Week 32

Papers included 7-13 August 2022

Vaccination

8 August 2022

Taylor L. Monkeypox: Concerns mount over vaccine inequity. BMJ. 2022 Aug 8;378:o1971. PubMed: https://pubmed.gov/35940615. Full text: https://doi.org/10.1136/bmj.o1971

“Whether vaccine supplies will be sufficient to supply all nations at their time of need is unclear, because of continuing uncertainty over vaccine production capacity and efficacy and the best strategies to contain the outbreak.”

Clinical Presentation

4 August 2022

Moschese D, Giacomelli A, Beltrami M, et al. Hospitalisation for monkeypox in Milan, Italy. Travel Med Infect Dis. 2022 Aug 4:102417. PubMed: https://pubmed.gov/35934310. Full text: https://doi.org/10.1016/j.tmaid.2022.102417

The hospitalisation rate observed in Milan, Italy was 8.8%. Bacterial superinfection and severe perianal pain were the main cause of hospitalisation requiring antibiotic treatment and analgesic therapy.

Prevention

8 August 2022

Ghebreyesus TA; World Health Organization. Why the monkeypox outbreak constitutes a public health emergency of international concern. BMJ. 2022 Aug 9;378:o1978. PubMed: https://pubmed.gov/35944916. Full text: https://doi.org/10.1136/bmj.o1978

The monkeypox outbreak is “another demonstration that breaking the cycle of “panic and neglect” that for decades has been the hallmark of the global response to epidemics and pandemics requires a paradigm shift in global health.”

Case Reports

26 July 2022

Ajmera KM, Goyal L, Pandit T, Pandit R. Monkeypox – An emerging pandemic. IDCases. 2022 Jul 26;29:e01587. PubMed: https://pubmed.gov/35938150. Full text: https://doi.org/10.1016/j.idcr.2022.e01587

A 26-year-old polygamous, homosexual man with a past medical history of syphilis and on tenofovir/emtricitabine for HIV pre-exposure prophylaxis (PrEP) with a progressively worsening rash on his tongue and around the mouth.

Overviews

4 August 2022

Samaranayake L, Anil S. The Monkeypox Outbreak and Implications for Dental Practice. Int Dent J. 2022 Aug 4:S0020-6539(22)00179-4. PubMed: https://pubmed.gov/35934521. Full text: https://doi.org/10.1016/j.identj.2022.07.006

“Dental care workers should note that premonitory signs of the disease usually appear on the oral mucosa as macules and ulcers prior to the characteristic skin lesions. Implementing standard, contact, and droplet infection control measures, patient isolation, and referral are important, particularly during a local outbreak.”

Week 31

Papers included 31 July – 6 August 2022

Transmission

Paper of the week

2 August 2022

Lapa D, Carletti F, Mazzotta V, 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 Aug 2:S1473-3099(22)00513-8. PubMed: https://pubmed.gov/35931095. Full text: https://doi.org/10.1016/S1473-3099(22)00513-8

“Semen collected on day 6 after symptom onset was inoculated in Vero E6 cells (ATCC; Manassas VA, USA). Clear cytopathic effect was observed 48 h after the inoculum and monkeypox virus replication was confirmed by real-time PCR on DNA purified from cell growth medium collected after 48 h, 72 h, and 96 h.” The authors conclude that prolonged shedding of monkeypox virus DNA might occur in the semen of infected patients for weeks after symptoms onset.

Clinical Presentation

31 July 2022

Hoffmann C, Jessen H, Boesecke C. Monkeypox in Germany-Initial Clinical Observations. Dtsch Arztebl Int. 2022 Aug 12;(Forthcoming):arztebl.m2022.0287. PubMed: https://pubmed.gov/35912445. Full text: https://doi.org/10.3238/arztebl.m2022.0287

Study from Germany. A total of 301 PCR-confirmed cases from 32 centres were recorded up to 23 June 2022. Only MSM were affected, including 141 (46.7%) with HIV infection and 135 (44.7%) with pre-exposure prophylaxis (PrEP). The vast majority of smallpox lesions were anal or genital. The most common general symptoms were fever, headache, pain in the limbs and often painful swelling of the lymph nodes. Most illnesses so far have been relatively mild, but hospitalisation occurred in 5.0%. No deaths were observed. The high number of sexually transmitted infections (STI) was striking. Only 41.0 % had not been diagnosed with an STI in the last six months before the MPXV infection.

Treatment

3 August 2022

Sherwat A, Brooks JT, Birnkrant D, Kim P. Tecovirimat and the Treatment of Monkeypox – Past, Present, and Future Considerations. N Engl J Med. 2022 Aug 3. PubMed: https://pubmed.gov/35921403. Full text: https://doi.org/10.1056/NEJMp2210125

Monkeypox can cause serious illness, including ocular involvement, soft-tissue superinfections, and excruciating anogenital lesions. How to manage compassionate access to the antiviral drug tecovirimat whose safety and efficacy in humans have not been established? The article explains the basis for the drugs’s approval by the U.S. Food and Drug Administration (FDA) for the treatment of smallpox and the knowledge gaps that remain.

2 August 2022

Rojek A, Dunning J, Olliaro P. Monkeypox: how will we know if the treatments work? Lancet Infect Dis. 2022 Aug 2:S1473-3099(22)00514-X. PubMed: https://pubmed.gov/35931096. Full text: https://doi.org/10.1016/S1473-3099(22)00514-X

“Our primary motivations for treating monkeypox vary depending on severity and risk of transmission and, therefore, might shift focus between symptom relief, preventing complications, shortening the duration of patient isolation, or preventing spread of disease.

Vaccination

4 August 2022

Rubin EJ, Baden LR, Morrissey S. Audio Interview: Updated Covid-19 Vaccines and a Look at Monkeypox. N Engl J Med. 2022 Aug 4;387(5):e16. PubMed: https://pubmed.gov/35921460. Full text: https://doi.org/10.1056/NEJMe2210394

“In this audio interview conducted on August 2, 2022, the editors discuss soon-to-be-released Covid-19 vaccines against BA.4/BA.5 strains, as well as the current state of therapeutics for monkeypox.”

