Confirmed and Suspected Cases

Monkeypox
- Monkeypox is a zoonotic disease caused by a Poxvirus known as monkeypox virus.
- Monkeypox disease results in a smallpox-like disease in humans although it is less severe than smallpox. In general, symptoms begin with fever, headache, muscle pains and feeling tired.
- Monkeypox is usually a self-limited disease with the symptoms lasting from 2 to 4 weeks.
- A rash usually appears 1–3 days after the onset of fever and lymphadenopathy, with lesions appearing simultaneously, and evolving at a similar rate. Their distribution is mainly peripheral but can cover the whole body during a severe illness.
- Human-to-human transmission is relatively inefficient, and this can result from close contact with respiratory secretions, skin lesions of an infected person or recently contaminated objects.
- In general, outbreaks occur occasionally in sub-Saharan Africa after someone comes in contact with an infected wild animal, and infected travelers sometimes carry the disease to other countries.
Monkeypox virus
The virus is closely related to smallpox and vaccinia viruses. Smallpox vaccination was approximately 85% protective against monkeypox
Two distinct genetic clades of the monkeypox virus: the West African clade and the Central African (Congo Basin) clade.
The West African clade demonstrates a case fatality rate (CFR) <1%, and no human-to-human transmission was documented previously.
The Central African clade shows a CFR up to 11% and causes more severe disease and human-to-human transmission.
Current Outbreaks of Monkeypox
Monkeypox outbreaks have been reported in over 60 countries globally.
Current global outbreaks are caused by the West African clade. It is not clear if they represent mutant strains with increased transmissibility or pathogenicity.
Most of the cases have lesions exclusively perigenital, perianal, and around the mouth.
Almost all of the cases include men aged 20–50, many of whom are gay, bisexual and have sex with men.
It is unclear whether sexual transmission is a contributing factor to current outbreak. One of the hypotheses is its transmission after close contact with lesions.
Available Vaccines
ACAM2000: similar to the vaccine used during the smallpox eradication campaign.
Jynneos: a nonreplicating form of vaccinia and explicitly approval for monkeypox.
News
- 2 new cases of mpox detected in N.J.
NJ.com, June 2, 2023 - Mpox could resurge this summer, CDC warns. Here’s why and how to stay safe
The Dallas Morning News, June 1, 2023 - Wastewater data unveils underreported Mpox cases in Texas
News Medical, May 31, 2023 - Monkeypox, now known as mpox, showing signs of return
Washington Post, May 12, 2023 - ‘The disease will be neglected’: scientists react to WHO ending mpox emergency
Nature, May 12, 2023 - Mpox is no longer a global health emergency, WHO announces
NBC News, May 11, 2023 - HIV Patients Fare Well with Mpox Treatment
Weill Cornell Medicine, May 5, 2023 - First mpox case in NSW (Australia) for six months sparks health warning
The Guardian, May 4, 2023 - Vigilance needed despite encouraging mpox situation: WHO/Europe launches key considerations for control and elimination
WHO, April 27, 2023 - Pakistan confirms its first case of mpox
Al Jazeera, April 26, 2023
Useful Links
Publications
- Pathogenesis of the circulating mpox virus and its adaptation to humans
PNAS, March 20, 2023 - Effectiveness of one dose of MVA–BN smallpox vaccine against mpox in England using the case-coverage method: an observational study
Lancet Infectious Diseases, March 13, 2023 - Mpox respiratory transmission: the state of the evidence
Lancet Microbe, March 7, 2023 - An Mpox-Related Death in the United States
NEJM, March 8, 2023 - First case of mpox diagnosed in Queensland, Australia: clinical and molecular aspects
Medical Journal of Australia, March 6, 2023 - Clade IIb A.3 monkeypox virus: an imported lineage during a large global outbreak
Lancet Infectious Diseases, February 21, 2023 - Mpox in people with advanced HIV infection: a global case series
Lancet, February 21, 2023 - Virulence differences of mpox (monkeypox) virus clades I, IIa, and IIb.1 in a small animal model
PNAS, Feb 14, 2023 - Clinical features, antiviral treatment and patient outcomes: a systematic review and comparative analysis of the previous and the 2022 mpox outbreaks
JID, February 3, 2023 - Real-world effectiveness of a single dose of mpox vaccine in males
Nature Medicine, January 31, 2023 - Novel severe oculocutaneous manifestations of human monkeypox virus infection and their historical analogues
Lancet infectious diseases, Jan 23 2023
References
- Nature. Monkeypox goes global: why scientists are on alert. https://www.nature.com/articles/d41586-022-01421-8
- Shchelkunov SN, Marennikova SS, Moyer RW. Orthopovxiruses Pathogenic for Humans. Chapter: Classification of Poxviruses and Brief Characterization of the Genus. New York, NY: Springer (2005)
- Ladnyi ID, Jezek Z, Fenner F, Henderson DA, Arita I. Smallpox and its Eradication Chapter: Human Monkeypox and Other Poxvirus Infections of Man. Geneva: World Health Organization (1988).
- Fine PE, Jezek Z, Grab B, Dixon H. The transmission potential of monkeypox virus in human populations. Int J Epidemiol. 1988; 17(3):643–650.
- Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022 Feb 11;16(2):e0010141. doi: 10.1371/journal.pntd.0010141. PMID: 35148313; PMCID: PMC8870502.
- Science. Monkeypox outbreak questions intensify as cases soar. https://www.science.org/content/article/monkeypox-outbreak-questions-intensify-cases-soar
- Sklenovská N, Van Ranst M. Emergence of Monkeypox as the Most Important Orthopoxvirus Infection in Humans. Front Public Health. 2018 Sep 4;6:241.
- Nature. Monkeypox goes global: why scientists are on alert. https://www.nature.com/articles/d41586-022-01421-8