Actualización epidemiológica mpox en la región de las américas: 29 de octubre del 2024

A nivel global, desde enero del 2022 hasta el 30 de septiembre del 2024, se notificaron 109.699 casos confirmados de mpox, incluidas 273 defunciones, en 123 Estados Miembros de las seis Regiones de la Organización Mundial de la Salud (OMS). En septiembre del 2024, el número de nuevos casos notificados mensualmente aumento en un 8%, en comparación con el mes de agosto. La mayoría de los casos notificados en septiembre fueron reportados en la Región de África (63,6%) y la Región de las Américas (15,5%). Desde enero y hasta el 6 de octubre del 2024 se notificaron en África 7.535 casos confirmados, incluyendo 32 defunciones, en 16 países. El país más afectado sigue siendo la República Democrática del Congo, seguido de Burundi y Nigeria. Dieciséis países de la Region de África de la OMS han notificado casos de mpox en las últimas seis semanas y se considera que hay brotes activos y en curso. El clado Ib que fue reportado en la República Democrática del Congo, del cual se identificaron casos en Burundi, Kenia, Ruanda y Uganda, y que está relacionado con la declaración del Director General de la OMS de la Emergencia de Salud Pública de Importancia Internacional (ESPII), realizada el 14 de agosto del 2024, ha sido identificado en casos confirmados fuera de la Región de África de la OMS en: Alemania (n=1 caso), India (1 caso), Suecia (1 caso) y Tailandia (1 caso).

Molecular Aspects of the Monkeypox Virus and their Impact on the Virus's Change in Epidemiology.

OBJECTIVE: Monkeypox is a viral zoonotic disease endemic to West and Central Africa; it has been reported in more countries during the last decade than in the previous 40 years. In 2022 a multinational outbreak occurred. This change in the epidemiology of the virus may represent an evolutionary adaptation. The purpose of this study is to analyze the molecular aspects of Monkeypox virus (MPXV) disease that may explain the latter's change in epidemiology during the 2022 outbreak. METHODS: From July 2022 through December 2022, the period of the outbreak, a narrative review was conducted on the available literature, with a total of 271 articles published in the MEDLINE/PubMed and LILACS databases being examined. The chosen articles were organized using the search and reference manager Mendeley Desktop 1.19.4. Duplicates and articles that did not meet the study's objective were eliminated, resulting in the selection of 49 articles for the present review. DISCUSSION: MPXV resurgence poses challenges due to waning immunity and changing epidemiological patterns. Recent outbreaks show different transmission routes, affecting new demographics. Genomic evolution, vaccination history, and potential new animal reservoirs complicate containment efforts. Continued surveillance and vaccination are crucial for control. CONCLUSIONS: It seems possible that MPXV has (re-)emerged to occupy the ecological niche left by the smallpox virus. Mutations of the apolipoprotein B mRNA editing enzyme, catalytic subunit 3G motif, in MPXV clade IIb since 2017 may explain the epidemiological change that has occurred in recent years. This pattern could be due to sustained transmission in a new host or a new route of infection.

Emergence of monkeypox virus in central Argentina: Epidemiological features and first complete genome sequences in the country.

Monkeypox (Mpox) is a zoonotic disease caused by the monkeypox virus (MPXV). MPXV can be transmitted by close contact with lesions, body fluids, respiratory droplets, and contaminated materials. A new pattern of spread among sexual networks has been recently described. The present work aimed to report the epidemiological and genomic characterization of the 2022 MPXV outbreak in central Argentina. A total of 113 scabs and/or lesion swab specimens were studied. MPXV infection was confirmed in 46.0% of the studied patients, all of whom were men. Varicella-zoster virus infection was the most frequent differential diagnosis. Eight complete viral genomes were obtained by next-generation sequencing. The Argentinian sequences were grouped intermingled with other sequences from the 2022 MPXV outbreak, related to samples from the USA, Europe, and Peru. Taken together, our study provided an initial assessment of the genetic and epidemiological characteristics of the 2022 MPXV outbreak in Córdoba, Argentina.

Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations.

Monkeypox (MPX), an orthopoxviral disease endemic in Africa, is now a public health emergency of international concern (PHEIC) as declared by the World Health Organization in July 2023. Although it is generally mild, the overall case fatality rate was reported to be 3%, and the basic reproduction number (R0) is > 1 in men who have sex with men (MSM, i.e., Portugal (1.4), the United Kingdom (1.6), and Spain (1.8)). However, R0 is < 1 in other settings. In concordance with the smallpox virus, it is also expected to increase the risk of adverse outcomes for both the mother and the fetus. The outcomes of the disease in an immunocompromised state of pregnancy are scary, showing high mortality and morbidity of both mother and fetus, with up to a 75% risk of fetal side effects and a 25% risk of severe maternal diseases. Therefore, it warrants timely diagnosis and intervention. The reverse transcription polymerase chain reaction (RT PCR) test is the standard approach to diagnosis. We summarized the recent findings of MPX on pregnancy, and the associated risk factors. We also give recommendations for active fetal surveillance, perinatal care, and good reporting to improve outcomes. The available vaccines have shown promise for primary disease prevention.

