Tag: monkeypox

Debunking Myths About Mpox

Mpox (monkeypox) virus. Source: NIH

Myths are widely held beliefs about various issues, including illness and disease. They come about through frequent storytelling and retelling. Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund, helps debunks myths about monkeypox (mpox).

Myth 1: Mpox (formerly monkeypox) is a new disease created in a lab

Fact: The mpox virus was discovered in Denmark (1958) in a colony of monkeys at a laboratory kept for research.  The first reported human case was in 1970 in the DRC. Mpox is a zoonotic disease, meaning it can be spread between animals and people. It is found regularly in parts of Central and West Africa and can spread from person to person or occasionally from animals to people.  

Myth 2: Mpox comes from monkeys

Fact: Despite its name, monkeypox does not come from monkeys. The disease earned the name when the ‘pox like’ outbreaks happened in the research monkeys. While monkeys can get mpox, they are not the reservoir (where a disease typically grows and multiplies). The reservoir appears to be rodents.

Myth 3:  Only a handful of people have contracted mpox

Fact: Globally, more than 97 000 cases and 186 deaths were reported across 117 countries in the first four months of 2024. South Africa is among the countries currently experiencing an outbreak.  On the 5 July, it was reported that the number of mpox cases in the country has risen to 20. This after four more cases have been confirmed in Gauteng and KwaZulu-Natal in the last few days.

15 patients have, however been given a clean bill of health.

Myth 4:  It is easy to diagnose mpox

Fact: It is easy to mistake mpox for something else. While the rash can be mistaken for chickenpox, shingles or herpes, there are differences between these rashes. Symptoms of mpox include fever, sore throat, headache, muscle aches, back pain, low energy and swollen lymph nodes. Fever, muscle aches and a sore throat appear first. The rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and develops over 2-4 weeks in stages. The ‘pox’ dip in the centre before crusting over.

Laboratory confirmation is required. A sample of one of the sores is diagnosed by a PCR test for the virus (MPXV).

Myth 5: Mpox is easily treated

Fact: ‘Currently,’ says the National Institute for Communicable Diseases (NICD), ‘there is no registered treatment for mpox in South Africa. However, the World Health Organization (WHO) recommends the use of TPOXX for treatment of severe cases, in immunocompromised people’. However, the Department of Health (DoH) has only obtained this treatment, with approval on a compassionate use basis, for the five known patients with severe disease.

There is no mpox vaccine currently available in South Africa.

Myth 6: You can get mpox from being in a crowd or from a public toilet seat

Fact: Mpox is not like Covid-19 which is highly contagious. It spreads through direct contact via blood, bodily fluid, skin or mucous lesions or respiratory droplets.

It can also spread though bites and scratches. Studies have shown that the virus can stay on surfaces but it is not spreading in that way or in a public setting. The risk of airborne transmission appears low.

Myth 7: Mpox is deadly

Fact: While mpox lesions can look similar to smallpox lesions, mpox infections are much milder and are rarely fatal. That said, symptoms can be severe in some patients, needing hospitalisation and, in rare cases, result in death. It is, however, painful and very unpleasant. So, it is important to avoid infection.

Myth 8: Mpox is sexually transmitted

Fact: You can become infected though close, direct contact with the lesions, rash, scabs or certain bodily fluids of someone who has mpox. Even though this could imply transmission though sexual activity, it is not limited to that.  You can also be exposed if you are in close physical proximity to infected people, such as spouses or young children who sleep in the same bed.

Myth 9: I can’t protect myself from getting Mpox

Fact:  You can take precautions: Avoid handling clothes, sheets, blankets or other materials that have been in contact with an infected animal or person. Wash your hands well with soap and water after any contact with an infected person or animal and clean and disinfect surfaces. Practice safe sex and use personal protective equipment (PPE) when caring for someone infected with the virus.

Myth 10:  You can’t stop other people being infected by you

Fact: You may not protect them by 100% but you can isolate. Also, alert people who have had recent contact with you.  Wash your hands regularly with soap and water or use hand sanitiser, especially before or after touching sore and disinfected shared spaces.  Cover lesions when around other people, keep skin dry and uncovered (unless in a room with someone else).

Mpox is a notifiable medical condition but is treatable, if you are concerned, call the DoH toll free number of 0800 029 999 but remember, your GP is your first port of call for all your healthcare needs.

