[Mpox, 40 years after smallpox eradication]. / Mpox, 40 ans après l'éradication de la variole humaine.

In 2022, mpox - a neglected tropical zoonosis - emerged to the world stage. From 1980, the disease was periodically noted, with increasing frequency, in endemic regions of Africa. In 2017, a large outbreak in Nigeria marks a turning point in the evolution of mpox and seems to be at the origin of the 2022 pandemic. The factors for mpox emergence are complex and include loss of cross-protection conferred by smallpox vaccination, increased exposure to the animal reservoir, and increased human-to-human transmission due to behavioral factors. While the current epidemic seems under control, an evolution towards a more transmissible or more virulent virus is not excluded. The 2022 pandemic is an opportunity to initiate and strengthen mpox surveillance, prevention and care management among all affected populations.

En 2022, le mpox ­ une zoonose tropicale négligée ­ a émergé sur la scène mondiale. Depuis 1980, la maladie a été notifiée avec une fréquence croissante dans les régions endémiques d'Afrique. En 2017, une large épidémie au Nigeria marque un tournant dans l'évolution du mpox et semble à l'origine de la pandémie 2022. Les facteurs d'émergence du mpox sont complexes et incluent la perte de la protection croisée conférée par la vaccination antivariolique, une exposition accrue au réservoir animal et une augmentation de la transmission interhumaine due à des facteurs comportementaux. Alors que l'épidémie actuelle semble sous contrôle, une évolution vers un virus plus transmissible ou plus virulent n'est pas exclue. La pandémie 2022 est une opportunité pour initier et renforcer la surveillance, la prévention et la prise en charge clinique du mpox auprès de toutes les populations affectées.

Variations in national surveillance reporting for Mpox virus: A comparative analysis in 32 countries.

Objectives: Case Reporting and Surveillance (CRS) are crucial to combat the global spread of the Monkeypox virus (Mpox). To support CRS, the World Health Organization (WHO) has released standardized case definitions for suspected, probable, confirmed, and discarded cases. However, these definitions are often subject to localized adaptations by countries leading to heterogeneity in the collected data. Herein, we compared the differences in Mpox case definitions in 32 countries that collectively reported 96% of the global Mpox caseload. Methods: We extracted information regarding Mpox case definitions issued by the competent authorities in 32 included countries for suspected, probable, confirmed, and discarded cases. All data were gathered from online public sources. Results: For confirmed cases, 18 countries (56%) followed WHO guidelines and tested for Mpox using species specific PCR and/or sequencing. For probable and suspected cases, seven and eight countries, respectively were found to have not released definitions in their national documentations. Furthermore, none of the countries completely matched WHO's criteria for probable and suspected cases. Overlapping amalgamations of the criteria were frequently noticed. Regarding discarded cases, only 13 countries (41%) reported definitions, with only two countries (6%) having definition consistent with WHO guidelines. For case reporting, 12 countries (38%) were found to report both probable and confirmed cases, in line with WHO requirements. Conclusion: The heterogeneity in case definitions and reporting highlights the pressing need for homogenization in implementation of these guidelines. Homogenization would drastically improve data quality and aid data-scientists, epidemiologists, and clinicians to better understand and model the true disease burden in the society, followed by formulation and implementation of targeted interventions to curb the virus spread.

Crucial choices in a global health crisis: Revealing the demand and willingness to pay for a hypothetical monkeypox vaccine - the PREVENT study.

Background: The latent monkeypox outbreak has become the most emergent public health challenge globally. This study was conducted to assess the acceptability, and willingness to take and pay for a hypothetical Monkeypox vaccine among the Vietnamese general public as well as investigate preference for individual vaccine attributes. Methods: An online cross-sectional study was conducted using snowball sampling among 842 respondents in Vietnam in 2022. A Discrete choice experiment (DCE) on preference for six major attributes of vaccine: effectiveness, immunity duration, side effects, mortality rate, restriction, and the cost was applied. Results: Fear of the impact of monkeypox on public health and the economy, vaccine service satisfaction and responsibility to the community were the most weighted factors in the decision to take a hypothetical monkeypox vaccine. Two-thirds of participants were willing to take the vaccine, while insufficient information on monkeypox and the vaccine were the main reasons for vaccine hesitancy. For vaccine attributes, the mortality rate after seven days of vaccination was the most weighted while cost was the least influential attribute. Factors associated with willingness to take and to pay for the monkeypox vaccine included knowledge of transmission, geographical location, service satisfaction, and risk of infection, while financial burden and fear of vaccine were major drivers of hesitancy. Conclusion: Our findings underline an urgent need for effective information dissemination through social media and counseling. The implementation of nationwide monkeypox vaccination requires prioritization and support for high-risk groups as well as consideration for the country's financial resources.