Epidemiological and clinical characteristics of monkeypox among people with and without HIV in Peru: a national observational study.

BACKGROUND: In Latin America, Peru has the second highest number of cases of monkeypox (Mpox), of which more than 50 % are Human Immunodeficiency Virus (HIV)-positive. Here, we compared the epidemiological and clinical characteristics of Mpox between people with and without HIV in Peru. METHODS: We conducted a national retrospective study using data on confirmed cases of Mpox reported by the Peruvian National Surveillance System from 15 June 2022 to 31 December 2023. RESULTS: A total of 3561 confirmed cases of Mpox were included. Of these, 2123 (60 %) patients were people living with HIV (PLWH), with increased odds for those aged 30 years or older, homosexual (adjusted odds ratio [aOR] 8.58 [6.95-10.59], p<0.0001), bisexual (aOR=4.44 [3.46-5.69], p<0.0001), sex workers (aOR=2.24 [1.07-4.68], p=0.032), people with a history of syphilis (aOR=2.07 [1.66-2.58], p<0.001), and hospitalized (aOR=3.08 [2.03-4.68], p<0.001). PLWH were more likely to have proctitis (aOR=1.73 [1.26-2.37], p=0.001). The overall mortality was 20 of 3561 (0.56 %). Among PLWH and Mpox, more deaths occurred in hospitalized (p<0.001) and non-ART (p<0.001) individuals. CONCLUSION: Our findings highlight that HIV infection among Mpox cases in Peru is associated with high-risk sexual behaviour and a high likelihood of hospitalization.

High Global Health Security Index is a determinant of early detection and response to monkeypox: A cross-sectional study.

INTRODUCTION: Recent outbreaks of monkeypox (Mpox) have occurred in countries outside of Africa, with large numbers of cases spreading rapidly to almost every continent. We aimed to analyze the correlation between the Global Health Security (GHS) Index (categories and indicators) and the Mpox case rate in different regions and globally. METHODS: In this cross-sectional study, we used data from Mpox cases from the WHO, and the GHS categories and indicators for detection, prevention, reporting, health system, rapid response, international norms compliance, and risk environment. Outcome measures were the relationship between GHS index (categories and indicators) and Mpox case rate using crude and adjusted non-linear regression models. RESULTS: After performing adjusted analyses, only risk environment and detection and reporting index were associated with Mpox case rates in the 99 countries and the Region of the Americas, respectively. Antimicrobial resistance (AMR) indicators of the prevention category, risk communication of the rapid response category, the joint external evaluation and performance veterinary services of the norms category, and the infrastructure adequacy of the risk environment category were associated with Mpox case rates in the 99 countries (p<0.05). Laboratory systems strength and quality indicator of the detection and reporting category, and emergency response operation indicator of the response rapid category were associated with Mpox case rates in the countries of the region of the Americas (p<0.05). AMR indicator of the prevention of the emergence category, and the infrastructure adequacy of the risk environment category were associated with Mpox case rates in the countries of the European Region (p<0.05). In the countries of the other regions, only the trade and travel restrictions indicator of the rapid response category was associated with Mpox case rates (p<0.05). CONCLUSIONS: Countries, particularly in the Americas region, with high levels of infrastructure adequacy and laboratory system strength and quality as measured by the GHS index are better equipped to detect more Mpox cases. Therefore, they have higher Mpox case detection rates and can successfully respond to Mpox outbreaks.

Differential diagnosis of exanthematous viruses during the 2022 Mpox outbreak in Minas Gerais, Brazil.