Virology

Thakur S, Kelkar D, Garg S, et al. Why Should RNA Viruses Have All the Fun – Monkeypox, a Close Relative of Smallpox and a DNA Virus. J Glob Infect Dis. 2022 Jun 29;14(2):47-49. PubMed: https://pubmed.gov/35910829. Full text: https://doi.org/10.4103/jgid.jgid_104_22

“The ongoing events around this DNA virus MPX makes us review the potential future possibilities, threats, and outcomes associated with this virus. MPX and SPX have been affecting humans for thousands of years since they settled for agriculture, producing somewhat similar clinical manifestations.To understand the reasons behind reemergence of MPX after 40 years of SPX eradication, we must study the similarities and differences between the two close relatives, i.e., MPX and SPX.”

Week 30

24 – 30 July 2022

Clinical Presentation

28 July 2022

Paper of the week

Patel A, Bilinska J, Tam JCH, et al. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. PubMed: https://pubmed.gov/35902115. Full text: https://doi.org/10.1136/bmj-2022-072410

Report on 197 patients with PCR-confirmed monkeypox infection (all men, median age: 38 years). All patients presented with mucocutaneous lesions, most commonly on the genitals (56.3%) or in the perianal area (41.6%). 86.3% of the patients reported systemic illness. The most common systemic symptoms were fever (61.9%), lymphadenopathy (57.9%), and myalgia (31.5%). 61.5% of the patients developed systemic features before the onset of mucocutaneous manifestations. 13.7% presented exclusively with mucocutaneous manifestations without systemic features. 36.0% reported rectal pain, 16.8% sore throat, and 15.7% penile oedema. 13.7% had oral lesions and 4.6% had tonsillar signs. 35.9% of the participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 10.2% of the participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.

Diagnosis

29 July 2022

Nörz D, Tang HT, Emmerich P, et al. Rapid Adaptation of Established High-Throughput Molecular Testing Infrastructure for Monkeypox Virus Detection. Emerg Infect Dis. 2022 Jul 29;28(9). PubMed: https://pubmed.gov/35905463. Full text: https://wwwnc.cdc.gov/eid/article/28/9/22-0917_article

The authors adapted 2 published quantitative PCRs for use as a dual-target monkeypox virus test on widely used automated high-throughput PCR systems. The lower limit of detection for the combined assays was 4.795 (95% CI 3.6–8.6) copies/mL. The assay showed 100% positive (n = 11) and 100% negative (n = 56) agreement.

Treatment

29 July 2022

Siegrist EA, Sassine J. Antivirals with Activity Against Monkeypox: A Clinically Oriented Review. Clin Infect Dis. 2022 Jul 29:ciac622. PubMed: https://pubmed.gov/35904001. Full text: https://doi.org/10.1093/cid/ciac622

The authors review basic pharmacology, animal models and experience in human patients of three antiviral agents with activity against monkeypox: cidofovir, brincidofovir, and tecovirimat. “Cidofovir, and its prodrug brincidofovir, are inhibitors of DNA replication with a broad spectrum of activity against multiple families of double-stranded DNA viruses. Tecovirimat has more specific activity against orthopoxviruses, and inhibits the formation of the extracellular enveloped virus necessary for cell-to-cell transmission.” 87 references.

Virology

29 July

Wang L, Shang J, Weng S, et al. Genomic Annotation and Molecular Evolution of Monkeypox Virus Outbreak in 2022. J Med Virol. 2022 Jul 29. PubMed: https://pubmed.gov/35906185. Full text: https://doi.org/10.1002/jmv.28036

The authors illustrate the genome evolution of the ongoing MPXV outbreak.

Epidemiology

25 July 2022

Yang ZS, Lin CY, Urbina AN, et al. The first monkeypox virus infection detected in Taiwan-the awareness and preparation. Int J Infect Dis. 2022 Jul 25:S1201-9712(22)00445-3. PubMed: https://pubmed.gov/35902024. Full text: https://doi.org/10.1016/j.ijid.2022.07.051

“On the 16^th of June, a 20-year-old young man who has studying in Germany, during January to June 2022, returned to Taiwan. After four days, he developed symptoms that included fever, sore throat, muscle pain, lymph node swelling in the groin, and a skin rash.”

27 July 2022

Abdelaal A, Serhan HA, Mahmoud MA, Rodriguez-Morales AJ, Sah R. Ophthalmic manifestations of monkeypox virus. Eye (Lond). 2022 Jul 27. PubMed: https://pubmed.gov/35896700. Full text: https://www.nature.com/articles/s41433-022-02195-z

A brief discussion of ophthalmic manifestations of monkeypox infection before the current epidemic. Corneal involvement could range from mild to severe. “Photophobia, alone, was reported in approximately 22% of affected patients. In addition, severe corneal infections that can result in severe keratitis forms (seen in 7.5% of patients in one study), corneal scarring (seen in 4% of unvaccinated, and 1% of previously smallpox-vaccinated case patients), and permanent vision loss were also reported. One study found unilateral or bilateral blindness, and weak vision in 10% of primary and 5% of secondary cases.” In another study, blepharitis was observed in 30% of unvaccinated, and in 7% of previously smallpox-vaccinated patients.

Diagnosis

26 July 2022

Suran M. Expanding Monkeypox Testing. JAMA. 2022 Jul 26;328(4):321. PubMed: https://pubmed.gov/35881138. Full text: https://doi.org/10.1001/jama.2022.11839

“To increase the accessibility of monkeypox testing, the US Department of Health and Human Services (HHS) began shipping monkeypox tests in late June to 5 commercial laboratory companies: Aegis Science, Labcorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare.”

