suspected of being infected with monkeypox virus should be handled by trained personnel in properly equipped laboratories. Patient samples must be securely prepared for transport using triple packaging in accordance with WHO guidance on the transport of infectious substances.

The identification of clusters of monkeypox cases in May 2022 in several non-endemic countries without direct travel links to an endemic area is atypical. Further investigations are underway to determine the possible source of infection and contain the spread. When investigating the source of this outbreak, it is important to consider all possible routes of transmission to protect public health.

Reducing the risk of zoonotic transmission

Over time, most human infections are due to primary animal-to-human transmission. Unprotected contact with wild animals, especially sick or dead animals, including their flesh, blood and other parts, should be avoided. Also, all foods containing meat or animal parts must be thoroughly cooked before consumption.

Preventing Monkeypox through restrictions on animal trade

Some international locations have installed vicinity rules proscribing importation of rodents and non-human primates. Captive animals which might be probably inflamed with monkeypox have to be remoted from different animals and positioned into instantaneously quarantine. Any animals that could have come into touch with an inflamed animal have to be quarantined, dealt with with fashionable precautions and discovered for monkeypox signs for 30 days.

How Monkeypox relates to smallpox

The medical presentation of monkeypox resembles that of smallpox, a associated orthopoxvirus contamination which has been eliminated. Smallpox changed into greater effortlessly transmitted and greater frequently deadly as approximately 30% of sufferers died. The ultimate case of certainly obtained smallpox took place in 1977, and in 1980 smallpox changed into declared to had been eliminated international after a worldwide marketing campaign of vaccination and containment.

It has been forty or greater years when you consider that all nations ceased ordinary smallpox vaccination with vaccinia-primarily based totally vaccines. As vaccination additionally covered in opposition to monkeypox in west and critical Africa, unvaccinated populations at the moment are additionally greater prone to monkeypox virus contamination.

Overview

Monkeypox virus is an orthopoxvirus that reasons a ailment with signs similar, however much less severe, to smallpox. While smallpox became eliminated in 1980, monkeypox maintains to arise in nations of vital and west Africa. Two wonderful clade are identified: the west African clade and the Congo Basin clade, additionally referred to as the vital African clade.

Monkeypox is a zoonosis: a ailment this is transmitted from animals to humans. Cases are regularly determined near tropical rainforests in which there are animals that deliver the virus. Evidence of monkeypox virus contamination has been determined in animals which includes squirrels, Gambian poached rats, dormice, distinctive species of monkeys and others.

Human-to-human transmission is limited, with the longest documented chain of transmission being 6 generations, that means that the final individual to be inflamed on this chain became 6 hyperlinks farfar from the unique ill individual. It may be transmitted thru touch with physical fluids, lesions at the pores and skin or on inner mucosal surfaces, which include withinside the mouth or throat, respiration droplets and infected objects.

Detection of viral DNA with the aid of using polymerase chain reaction (PCR) is the desired laboratory check for monkeypox. The satisfactory diagnostic specimens are at once from the rash – skin, fluid or crusts, or biopsy wherein feasible. Antigen and antibody detection techniques might not be beneficial as they do now no longer distinguish among orthopoxviruses.

Symptoms

Monkeypox affords with fever, an in depth function rash and generally swollen lymph nodes. It is essential to differentiate monkeypox from different ailments including chickenpox, measles, bacterial pores and skin infections, scabies, syphilis and medication-related allergies.
The incubation duration of monkeypox can variety from five to 21 days. The febrile level of contamination generally lasts 1 to a few days with signs together with fever, severe headache, lymphadenopathy (swelling of the lymph nodes), again pain, myalgia (muscle ache), and an severe asthenia (loss of energy). The febrile level is accompanied with the aid of using the pores and skin eruption level, lasting for two to four weeks. Lesions evolve from macules (lesions with a flat base) to papules (raised organization painful lesions) to vesicles (full of clean fluid) to pustules (full of pus), accompanied with the aid of using scabs or crusts.
The share of sufferers who die has numerous among zero and 11% in documented instances and has been better amongst younger children.

Treatment

Treatment of monkeypox sufferers is supportive depending on the symptoms. Various compounds that can be powerful towards monkeypox virus contamination are being evolved and tested.
Prevention and manage of human monkeypox rely upon elevating focus in groups and teaching medical examiners to save you contamination and prevent transmission.
Most human monkeypox infections end result from a number one animal-to-human transmission. Contact with unwell or lifeless animals need to be avoided, and all meals containing animal meat or components want to be nicely cooked earlier than eating.
Close touch with inflamed human beings or infected substances need to be avoided. Gloves and different private defensive apparel and device need to be worn at the same time as looking after the unwell, whether or not in a sanatorium or withinside the home.
Populations have emerge as extra liable to monkeypox because of the termination of recurring smallpox vaccination, which supplied a few cross-safety withinside the past. Vaccination towards smallpox with first technology vaccinia-virus primarily based totally smallpox vaccine changed into proven to be 85% fective in stopping monkeypox withinside the past. Family and network members, medical examiners and laboratory employees who have been vaccinated towards smallpox in youth may also have a few last safety towards monkeypox.

Monkeypox/Milao Haath

Comments (1)


  1. We must take preventive measures until this breakout is fully eradicated.

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