The monkeypox virus (MPXV) outbreak, primarily endemic to Africa, has spread globally, with Brazil reporting the second-highest number of cases. The emergence of MPXV in non-endemic areas has raised concerns, particularly due to the co-circulation of other exanthematous viruses such as varicella-zoster virus (VZV) and molluscum contagiosum virus (MOCV). To perform an accurate differential diagnosis of MPXV during the ongoing outbreak in Minas Gerais, Brazil, a 5PLEX qPCR assay targeting orthopoxviruses (OPV), VZV, and MOCV was used to retrospectively analyze all clinical samples that tested negative for MPXV in the initial screening conducted at Funed. In summary, our study analyzed 1,175 clinical samples received from patients suspected of MPXV infection and found a positivity rate of 33.8% (397 samples) for MPXV using the non-variola qPCR assay. Testing the 778 MPXV-negative clinical samples using the 5PLEX qPCR assay revealed that 174 clinical samples (22.36%) tested positive for VZV. MOCV DNA was detected in 13 and other OPV in 3 clinical samples. The sequencing of randomly selected amplified clinical samples confirmed the initial molecular diagnosis. Analysis of patient profiles revealed a significant difference in the median age between groups testing positive for MPXV and VZV and a male predominance in MPXV cases. The geographic distribution of positive cases was concentrated in the most populous mesoregions of Minas Gerais state. This study highlights the challenges posed by emerging infectious diseases. It emphasizes the importance of epidemiological surveillance and accurate diagnosis in enabling timely responses for public health policies and appropriate medical care. IMPORTANCE: Brazil ranks second in the number of cases during the global monkeypox epidemic. The study, conducted in Minas Gerais, the second most populous state in Brazil with over 20 million inhabitants, utilized differential diagnostics, revealing a significant number of positive cases for other exanthematous viruses and emphasizing the need for accurate diagnoses. During the study, we were able to assess the co-circulation of other viruses alongside monkeypox, including varicella-zoster virus, molluscum contagiosum virus, and other orthopoxviruses. The significance of the research is underscored by the concentration of positive cases in populous areas, highlighting the challenges posed by emerging infectious diseases. This demographic context further amplifies the importance of the research in guiding public health policies and medical interventions, given the substantial population at risk. The study not only addresses a global concern but also holds critical implications for a state with such a large population and geographic expanse within Brazil. Overall, the study emphasizes the pivotal role of surveillance and precise diagnosis in guiding effective public health responses and ensuring appropriate medical interventions.

Exploring the Genomic Dynamics of the Monkeypox Epidemic in Paraguay.

In recent months, Paraguay has been grappled with a notable monkeypox outbreak, straining its healthcare infrastructure. The sudden spike in cases underlines the imperative need for a comprehensive understanding of the virus's dynamics, enabling the formulation of robust containment measures. To address this challenge, our team joined forces with the Central Public Health Laboratory of Asunción and the Pan-American Health Organization. Through this collaboration, we employed portable whole-genome sequencing combined with phylodynamic analysis to examine the MPXV strains circulating in Paraguay. Our genomic monitoring approach has produced the first 30 whole-genome sequences from Paraguay, all of which were identified under lineage IIb. Interestingly, our data suggest that the origin of the monkeypox virus in Paraguay at the beginning of 2022 can be traced back to Brazil. This introduction subsequently catalyzed further community spread that was further exacerbated by several independent introduction events as time progressed. These findings not only shed light on the transmission patterns of the virus but also highlight the pivotal role such insights play in sculpting effective response strategies and driving impactful public health measures. Furthermore, our findings strongly advocate intensified surveillance at international borders, ensuring swift detection and proactive countermeasures against potential outbreaks in the future.

[Monkeypox: characteristics in female population, Buenos Aires, Argentina]. / Viruela símica: características en población femenina, Buenos Aires, Argentina.

Monkeypox is a zoonotic viral disease caused by a virus of the genus Orthopoxvirus. As of January 1, 2022, it has been reported in 110 WHO Member States. It presents with fever, fatigue, painful lymphadenopathy, and rash. It lasts between 2 and 4 weeks. It is usually self-limited, but severe cases have been described in immunocompromised people. This study describes cases of monkeypox in women, diagnosed between June 2022 and February 2023, and it reports epidemiology, clinical aspects, and complications after infection. A retrospective observational study was carried out in the Febrile Emergency Unit (UFU), reviewing positive cases (RT-PCR) for monkeypox and the population with female biological sex was selected. They were questioned about gynecological complications, menstrual pattern, dyspareunia and pelvic pain. 340 consultations for monkeypox were made, 214 (63%) were positive, 211 cases (99%) male and 3 cases (1%) female. Among these cases is a trans woman, who was not included. The average age is 31 years, immunocompetent, with a negative serology report for HIV, syphilis, hepatitis B and C. Both cases had sexual intercourse without a barrier method. The most frequent symptoms are asthenia and skin lesions, especially in the upper and lower limbs, perianal and genital region. As a risk factor they presented unprotected sexual contact. Within the differential diagnoses, other sexually transmitted infections (STIs) should be considered. There were no gynecological complications reported during follow-up.