Overviews

27 July 2022

Titanji BK, Tegomoh B, Nematollahi S, Konomos M, Kulkarni PA. Monkeypox: A Contemporary Review for Healthcare Professionals. Open Forum Infect Dis. 2022 Jun 23;9(7):ofac310. PubMed: https://pubmed.gov/35891689. Full text: https://academic.oup.com/ofid/article/9/7/ofac310/6615388

A “review for healthcare professionals”, 13 pages, 128 references.

27 July 2022

Kmiec D, Kirchhoff F. Monkeypox: A New Threat? Int J Mol Sci. 2022 Jul 17;23(14):7866. PubMed: https://pubmed.gov/35887214. Full text: https://doi.org/10.3390/ijms23147866

The authors summarize the current knowledge about monkeypox virus, discuss available strategies to limit its spread and pathogenicity and evaluate its risk to the human population. 14 pages, 101 references.

Prevention

29 July 2022

Ortiz-Martínez Y, Sarmiento J, Bonilla-Aldana DK, Rodríguez-Morales AJ. Monkeypox goes viral: measuring the misinformation outbreak on Twitter. J Infect Dev Ctries. 2022 Jul 28;16(7):1218-1220. PubMed: https://pubmed.gov/35905027. Full text: https://doi.org/10.3855/jidc.16907

Previous studies have highlighted the misinformation spread on Twitter during recent public health emergencies, mainl y Ebola, Yellow fever, and COVID-19. After analyzing the 100 top tweets in English with the term “monkey pox” and with at least 100 replies, the authors find that most tweets (52%) included misinformation and unverifiable information, 20% included humorous/non-serious content, and only 28% of the collected tweets provided serious information regarding monkeypox. As expected, the misleading tweets were more likely to receive replies, retweets and likes compared to the medically correct content.

27 July 2022

Jacobs JW, Filkins L, Booth GS, Adkins BD. The potential impact of monkeypox infection and vaccination on blood donor deferrals and the blood supply. Br J Haematol. 2022 Jul 27. PubMed: https://pubmed.gov/35894704. Full text: https://doi.org/10.1111/bjh.18388

The authors point out that there might be a “need to investigate the potential for transfusion transmission via focused studies on detection of monkeypox DNA and infectivity in relevant patient and blood donor populations (e.g., donors with multiple sexual partners of recent syphilis seroreactivity).”

27 July 2022

Nuzzo JB, Borio LL, Gostin LO. The WHO Declaration of Monkeypox as a Global Public Health Emergency. JAMA. 2022 Jul 27. PubMed: https://pubmed.gov/35895041. Full text: https://doi.org/10.1001/jama.2022.12513

The window for controlling monkeypox is closing and a well-funded global plan for containment is needed.

26 July 2022

Taylor L. Monkeypox: WHO declares a public health emergency of international concern. BMJ. 2022 Jul 26;378:o1874. PubMed: https://pubmed.gov/35882402. Full text: https://doi.org/10.1136/bmj.o1874

WHO has declared the global monkeypox outbreak a public health emergency of international concern (PHEIC). The four recommendations: 1) implement a coordinated response to stop transmission, 2) protect vulnerable groups, 3) increase public health surveillance and measures, and 4) strengthen clinical management and infection prevention and control in hospitals and clinics.

26 July 2022

[Editorial] Monkeypox: wealthy countries must avoid their COVID-19 mistakes. Nature. 2022 Jul;607(7920):635-636. PubMed: https://pubmed.gov/35882992. Full text: https://www.nature.com/articles/d41586-022-02036-9

Now that WHO has declared monkeypox a public health emergency of international concern (PHEIC), “nations must work together to tackle the outbreak and ensure that sufficient resources are provided to low- and middle-income countries (LMICs), where the disease has historically been most prevalent. “

25 July 2022

Kwon SL, Ban S, Shin J, Bae H, Park H, Kwon GY. Monkeypox Vaccination in the Republic of Korea: Identifying the High-Risk Target Group. J Korean Med Sci. 2022 Jul 25;37(29):e239. PubMed: https://pubmed.gov/35880509. Full text: https://doi.org/10.3346/jkms.2022.37.e239

“A ring vaccination strategy for the high-risk group is more appropriate than the mass population vaccination with smallpox vaccines. Therefore, identifying the proper target group by available vaccines based on the risk and benefit analysis is a key issue of the vaccination program.”

Case Reports

27 July 2022

Ortiz-Martínez Y, Rodríguez-Morales AJ, Franco-Paredes C, et al. Monkeypox – a description of the clinical progression of skin lesions: a case report from Colorado, USA. Ther Adv Infect Dis. 2022 Jul 27;9:20499361221117726. PubMed: https://pubmed.gov/35910397. Full text: https://doi.org/10.1177/20499361221117726

“Skin lesions caused by MPXV are susceptible to bacterial superinfection, and strict follow-up of patients is necessary, even in mild or moderate forms. Clinicians should have a high index of suspicion for any atypical genital lesions in the right epidemiologic setting.”

Pembi E, Awang S, Salaudeen SO, Agaba IA, Omoleke S. First confirmed case of monkeypox in Adamawa State, Nigeria: a clinico-epidemiological case report. Pan Afr Med J. 2022 May 16;42:38. PubMed: https://pubmed.gov/35910060. Full text: https://doi.org/10.11604/pamj.2022.42.38.34715

“The patient was also found reactive for syphilis when evaluated at the 23 BMC Yola before his referral to FMC Yola on account of secondary syphilis. Syphilis mimics monkeypox in its clinical manifestation of fever, sore throat, headaches, swollen lymph glands, muscle aches, skin rashes and/or mucous membrane lesions. However, patchy hair loss, painless chancre and weight loss that often occurs in syphilis are not seen in monkeypox.”

