Monkeypox�Another pandemic in the making?

The world has yet to recover from the COVID-19 pandemic, and it is now challenged with another threat, the monkeypox virus.

1. Monkeypox Another pandemic in the making? BY CHINKLE SHARMA 3 rd year PG RESIDENT Department of microbiology

2. INTRODUCTION The world has yet to recover from the COVID-19 pandemic, and it is now challenged with another threat, the monkeypox virus. Monkeypox belongs to the Poxviridae family, under the Chordopoxvirinae subfamily, and the Orthopoxvirus genus. Related Viruses : Other poxviruses that infect humans include: Variola virus (smallpox) Molluscum contagiosum Vaccinia virus Cowpox virus Pseudocowpox virus

3. Structure of the Virus Virus Shape : The monkeypox virus is large, brick-shaped (200–250 nanometers), and encased in a lipoprotein envelope. Genome : Linear double-stranded DNA encodes proteins for replication, transcription, assembly, and exit. Host Dependence : Relies on host cell ribosomes only for mRNA translation.

4. WHO Declaration Global Health Emergency: On July 23, 2022 , the World Health Organization declared the monkeypox outbreak a Public Health Emergency of International Concern. May 2023 : After significant global efforts WHO declared that mpox no longer constituted a global health emergency but warned against complacency​ In August 2024 , the World Health Organization (WHO) declared a new global public health emergency due to a surge in mpox (formerly known as monkeypox ) cases . This declaration marked the second time in two years that mpox was categorized as a Public Health Emergency of International Concern (PHEIC).

5. The outbreak originated primarily in the Democratic Republic of Congo (DRC) and several neighboring countries in Central and Eastern Africa. A new strain, known as Clade Ib , has been identified as more severe than previous types, contributing to a significant rise in cases and fatalities, particularly among children.​

6. Modes of Transmission Human-to-Human Spread : Monkeypox spreads through direct contact with fluid secretions from the respiratory tract or skin lesions. Prolonged Contact : Droplet transmission requires extended face-to-face interaction, posing a higher risk for healthcare workers and close contacts. Mother-to-Fetus Transmission : The virus can pass from mother to fetus through the placenta (causing congenital monkeypox ) or through close contact after birth .

7. Pathogenesis Incubation Period: The incubation period of mpox , which is the time from exposure to the virus to the onset of symptoms, typically ranges from 5 to 21 days , with an average of 6 to 13 days . During this time, an individual may be infected but asymptomatic and thus unaware of their contagious status ​

8. MONKEYPOX :- A TIMELINE

9. Duration of Illness: The disease typically lasts 2 to 4 weeks . The course of the infection includes several stages, starting with fever, headaches, and swollen lymph nodes, followed by the development of a rash. The rash progresses through different stages—macules, papules, vesicles, pustules, and eventually scabs before healing. Severe cases, especially with the newer Clade Ib strain , may last longer and require more intensive treatment​

10. Contagion Monkeypox is not considered contagious during its incubation period. There have been no noted cases of asymptomatic infection or transmission.

11. Similarities with Smallpox Clinical Features : Monkeypox symptoms are quite similar to smallpox. Vaccinia Virus Vaccine : The smallpox vaccine ( vaccinia virus) provides protection against monkeypox . Effectiveness : If given within 4 days of infection, the vaccine can prevent or alter disease progression.

12. Fear of Potential Outbreak Genomic Evolution : Due to similarities with its cousin smallpox and constant virus evolution, concerns are rising about monkeypox potentially causing widespread outbreaks similar to smallpox. Global Panic : The ongoing outbreak has sparked fear and panic worldwide.

13. PATHOPHYSIOLOGY OF MONKEYPOX VIRUS

14. PATHOPHYSIOLOGY Virus Entry and Replication Entry Routes : Nasopharyngeal, oropharyngeal , intradermal, anogenital . Initial Replication : Starts at inoculation site. Primary Viremia : Seeds organs and lymph nodes. Incubation Period : 5-21 days before symptoms. Symptom Onset Prodromal Symptoms : Fever, chills, headache, lymphadenopathy. Unique Feature : Enlarged lymph nodes (90% cases). Maculopapular Rash : Starts on face, trunk. Infectious Period : Starts with rash. Rash Stages Lesion Types : Macules, papules, vesicles, pustules. Lesion Duration : Pustules last 5-7 days. Crust Formation : Falls off in 7-14 days.

