3. Introduction
⢠Monkeypox is a zoonotic infection due to
monkeypox virus
⢠Presents with a rash similar to that of smallpox
but less severe
⢠Monkeypox highly seen in endemic areas of
Central &Western Africa
⢠Multiple new cases found Worldwide in the
last two decades
⢠Public health concerned about it as a pandemic
and its use as an agent of bioterrorism
5. History
⢠DNA Virus first isolated in Denmark in 1958
⢠Found in colony of laboratory monkeys from
Singapore: polio virus research
⢠US &Rotterdam: Lab animals outbreak a
decade later
⢠Caused disease in humans early 1970s in DRC
⢠Cases increased post eradication of smallpox
(1980s)
6. Hx âContâd
⢠Monkeypox virus infection detected in:
ď Squirrels
ďRodents
ďspecies of monkeys
⢠West and Central Africa: 2 clades
ď Clade 1: Central Africa-Congo Basin Clade
ďClade 2: West Africa (less virulent)-IIa&IIb
⢠Monkeys and Humans: Hosts, unknown reservoir
9. Epidemiology
⢠Reached in 76 countries Worlwide
⢠First cases in 1980 ~ Countries of CWA
⢠2003: US outbreak
⢠DRC: 2005-2007 Surveillance report
ďśa 20-fold â in incidence of Mpox Vs 1980
ďśCessation of Smallpox vaccination /eradication
ďśRisk : forested areas, male, and age <15 years.
⢠2017: Cases of Nigeria from returning
⢠July 23, 2022, the WHO declared Mpox new outbreak
of a public health emergency of international concern
10. Number of suspected cases versus confirmed, probable and/or possible
cases
PLOS NEGLECTED TROPICAL DISEASES, Feb 2022
11. Epidem-Contâd
⢠Outbreak of 2022: 57995 cases
⢠Clade I mortality: 10%
⢠Clade II: < 0.1% except in Nigeria(3.6%)
2017-18
⢠Predictors of severe form:
ďImmunocompromisation : HIV
ďChildren
ďSmall pox/đ Immunisation
14. Virology
⢠Mpox virus , orthopoxvirus genus
⢠Poxviridae family, w/ other species like:
ďś Variola virus that causes smallpox
ďś Vaccinia virus, which was used in making smallpox vaccine
ďś Mollusci virus that causes Molluscum Contagiosum
⢠Enveloped virus
⢠Double stranded DNA genome
15. Who is at high risk?
⢠Household of someone with Monkeypox
⢠HCP of an infected person/ IPC.
⢠Travel to an area with confirmed cases: 21 days
⢠Contact w/ a person who has a similar rash or a
dx of confirmed or suspected Monkeypox
⢠Sexual partners of diagnosed or suspected
Monkeypox, predominantly MSM
16. Transmission: How it spreads?
⢠Animal to human
transmission.
ďś Non invasive
ďś Complex
⢠Human to Human
ďś Direct contact
ďś Indirect contact: fomites
ďś Respiratory secretions
ďś Vertical transmission
ďś Percutaneous inoculation
ďś Body fluids~ seen
18. Symptoms
⢠Incubation period: 4-21 days
⢠Traditional : systemic illness with
ďfevers, chills, and myalgias
ď characteristic rash â other vesicular (eg,
varicella, smallpox)
⢠2022 Mpox outbreak special attention:
ďgenital, anal
ďand/or oral lesions without the systemic illness
19. Symptomatology- Contâd
⢠Prodrome: Viremic phase of illness
ďś From 1-5 days
ďś Fever, headache, sore throat, back pain,
myalgia & fatigue
⢠Rash: Persist 2-3 weeks
⢠Generalized lymphadenopathies
⢠Proctitis and tonsillitis
⢠Encephalitis
20. Progression of the rash
⢠Within 1 to 3 days (may be longer) the patient
can develop a rash
⢠Rash progresses from red and flat (macular) ->
a bump (papular) -> water filled (vesicle) ->
pus-filled (pustule) -> crusting (desquamation)
⢠Starts on the face and then spreading to other
parts of the body (like the extremities and
genital areas) and palms and soles.
24. Investigations
⢠PCR: Confirmation of MPXV infection is
based on NAAT
ď Using real-time or conventional PCR
ď Detection of unique sequences of viral
DNA.
ď Viral swab taken from one or more
vesicles or ulcers, or a dry scraping of the
scab.
⢠Routine Chemistry, Hematology, and
Urinalysis
⢠Sodium and potassium
⢠Proteins â especially albumin
⢠Routine examination of bacterial and
mycotic cultures & sensitivity
27. Gilada/Unison/Mumbai
Complications and sequelae
⢠Features of illness that may be predictive of
illness severity and poor outcomes
⢠Consequences of compromised skin and mucosa
⢠Systemic Illness
⢠Hypoalbuminemia and low hematocrit, s/o
malnutrition
⢠Bronchopneumonia
⢠Secondary infection of the integument, sepsis,
⢠Encephalitis
⢠Infection of the cornea with ensuing loss of vision
28. Monkeypox Treatment
⢠There is no proven treatment
⢠Only supportive approach
⢠Some anti-virals: Brincidofovir/ Cidofovir
&Tecovirimat
⢠Smallpox vaccine
⢠Prevention & treatment of 2nd bacterial
infections + complications
⢠Ensuring adequate hydration and nutrition
⢠Protecting vulnerable anatomical locations such as
the eyes and genitals.
30. Prevention
⢠Isolate infected patients
⢠Practice IPC Measures
⢠Avoid contact with animals that could harbor the virus (including
sick or dead animals) where monkeypox is endemic
⢠Avoid direct contact with any materials, such as bedding or
laundry, that has been in contact with a sick patient.
⢠Use PPE when caring for patients, which includes gown,
gloves, respirator/mask and eye protection.
31. Prevention : Vaccine
⢠JYNNEOSTM
ď is a USFDA approved live attenuated virus
vaccine
ď has been approved for the prevention of
Monkeypox.
⢠Research ongoing for use in Preexposure
ď the protection: risk of occupational exposure
to orthopoxviruses.
⢠Smallpox vaccine can provide 85% protection
32. Take Home Message
⢠Mpox virus is expected to spread more, we
have to tackle it
⢠No perfect anti-Monkeypox treatment
⢠Mainstay: treat of symptoms & secondary
infections, fluid balance.
⢠Smallpox vaccine can be used for therapeutic
and prevention purposes
⢠Disaster management plan & Global Health
Security should be in place
33. References
⢠monkeypoxâA potential threat? A systematic
review. Gromowski G, editor. PLoS Negl Trop
Dis. 2022 Feb 11;16(2):e0010141.
⢠El Eid R, Allaw F, Haddad SF, Kanj SS. Human
monkeypox: A review of the literature. PLoS
Pathog. 2022 Sep 22;18(9):e1010768.
⢠Huang Y, Mu L, Wang W. Monkeypox:
epidemiology, pathogenesis, treatment and
prevention. Signal Transduct Target Ther. 2022
Nov 2;7:373.
34. References
⢠monkeypoxâA potential threat? A systematic review. Gromowski G, editor. PLoS
Negl Trop Dis. 2022 Feb 11;16(2):e0010141.
⢠2. El Eid R, Allaw F, Haddad SF, Kanj SS. Human monkeypox: A review of the
literature. PLoS Pathog. 2022 Sep 22;18(9):e1010768.
⢠3. Huang Y, Mu L, Wang W. Monkeypox: epidemiology, pathogenesis,
treatment and prevention. Signal Transduct Target Ther. 2022 Nov 2;7:373.