Week 29

18 – 24 July 2022

Pediatric cases

23 July 2022

Paper of the week

Tutu van Furth AM, van der Kuip M, van Els AL, et al. Paediatric monkeypox patient with unknown source of infection, the Netherlands, June 2022. Euro Surveill. 2022 Jul;27(29). PubMed: https://pubmed.gov/35866435. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.29.2200552

A pediatric case of monkeypox infection in the Netherlands. Three weeks before presenting to the hospital, a young boy complained of a sore throat. He had no fever and was fine the next day. The next day, he went with his parents on vacation to Turkey. When he returned a week later, the boy noticed two small circular lesions on the left side of his face, one in front of his lower jaw and the other on his cheek. No plausible source of the monkeypox (MPX) infection could be identified. Physicians should know that monkeypox can develop in children and be present in the general population. The authors “advise prompt diagnostic testing in case of clinical symptoms potentially related to MPX to prevent potential undetected transmission in the community.”

Clinical presentation

21 July 2022

Thornhill JP, Barkati S, Walmsley S, et al. Monkeypox Virus Infection in Humans across 16 Countries – April-June 2022. N Engl J Med. 2022 Jul 21. PubMed: https://pubmed.gov/35866746. Full text: https://doi.org/10.1056/NEJMoa2207323

The authors report 528 infections diagnosed between April 27 and June 24, 2022. 98% of the persons with infection were gay or bisexual men, 41% had HIV infection (median age was 38 years). “95% of the persons presented with a rash (with 64% having <10 lesions), 73% had anogenital lesions, and 41% had mucosal lesions (with 54 having a single genital lesion). Common systemic features preceding the rash included fever (62%), lethargy (41%), myalgia (31%), and headache (27%); lymphadenopathy was also common (reported in 56%). Concomitant sexually transmitted infections were reported in 109 of 377 persons (29%) who were tested. Among the 23 persons with a clear exposure history, the median incubation period was 7 days (range, 3 to 20). Monkeypox virus DNA was detected in 29 of the 32 persons in whom seminal fluid was analyzed.” 70 patients (13%) were hospitalized, mainly for severe anorectal pain (21 persons); soft-tissue superinfection (18); pharyngitis limiting oral intake (5); eye lesions (2); acute kidney injury (2); myocarditis (2); and infection-control purposes (13). No deaths.

Overviews

20 July 2022

Alakunle EF, Okeke MI. Monkeypox virus: a neglected zoonotic pathogen spreads globally. Nat Rev Microbiol. 2022 Jul 20. PubMed: https://pubmed.gov/35859005. Full text: https://doi.org/10.1038/s41579-022-00776-z

“The current outbreak of MPX in non-endemic regions should be a wake-up call and highlights how little-to-no attention has been paid to the spread of the virus within endemic areas. It should also serve as a reminder that in an inter-connected and globalized world, no region or country is safe from zoonotic pathogens like MPXV unless the virus is contained in endemic regions.”

19 July 2022

Osterholm MT, Gellin B. Confronting 21st-century monkeypox. Science. 2022 Jul 19:eadd9651. PubMed: https://pubmed.gov/35857487. Full text: https://doi.org/10.1126/science.add9651

“Long-term control of monkeypox will require vaccinating as many as possible of the 327 million people 40 years of age and younger living in the 11 African countries where monkeypox is endemic in an animal (rodent) reservoir.”

19 July 2022

Choudhary G, Prabha PK, Gupta S, Prakash A, Medhi B. Monkeypox infection: A quick glance. Indian J Pharmacol. 2022 May-Jun;54(3):161-164. PubMed: https://pubmed.gov/35848685. Full text: https://doi.org/10.4103/ijp.ijp_400_22

“A quick glance.”

Week 28

11 – 17 July 2022

Virology

14 July 2022

Forni D, Molteni C, Cagliani R, Sironi M. Geographic structuring and divergence time frame of monkeypox virus in the endemic region. J Infect Dis. 2022 Jul 14:jiac298. PubMed: https://pubmed.gov/35831941. Full text: https://doi.org/10.1093/infdis/jiac298

The authors discuss the genetic diversity and separation timeframe of monkeypox virus in endemic areas (i.e., where the virus has spent the overwhelming majority of its evolutionary history). They estimate that the two clades separated ~560-860 years ago.

12 July 2022

Luna N, Ramírez AL, Muñoz M, et al. Phylogenomic analysis of the monkeypox virus (MPXV) 2022 outbreak: Emergence of a novel viral lineage? Travel Med Infect Dis. 2022 Jul 12:102402. PubMed: https://pubmed.gov/35840078. Full text: https://doi.org/10.1016/j.tmaid.2022.102402

The authors performed a phylogenomic analysis of available Monkeypox virus (MPXV) genomes to determine their evolution and diversity. All MPXV genomes grouped into three monophyletic clades, where the newly classified lineage B.1 includes all MPXV genomes from the 2022 outbreak. The authors estimate that the B.1 lineage emerged in Europe on 03/02/2022 [95%CI = 11/13/2021 to 50/10/2022].

Transmission

15 July 2022

Atkinson B, Burton C, Pottage T, et al. Infection-competent monkeypox virus contamination identified in domestic settings following an imported case of monkeypox into the UK. Environ Microbiol. 2022 Jul 15. PubMed: https://pubmed.gov/35837859. Full text: https://doi.org/10.1111/1462-2920.16129

Environmental sampling was performed at two adjoining single room residences occupied by a monkeypox case and their sibling. Monkeypox virus DNA was identified in multiple locations throughout both properties, and monkeypox virus was isolated from several samples three days after the patient was last in these locations.

Clinical presentation

13 July 2022

Rodríguez BS, Herrador BRG, Franco AD, et al. Epidemiologic Features and Control Measures during Monkeypox Outbreak, Spain, June 2022. Emerg Infect Dis. 2022 Jul 12;28(9). PubMed: https://pubmed.gov/35820165. Full text: https://wwwnc.cdc.gov/eid/article/28/9/22-1051_article

The authors provide epidemiologic features of 1256 cases (1,242 cases were in men and 14 in women) reported in Spain and the coordinated measures taken to respond to this outbreak. Among 45 patients who self-referred a clear exposure date the average incubation period was 7‒9.6 days. The most frequent symptoms reported (n = 530) were rash (mainly anogenital), fever, asthenia, and lymphadenopathy. Of the 216 case-patients who had localized lymphadenopathy, 191 had general symptoms. A total of 30 of the 530 case-patients were hospitalized (median admission 2 days); 33 reported complications, mainly secondary bacterial infections (n = 15) oral ulcers (n = 11), proctitis (n = 2), and pharyngotonsillitis (n = 2). No deaths were reported.

