The Challenges of Monkeypox

Monkeypox is a neglected tropical zoonotic disease endemic in the tropical rainforest regions of Central and West Africa. The virus causing it, the Monkeypoxvirus (MPXV), is so-called because it was first found in Cynomolgus monkeys, in Denmark, back in 1958. However, primates, including humans, are now suspected to be only incidental hosts, though there is little evidence to support the hypothesis that small mammals, including rodents, are the natural hosts.

Since the first human case of monkeypox in 1970, several outbreaks have been reported, mostly in the Democratic Republic of Congo and Nigeria, with over 19,000 cases documented over the two decades from 2000-2019. Since then, almost 16,000 cases have been reported from 2021-22. This indicates the rapidly increasing scale of infection.

This could be due to many different reasons: better surveillance and reporting, cutting down of forests and thus greater contact with animal reservoirs, loss of poxvirus immunity as the present generation is not immunized against smallpox and mutations in the monkeypox virus that drive higher rates of spread among humans. At present, the reproductive number is calculated as being above 2, up from earlier estimates of 0.8 and 0.6 from the 80s and again from the first decade of this millennium.

The infection is diagnosed by PCR of a swab from a lesion, though genomic sequencing is also useful to track its phylogenetic development. Virology and serology are limited at present, the one for use by reference laboratories and the other for public health surveillance or studies, especially since the antibodies are cross-reactive to multiple Orthopoxviruses.

Without specific antiviral treatments for this disease, brincidofovir and tecovirimat are two orally effective experimental agents that have been approved by the Food and Drugs Administration (FDA) against smallpox in animal studies. The latter received approval in its intravenous form also, where indicated. Their efficacy against monkeypox remains to be established.

In detail: https://www.tridhascholars.org/press-release/the-challenges-of-monkeypox-illustrated-in-review-and-case-study.php