More Monkeypox Antibodies with Childhood Smallpox Vaccination

Mpox (monkeypox) virus. Source: NIH

In a study published in Cell Host & Microbe, scientists studied the sensitivity of MPXV, the virus that causes mpox (formerly monkeypox) to neutralising antibodies (NAbs) generated after infection with the virus and/or vaccination with IMVANEX. They found that those who had been born before 1980 had more antibodies in response to either IMVANEX vaccination or mpox infection, highlighting the lasting protection of smallpox vaccination.

The IMVANEX vaccine has been used as pre- and post-exposure prophylaxis in high-risk populations, but its effectiveness is not yet well characterised. To analyse the sensitivity of the virus, a team of scientists led by Pasteur Institut developed two cellular tests to quantify neutralising antibodies, using either the attenuated virus as a vaccine (MVA) or an MPXV strain isolated in a recently infected individual.

In 2022-2023, an unprecedented epidemic of 87 000 cases of mpox occurred in non-endemic areas, affecting people with no direct link to travel in Central or West Africa, where the virus has historically been present. MPXV is mainly transmitted to humans by rodents, with human-to-human transmission occurring via respiratory droplets or close contact. Symptoms are less severe than those of smallpox, and the case-fatality rate is lower. MPXV is still circulating at very low levels in non-endemic areas, which is why it is important to improve characterisation and analyse the immune response of people infected with the virus or vaccinated with IMVANEX, the third-generation vaccine currently available, initially developed for smallpox.

The large number of sera analysed provided good statistical power, meaning that the analysis could be narrowed to subgroups of patients based on various criteria such as age.

The study demonstrated the role of complement, already known for other poxviruses, and the neutralising activity of the antibodies generated by infection or vaccination. Robust levels of anti-MVA antibodies were detected after infection, vaccination with the historic smallpox vaccine, or administration of IMVANEX or another MVA-based vaccine candidate. MPXV was minimally sensitive to neutralisation in the absence of complement. The addition of complement from sera enhanced detection of individuals with antibodies and increased their level of anti-MPXV antibodies. Four weeks after infection, anti-MVA and -MPXV NAbs were observed in 94% and 82% of individuals, respectively. Two doses of IMVANEX generated anti-MVA and -MPXV NAbs that were detectable in 92% and 56% of vaccinees, respectively.

The highest level of antibodies was found in individuals born before 1980 (who had therefore been vaccinated for smallpox), whether after infection or after administration of IMVANEX, highlighting the impact of historic smallpox vaccination on immune responses to infection or administration of IMVANEX. This suggests that a sort of hybrid immunity was generated in infected individuals who were vaccinated in childhood.

The number of MPXV infections has been constantly on the rise since mass vaccination for smallpox was discontinued in the 1980s. “The neutralisation assays developed in connection with this research may help define correlates of protection against infection or disease severity. The assays can also be used to conduct epidemiological surveys, assess the duration of protection conferred by previous infection or by authorised and candidate vaccines, and analyse the use of immunotherapeutic intervention. The assays represent useful tools to understand the mechanisms of multiplication of MPXV and its effects on public health, and to optimsze patient treatment,” commented Olivier Schwartz, Head of the Institut Pasteur’s Virus and Immunity Unit and last author of the study.

Source: Institut Pasteur

Smallpox Vaccine Offers Protection Against Mpox

Photo by Gustavo Fring on Pexels

Smallpox vaccines offer continuing cross-reactive immunity to mpox (previously known as monkeypox), researchers from Karolinska Institutet in Sweden report in a study published in the scientific journal Cell Host & Microbe. The smallpox vaccine had been administered in Sweden from the early 19th century until it was discontinued in 1976 with the eradication of the disease.

During last year’s mpox outbreak, the virus spread for the first time outside Africa, causing over 85 000 cases of the disease to date. Men who have sex with men account for the most infections, with a marked skew towards the young.

The virus that causes mpox is what is known as an orthopoxvirus and is very similar to the virus that caused smallpox until the mid-1970s when it was finally eradicated. South Africa stopped its smallpox vaccinations in 1982.

Since there were data indicating that the old smallpox vaccine could protect against mpox, the researchers at Karolinska Institutet wondered if the individuals who were vaccinated decades ago against the former would have some protection against the latter owing to a remaining memory response.

“Our study shows that this is the case, which implies that the memory cells are very long-lived and that they can recognise closely related viruses such as the mpox virus and provide overlapping, or cross-reactive immunity,” says the study’s corresponding author Marcus Buggert, docent and researcher at the Center for Infectious Medicine, Karolinska Institutet.