Diagnosis

16 July 2022

Peiró-Mestres A, Fuertes I, Camprubí-Ferrer D, 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 Jul;27(28). PubMed: https://pubmed.gov/35837964. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.28.2200503

In 147 clinical samples from 12 patients tested by by real-time PCR, monkeypox virus DNA was detected in saliva from all cases, sometimes with high viral loads. Other samples were frequently positive: rectal swab (11/12 cases), nasopharyngeal swab (10/12 cases), semen (7/9 cases), urine (9/12 cases) and faeces (8/12 cases).

15 July 2022

Aden TA, Blevins P, York SW, et al. Rapid Diagnostic Testing for Response to the Monkeypox Outbreak – Laboratory Response Network, United States, May 17-June 30, 2022. MMWR Morb Mortal Wkly Rep. 2022 Jul 15;71(28):904-907. PubMed: https://pubmed.gov/35834423. Full text: https://doi.org/10.15585/mmwr.mm7128e1

By the end of June 2022, <10% of the US Laboratory Response Network (LRN) non-variola Orthopoxvirus (NVO) testing capacity had been used. Expansion to five commercial laboratories starting the week of July 5 will make testing in more accessible and increase convenience for providers and patients.

Case Reports

11 July 2022

Noe S, Zange S, Seilmaier M, et al. Clinical and virological features of first human monkeypox cases in Germany. Infection. 2022 Jul 11. PubMed: https://pubmed.gov/35816222. Full text: https://doi.org/10.1007/s15010-022-01874-z

The authors present clinical and virological findings of the first two cases of MPX infection in humans diagnosed in Germany, including the detection of monkeypox virus DNA in blood and semen. They assume that close physical contact during sexual interactions was the route of infection.

11 July 2022

Jang YR, Lee M, Shin H, et al. The First Case of Monkeypox in the Republic of Korea. J Korean Med Sci. 2022 Jul 11;37(27):e224. PubMed: https://pubmed.gov/35818706. Full text: https://doi.org/10.3346/jkms.2022.37.e224

Monkeypox in a in a 34-year-old male patient from South Korea who traveled to Europe in June 2022.

Week 27

4 – 10 July 2022

Epidemiology

9 July 2022

Selb R, Werber D, Falkenhorst G, et al. A shift from travel-associated cases to autochthonous transmission with Berlin as epicentre of the monkeypox outbreak in Germany, May to June 2022. Euro Surveill. 2022 Jul;27(27). PubMed: https://pubmed.gov/35801518. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.27.2200499

In early July 2022, Germany has one of the highest overall number of monkeypox (MPX) cases in Europe. The authors describe the epidemiology of MPX in Germany and the shift from travel-associated to autochthonous transmission in Berlin, often in association with visits to clubs and parties. (Berlin is the epicenter of the outbreak in Germany with 69% of all cases.) Median age: 38 years (IQR: 32-44). Hospitalization status was reported for 455 cases of which 38 cases (8%) were admitted to hospital.

8 July 2022

Iñigo Martínez J, Gil Montalbán E, Jiménez Bueno S, et al. Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022. Euro Surveill. 2022 Jul;27(27). PubMed: https://pubmed.gov/35801519. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.27.2200471

Iñigo Martínez et al. report 508 confirmed cases of monkeypox (MPX) in the Madrid region of Spain, 503 (99%) of whom were men. Median age was 35 years (range: 18-67). 427 cases (84.1%) reported condomless sex or sex with multiple partners (predominantly MSM) within the 21 days before onset of symptoms. The authors hypothesize that both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy, might suggest that close physical contact during sexual activity played a key role in transmission. They recommend to actively work with LGBTIQ+ groups to adopt preventive measures.

Clinical Presentation

10 July 2022

Orviz E, Negredo A, Ayerdi O, et al. Monkeypox outbreak in Madrid (Spain): clinical and virological aspects. J Infect. 2022 Jul 10:S0163-4453(22)00415-7. PubMed: https://pubmed.gov/35830908. Full text: https://doi.org/10.1016/j.jinf.2022.07.005

The median age (n=48) was 35 years (IQR 29 – 44), and 87.5% were MSM. The most prevalent symptoms were the presence of vesicular-umbilicated and pseudo-pustular skin lesions (93.8%), asthenia (66.6%), and fever (52.1%). In addition, the location of the lesions in the genital or perianal area was related to the role in sexual intercourse (p<0.001).

7 July 2022

Patrocinio-Jesus R, Peruzzu F. Monkeypox Genital Lesions. N Engl J Med. 2022 Jul 7;387(1):66. PubMed: https://pubmed.gov/35704421. Full text: https://doi.org/10.1056/NEJMicm2206893

“A 31-year-old man with well-controlled infection with the human immunodeficiency virus presented to the clinic with a 1-week history of a painless genital rash and a 2-day history of fever and sore throat.”

Diagnosis

4 July 2022

Ulaeto DO, Lonsdale SG, Laidlaw SM, Clark GC, Horby P, Carroll MW. A prototype lateral flow assay for detection of orthopoxviruses. Lancet Infect Dis. 2022 Jul 4:S1473-3099(22)00440-6. PubMed: https://pubmed.gov/35798023. Full text: https://doi.org/10.1016/S1473-3099(22)00440-6

The authors describe a prototype lateral flow assay that uses a cocktail of four monoclonal antibodies specific for Old World orthopoxviruses. The monoclonal antibodies do not recognise New World orthopoxviruses or members of the Parapoxvirus, Leporipoxvirus, or Suipoxvirus genera.

