MONKEYfacts

Is monkeypox the next pandemic?

MPX
PLE High-yield

Risk factors, Transmission, Signs/Symptoms

https://ourworldindata.org/monkeypox
 MPX cases from ENDEMIC COUNTRIES
N = 1, 315

Country No. of confirmed cases No. of deaths

Cameroon 25 <5

Central Africa 6 <5

Congo 1238 57

Nigeria 46 0
First confirmed monkeypox detected: JULY 29, 2022 (33/M)
NLE High-yield
• Incident 1: Single isolated case imported from Nigeria
– 116 contacts identified (including HCWs), none developed MPX

• Incident 2: Household cluster (2 cases)

– No travel link and no source of infection identified
– 98 contacts identified (including HCWs), none developed MPX

• Incident 3: Community transmission (82 cases)

– All males
– Median age 38 years (IQR: 32-43 years)
– 18 reported foreign travel to multiple countries outside Africa
– 83% identified as gay, bisexual, or men who have sex with men (MSM)
– Sexual histories: identified links to sex parties and use of dating apps both in
the UK and abroad suggesting transmission in sexual networks
– 356 community (non-hospital) contacts identified (23%household, 22% sexual, 25%
friend/shared space, 23% workplace, 7% community healthcare)

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.22.2200422
• Study reports preliminary findings from 27 cases in Portugal
– All male
– Median age 33 years (range from 22-51 years)
– “Almost all” identified as MSM (one person reported having sex with only
women)
– Most (14 out of 16 persons with data) reported sex with multiple partners
– Most common symptoms: rash (n=14), inguinal lymphadenopathy (n=14), fever
(n=13), genital ulcers (n=6)
– No deaths
• Skin lesions started in the perianal and genital areas in some patients
• Exposures: saunas used for sexual encounters and/or travel abroad
• Earliest symptom onset: April 29th
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.22.2200424
Ano ang response ng Pilipinas?
 Understanding Monkeypox
A viral disease that is
caused by infection with
monkeypox virus.
NLE High-yield:
✓ dsDNA virus
✓ Genus: orthopoxvirus
✓ Family: Poxviridae
MPX
Monkeypox is a zoonosis: a
disease that is transmitted
from animals to humans.
Zoonotic = animals to
humans
Human-to-human transmission is
limited. with the longest
documented chain of transmission
being 6 generations.
Detection of viral DNA by polymerase chain
reaction (PCR) is the preferred laboratory test
for monkeypox.
Remerging human pathogens
Initial discover in monkeypox is in a DANISH
LAB in 1958
First human case 9 year old boy in the
democratic republic of Congo in 1970
HUMAN MONKEYPOX (MPX).
 Human MPX smallpox-like disease mainly reported in the
rainforests of central and western Africa caused by an
orthopoxvirus.
 First case detected in a child from Basankusu village,Equateur
province, DRC, in 1970 after smallpox global eradication.
NLE: West and Central Africa
 Travel associated outbreak in UK (May 2022)
 On July 23, 2022 – WHO declared outbreak of MPX
 Transmission: contact with infected rodent or monkey(72%) or MPX
with a patient (28%). High-yield
 Majority of patients: children(86%) and non smallpox
2
vaccinated adults.
NLE High-yield:
✓ dsDNA virus
✓ Genus: orthopoxvirus
✓ Family: Poxviridae

MPX
High-yield
 MPX RISK FACTORS FOR CHILDREN

•Trapping.
•Hunting
•Handling.
•Dead rodents found
in the forest are Gambian
source of food Rats
Reservoir:
1. Rodents
MPX 2. Apes
High-yield
3. Monkeys
4. Human* 5
 MPX RISK FACTOR FOR ADULT
• Monkeys
found dead in Trapping
the forest are Hunting
source of food
• High-risk sexual
behavior
• Men who have sex with
men (MSM) with
multiple partners
• Occupational exposure
• Exposure to animal
reservoirs

6
Transmission
• Contact through cutaneous or mucosal lesions and or body
fluids
• Sex
• Kissing
• Hugging MPX
• Massaging NLE High-yield

• Respiratory droplet transmission

• Vertical Transmission
• Fomite transmission (contaminate clothes , bed sheets)
• Anima-to-animal transmission = bite or scratch from an
infected animal
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.22.2200421
MPX
NLE High-yield
Incubation period

•Range: 5-21 days

•Average: 7-14 days
•A person is NOT
contagious during
MPX
incubation period NLE High-yield
CLINICAL SEVERITY SCORE OF MPX
MPX
BASED ON NUMBER/LESIONS (WHO) High-yield

❑ I. Mild illness(<25 skin lesions ), no disability.