By analysing the T-cell immune response in 105 healthy blood donors, the researchers were able to show that individuals born before 1976 had a significantly stronger immune response against both viral types. The researchers also analysed the immune response in 22 men with a recent mpox infection and showed that they also exhibited a strong immune response to the virus, which may provide future immunity.

The current study was too small to judge how much protection previous smallpox vaccination provides, but Dr Buggert refers to a recently published British observational study examining the effect of a smallpox vaccine given to risk-group males in 2022.

“This study shows that smallpox vaccine can provide about 80% protection against mpox,” he says.

Source: Karolinska Institutet

Monkeypox Virus can Linger for up to a Month on Surfaces

Monkeypox virus. Source: NIH

According to a study published in the Journal of Infectious Diseases, the monkeypox virus remains infectious on steel surfaces for up to 30 days, especially in cold conditions, but can be effectively inactivated by alcohol-based disinfectants.

Smallpox viruses are notorious for their ability to remain infectious in the environment for a very long time. A study conducted by the Department of Molecular and Medical Virology at Ruhr University Bochum, Germany, has shown that temperature is a major factor in this process: at room temperature, a monkeypox virus that is capable of replicating can survive on a stainless steel surface for up to 11 days, and at 4°C for up to a month. Consequently, it’s very important to disinfect surfaces. According to the study, alcohol-based disinfectants are very effective against monkeypox viruses, whereas hydrogen peroxide-based disinfectants have proved inadequate.

Weeks of monitoring

Since 2022, the monkeypox virus has been transmitted more and more frequently from one human host to another. Although infections primarily result from direct physical contact, it’s also possible to contract the virus through contaminated surfaces, for example in the household or in hospital rooms. “Smallpox viruses are notorious for their ability to remain infectious in the environment for a very long time,” explains Dr Toni Meister from the Department for Molecular and Medical Virology at Ruhr University Bochum. “For monkeypox, however, we didn’t know the exact time frames until now.”

The researchers therefore studied them by applying the virus to sanitised stainless steel plates and storing them at different temperatures: at 4°C, at 22°C, which roughly corresponds to room temperature, and at 37°C. They determined the amount of infectious virus after different periods of time, ranging from 15 minutes to several days to weeks.

Viruses remain infectious for a long time

Regardless of the temperature, there was little change in the amount of infectious virus during the first few days. At 22 and 37°C, the virus concentration dropped significantly only after five days. At 37°C, no virus capable of reproducing was detected after six to seven days, at 22°C it took 10–11 days until infection was no longer possible. At 4°C, the amount of virus only dropped sharply after 20 days, and after 30 days there was no longer any danger of infection. “This is consistent with our experience that people can still contract monkeypox from surfaces in the household after almost two weeks,” points out Professor Eike Steinmann, Head of the Department for Molecular and Medical Virology.

In order to reduce the risk of infection in the event of an outbreak, it is therefore extremely important to disinfect surfaces. This is why the researchers tested the effectiveness of five common disinfectants. They found that alcohol-based or aldehyde-based disinfectants reliably reduced the risk of infection. A hydrogen peroxide-based disinfectant, however, didn’t inactivate the virus effectively enough in the study. “Our results support the WHO’s recommendation to use alcohol-based surface disinfectants,” concludes Toni Meister.

Source: Ruhr-University Bochum

Study Finds Wastewater Monitoring can Work for Most Pathogens

Photo by Jan Antonin Kolar on Unsplash

Researchers in the American Journal of Epidemiology report that wastewater surveillance of diseases that infect humans should work in most cases. But more research is needed to apply the science for public health benefit, the research team concluded.

Led by epidemiologist David Larsen from Syracuse University, the team’s work published examined all peer-reviewed scientific articles of wastewater surveillance published through July 2020. The team identified a variety of pathogens that can be found in wastewater, including almost all infectious diseases that the World Health Organization has classified as a Public Health Emergency of International Concern (PHEIC) such as Ebola virus and Zika virus.

But despite this positive finding, few studies relate what is found in the wastewater to public health and the amount of disease that is circulating.

“Testing the wastewater is only one component of this powerful science,” said Dr Larsen, an associate professor of public health at Syracuse University. “Understanding the results and implications for public health is just as challenging. We need interdisciplinary teams working together to maximise the benefit of wastewater-based epidemiology.”