[Research progress on the effectiveness of smallpox vaccination against mpox virus infection].

With the expansion of mpox virus infection from endemic to a global epidemic in 2022, the WHO declared that the mpox event constituted a Public Health Emergency of International Concern. Due to the high degree of gene sequence similarity among orthopox viruses and cross-reactive antibodies induced by orthoviruses, smallpox vaccination may affect the immune response induced by mpox virus infection. The analysis of the protective effects of smallpox vaccination against mpox virus infection will help define the focus of prevention and control. In this review, we clarify the protection of the smallpox vaccine against mpox virus infection by analyzing the correlation between smallpox vaccination, immune response status, and clinical data and providing evidence for the prevention, control, and strategies of mpox epidemics.

Mpox Panic, Infodemic, and Stigmatization of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual Community: Geospatial Analysis, Topic Modeling, and Sentiment Analysis of a Large, Multilingual Social Media Database.

BACKGROUND: The global Mpox (formerly, Monkeypox) outbreak is disproportionately affecting the gay and bisexual men having sex with men community. OBJECTIVE: The aim of this study is to use social media to study country-level variations in topics and sentiments toward Mpox and Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual (2SLGBTQIAP+)-related topics. Previous infectious outbreaks have shown that stigma intensifies an outbreak. This work helps health officials control fear and stop discrimination. METHODS: In total, 125,424 Twitter and Facebook posts related to Mpox and the 2SLGBTQIAP+ community were extracted from May 1 to December 25, 2022, using Twitter application programming interface academic accounts and Facebook-scraper tools. The tweets' main topics were discovered using Latent Dirichlet Allocation in the sklearn library. The pysentimiento package was used to find the sentiments of English and Spanish posts, and the CamemBERT package was used to recognize the sentiments of French posts. The tweets' and Facebook posts' languages were understood using the Twitter application programming interface platform and pycld3 library, respectively. Using ArcGis Online, the hot spots of the geotagged tweets were identified. Mann-Whitney U, ANOVA, and Dunn tests were used to compare the sentiment polarity of different topics and countries. RESULTS: The number of Mpox posts and the number of posts with Mpox and 2SLGBTQIAP+ keywords were 85% correlated (P<.001). Interestingly, the number of posts with Mpox and 2SLGBTQIAP+ keywords had a higher correlation with the number of Mpox cases (correlation=0.36, P<.001) than the number of posts on Mpox (correlation=0.24, P<.001). Of the 10 topics, 8 were aimed at stigmatizing the 2SLGBTQIAP+ community, 3 of which had a significantly lower sentiment score than other topics (ANOVA P<.001). The Mann-Whitney U test shows that negative sentiments have a lower intensity than neutral and positive sentiments (P<.001) and neutral sentiments have a lower intensity than positive sentiments (P<.001). In addition, English sentiments have a higher negative and lower neutral and positive intensities than Spanish and French sentiments (P<.001), and Spanish sentiments have a higher negative and lower positive intensities than French sentiments (P<.001). The hot spots of the tweets with Mpox and 2SLGBTQIAP+ keywords were recognized as the United States, the United Kingdom, Canada, Spain, Portugal, India, Ireland, and Italy. Canada was identified as having more tweets with negative polarity and a lower sentiment score (P<.04). CONCLUSIONS: The 2SLGBTQIAP+ community is being widely stigmatized for spreading the Mpox virus on social media. This turns the community into a highly vulnerable population, widens the disparities, increases discrimination, and accelerates the spread of the virus. By identifying the hot spots and key topics of the related tweets, this work helps decision makers and health officials inform more targeted policies.

Global mpox research in the light of the current outbreak: demands, drivers, and obstacles.

