Monkeypox: A Comprehensive Review of Virology, Epidemiology, Transmission, Diagnosis, Prevention, Treatment, and Artificial Intelligence Applications
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 Dey 2024
,
Page e70
https://doi.org/10.22037/aaem.v12i1.2491
Abstract
Monkeypox (Mpox), an uncommon zoonotic Orthopoxvirus, is commonly manifested by blisters on the skin and has a mortality rate of approximately 0-10%. Approximately two decades after the cessation of global smallpox vaccination, the number of confirmed cases of Mpox has been growing, making it the most common Orthopoxvirus infection. Therefore, in this narrative review, we aimed to shed light on recent advancements in the pathophysiology, transmission routes, epidemiology, manifestations, diagnosis, prevention, and treatment of Mpox, as well as the application of artificial intelligence (AI) methods for predicting this disease. The clinical manifestations of Mpox, including the onset of symptoms and dermatologic characteristics, are similar to those of the infamous smallpox, but Mpox is clinically milder. Notably, a key difference between smallpox and Mpox is the high prevalence of lymphadenopathy. Human-to-human, animal-to-human, and animal-to-animal transmission are the three main pathways of Mpox spread that must be considered for effective prevention, particularly during outbreaks. PCR testing, as the preferred method for diagnosing Mpox infection, can enhance early detection of new cases and thereby improve infection control measures. JYNNEOS and ACAM2000 are among the vaccines most commonly recommended for the prevention of Mpox. Brincidofovir, Cidofovir, and Tecovirimat are the primary treatments for Mpox cases. Similar to other viral infections, the best approach to managing Mpox is prevention. This can, in part, be achieved through measures such as reducing contact with individuals displaying symptoms, maintaining personal safety, and adhering to practices commonly used to prevent sexually transmitted infections.
- Artificial Intelligence
- Mpox
- Monkeypox virus
- Outbreak
- Prevention
- Transmission
- Treatment
How to Cite
References
Ladnyj I, Ziegler P, Kima E. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bulletin of the World Health Organization. 1972;46(5):593.
Okyay RA, Bayrak E, Kaya E, Şahin AR, Koçyiğit BF, Taşdoğan AM, et al. Another epidemic in the shadow of Covid 19 pandemic: a review of monkeypox. proteins. 2022;7(10):10.14744.
von Magnus P, Andersen EK, Petersen KB, Birch Andersen A. A pox-like disease in cynomolgus monkeys. 1959.
Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022;387(8):679-91.
Saijo M, Ami Y, Suzaki Y, Nagata N, Iwata N, Hasegawa H, et al. Virulence and pathophysiology of the Congo Basin and West African strains of monkeypox virus in non-human primates. J Gen Virol. 2009;90(Pt 9):2266-71.
Likos AM, Sammons SA, Olson VA, Frace AM, Li Y, Olsen-Rasmussen M, et al. A tale of two clades: monkeypox viruses. J Gen Virol. 2005;86(Pt 10):2661-72.
Levitt CV, Tran QK, Hraky H, Mazer-Amirshahi M, Pourmand A. Emergency department approach to monkeypox. World J Emerg Med. 2023;14(5):341-8.
Abdelaal A, Serhan HA, Mahmoud MA, Rodriguez-Morales AJ, Sah R. Ophthalmic manifestations of monkeypox virus. Eye. 2023;37(3):383-5.
Marennikova S, Šeluhina EM, Mal'Ceva N, Čimiškjan K, Macevič G. Isolation and properties of the causal agent of a new variola-like disease (monkeypox) in man. Bulletin of the World Health Organization. 1972;46(5):599.
Elsheikh R, Makram AM, Vasanthakumaran T, Tomar S, Shamim K, Tranh ND, et al. Monkeypox: A comprehensive review of a multifaceted virus. Infectious Medicine. 2023;2(2):74-88.
Zumla A, Valdoleiros SR, Haider N, Asogun D, Ntoumi F, Petersen E, et al. Monkeypox outbreaks outside endemic regions: scientific and social priorities. The Lancet Infectious Diseases. 2022;22(7):929-31.