Wastewater-based epidemiology is the science of taking what is found in wastewater and using that information to understand population-level health trends. Most of the articles reviewed looked at what they could find in the wastewater and omitted the second step of relating the findings to other measures of population-level health, such as numbers of cases, test positivity, or hospitalisations.

Wastewater-based epidemiology of COVID has enjoyed substantial availability of clinical COVID data, and results from wastewater surveillance are more easily understood in terms of COVID transmission. However, the research team determined that more work is needed to be done for other pathogens, including monkeypox and polio, to increase the utility of wastewater surveillance to benefit public health.

Source: Syracuse University

Tecovirimat Safe and Effective against Monkeypox

Colourised transmission electron micrograph of monkeypox virus particles (green) cultivated and purified from cell culture. Image captured at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Credit: NIAID

In a research letter published in JAMA, infectious disease experts reported on 25 monkeypox patients given tecovirimat therapy, with data showing that it is safe and effective for the treatment of monkeypox symptoms and skin lesions.

The recent global outbreak of monkeypox has led to more than 45 500 cases as of August 22, 2022. While symptoms usually resolve on their own in 2–4 weeks, a recent study showed that 13% of patients needed hospitalisation.

Tecovirimat (TPOXX) is an FDA-approved antiviral drug for the treatment of smallpox which limits viral spread in the body by inhibiting the release of the enveloped virus. Recently, the Centers for Disease Control and Prevention (CDC) allowed physicians to prescribe tecovirimat on a compassionate use basis to treat adults and children with orthopoxvirus infections, including monkeypox.

“We have very limited clinical data on the use of tecovirimat for monkeypox infection. There is much to learn about the natural progression of the disease and how tecovirimat and other antivirals may affect it,” said lead author Angel Desai, an adult infectious disease specialist.

The new study included patients referred to UC Davis Medical Center, between June 3 and August 13, 2022.

Patients with skin lesions in multiple body parts or in sensitive areas such as the face or genital region were offered oral tecovirimat treatment. The treatment was weight-based, given every 8 or 12 hours, and was taken within 30 minutes of a high-fat meal.

The researchers collected clinical data on evaluation for treatment and on day 7 and day 21 following the beginning of therapy.

In total, 25 male patients (ages 27–76 years) with confirmed monkeypox infection completed a course of tecovirimat therapy. Nine patients had HIV.

Only one patient had the smallpox vaccine (taken more than 25 years ago) and four others received a dose of JYNNEOS vaccination after symptoms started.

The study found that 92% of patients had lesions in their genital or anal area. While all patients had painful lesions, around half had fewer than 10 lesions over their entire body.

On average, the patients had symptoms or lesions for 12 days before they started their antiviral treatment. Fever was the most common symptom (76% of the patients), followed by fatigue (32%), sore throat (20%) and chills (20%). Other symptoms included backache (12%), muscle pain (8%), nausea (4%) and diarrhoea (4%).

All patients completed the tecovirimat therapy and tolerated their treatment well. They were treated for two weeks, except for one patient who was treated for 21 days.

On day 7 of therapy, 40% of patients had healed from their lesions. By day 21, 92% had healed and were pain-free.

The most reported adverse events on day 7 of therapy included: fatigue (28%), headache (20%), nausea (16%), itching (8%) and diarrhoea (8%).

“We have to be very careful in how we interpret the data. It is hard to differentiate the side effects due to therapy from those caused by the infection,” cautioned infectious diseases expert and co-author George Thompson.

This small study lacked a control group, limiting assessment of antiviral efficacy in terms of symptom duration and severity. Also, the time from symptom onset to starting the antiviral therapy varied among the patients.

The researchers called for large-scale studies to explore antiviral efficacy dosing and adverse events.

Source: UC Davis Health

Asymptomatic Detection of Monkeypox Suggests it is More Widespread

Colourised transmission electron micrograph of monkeypox virus particles (green) cultivated and purified from cell culture. Credit: NIAID

A brief research report in Annals of Internal Medicine documents positive monkeypox virus PCR results found in anal samples taken from asymptomatic MSM (men who have sex with men). These findings suggest that vaccination limited to those with known exposure to the monkeypox virus may not be an effective strategy for preventing infection.

The findings come as the World Health Organization has renamed the variants, or clades, of monkeypox from their previous geographically-derived names to Roman numerals, eg, the former Congo Basin (Central African) clade is now Clade one (I). It is also seeking inputs on a possible new name for the virus in order to avoid stigmatisation.