Prevention

6 July 2022

Rodriguez-Morales AJ, Lopardo G, Verbanaz S, et al. Latin America: Situation and preparedness facing the multi-country human monkeypox outbreak. Lancet Reg Health Am. 2022 Sep;13:100318. PubMed: https://pubmed.gov/35813461. Full text: https://doi.org/10.1016/j.lana.2022.100318

In Latin America, the risk for expansion of MPX Is still moderate. Will the continent be able to allocate necessary resources and strengthen epidemiological surveillance to detect imported cases and limit onward transmission?

Case Reports

6 July 2022

Sukhdeo SS, Aldhaheri K, Lam PW, Walmsley S. A case of human monkeypox in Canada. CMAJ. 2022 Jul 6:cmaj.220886. PubMed: https://pubmed.gov/35793837. Full text: https://doi.org/10.1503/cmaj.220886

Twelve days after unprotected, receptive orogenital and oroanal intercourse with a new, anonymous male partner, the patient described in this report developed enlarged, painful, tender inguinal and cervical lymphadenopathy, chills and night sweats. One day later, he developed rectal pain and tenesmus, followed by the appearance of 4 pruritic, painless macules on his forearm and wrist on day 15, which became vesicular and then pustular over the subsequent 7 days.

Overviews

8 July 2022

Titanji BK. Neglecting emerging diseases – monkeypox is the latest price of a costly default. Med (N Y). 2022 Jul 8;3(7):433-434. PubMed: https://pubmed.gov/35809556. Full text: https://doi.org/10.1016/j.medj.2022.06.002

“Many [current] infection clusters have no travel link to an endemic country, indicating local transmission as a major source of new infections. Why is this happening now and what has changed about a virus we have known to exist and to infect humans for over 50 years? The answer is a combination of timing, neglect and opportunity.”

6 July 2022

Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, et al. Monkeypox in humans: a new outbreak. Rev Esp Quimioter. 2022 Jul 6:martin06jul2022. PubMed: https://pubmed.gov/35785957. Full text: https://doi.org/10.37201/req/059.2022

Received: 27 June 2022; Accepted: 1 July 2022; Published: 6 July2022. A review with 105 references.

Week 26

27 June – 3 July 2022

Virology

2 July 2022

Pfaff F, Hoffmann D, Beer M. Monkeypox genomic surveillance will challenge lessons learned from SARS-CoV-2. Lancet. 2022 Jul 2;400(10345):22-23. PubMed: https://pubmed.gov/35780786. Full text: https://doi.org/10.1016/S0140-6736(22)01106-0

The authors waren that unlike smallpox, other orthopoxviruses have reservoirs in wildlife, such as cowpox virus (in voles), taterapox virus (in African gerbils), and monkeypox virus (in small mammals) and thus have the potential to spill into the human population, thereby facilitating a restart of the genetic adaptation of the virus to the human host, which once resulted in variola virus.

Transmission

28 June 2022

Schneider KA, Eichner M. Does it matter who is spreading monkeypox? Lancet Infect Dis. 2022 Jun 28:S1473-3099(22)00431-5. PubMed: https://pubmed.gov/35777384. Full text: https://doi.org/10.1016/S1473-3099(22)00431-5

The magic word: awareness. The authors point out that as with smallpox, individuals who are infected with monkeypox take rather long to develop symptoms and they have—compared with influenza or SARS-CoV-2—a rather long infectious period. Therefore, the average generation time of monkeypox is rather long (about 20 days).This renders monkeypox highly vulnerable to interventions: even with R₀=3, it would take months until a few thousand cases occur.

27 June 2022

Nörz D, Pfefferle S, Brehm TT, et al. Evidence of surface contamination in hospital rooms occupied by patients infected with monkeypox, Germany, June 2022. Euro Surveill. 2022 Jun;27(26). PubMed: https://pubmed.gov/35775427. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.26.2200477

The authors examined surfaces of two hospital rooms occupied by monkeypox patients and the adjacent anterooms, which were used for donning and doffing personal protective equipment (PPE). They successfully isolated monkeypox virus from three different samples, each with a total of at least 10⁶ virus copies.

Clinical Presentation

1 July 2022

Girometti N, Byrne R, Bracchi M, et al. Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis. Lancet Infect Dis. 2022 Jul 1:S1473-3099(22)00411-X. PubMed: https://pubmed.gov/35785793. Full text: https://doi.org/10.1016/S1473-3099(22)00411-X

Can monkeypox be transmitted through local inoculation during close skin-to-skin or mucosal contact, during sexual activity? The author’s preliminary answer would be “Yes”. Here, they describe the clinical characteristics of 54 individuals, all identifying as men who have sex with men (MSM), of whom 13 (24%) were living with HIV. 36 (67%) of patients reported fatigue or lethargy, 31 (57%) reported fever, 10 (18%) had no prodromal symptoms, and 30 (55%) had lymphadenopathy. All patients presented with skin lesions, of which 51 (94%) were anogenital. 37 (89%) of 54 individuals had skin lesions affecting more than one anatomical site and four (7%) had oropharyngeal lesions. Around 25% had a concurrent sexually transmitted infection (STI). Five (9%) of 54 individuals required hospitalization. There were no deaths.

Treatment

29 June 2022

Harris E. Global Monkeypox Outbreaks Spur Drug Research for the Neglected Disease. JAMA. 2022 Jun 29. PubMed: https://pubmed.gov/35767293. Full text: https://doi.org/10.1001/jama.2022.11224

Monkeypox virus disease usually improves without specific treatment within a month, but the infection requires isolation to prevent transmission. In Africa, depending on the viral clade, it has been found to be fatal in 1% to 11%.

Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and Treatment of Monkeypox. Drugs. 2022 Jun 28:1-7. PubMed: https://pubmed.gov/35763248. Full text: https://doi.org/10.1007/s40265-022-01742-y

Key points: 1) Prevention and management of monkeypox is similar to that of other orthopoxvirus infections. 2) Immunization with smallpox vaccines (JYNNEOSTM and ACAM2000®) may have a protective effect against monkeypox virus and improve clinical manifestations. 3) Most patients have mild disease and recover without medical intervention, but treatment with antivirals or vaccinia immune globulin may be used in seriously ill or immunocompromised individuals.

Vaccination

1 July 2022

Petersen E, Zumla A, Hui DS, 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 Jul 1:S1201-9712(22)00378-2. PubMed: https://pubmed.gov/35788415. Full text: https://doi.org/10.1016/j.ijid.2022.06.047

The authors caution that we do not know if immunization with a smallpox vaccine like IMVANEX® (EU) / JYNNEOS® (US) will provide protective immunity against sexually transmitted monkeypox virus (MPXV). Therefore, the use of a vaccine as pre-exposure prophylaxis (PrEP) against MPXV must be in the form of a randomized, controlled trial with another vaccine used in the control arm. (IMVANEX® (EU) / JYNNEOS® (US) is a live vaccine produced from the Modified Vaccinia Ankara-Bavarian Nordic [MVA-BN) strain, an attenuated, non-replicating orthopoxvirus manufactured by Bavarian Nordic, Hellerup, Denmark.)

Pregnancy

2 July 2022

Dashraath P, Nielsen-Saines K, Mattar C, Musso D, Tambyah P, Baud D. Guidelines for pregnant individuals with monkeypox virus exposure. Lancet. 2022 Jul 2;400(10345):21-22. PubMed: https://pubmed.gov/35750071. Full text: https://doi.org/10.1016/S0140-6736(22)01063-7

Clinicians should maintain a high index of suspicion for monkeypox virus in any pregnant woman presenting with lymphadenopathy and vesiculopustular rash—including rash localised to the genital or perianal region—even if there are no apparent epidemiological links. The authors propose a clinical management algorithm for pregnant women with suspected monkeypox virus exposure (see the figure).

27 June 2022

Khalil A, Samara A, O’Brien P, et al. Monkeypox vaccines in pregnancy: lessons must be learned from COVID-19. Lancet Glob Health. 2022 Jun 27:S2214-109X(22)00284-4. PubMed: https://pubmed.gov/35772413. Full text: https://doi.org/10.1016/S2214-109X(22)00284-4

Currently, no vaccine against monkeypox is approved for use in pregnancy. Because MVA-BN (EU: Imvanex; US: JYNNEOS) is a non-replicating vaccine, there is no theoretical reason for concern about its use in pregnancy. However, “MVA-BN should be avoided during pregnancy unless the possible benefits in terms of preventing monkeypox outweigh any potential unknown risk of the vaccine.” MVA-BN is considered safe in breastfeeding.

Prevention

28 June 2022

Kampf G. Efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses. J Hosp Infect. 2022 Jun 28:S0195-6701(22)00200-6. PubMed: https://pubmed.gov/35777702. Full text: https://doi.org/10.1016/j.jhin.2022.06.012

Evaluation of published data on the antiviral efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses. Vaccinia viruses could be inactivated by at least 4 log₁₀ in suspension tests and on artificially contaminated surfaces by 70% ethanol (≤ 1 min), 0.2% peracetic acid (≤ 10 min) and 1% to 10% of a probiotic cleaner (1 h), mostly shown with different types of organic load. Hydrogen peroxide (14.4%) and iodine (0.04% – 1%) were effective in suspension tests, sodium hypochlorite (0.25% – 2.5%; 1 min), 2% glutaraldehyde (10 min) and 0.55% ortho-phthalaldehyde (5 min) were effective on artificially contaminated surfaces.

Overviews

1 July 2022

The Lancet Regional Health-Europe. Lessons from COVID-19 are shaping the response to monkeypox outbreak. Lancet Reg Health Eur. 2022 Jul;18:100463. PubMed: https://pubmed.gov/35791347. Full text: https://doi.org/10.1016/j.lanepe.2022.100463

“There is growing concern that the virus might find an animal reservoir outside Africa that can spread more easily in humans. Therefore, there is a need for close collaboration between veterinary and public health authorities working from a ‘One Health’ perspective, to manage exposed pets and also to prevent the disease from being transmitted to wildlife.”

30 June 2022

Simões P, Bhagani S. A viewpoint: The 2022 monkeypox outbreak. J Virus Erad. 2022 Jun 18;8(2):100078. PubMed: https://pubmed.gov/35784677. Full text: https://doi.org/10.1016/j.jve.2022.100078. eCollection 2022 Jun

A short overview of the current monkeypox outbreak with the four key questions: Why now? Why in Europe? Why are MSM in the United Kingdom disproportionally affected? Why is the clinical presentation milder?

Week 25

20 – 26 June 2022

Previous weeks

Isidro J, Borges V, Pinto M, et al. Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus. Nat Med. 2022 Jun 24. PubMed: https://pubmed.gov/35750157. Full text: https://doi.org/10.1038/s41591-022-01907-y

Mileto D, Riva A, Cutrera M, et al. New challenges in human monkeypox outside Africa: A review and case report from Italy. Travel Med Infect Dis. 2022 Jun 20;49:102386. PubMed: https://pubmed.gov/35738529. Full text: https://doi.org/10.1016/j.tmaid.2022.102386

Miura F, van Ewijk CE, Backer JA, et al. Estimated incubation period for monkeypox cases confirmed in the Netherlands, May 2022. Euro Surveill. 2022 Jun;27(24):2200448. PubMed: https://pubmed.gov/35713026. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.24.2200448

Patrocinio-Jesus R, Peruzzu F. Monkeypox Genital Lesions. N Engl J Med. 2022 Jul 7;387(1):66. PubMed: https://pubmed.gov/35704421. Full text: https://doi.org/10.1056/NEJMicm2206893