15. Extracutaneous Manifestations Complications : Bronchopneumonia, sepsis, encephalitis. No Hemorrhagic Form : Unlike smallpox. Recent Outbreak Differences Clade Variation : Different from endemic clade. Anogenital Involvement : Severe pain, oral mucosa. Vaccinated vs. Unvaccinated : Milder symptoms, fewer fatalities. Fatality Rate : 11% overall, 15% in children.

16. Complications in monkeypox and their treatment modalities

17. DIAGNOSIS

18. Sample processing 1. Types of Specimens: Rash specimens Crusts Blister fluid Nasopharyngeal or oropharyngeal secretions Collection Method: Swab or scraping from the skin lesions (especially vesicles and pustules) Collection from the nasopharyngeal and oropharyngeal region

19. 2. Specimen Storage Condition: Store in a cold, dry, sterile environment Time Sensitivity: Ensure quick transportation to lab

20. 3. Virus Isolation & Growth Specimen Processing: Specimen placed in Virus Growth Medium (Vero cells or EMEM) Virus isolated for further analysis

21. 4. Diagnostic Methods: PCR Test: Preferred test for its high accuracy Focus on skin lesion samples for better results Blood samples are inconclusive as the virus does not survive long in the blood Electron Microscopy: Observes round-oval intracytoplasmic inclusions with centrally located sausage-shaped structures

22. Prevention and treatment Monkeypox virus eradication is difficult due to the existence of an animal reservoir.

23. JYNNEOS ( Imvamune or Imvanex ) or MVA-BN (Modified Vaccinia Ankara - Bavarian Nordic) Vaccine : A non-replicating live vaccine, specifically approved for both smallpox and mpox . Dosing : Two doses are administered, spaced 28 days apart . Route : Given subcutaneously or intradermally . Eligibility : Recommended for high-risk groups, including healthcare workers, close contacts of mpox cases, and individuals in populations with higher transmission rates, such as men who have sex with men (MSM).

24. ACAM 2000 : A live, replicating smallpox vaccine that can also be used to protect against mpox . Dosing : A single dose is administered. Route : Administered via a bifurcated needle using a special technique (scarification), creating a localized skin lesion. Risks : As this is a live vaccine, it is not recommended for people with weakened immune systems, certain skin conditions, or pregnant women, due to a higher risk of side effects.

25. Post-Exposure Prophylaxis (PEP): For individuals exposed to mpox , vaccination can be administered within 4 days of exposure to prevent onset of the disease. If given within 14 days , it may reduce the severity of symptoms even if it doesn’t prevent the disease entirely​ In areas with limited vaccine supply, the priority is given to high-risk groups, with recommendations for continued surveillance and rapid access to vaccines in case of outbreaks.

26. Preventive Measures: Infected individuals should wear masks, stay isolated, and keep lesions covered until they heal. Cidofovir : A broad-spectrum antiviral with in vivo activity against orthopox viruses, including monkeypox . CDC Approval : Intravenous cidofovir is approved for severe cases, but it’s highly nephrotoxic. Safety Precautions : Use with probenecid and ensure adequate hydration to mitigate risks.

27. Brincidofovir : A pro-drug of cidofovir used for monkeypox , but don't mix it with cidofovir . Tecovirimat ( Tpoxx ) : Consider for severe monkeypox , especially with hemorrhagic lesions, scarring, or severe immunocompromise . Safe for kids <8 and pregnant/breastfeeding women. Caution : Risk of resistance with nonjudicious use. Side effects include headache (12%), nausea (5%), and infusion site issues (pain 73%, swelling 39%).

28. Conclusion Global Spread: Monkeypox has evolved from an endemic disease to a global threat, spreading rapidly across continents. Smallpox Connection : Its eerie resemblance to smallpox heightens the urgency, recalling the havoc caused in the 20th century. International Travel : The ease of global travel accelerates the spread of this dangerous pathogen across borders. Urgent Action : The virus’s continuous evolution and transmission make it more severe and harder to control. Importance of Early Detection : Swift detection and treatment are crucial to prevent complications and reduce the spread of monkeypox . Call to Action : By acting together with vigilance and unity, we can turn the tide and protect the world from this growing threat.

29. Monkeypox as well as COVID-19 have taught us how no one is safe until everyone is. Thankyou