Researchers from Bichat–Claude Bernard Hospital, Paris, retrospectively performed testing for monkeypox virus on all anorectal swabs that were collected as part of a sexually transmitted infection screening program. This type of screening is performed every three months among MSM with multiple sexual partners who are either taking HIV preexposure prophylaxis (PrEP) or living with HIV and receiving antiretroviral treatment. Of the 200 asymptomatic persons screened that were negative for N. gonorrhoeae and C. trachomatis, 13 (6.5%) samples were PCR positive for monkeypox virus.  Two of the 13 later developed symptoms of monkeypox.

While it is not know whether asymptomatic transmission will play a role in the current worldwide monkeypox epidemic and the mode of human-to-human transmission may provide evidence that asymptomatic or preclinical spread can occur. In an accompanying editorial, Stuart N. Isaacs, MD, at the University of Pennsylvania, suggests that an expanded ring vaccination strategy and other public health interventions in the highest-risk communities are likely needed to help control the outbreak. 

Source: EurekAlert!

What Antivirals are Suitable for Monkeypox Treatment?

Colourised transmission electron micrograph of monkeypox virus particles (green) cultivated and purified from cell culture. Credit: NIAID

In light of the recent spread of monkeypox virus, now declared a public health emergency of international concern by the World Health Organization, there is a need for treatments. In an article published in Clinical Infectious Diseases, authors review three antiviral agents with activity against monkeypox: cidofovir, brincidofovir, and tecovirimat.

Human monkeypox, caused by the monkeypox virus, a member of the genus Orthopoxvirus within the Poxviridae family of double-stranded DNA (dsDNA) viruses, was first described in a baby in the Democratic Republic of Congo in 1970. Since then, it has resulted in multiple outbreaks in Central and West Africa, and occasionally in Europe and North America. Human-to-human transmission in households has been reported, especially among those unvaccinated against smallpox.

Cidofovir
Although cidofovir has broad activity against many DNA viruses including orthopoxviruses, it is only FDA approved for the treatment of cytomegalovirus retinitis. Cidofovir (CDV) is a prodrug, which must first enter host cells, where it is converted into the active form, CDV diphosphate (CDV-pp). CDV-pp has a prolonged intracellular half-life, and slows viral DNA replication by being incorporated into the growing DNA strand. Pharmokinetics suggest poor oral absorption and is available as intravenous infusions.

In humans, CDV has been used to treat ocular cowpox and as a topical treatment for molluscum cantiogosum.

Brincidofovir
Brincidofovir (BCV) is a lipid-conjugated CDV analogue, FDA-approved in 2021 for the treatment of smallpox. Like CDV, BCV has broad activity against dsDNA viruses. It can be be taken up by the small intestines, and unlike CDV, which slowly crosses cellular membranes, brincidofovir readily enters host cells due to its lipophilicity. Inside cells, BCV is converted into CDV and then CDV-pp. CDV-pp reaches higher intracellular concentrations after BCV administration due to its ability to cross cellular membranes more efficiently. Like CDV, BCV has a prolonged intracellular half-life and inhibits viral replication.

In prairie dog models, which exhibit similarity to the human course, BCV improved survival when administered shortly after infection, suggesting that early treatment is important.

Tecovirimat
Tecovirimat was FDA approved in 2018 for the treatment of smallpox, and has activity against orthopoxviruses, but has no notable activity against other dsDNA viruses. Tecovirimat targets a gene which encodes for membrane protein p37, responsible for the formation of extracellular enveloped virus.

The oral route results in better absorption for tecovirimat, and is effective against monkeypox virus in macaques and prairie dogs. Administration within 72 hours of exposure to poxvirus reduced lesion severity and mortality in various animal models.

Tecovirimat synergises with BCV, and was successfully used to treat monkeypox in two human cases.

Conclusion
The authors note that while CDV and BCV inhibit DNA replication, tecovirimat is more specific to orthopoxviruses and prevents enveloped virus formation, stalling cell-cell transmission.

BCV and tecovirimat could be promising therapeutic candidates based on their tolerability profiles, they conclude. More studies are needed to identify those most at risk from monkeypox and establish the optimal initiation time and duration for therapy.

Despite Disagreement, WHO Sounds Highest Alert for Monkeypox

Source: Pixabay CC0

On 22 July, World Health Organisation (WHO) director general Dr Tedros Adhanom Ghebreyesus declared the global spread of monkeypox a Public Health Emergency of International Concern (PHEIC) – a move which went against the recommendation of a special committee. This was the first time since the PHEIC’s inception in 2005 that it had done so. The special committee’s reluctance to recommend a PHEIC has previously drawn criticism from public health experts.