Following the current outbreak, the mpox virus (formerly: monkeypox virus) is a highly threatening pathogen with public health significance, although mpox is still considered a neglected disease. Previously confined mainly to Africa, the virus spread globally in 2022. However, knowledge about mpox is limited, causing a distorted perception of the disease. Therefore, this study aimed to collect all information on scientific mpox publishing and to analyse them according to their chronological, geographical, and epidemiological patterns. It was not until the global outbreak that the relatively small number of publications was replaced by the immense increase in annual publication numbers. The most important player is the USA with a central role in international networking. They collaborated mainly with the Democratic Republic of Congo, a primary endemic country where the first viral clades were determined. Nigeria and other African countries were also represented, although mainly in the form of co-authorships. The fact that few of the first authors are from low- or middle-economic countries demonstrates the need to promote equitable networking at the global level and their support for surveillance and targeted immunization programmes.

[Monkeypox: the other pandemic, the other challenge]. / Viruela símica: la otra pandemia, el otro reto.

Since the emergence of monkeypox in Europe, this disease has gradually spread throughout the rest of the world. In Mexico, epidemiological notices have been issued with the main guidelines to follow in terms of epidemiological surveillance and official figures have been published regularly on a microsite weeks after the first cases. These sources of information were reviewed and analyzed, based on which observations are issued, in addition to other relevant publications on the subject, with the interest of reinforcing the surveillance of this disease in the country.

Desde el surgimiento de la viruela símica en Europa la enfermedad se ha extendido paulatinamente por el resto del mundo. En México se han emitido avisos epidemiológicos con las principales pautas a seguir en materia de vigilancia epidemiológica y publicado las cifras oficiales de forma regular en un micrositio semanas después de los primeros casos. Se revisaron y analizaron dichas fuentes de información, con base en las cuales se emiten observaciones, además de otras publicaciones relevantes del tema, con el interés de reforzar la vigilancia de esta enfermedad en el país.

Ophthalmic manifestations of monkeypox infection.

After the global COVID-19 pandemic, there has been an alarming concern with the monkeypox (mpox) outbreak, which has affected more than 110 countries worldwide. Monkeypox virus is a doublestranded DNA virus of the genus Orthopox of the Poxviridae family, which causes this zoonotic disease. Recently, the mpox outbreak was declared by the World Health Organization (WHO) as a public health emergency of international concern (PHEIC). Monkeypox patients can present with ophthalmic manifestation and ophthalmologists have a role to play in managing this rare entity. Apart from causing systemic involvement such as skin lesions, respiratory infection and involvement of body fluids, Monkeypox related ophthalmic disease (MPXROD) causes varied ocular manifestations such as lid and adnexal involvement, periorbital and lid lesion, periorbital rash, conjunctivitis, blepharocounctivitis and keratitis. A detailed literature review shows few reports on MPXROD infections with limited overview on management strategies. The current review article is aimed to provide the ophthalmologist with an overview of the disease with a spotlight on ophthalmic features. We briefly discuss the morphology of the MPX, various modes of transmission, an infectious pathway of the virus, and the host immune response. A brief overview of the systemic manifestations and complications has also been elucidated. We especially highlight the detailed ophthalmic manifestations of mpox, their management, and prevention of vision threatening sequelae.

Monkeypox resurgence and its implications for Dentistry - A scoping review.

INTRODUCTION: Monkeypox caused by the Monkeypox virus, a member of the Orthopoxvirus genus, is currently considered a major concern among healthcare authorities due to its high transmissibility rate. Currently, no specific treatment is available for this disease, due to which healthcare professionals, specifically Dentists, are required to look out for symptoms at early stages to prevent its spread. OBJECTIVE: To analyze the role of dentists in identifying Monkeypox cases and limiting its spread. METHODS: We conducted a scoping review on monkeypox and its oral manifestation. PRISMA protocols were observed in data collection. The relevant literature search was conducted in relevant databases like PubMed, Scopus, Web of Science, Embase, CINAHL, and Google Scholar. Relevant articles related to Monkeypox, and Dentistry were included in the final review. Articles published from March 2022- September 2022 were included in the review. Keywords and Mesh words related to monkeypox, and dentistry were used as part of the search strategy. RESULTS: A total of 1881 articles were reviewed, among which 7 articles were included. Dentists were strongly advised to be on high alert for Monkeypox symptoms due to their close contact with patients. Around 70% of Monkeypox cases reported oral lesions at early stages, which requires a differential diagnosis from other oral lesions. Considering this, dentists should be well-versed in this new and emerging threat. CONCLUSION: Although dentists have been shown to play an important role in the treatment of monkeypox, there is insufficient data available. More research on dentistry and monkeypox will be needed in the near future.