La viruela símica es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus. Desde el 1 de enero de 2022, se ha notificado en 110 Estados Miembros de la OMS. Se presenta con fiebre, astenia, linfoadenopatías dolorosas y exantema. Dura entre 2 y 4 semanas. Suele ser autolimitada y se han descrito casos graves en personas inmunocomprometidas. El presente trabajo describe casos de viruela símica en mujeres, diagnosticados entre junio del 2022 y febrero del 2023 Se realizó un estudio observacional retrospectivo en la Unidad Febril de Urgencias (UFU), revisando casos positivos (RT-PCR) para viruela símica y se seleccionó la población con sexo biológico femenino. Se consultó sobre complicaciones ginecológicas, patrón menstrual, dispareunia y dolor pélvico. Se realizaron 340 consultas por viruela símica, 214 (63%) fueron positivos, 211 casos (99%) de sexo masculino y 3 casos (1%) femeninos. Dentro de estos casos se encuentra una mujer trans, la cual no se incluyó. La edad promedio es de 31 años, inmunocompetentes, con reporte de serologías negativas para HIV, sífilis, hepatitis B y C. Ambos casos mantuvieron relaciones sexuales sin método de barrera. Los síntomas más frecuentes fueron astenia y lesiones en piel, sobre todo en miembros superiores e inferiores, región perianal y genital. Como factor de riesgo presentaron contacto sexual sin protección. Dentro de los diagnósticos diferenciales, debe tenerse en cuenta otras infecciones de transmisión sexual (ITS). En seguimiento epidemiológico no refirieron complicaciones ginecológicas.

Monkeypox infection and pregnancy in lower and middle-income countries: Precautions & recommendations

Abstract Monkeypox (MPX), an orthopoxviral disease endemic in Africa, is now a public health emergency of international concern (PHEIC) as declared by the World Health Organization in July 2023. Although it is generally mild, the overall case fatality rate was reported to be 3%, and the basic reproduction number (R0) is > 1 in men who have sex with men (MSM, i.e., Portugal (1.4), the United Kingdom (1.6), and Spain (1.8)). However, R0 is < 1 in other settings. In concordance with the smallpox virus, it is also expected to increase the risk of adverse outcomes for both the mother and the fetus. The outcomes of the disease in an immunocompromised state of pregnancy are scary, showing high mortality and morbidity of both mother and fetus, with up to a 75% risk of fetal side effects and a 25% risk of severe maternal diseases. Therefore, it warrants timely diagnosis and intervention. The reverse transcription polymerase chain reaction (RT PCR) test is the standard approach to diagnosis. We summarized the recent findings of MPX on pregnancy, and the associated risk factors. We also give recommendations for active fetal surveillance, perinatal care, and good reporting to improve outcomes. The available vaccines have shown promise for primary disease prevention.

La viruela sísmica aspectos relacionados a la fisiopatología, genoma, patogénesis, transmisión, replicación e inmunología / Aspects Related to pathophysiology, Genome, Pathogenesis, Transmission, Replication and Immunology of Monkeypox

Introducción: La viruela símica es una enfermedad zoonótica identificada por primera vez en 1958. El virus es un miembro del género Orthopoxvirus, de la familia Poxviridae. Infecta a una amplia variedad de mamíferos y se desconoce su reservorio natural. Objetivos: Describir los aspectos importantes relacionados a la fisiopatología, genoma, patogénesis, transmisión, replicación e inmunología de la viruela símica. Métodos: Se realizó una búsqueda de artículos originales, reportes de casos, revisiones bibliográficas y sistemáticas en el Portal Regional de la BVS, PubMed, Science, Nature y Lancet. Se consultaron los informes de la Organización Mundial de la Salud y la Organización Panamericana de la Salud sobre la viruela símica. Resultados: La propagación del virus de la viruela símica puede ocurrir a través del contacto cercano con lesiones, fluidos corporales, gotitas respiratorias y objetos contaminados. Una vez dentro del organismo, el virus infecta mucosas, células epiteliales y células inmunitarias de los tejidos adyacentes. El virus se replica y disemina rápidamente a través del sistema hemático y linfático. Las células T desempeñan un papel importante en la regulación de la respuesta inmunitaria contra el virus. Sin embargo, los Orthopoxvirus han desarrollado varios mecanismos para la evasión de la respuesta inmunitaria. Conclusiones: Los aspectos importantes descritos que se tuvieron en cuenta acerca de la transmisión de la viruela símica han tenido cambio significativo con el tiempo. El brote mundial de viruela símica de 2022 presentó una cadena de transmisión principalmente entre humanos asociada al contacto sexual(AU).