The 21 July meeting of WHO’s Emergency Committee, did not reach a consensus on whether to declare the growing monkeypox outbreak a PHEIC; a narrow majority voting against doing so. But Dr Tedros invoked a PHEIC at a press conference the next day in Geneva. “We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations,” he said.

Data presented during the meeting including modelling which showed the basic reproduction number (R0) to be above 1 among gay or bisexual men, and below 1 in other groups. For example, in Spain, the estimated R0 is 1.8, in the United Kingdom 1.6, and in Portugal 1.4.

In June, the committee first recommended against declaring a PHEIC , which was roundly criticised by epidemiologists and global health experts. Dr Tedros reconvened the group this week and asked it to reconsider the question. Nine members were against declaring a PHEIC and six in favour, Dr Tedros said at the press conference.

According to Science, the Thursday meeting of the expert panel was followed by tense exchanges via email and text messages between its participants.

One of the objections to a PHEIC was that few deaths had been caused by the disease so far and was not spreading in the general population. Another was that a PHEIC could possibly lead to further stigmatisation of men who have sex with men (MSM), the group primarily affected.

Many gay rights and sexual health advocates were for the PHEIC, as it would help raise awareness and help protect the most at-risk group of MSM.

“Although I’m declaring a public health emergency of international concern, for the moment, this is an outbreak that’s concentrated among men who have sex with men, especially those with multiple sexual partners,” Dr Tedros said. “That means that this is an outbreak that can be stopped with the right strategies in the right groups.”

Those who push for declaring a PHEIC also cited the rising number of monkeypox cases (over 15 000) and the countries affected (70), and that many cases are likely still not being picked up. The virus could also potentially establish itself permanently worldwide – indeed, the CDC reported that two children in the US had been infected.

Sources familiar with the deliberations of the committee said the votes for a PHEIC were driven by those with expertise in monkeypox and LGBT health, and those against by more generalist global heath voices.

According to Science, sources familiar with the committee’s deliberation said that those in favour of a PHEIC had monkeypox and LGBT health expertise, and those against were from a global health standpoint.

While a PHEIC can give the WHO some extra powers, it is the loudest level of alert it can sound. Since its creation in 2005, PHEIC has been declared six times: for outbreaks of H1N1 influenza, polio, Zika, COVID (ongoing), and twice for Ebola outbreaks (one ongoing).

Source: Science.org

Monkeypox Symptoms Described in Case Series

Source: Wikimedia CC0

A large case series on monkeypox was published in The New England Journal of Medicine, which will help direct the limited resources such as vaccines to contain the recent spread of the virus. In the study, clinicians led by Queen Mary University of London identified new clinical symptoms of monkeypox infection, which will aid future diagnosis and help to slow the spread of infection. This is the largest case study series to date, reporting on 528 confirmed monkeypox infections at 43 sites between 27 April and 24 June 2022.

Gay and bisexual men make up 98% of infected persons in the current spread of the virus. While in most cases sexual closeness is the most likely route of transmission, researchers stress that the virus can be transmitted by any close physical contact through large respiratory droplets and potentially through clothing and other surfaces.

There is a global shortage of both vaccines and treatments for human monkeypox infection. The findings of this study, including the identification of those most at risk of infection, will help to aid the global response to the virus. Public health interventions aimed at higher risk of exposure could help to detect and slow the spread of the virus. Recognising the disease, contact tracing and advising people to isolate will be key components of the public health response.  

Many of the infected individuals reviewed in the study presented with symptoms not recognised in current medical definitions of monkeypox. These symptoms include single genital lesions and sores on the mouth or anus. The clinical symptoms are similar to those of sexually transmitted infections (STIs) and can easily lead to misdiagnosis.

In some people, anal and oral symptoms have led to people being admitted to hospital for management of pain and difficulties swallowing. Since misdiagnosis can slow detection, hindering efforts to control the spread of the virus, this information is important for clinicians. This information will help increase diagnoses in persons from at-risk groups present with traditional STI symptoms.

Public health measures – such as enhanced testing and education – should be developed and implemented working with at-risk groups to ensure that they are appropriate, non-stigmatising, and to avoid messaging that could drive the outbreak underground.

Source: Queen Mary University of London