Emerging evidence on Monkeypox: resurgence, global burden, molecular insights, genomics and possible management.

An outbreak of monkeypox (encoded enveloped double stranded DNA), resurgence and expansion has emerged in early 2022, posing a new threat to global health. Even though, many reports are available on monkeypox, still a comprehensive updated review is needed. Present updated review is focused to fill the research gaps pertaining to the monkeypox, and an extensive search was conducted in a number of databases, including Google Scholar, Scopus, Web of Science, and Science Direct. Although the disease usually progresses self-limiting, some patients require admission for kidney injury, pharyngitis, myocarditis, and soft tissue super infections. There is no well-known treatment available yet; still there has been a push for the use of antiviral therapy and tecovirimat as a promising option when dealing with co-morbidities. In this study, we mapped and discussed the updates and scientific developments surrounding monkeypox, including its potential molecular mechanisms, genomics, transmission, risk factors, diagnosis, prevention, vaccines, treatment, possible plant-based treatment along with their proposed mechanisms. Each day, a growing number of monkeypox cases are reported, and more cases are expected in the near future. As of now, monkeypox does not have a well-established and proven treatment, and several investigations are underway to find the best possible treatment from natural or synthetic drug sources. Multiple molecular mechanisms on pathophysiological cascades of monkeypox virus infection are discussed here along with updates on genomics, and possible preventive and therapeutic strategies.

In-depth Temporal Transcriptome Profiling of Monkeypox and Host Cells using Nanopore Sequencing.

The recent human Monkeypox outbreak underlined the importance of studying basic biology of orthopoxviruses. However, the transcriptome of its causative agent has not been investigated before neither with short-, nor with long-read sequencing approaches. This Oxford Nanopore long-read RNA-Sequencing dataset fills this gap. It will enable the in-depth characterization of the transcriptomic architecture of the monkeypox virus, and may even make possible to annotate novel host transcripts. Moreover, our direct cDNA and native RNA sequencing reads will allow the estimation of gene expression changes of both the virus and the host cells during the infection. Overall, our study will lead to a deeper understanding of the alterations caused by the viral infection on a transcriptome level.

Analysis of Monkeypox viral infection with human to animal transmission via a fractional and Fractal-fractional operators with power law kernel.

Monkeypox (MPX) is a global public health concern. This infectious disease affects people all over the world, not just those in West and Central Africa. Various approaches have been used to study epidemiology, the source of infection, and patterns of transmission of MPX. In this article, we analyze the dynamics of MPX using a fractional mathematical model with a power law kernel. The human-to-animal transmission is considered in the model formulation. The fractional model is further reformulated via a generalized fractal-fractional differential operator in the Caputo sense. The basic mathematical including the existence and uniqueness of both fractional and fractal-fractional problems are provided using fixed points theorems. A numerical scheme for the proposed model is obtained using an efficient iterative method. Moreover, detailed simulation results are shown for different fractional orders in the first stage. Finally, a number of graphical results of fractal-fractional MPX transmission models are presented showing the combined effect of fractal and fractional orders on model dynamics. The resulting simulations conclude that the new fractal-fractional operator added more biological insight into the dynamics of illness.

Characteristics of 86 individuals with mpox diagnosed at Copenhagen University Hospital.