❑ II. Moderate illness (25-99 lesions), unable to perform
most physical activities but does not require nursing
cares.
❑ III. Severe illness (100-250 skin lesions), unable to
perform most physical activities and requires nursing
cares.
❑ IV. Grave illness (>250 skin lesions), unable to perform
most physical activities and requires intensive nursing
cares.
 NLE High-yield:

VIRAL PRODROME
- Last 1-4 days
- Fever
- Cough
- Sore throat
- LAD
- A person
MAYBE
contagious

MPX
High-yield

NLE High-yield (no LAD in chickenpox and smallpox

https://www.cdc.gov/mmwr/volumes/71/wr/mm7123e1.htm?s_cid=mm7123e1_w
Characteristic of rash

MPX
NLE High-yield
NLE High-yield
NLE High-yield
• Uniformly progresses from macules to papules, vesicles and pustules,
then to scabs and scars.
• Note: (This is in contrast to chickenpox rash that appears in various
stages of development)
• Firm, well circumscribed, measuring 0.5-1 cm in diameter
• Initially painful then pruritic
• Rash period: Slow, 2 - 4 weeks
• Rash distribution: Starts on mouth, head; more dense on face and limbs;
appears on palms and soles (mouth>face> arms/legs>hands/feet
• Duration of disease: Long, usually between 3 and 4 weeks
• A person is CONTAGIOUS from the onset of rash until scab
NLE High-yield
Rash resolved
• Pitted scars and/or areas of lighter or darker skin may
remain after scabs have fallen off. Once all scabs have fallen
off and a fresh layer of skin has formed, a person is no
longer contagious.
MPX
High-yield
MPX
High-yield
MPX
High-yield
Diagnostic Test
❑ PCR (preferred lab test given its accuracy
and sensi) + skin lesions
❑What are the indications of RT-PCR? Clinical suspicion and the presence
of one of more:
1. A similar rash
2. Confirmed or probable monkeypox
3. Risk factors for monkeypox infection
4. Travel to a country with MPX cases
5. Contact with animals derived from known animals MPX carriage
Remain isolated while awaiting for the result of RT-PCR
Diagnosis
Rule out other rash illnesses
• Chickenpox = Varicella IgM/IgG
• Measles – Measles IgM/IgG
• Bacterial skin infections- GS CS
• Scabies – characteristic is “burrow”
• Syphilis – palms and soles involvement, RPR/VDRL
• Drug-induced allergies
Other diagnostic tests
• PCR of skin lesion
• GeneXpert MPX assay is also highly sensitive and specific
• Viral isolation by cell culture (indicate the presence of
virus) – not yet available in Philippines
• ELISA – detect EXPOSURE to the virus , not available in
Philippines
• Histopath (skin biopsy)→ ballooning degeneration of
keratinocytes, prominent spongiosis, dermal edema and
acute inflammation -→ but non specific
• Electron microscope →
Other Diagnostic tests for severity assessment
MONKEYPOX LAB RESULTS: COVID-19 LABORATORY DIAGNOSIS
• CBC: • RT PCR of nasopharyngeal swab –
• Leukocytosis GOLD STANDARD
• Lymphocytosis • Rapid Antigen – low sensitivity
• Thrombocytopenia • CBC: Leukopenia and Lymphopenia
• Transaminitis • BUN and Crea – high
• Low BUN • AST/ALT, TB – high
• Hypoalbuminemia • Cytokine release/storm – Ferritin, D-
MPX dimer, CRP and IL-6
NLE High-yield • Low procalcitonin
MANAGEMENT of MPX
• Supportive care – antipyretics, hydration if with losses
• Keep skin clean, dry with lesions covered with sterile
wound dressing
• Change bed lines at regular intervals
• Antibacterial treatment – if with superimposed
bacterial infection
• (Cloxacillin or clindamycin)
MANAGEMENT of MPX
❑ Supportive care
❑ No proven antiviral therapy. Currently, NO STRONG
RECOMMENDATION FOR USE FROM ANY INTERNATIONAL GUIDANCE
❑ TECOVIRIMAT: Antiretroviral agent that was developed for SMALLPOX
was licensed by EMA for monkeypox 2022 based on data in animal and
human studies
❑ Others: CIDOFOVIR, BRINCIDOFOVIR (USA) and VIG
❑ Isolation control and quarantine
❑ Primary prevention: surveillance and rapid identification of case
❑ JYNNEOS = 2 doses given 4 weeks apart (vaccine is effective 2 weeks after 2nd
dose)
❑ 85% effective in preventing monkeypox
❑ ACAM2000 = single dose (vaccine is effective after 28 days)
 Treatment and Prevention
01
No specific proven or safe
treatments or vaccines available.
Treatment of monkeypox patients
is supportive dependent on the
symptoms.
04
Avoid contact with wild animals
that could harbour the virus, and
consumption of bush meat.
Ex monkey, squirrels
02
Maintain a high standard of
personal hygiene, including
frequent hand washing after
going to the toilet, or when
hands are soiled.
05
Returning travellers, especially from areas
affected by monkeypox, should seek
immediate medical attention and RT-PCR if
they develop any disease symptoms within
three weeks of their return.
03
Avoid direct contact with skin lesions
of infected living or dead persons or
animals, as well as objects that may
have become contaminated with
infectious fluids.
06
Given the evolving global situation, to keep
updated with health issues that impact
travellers’ health including disease outbreaks
and travel risk at travel destination.