monkeypox

1. OVERVIEW OF MONKEYPOX
Presenter: Dr INGABIRE Prosper
Supervisors: Dr Marcellin MUSABENDE
March 29, 2023

2. Outline
• Introduction
• Epidemiology
• Pathogenesis
• Clinical Presentation
• Diagnosis
• Management

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

4. Introduction Con’t

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 –Cont’d
• Monkeypox virus infection detected in:
 Squirrels
Rodents
species of monkeys
• West and Central Africa: 2 clades
 Clade 1: Central Africa-Congo Basin Clade
Clade 2: West Africa (less virulent)-IIa&IIb
• Monkeys and Humans: Hosts, unknown reservoir

7. Epidemiology

8. Epidemiology: Continued concerns

9. Epidemiology
• Reached in 76 countries Worlwide
• First cases in 1980 ~ Countries of CWA
• 2003: US outbreak
• DRC: 2005-2007 Surveillance report
a 20-fold ↑ in incidence of Mpox Vs 1980
Cessation of Smallpox vaccination /eradication
Risk : 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-Cont’d
• Outbreak of 2022: 57995 cases
• Clade I mortality: 10%
• Clade II: < 0.1% except in Nigeria(3.6%)
2017-18
• Predictors of severe form:
Immunocompromisation : HIV
Children
Small pox/𝜃 Immunisation

12. Jan –Sept 2022 Outbreak , CDC

13. Global Picture

14. Virology
• Mpox virus , orthopoxvirus genus
• Poxviridae family, w/ other species like:
 Variola virus that causes smallpox
 Vaccinia virus, which was used in making smallpox vaccine
 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.
 Non invasive
 Complex
• Human to Human
 Direct contact
 Indirect contact: fomites
 Respiratory secretions
 Vertical transmission
 Percutaneous inoculation
 Body fluids~ seen

17. Pathogenesis

18. Symptoms
• Incubation period: 4-21 days
• Traditional : systemic illness with
fevers, chills, and myalgias
 characteristic rash ≠other vesicular (eg,
varicella, smallpox)
• 2022 Mpox outbreak special attention:
genital, anal
and/or oral lesions without the systemic illness

19. Symptomatology- Cont’d
• Prodrome: Viremic phase of illness
 From 1-5 days
 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.

21. Monkeypox rash and stages

22. Diagnosis

23. Diagnostic tools
Tropical Medicine and ID, Oct 2022

24. Investigations
• PCR: Confirmation of MPXV infection is
based on NAAT
 Using real-time or conventional PCR
 Detection of unique sequences of viral
DNA.
 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 – especially albumin
• Routine examination of bacterial and
mycotic cultures & sensitivity

25. Gilada/Unison/Mumbai
Differential Diagnosis
• Small pox
• Chicken pox & Herpes Zoster (bilateral)
• Measles
• Superficial Bacterial infections –
Impetigo
• Scabies
• Syphilis
• Drug reactions
• Pemphigus Vulgaris
• Bullous Pemphigoid

26. Monkeypox versus other common
rashes

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.

29. Symptomatic Treatment
Tropical Medicine and Infectious Disease

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
 is a USFDA approved live attenuated virus
vaccine
 has been approved for the prevention of
Monkeypox.
• Research ongoing for use in Preexposure
 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
• monkeypox—A 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
• monkeypox—A 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.

35. Remerciements
Thanking
appreciation