INTRODUCTION: Since the beginning of the mpox (previously called monkeypox) outbreak in 2022, almost half of cases in Denmark have been diagnosed at the Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre Hospital. This article describes the patient cohort seen at the Department with a view to increasing knowledge of mpox among colleagues who are most likely to identify future cases. METHODS: A retrospective observational study reporting patient characteristics, coinfections, clinical presentation and diagnostic delay among mpox cases diagnosed at the department between 23 May 2022 and 8 February 2023. Furthermore, a case report of a patient hospitalised with severe rectal pain is presented to highlight anorectal symptoms. RESULTS: A total of 86 patients were diagnosed with mpox, all were men who have sex with men, with a median age of 39 years. Twenty-six patients (31%) took HIV pre-exposure prophylaxis, and 20 patients (24%) were people living with HIV. All patients (100%) presented with lesions, most frequently on or around the genitals. Twenty-nine patients (35%) had anorectal discomfort or pain. Seven patients (10%) had chlamydia, 19 (26%) gonorrhoea and two (5%) syphilis. In 13 cases (15%), mpox was not suspected at the first medical consultation, mainly because symptoms were attributed to a gonorrhoeal coinfection. Five patients (6%) were hospitalised for a median of three days. CONCLUSION: As mpox may become endemic in Denmark, clinicians should remain aware of its symptoms and the risk of coinfection with sexually transmitted infections. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Characterization of immune response against monkeypox virus in cohorts of infected patients, historic and newly vaccinated subjects.

Monkeypox virus (MPXV) is a zoonotic disease endemic in the rainforest countries of Central and West Africa. Understanding the immune response in zoonosis is fundamental to prevent and contrast viral spreading. MPXV is a close relative of Variola (smallpox) virus and vaccination with vaccinia virus gives approximatively 85% of protection against MPXV. With the emergence of the recent MPXV outbreak, JYNNEOS vaccine has been proposed to individuals at high-risk of exposure. Comparative data on MPXV immune response in vaccinated or infected subjects are still limited. Here we set-up an immunofluorescence method for the evaluation of humoral response elicited by natural infection and healthy vaccinated subjects, including historically smallpox-vaccinated individuals and newly vaccinated subjects. Neutralization assay was also included, and in vaccinated subjects, cell-mediated response was evaluated. We observed that the natural infection produces a strong immune response that can control the disease. In naïve subjects, a second dose boosts the serological response to levels similar to those of the MPXV patients. Last, smallpox-vaccinated controls retain a degree of protection, even after years from vaccination, most visible in the t-cellular response.

Serological responses to smallpox A33 antigen and monkeypox A35 antigen in healthy people and people living with HIV-1 from Guangzhou, China.

People are expected to have been previously vaccinated with a Vaccinia-based vaccine, as until 1980 smallpox vaccination was a standard protocol in China. It is unclear whether people with smallpox vaccine still have antibody against vaccinia virus (VACV) and cross-antibody against monkeypox virus (MPXV). Herein, we assessed the binding antibodies with antigen of VACV-A33 and MPXV-A35 in the general population and HIV-1 infected patients. Firstly, we detected VACV antibody with A33 protein to evaluate the efficiency of smallpox vaccination. The result show that 29% (23 of 79) of hospital staff (age ≥ 42 years) and 63% (60 of 95) of HIV-positive patients (age ≥ 42 years) from Guangzhou Eighth People's Hospital were able to bind A33. However, among the subjects below 42 years of age, 1.5% (3/198) of the hospital volunteer samples and 1% (1/104) of the samples from HIV patients were positive for antibodies against A33 antigen. Then, we assessed the specific cross-reactive antibodies against MPXV A35 protein. 24% (19 of 79) hospital staff (age〉 = 42 years) and 44% (42 of 95) of HIV-positive patients (age〉 = 42 years) were positive. 98% (194/198) of the hospital staff and 99% (103/104) of the HIV patients had no A35-binding antibodies. Further, we found significant sex differences for the reactivity to A35 antigen were observed in HIV population, but no significant sex differences in hospital staff. Further, we analyzed the positivity rate of anti-A35 antibody of men who have sex with men (MSM) and non-MSM in HIV patients (age〉 = 42years). We found that 47% of no-MSM population and 40% of MSM population were positive for A35 antigen, with no significant difference. Lastly, we found only 59 samples were positive for anti-A33 IgG and anti-A35 IgG in all participants. Together, we demonstrated A33 and A35 antigens binding antibodies were detected in HIV patients and general population who were older than 42 years, and cohort studies only provided data of serological detection to support early response to monkeypox outbreak.