Capobianchi MR, Di Caro A, Piubelli C, Mori A, Bisoffi Z, Castilletti C. Monkeypox 2022 outbreak in non-endemic countries: Open questions relevant for public health, nonpharmacological intervention and literature review. Front Cell Infect Microbiol. 2022;12:1005955.
Ranjan S, Vashishth K, Sak K, Tuli HS. The Emergence of Mpox: Epidemiology and Current Therapeutic Options. Curr Pharmacol Rep. 2023;9(3):144-53.
Tehranchinia Z, Robati RM, Moravvej H, Memariani M, Memariani H. Monkeypox Disease with a Focus on the 2022 Outbreak; a Narrative Review. Arch Acad Emerg Med. 2023;11(1):e19.
Alavi-Moghaddam M. Monkeypox Outbreak in Non-Endemic Areas: Will it Cause a New Pandemic? a Letter to Editor. Arch Acad Emerg Med. 2022;10(1):e60.
WHO WHO. WHO Director-General declares mpox outbreak a public health emergency of international concern 2024 [Available from: https://www.who.int/news/item/14-08-2024-who-director-general-declares-mpox-outbreak-a-public-health-emergency-of-international-concern.
Sklenovská N, Van Ranst M. Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans. Front Public Health. 2018;6:241.
McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014;58(2):260-7.
Elsheikh R, Makram AM, Vasanthakumaran T, Tomar S, Shamim K, Tranh ND, et al. Monkeypox: A comprehensive review of a multifaceted virus. Infect Med (Beijing). 2023;2(2):74-88.
Kaler J, Hussain A, Flores G, Kheiri S, Desrosiers D. Monkeypox: A Comprehensive Review of Transmission, Pathogenesis, and Manifestation. Cureus. 2022;14(7):e26531.
Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, et al. Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Infect Dis Clin North Am. 2019;33(4):1027-43.
Nyame J, Punniyakotti S, Khera K, Pal RS, Varadarajan N, Sharma P. Challenges in the treatment and prevention of monkeypox infection; A comprehensive review. Acta Trop. 2023;245:106960.
Zaucha GM, Jahrling PB, Geisbert TW, Swearengen JR, Hensley L. The pathology of experimental aerosolized monkeypox virus infection in cynomolgus monkeys (Macaca fascicularis). Lab Invest. 2001;81(12):1581-600.
Lum FM, Torres-Ruesta A, Tay MZ, Lin RTP, Lye DC, Rénia L, et al. Monkeypox: disease epidemiology, host immunity and clinical interventions. Nat Rev Immunol. 2022;22(10):597-613.
Nagata N, Saijo M, Kataoka M, Ami Y, Suzaki Y, Sato Y, et al. Pathogenesis of fulminant monkeypox with bacterial sepsis after experimental infection with West African monkeypox virus in a cynomolgus monkey. Int J Clin Exp Pathol. 2014;7(7):4359-70.
Tree JA, Hall G, Pearson G, Rayner E, Graham VA, Steeds K, et al. Sequence of pathogenic events in cynomolgus macaques infected with aerosolized monkeypox virus. J Virol. 2015;89(8):4335-44.
Al-Musa A, Chou J, LaBere B. The resurgence of a neglected orthopoxvirus: Immunologic and clinical aspects of monkeypox virus infections over the past six decades. Clin Immunol. 2022;243:109108.
Song H, Josleyn N, Janosko K, Skinner J, Reeves RK, Cohen M, et al. Monkeypox virus infection of rhesus macaques induces massive expansion of natural killer cells but suppresses natural killer cell functions. PLoS One. 2013;8(10):e77804.
Thornhill JP, Gandhi M, Orkin C. Mpox: The Reemergence of an Old Disease and Inequities. Annu Rev Med. 2024;75:159-75.
Shao L, Huang D, Wei H, Wang RC, Chen CY, Shen L, et al. Expansion, reexpansion, and recall-like expansion of Vgamma2Vdelta2 T cells in smallpox vaccination and monkeypox virus infection. J Virol. 2009;83(22):11959-65.