[No authors listed] Saving energy, monkeypox’s march – the week in infographics. Nature. 2022 Jun 14. PubMed: https://pubmed.gov/35701614. Full text: https://doi.org/10.1038/d41586-022-01661-8

Bragazzi NL, Kong JD, Mahroum N, et al. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: A preliminary pooled data analysis and literature review. J Med Virol. 2022 Jun 12. PubMed: https://pubmed.gov/35692117. Full text: https://doi.org/10.1002/jmv.27931

The Lancet Infectious Diseases. Monkeypox: a neglected old foe. Lancet Infect Dis. 2022 Jul;22(7):913. PubMed: https://pubmed.gov/35691304. Full text: https://doi.org/10.1016/S1473-3099(22)00377-2

Ferraro F, Caraglia A, Rapiti A, et al. Letter to the editor: multiple introductions of MPX in Italy from different geographic areas. Euro Surveill. 2022 Jun;27(23):2200456. PubMed: https://pubmed.gov/35686566. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.23.2200456

Kupferschmidt K. Monkeypox vaccination plans take shape amid questions. Science. 2022 Jun 10;376(6598):1142-1143. PubMed: https://pubmed.gov/35679422. Full text: https://doi.org/10.1126/science.add3743

WHO. Monkeypox. https://www.who.int/news-room/fact-sheets/detail/monkeypox

Minhaj FS, Ogale YP, Whitehill F, et al. Monkeypox Outbreak – Nine States, May 2022. MMWR Morb Mortal Wkly Rep. 2022 Jun 10;71(23):764-769. PubMed: https://pubmed.gov/35679181. Full text: https://doi.org/10.15585/mmwr.mm7123e1

Walter K, Malani PN. What Is Monkeypox? JAMA. 2022 Jun 9. PubMed: https://pubmed.gov/35679066. Full text: https://doi.org/10.1001/jama.2022.10259

Kozlov M. Monkeypox vaccination begins – can the global outbreaks be contained? Nature. 2022 Jun;606(7914):444-445. PubMed: https://pubmed.gov/35676362. Full text: https://doi.org/10.1038/d41586-022-01587-1

Antinori A, Mazzotta V, Vita S, et al. Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Euro Surveill. 2022 Jun;27(22):2200421. PubMed: https://pubmed.gov/35656836. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200421

Vivancos R, Anderson C, Blomquist P, et al. Community transmission of monkeypox in the United Kingdom, April to May 2022. Euro Surveill. 2022 Jun;27(22):2200422. PubMed: https://pubmed.gov/35656834. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200422

Perez Duque M, Ribeiro S, Martins JV, et al. Ongoing monkeypox virus outbreak, Portugal, 29 April to 23 May 2022. Euro Surveill. 2022 Jun;27(22):2200424. PubMed: https://pubmed.gov/35656830. Full text: https://doi.org/10.2807/1560-7917.ES.2022.27.22.2200424

Cohen J. Global outbreak puts spotlight on neglected virus. Science. 2022 Jun 3;376(6597):1032-1033. PubMed: https://pubmed.gov/35653477. Full text: https://doi.org/10.1126/science.add2701

Rao AK, Petersen BW, Whitehill F, 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 Jun 3;71(22):734-742. PubMed: https://pubmed.gov/35653347. Full text: https://doi.org/10.15585/mmwr.mm7122e1

Kozlov M. Monkeypox outbreaks: 4 key questions researchers have. Nature. 2022 Jun;606(7913):238-239. PubMed: https://pubmed.gov/35624160. Full text: https://doi.org/10.1038/d41586-022-01493-6

Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 May 24:S1473-3099(22)00228-6. PubMed: https://pubmed.gov/35623380. Full text: https://doi.org/10.1016/S1473-3099(22)00228-6

Harris E. What to Know About Monkeypox. JAMA. 2022 Jun 21;327(23):2278-2279. PubMed: https://pubmed.gov/35622356. Full text: https://doi.org/10.1001/jama.2022.9499

Cohen J. Monkeypox outbreak questions intensify as cases soar. Science. 2022 May 27;376(6596):902-903. PubMed: https://pubmed.gov/35617408. Full text: https://doi.org/10.1126/science.add1583

Graham F. Daily briefing: Why scientists are worried about monkeypox. Nature. 2022 May 20. PubMed: https://pubmed.gov/35606433. Full text: https://doi.org/10.1038/d41586-022-01455-y

Adalja A, Inglesby T. A Novel International Monkeypox Outbreak. Ann Intern Med. 2022 May 24. PubMed: https://pubmed.gov/35605243. Full text: https://doi.org/10.7326/M22-1581

Kozlov M. Monkeypox goes global: why scientists are on alert. Nature. 2022 Jun;606(7912):15-16. PubMed: https://pubmed.gov/35595996. Full text: https://doi.org/10.1038/d41586-022-01421-8

Rao AK, Schulte J, Chen TH, et al. Monkeypox in a Traveler Returning from Nigeria – Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep. 2022 Apr 8;71(14):509-516. PubMed: https://pubmed.gov/35389974. Full text: https://doi.org/10.15585/mmwr.mm7114a1

Costello V, Sowash M, Gaur A, et al. Imported Monkeypox from International Traveler, Maryland, USA, 2021. Emerg Infect Dis. 2022 May;28(5):1002-1005. PubMed: https://pubmed.gov/35263559. Full text: https://doi.org/10.3201/eid2805.220292

Babkin IV, Babkina IN, Tikunova NV. An Update of Orthopoxvirus Molecular Evolution. Viruses. 2022 Feb 14;14(2):388. PubMed: https://pubmed.gov/35215981. Full text: https://doi.org/10.3390/v14020388

Bunge EM, Hoet B, Chen L, et al. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022 Feb 11;16(2):e0010141. PubMed: https://pubmed.gov/35148313. Full text: https://doi.org/10.1371/journal.pntd.0010141. eCollection 2022 Feb

Book

Moore M, Zahra F. Monkeypox. PubMed: https://pubmed.gov/34662033. Full text: https://doi.org/