Introduction: Monkeypox is a zoonotic disease that was first identified in 1958. The virus is a member of Orthopoxvirus genus, of Poxviridae family. It infects wide variety of mammals and its natural reservoir is unknown. Objectives: To describe the important aspects related to pathophysiology, genome, pathogenesis, transmission, replication and immunology of monkeypox. Methods: A search of original articles, case reports, bibliographic and systematic reviews was carried out in VHL Regional Portal, PubMed, Science, Nature and Lancet. Reports from the World Health Organization and the Pan American Health Organization on monkeypox were consulted. Results: Spread of monkeypox virus can occur through close contact with lesions, body fluids, respiratory droplets, and contaminated objects. Once inside the body, the virus infects mucous membranes, epithelial cells and immune cells of adjacent tissues. The virus replicates and spreads rapidly through the blood and lymphatic system. T cells play an important role in regulating the immune response against the virus. However, Orthopoxviruses have developed several mechanisms to evade the immune response. Conclusions: The important aspects described, taken into account about monkeypox transmission, have significantly changed over time. 2022 global monkeypox outbreak presented a chain of transmission primarily among humans associated with sexual contact(AU)

Asociación entre las tendencias de búsqueda en internet con el número de casos confirmados por la viruela símica: estudio multinacional en diez países / Association between internet search trends and the number of confirmed monkeypox cases: a multinational study in ten countries

INTRODUCCIÓN: La viruela símica es una infección zoonótica que se ha distribuido por todo el mundo. La búsqueda de información en internet refleja el interés y concientización de la población acerca de salud. OBJETIVO: Determinar la asociación entre el volumen relativo de búsquedas en internet con el número de casos confirmados por la viruela símica en diez países. MÉTODOS: Se realizó un estudio obser- vacional, analítico, retrospectivo, utilizando la herramienta Google Trends (GT™) para encontrar el volumen relativo búsqueda (VRB) sobre viruela símica desde 01 de enero al 31 de agosto del 2022 usando términos de búsqueda en el idioma oficial de los 10 países con mayor número de casos en dichas fechas, registrado por Our World in Data. Para establecer la relación lineal entre el VRB con los nuevos de casos por día se usó el coeficiente de correlación de Pearson con un nivel de significancia (p ≤ 0,05). RESULTADOS: Se encontró un coeficiente de correlación de Pearson fuerte en Brasil (Rp = 0,562,p = 0,001), y débil en países como Alemania (Rp = 0,281, p = 0,004), Estados Unidos de Norteamérica (Rp = 0,255, p = 0,008), España (Rp = 0,122, p = 0,213), Perú (Rp = 0,120, p = 0,333), Canadá (Rp = 0,116, p = 0,238), Francia (Rp = 0,095, p = 0,335), Reino Unido (Rp = 0,085, p = 0,362), Portugal (Rp = 0,024, p = 0,805) y Países Bajos (Rp = 0,067, p = 0,497). CONCLUSIÓN: Nuestro estudio evidencio que el VRB presento una relación positiva con el número de nuevos casos de viruela símica. Asimismo, se observo un coeficiente de correlación fuerte en Brasil, y en el resto de países fue débil.

BACKGROUND: Smallpox is a zoonotic infection that has been distributed worldwide. The search for information on the Internet reflects the interest and awareness of the population about health. AIM: To determine the correlation between the relative volume of internet searches and the number of confirmed cases of smallpox in ten countries. METHODS: An observational, analytical, retrospective study was conducted using the Google Trends (GT™) tool to find the relative search volume (RSV) on monkeypox from January 1 to August 31, 2022 using search terms in the official language of the 10 countries with the highest number of cases on those dates, as recorded by Our World in Data. To establish the relationship between RSV and new cases per day, Spearman's correlation was used with a significance level (p ≤ 0.05). RESULTS: A. strong Pearson correlation coefficient was found in Brazil (Rp = 0.562, p = 0.001), and weak in countries like Germany (Rp = 0.281, p = 0.004), United States (Rp = 0.255, p = 0.008), Spain (Rp = 0. 122, p = 0.213), Peru (Rp = 0.120, p = 0.333), Canada (Rp = 0.116, p = 0.238), France (Rp = 0.095, p = 0.335), United Kingdom (Rp = 0.085, p = 0.362), Portugal (Rp = 0.024, p = 0.805) and Netherlands (Rp = 0.067, p = 0.497). CONCLUSION: Our study showed that RSV had a positive relationship with the number of new cases of smallpox. Also, a strong correlation coefficient was observed in Brazil, while the rest of the countries showed a weak correlation coefficient.