Prevention and Treatment of Monkeypox

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Abstract

Human monkeypox is a zoonotic orthopoxvirus with presentation similar to smallpox. Monkeypox is transmitted incidentally to humans when they encounter infected animals. Reports have shown that the virus can also be transmitted through direct contact (sexual or skin-to-skin), respiratory droplets, and via fomites such as towels and bedding. Multiple medical countermeasures are stockpiled for orthopoxviruses such as monkeypox. Two vaccines are currently available, JYNNEOS ^TM (live, replication incompetent vaccinia virus) and ACAM2000 ^® (live, replication competent vaccinia virus). While most cases of monkeypox will have mild and self-limited disease, with supportive care being typically sufficient, antivirals (e.g. tecovirimat, brincidofovir, cidofovir) and vaccinia immune globulin intravenous (VIGIV) are available as treatments. Antivirals can be considered in severe disease, immunocompromised patients, pediatrics, pregnant and breastfeeding women, complicated lesions, and when lesions appear near the mouth, eyes, and genitals. The purpose of this short review is to describe each of these countermeasures.

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Clinical features and management of human monkeypox: a retrospective observational study in the UK

Hugh Adler, Susan Gould, Paul Hine … (2022)

Background Cases of human monkeypox are rarely seen outside of west and central Africa. There are few data regarding viral kinetics or the duration of viral shedding and no licensed treatments. Two oral drugs, brincidofovir and tecovirimat, have been approved for treatment of smallpox and have demonstrated efficacy against monkeypox in animals. Our aim was to describe the longitudinal clinical course of monkeypox in a high-income setting, coupled with viral dynamics, and any adverse events related to novel antiviral therapies. Methods In this retrospective observational study, we report the clinical features, longitudinal virological findings, and response to off-label antivirals in seven patients with monkeypox who were diagnosed in the UK between 2018 and 2021, identified through retrospective case-note review. This study included all patients who were managed in dedicated high consequence infectious diseases (HCID) centres in Liverpool, London, and Newcastle, coordinated via a national HCID network. Findings We reviewed all cases since the inception of the HCID (airborne) network between Aug 15, 2018, and Sept 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a health-care worker who acquired the virus nosocomially, and one patient who acquired the virus abroad transmitted it to an adult and child within their household cluster. Notable disease features included viraemia, prolonged monkeypox virus DNA detection in upper respiratory tract swabs, reactive low mood, and one patient had a monkeypox virus PCR-positive deep tissue abscess. Five patients spent more than 3 weeks (range 22–39 days) in isolation due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes resulting in cessation of therapy. One patient was treated with tecovirimat (600 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral shedding and illness (10 days hospitalisation) compared with the other six patients. One patient experienced a mild relapse 6 weeks after hospital discharge. Interpretation Human monkeypox poses unique challenges, even to well resourced health-care systems with HCID networks. Prolonged upper respiratory tract viral DNA shedding after skin lesion resolution challenged current infection prevention and control guidance. There is an urgent need for prospective studies of antivirals for this disease. Funding None.

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The transmission potential of monkeypox virus in human populations.

P. Fine, Z Jezek, B Grab … (1988)

Data on monkeypox in Zaire over the five years 1980-1984 are analysed to assess the protection imparted by past smallpox vaccination and the transmission potential of the virus in unvaccinated communities. Attack rates in individuals with and without vaccination scars indicated that smallpox vaccination (discontinued in 1980) imparted approximately 85% protection against monkeypox. It is predicted that monkeypox virus will continue to be introduced into human communities from animal sources, and that the average magnitude and duration of monkeypox epidemics will increase as vaccine-derived protection declines in the population. On the other hand, current evidence indicates that the virus is appreciably less transmissible than was smallpox, and that it will not persist in human communities, even in the total absence of vaccination. The findings thus support the recommendation of the Global Commission for the Certification of Smallpox Eradication to cease routine smallpox vaccination in monkeypox endemic areas, but to encourage continued epidemiological surveillance.

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Oral Tecovirimat for the Treatment of Smallpox.

Annie Frimm, Ingrid Meara, Douglas Grosenbach … (2018)

Smallpox was declared eradicated in 1980, but variola virus (VARV), which causes smallpox, still exists. There is no known effective treatment for smallpox; therefore, tecovirimat is being developed as an oral smallpox therapy. Because clinical trials in a context of natural disease are not possible, an alternative developmental path to evaluate efficacy and safety was needed.

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Author and article information

Contributors

John G. Rizk:

ORCID: http://orcid.org/0000-0002-5216-8695

john.rizk@umaryland.edu

Journal

Journal ID (nlm-ta): Drugs

Journal ID (iso-abbrev): Drugs

Title: Drugs

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0012-6667

ISSN (Electronic): 1179-1950

Publication date (Electronic): 28 June 2022

Pages: 1-7

Affiliations

[1 ]GRID grid.411024.2, ISNI 0000 0001 2175 4264, Department of Pharmaceutical Health Services Research, , University of Maryland, Baltimore, School of Pharmacy, ; 220 Arch Street, 12th Floor, Room 01-409-E, Baltimore, MD 21201 USA

[2 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Section of Clinical Biochemistry, , University of Verona, ; Verona, Italy

[3 ]GRID grid.239573.9, ISNI 0000 0000 9025 8099, The Heart Institute, Cincinnati Children’s Hospital Medical Center, ; Cincinnati, OH USA

[4 ]GRID grid.266093.8, ISNI 0000 0001 0668 7243, Division of Infectious Diseases, Department of Medicine, , University of California, Irvine, School of Medicine, ; Irvine, CA USA

[5 ]GRID grid.266093.8, ISNI 0000 0001 0668 7243, Department of Molecular Biology and Biochemistry, , University of California, Irvine, School of Medicine, ; Irvine, CA USA

[6 ]GRID grid.411323.6, ISNI 0000 0001 2324 5973, Division of Family Medicine, Department of Internal Medicine, , Lebanese American University School of Medicine, ; Beirut, Lebanon

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John G. Rizk http://orcid.org/0000-0002-5216-8695

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Publisher ID: 1742

DOI: 10.1007/s40265-022-01742-y

PMC ID: 9244487

PubMed ID: 35763248

SO-VID: 99633655-232b-489e-812f-07266e7d6210

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This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Prevention and Treatment of Monkeypox

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Monkeypox

Most cited references 27

Clinical features and management of human monkeypox: a retrospective observational study in the UK

The transmission potential of monkeypox virus in human populations.

Oral Tecovirimat for the Treatment of Smallpox.

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