Edghill-Smith Y, Golding H, Manischewitz J, King LR, Scott D, Bray M, et al. Smallpox vaccine-induced antibodies are necessary and sufficient for protection against monkeypox virus. Nat Med. 2005;11(7):740-7.
Jezek Z, Szczeniowski M, Paluku KM, Mutombo M. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987;156(2):293-8.
Araf Y, Nipa JF, Naher S, Maliha ST, Rahman H, Arafat KI, et al. Insights into the Transmission, Host Range, Genomics, Vaccination, and Current Epidemiology of the Monkeypox Virus. Vet Med Int. 2024;2024:8839830.
WHO WHO. Mpox (monkeypox) 2023 [Available from: https://www.who.int/en/news-room/fact-sheets/detail/monkeypox.
Yahoo is part of the Yahoo family of brands 2022 [Available from: https://www.yahoo.com/news/austrias-first-case-monkeypox-confirmed-153959022.html.
Mpox (monkeypox) 2022 [Available from: https://www.france24.com/en/europe/20220520-france-germany-belgium-report-first-monkeypox-cases-amid-unusual-spread-in-europe.
2022-24 Mpox (Monkeypox) Outbreak: Global Trends 2024 [Available from: https://worldhealthorg.shinyapps.io/mpx_global/.
Mpox 2024 [Available from: https://www.who.int/news-room/fact-sheets/detail/mpox.
Kumar N, Acharya A, Gendelman HE, Byrareddy SN. The 2022 outbreak and the pathobiology of the monkeypox virus. J Autoimmun. 2022;131:102855.
Quarleri J, Delpino MV, Galvan V. Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries. Geroscience. 2022;44(4):2095-103.
Meyer H, Perrichot M, Stemmler M, Emmerich P, Schmitz H, Varaine F, et al. Outbreaks of disease suspected of being due to human monkeypox virus infection in the Democratic Republic of Congo in 2001. J Clin Microbiol. 2002;40(8):2919-21.
Rimoin AW, Kisalu N, Kebela-Ilunga B, Mukaba T, Wright LL, Formenty P, et al. Endemic human monkeypox, Democratic Republic of Congo, 2001-2004. Emerg Infect Dis. 2007;13(6):934-7.
O'Neill M, LePage T, Bester V, Yoon H, Browne F, Nemec EC. Mpox (Formally Known as Monkeypox). Physician Assist Clin. 2023;8(3):483-94.
How to Report Test Results | Mpox | Poxvirus | CDC 2024 [Available from: https://www.cdc.gov/poxvirus/Mpox/lab-personnel/report-results.html.
Anwar F, Haider F, Khan S, Ahmad I, Ahmed N, Imran M, et al. Clinical Manifestation, Transmission, Pathogenesis, and Diagnosis of Monkeypox Virus: A Comprehensive Review. Life (Basel). 2023;13(2).
Sharma A, Prasad H, Kaeley N, Bondalapati A, Edara L, Kumar YA. Monkeypox epidemiology, clinical presentation, and transmission: a systematic review. Int J Emerg Med. 2023;16(1):20.
Gessain A, Nakoune E, Yazdanpanah Y. Monkeypox. N Engl J Med. 2022;387(19):1783-93.
Benites-Zapata VA, Ulloque-Badaracco JR, Alarcon-Braga EA, Hernandez-Bustamante EA, Mosquera-Rojas MD, Bonilla-Aldana DK, et al. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Ann Clin Microbiol Antimicrob. 2022;21(1):36.
Learned LA, Reynolds MG, Wassa DW, Li Y, Olson VA, Karem K, et al. Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo, 2003. Am J Trop Med Hyg. 2005;73(2):428-34.
Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS, et al. Mpox in people with advanced HIV infection: a global case series. Lancet. 2023;401(10380):939-49.
Ogoina D, Iroezindu M, James HI, Oladokun R, Yinka-Ogunleye A, Wakama P, et al. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis. 2020;71(8):e210-e4.
Silva S, Kohl A, Pena L, Pardee K. Clinical and laboratory diagnosis of monkeypox (mpox): Current status and future directions. iScience. 2023;26(6):106759.
Kannan S, Shaik Syed Ali P, Sheeza A. Monkeypox: epidemiology, mode of transmission, clinical features, genetic clades and molecular properties. Eur Rev Med Pharmacol Sci. 2022;26(16):5983-90.
Wawina-Bokalanga T, Sklenovska N, Vanmechelen B, Bloemen M, Vergote V, Laenen L, et al. An accurate and rapid Real-time PCR approach for human Monkeypox virus diagnosis. medRxiv. 2022:2022.06.23.22276033.
Kanji JN, Dieu P, Wong A, Pabbaraju K, Shokoples S, Smyczek P, et al. Retrospective testing for the presence of monkeypox virus in a high-risk population from February-June 2022 in Alberta, Canada. J Assoc Med Microbiol Infect Dis Can. 2023;8(1):85-9.
Rabaan AA, Al-Shwaikh SA, Alfouzan WA, Al-Bahar AM, Garout M, Halwani MA, et al. A Comprehensive Review on Monkeypox Viral Disease with Potential Diagnostics and Therapeutic Options. Biomedicines. 2023;11(7).
Doshi RH, Guagliardo SAJ, Doty JB, Babeaux AD, Matheny A, Burgado J, et al. Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Emerg Infect Dis. 2019;25(2):281-9.
Sood A, Sui Y, McDonough E, Santamaría-Pang A, Al-Kofahi Y, Pang Z, et al. Comparison of Multiplexed Immunofluorescence Imaging to Chromogenic Immunohistochemistry of Skin Biomarkers in Response to Monkeypox Virus Infection. Viruses. 2020;12(8).
Dye C, Kraemer MUG. Investigating the monkeypox outbreak. Bmj. 2022;377:o1314.
Alakunle EF, Okeke MI. Monkeypox virus: a neglected zoonotic pathogen spreads globally. Nat Rev Microbiol. 2022;20(9):507-8.
Karagoz A, Tombuloglu H, Alsaeed M, Tombuloglu G, AlRubaish AA, Mahmoud A, et al. Monkeypox (mpox) virus: Classification, origin, transmission, genome organization, antiviral drugs, and molecular diagnosis. J Infect Public Health. 2023;16(4):531-41.
Peiró-Mestres A, Fuertes I, Camprubí-Ferrer D, Marcos M, Vilella A, Navarro M, et al. Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022. Euro Surveill. 2022;27(28).
Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE, et al. Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Euro Surveill. 2022;27(22).
Lapa D, Carletti F, Mazzotta V, Matusali G, Pinnetti C, Meschi S, et al. Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding. Lancet Infect Dis. 2022;22(9):1267-9.
Moschese D, Pozza G, Mileto D, Giacomelli A, Cutrera M, Cossu MV, et al. Isolation of viable monkeypox virus from anal and urethral swabs, Italy, May to July 2022. Euro Surveill. 2022;27(36).
Allan-Blitz LT, Gandhi M, Adamson P, Park I, Bolan G, Klausner JD. A Position Statement on Mpox as a Sexually Transmitted Disease. Clin Infect Dis. 2023;76(8):1508-12.
Kisalu NK, Mokili JL. Toward Understanding the Outcomes of Monkeypox Infection in Human Pregnancy. J Infect Dis. 2017;216(7):795-7.
Fahrni ML, Priyanka, Choudhary OP. Possibility of vertical transmission of the human monkeypox virus. Int J Surg. 2022;105:106832.
Huang Y, Mu L, Wang W. Monkeypox: epidemiology, pathogenesis, treatment and prevention. Signal Transduct Target Ther. 2022;7(1):373.
Del Rio C, Malani PN. Update on the Monkeypox Outbreak. Jama. 2022;328(10):921-2.
Aden D, Zaheer S, Kumar R, Ranga S. Monkeypox (Mpox) outbreak during COVID-19 pandemic-Past and the future. J Med Virol. 2023;95(4):e28701.
McAndrew T, Majumder MS, Lover AA, Venkatramanan S, Bocchini P, Besiroglu T, et al. Early human judgment forecasts of human monkeypox, May 2022. Lancet Digit Health. 2022;4(8):e569-e71.
Costello V, Sowash M, Gaur A, Cardis M, Pasieka H, Wortmann G, et al. Imported Monkeypox from International Traveler, Maryland, USA, 2021. Emerg Infect Dis. 2022;28(5):1002-5.
Lai CC, Hsu CK, Yen MY, Lee PI, Ko WC, Hsueh PR. Monkeypox: An emerging global threat during the COVID-19 pandemic. J Microbiol Immunol Infect. 2022;55(5):787-94.
Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26(4):782-5.
Parker S, Nuara A, Buller RM, Schultz DA. Human monkeypox: an emerging zoonotic disease. Future Microbiol. 2007;2(1):17-34.
Smallpox: post-eradication vigilance continues. WHO Chron. 1982;36(3):87-91.
Miller L, Richter M, Hapke C, Stern D, Nitsche A. Genomic expression libraries for the identification of cross-reactive orthopoxvirus antigens. PLoS One. 2011;6(7):e21950.
Rao A, Mena LA, Petersen B. Monkeypox: updates about clinical diagnosis and treatment. 2022.
Petersen E, Zumla A, Hui DS, Blumberg L, Valdoleiros SR, Amao L, et al. Vaccination for monkeypox prevention in persons with high-risk sexual behaviours to control on-going outbreak of monkeypox virus clade 3. Int J Infect Dis. 2022;122:569-71.
Asadi Noghabi F, J GR, Makkar D, Roozbeh N, Ghelichpour S, Zarei A. Managing Monkeypox Virus Infections: A Contemporary Review. Iran J Med Sci. 2024;49(1):1-9.
Radix M, Hoffmann CJ, Gonzalez CJ. Monkeypox Vaccination in Adults With HIV. 2022.
Rao AK, Petersen BW, Whitehill F, Razeq JH, Isaacs SN, Merchlinsky MJ, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(22):734-42.
Greenberg RN, Kennedy JS. ACAM2000: a newly licensed cell culture-based live vaccinia smallpox vaccine. Expert Opin Investig Drugs. 2008;17(4):555-64.
Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and Treatment of Monkeypox. Drugs. 2022;82(9):957-63.
Wang J, Shahed-Ai-Mahmud M, Chen A, Li K, Tan H, Joyce R. An Overview of Antivirals against Monkeypox Virus and Other Orthopoxviruses. J Med Chem. 2023;66(7):4468-90.
Grosenbach DW, Honeychurch K, Rose EA, Chinsangaram J, Frimm A, Maiti B, et al. Oral Tecovirimat for the Treatment of Smallpox. N Engl J Med. 2018;379(1):44-53.
Sliva K, Schnierle B. From actually toxic to highly specific--novel drugs against poxviruses. Virol J. 2007;4:8.
Quenelle DC, Buller RM, Parker S, Keith KA, Hruby DE, Jordan R, et al. Efficacy of delayed treatment with ST-246 given orally against systemic orthopoxvirus infections in mice. Antimicrob Agents Chemother. 2007;51(2):689-95.
Xiang Y, White A. Monkeypox virus emerges from the shadow of its more infamous cousin: family biology matters. Emerg Microbes Infect. 2022;11(1):1768-77.
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022;16(2):e0010141.
Poland GA, Kennedy RB, Tosh PK. Prevention of monkeypox with vaccines: a rapid review. Lancet Infect Dis. 2022;22(12):e349-e58.
Shapovalova V. Monkeypox Virus – New Challenges of Modernity: Experimental Organizational and Legal, Clinical and Pharmacological Studies. SSP Modern Pharmacy and Medicine. 2022;2(3):1-15.
Chadaga K, Prabhu S, Sampathila N, Nireshwalya S, Katta SS, Tan RS, et al. Application of Artificial Intelligence Techniques for Monkeypox: A Systematic Review. Diagnostics (Basel). 2023;13(5).
Patel M, Surti M, Adnan M. Artificial intelligence (AI) in Monkeypox infection prevention. J Biomol Struct Dyn. 2023;41(17):8629-33.
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