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      Features of Mpox infection: The analysis of the data submitted to the ID-IRI network

      research-article
      a , , b , c , d , d , d , d , d , d , d , c , e , f , f , g , h , i , j , j , k , l , a , m , m , n , o , p , p , p , p , p , q , r , s , t , u , v , w , x , y , z , aa , ab , ac
      New Microbes and New Infections
      Elsevier
      Mpox, Outbreak, Smallpox vaccine, HIV-Infected mpox

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          Abstract

          Background

          Mpox is a rare zoonotic disease caused by the Mpox virus. On May 21, 2022, WHO announced the emergence of confirmed Mpox cases in countries outside the endemic areas in Central and West Africa.

          Methods

          This multicentre study was performed through the Infectious Diseases International Research Initiative network. Nineteen collaborating centres in 16 countries participated in the study. Consecutive cases with positive Mpoxv-DNA results by the polymerase chain reaction test were included in the study.

          Results

          The mean age of 647 patients included in the study was 34.5.98.6% of cases were males, 95.3% were homosexual-bisexual, and 92.2% had a history of sexual contact. History of smallpox vaccination was present in 3.4% of cases. The median incubation period was 7.0 days. The most common symptoms and signs were rashes in 99.5%, lymphadenopathy in 65.1%, and fever in 54.9%. HIV infection was present in 93.8% of cases, and 17.8% were followed up in the hospital for further treatment. In the two weeks before the rash, prodromal symptoms occurred in 52.8% of cases. The incubation period was 3.5 days shorter in HIV-infected Mpox cases with CD4 count <200/μL, we disclosed the presence of lymphadenopathy, a characteristic finding for Mpox, accompanied the disease to a lesser extent in cases with smallpox vaccination.

          Conclusions

          Mpox disseminates globally, not just in the endemic areas. Knowledge of clinical features, disease transmission kinetics, and rapid and effective implementation of public health measures are paramount, as reflected by our findings in this study.

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          Most cited references20

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          Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022

          Before April 2022, monkeypox virus infection in humans was seldom reported outside African regions where it is endemic. Currently, cases are occurring worldwide. Transmission, risk factors, clinical presentation, and outcomes of infection are poorly defined.
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            Human monkeypox.

            Human monkeypox is a zoonotic Orthopoxvirus with a presentation similar to smallpox. Clinical differentiation of the disease from smallpox and varicella is difficult. Laboratory diagnostics are principal components to identification and surveillance of disease, and new tests are needed for a more precise and rapid diagnosis. The majority of human infections occur in Central Africa, where surveillance in rural areas with poor infrastructure is difficult but can be accomplished with evidence-guided tools and educational materials to inform public health workers of important principles. Contemporary epidemiological studies are needed now that populations do not receive routine smallpox vaccination. New therapeutics and vaccines offer hope for the treatment and prevention of monkeypox; however, more research must be done before they are ready to be deployed in an endemic setting. There is a need for more research in the epidemiology, ecology, and biology of the virus in endemic areas to better understand and prevent human infections.
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              A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy

              Monkeypox is a vesicular-pustular illness that carries a secondary attack rate in the order of 10% in contacts unvaccinated against smallpox. Case fatality rates range from 1 to 11%, but scarring and other sequelae are common in survivors. It continues to cause outbreaks in remote populations in Central and West Africa, in areas with poor access and weakened or disrupted surveillance capacity and information networks. Recent outbreaks in Nigeria (2017-18) and Cameroon (2018) have occurred where monkeypox has not been reported for over 20 years. This has prompted concerns over whether there have been changes in the biology and epidemiology of the disease that may in turn have implications for how outbreaks and cases should best be managed. A systematic review was carried out to examine reported data on human monkeypox outbreaks over time, and to identify if and how epidemiology has changed. Published and grey literature were critically analysed, and data extracted to inform recommendations on outbreak response, use of case definitions and public health advice. The level of detail, validity of data, geographical coverage and consistency of reporting varied considerably across the 71 monkeypox outbreak documents obtained. An increase in cases reported over time was supported by literature from the Democratic Republic of Congo (DRC). Data were insufficient to measure trends in secondary attack rates and case fatality rates. Phylogenetic analyses consistently identify two strains of the virus without evidence of emergence of a new strain. Understanding of monkeypox virulence with regard to clinical presentation by strain is minimal, with infrequent sample collection and laboratory analysis. A variety of clinical and surveillance case definitions are described in the literature: two definitions have been formally evaluated and showed high sensitivity but low specificity. These were specific to a Congo-Basin (CB) strain–affected area of the DRC where they were used. Evidence on use of antibiotics for prophylaxis against secondary cutaneous infection is anecdotal and limited. Current evidence suggests there has been an increase in total monkeypox cases reported by year in the DRC irrespective of advancements in the national Integrated Disease Surveillance and Response (IDSR) system. There has been a marked increase in number of individual monkeypox outbreak reports, from outside the DRC in between 2010 and 2018, particularly in the Central African Republic (CAR) although this does not necessarily indicate an increase in annual cases over time in these areas. The geographical pattern reported in the Nigeria outbreak suggests a possible new and widespread zoonotic reservoir requiring further investigation and research. With regards to outbreak response, increased attention is warranted for high-risk patient groups, and nosocomial transmission risks. The animal reservoir remains unknown and there is a dearth of literature informing case management and successful outbreak response strategies. Up-to-date complete, consistent and longer-term research is sorely needed to inform and guide evidence-based response and management of monkeypox outbreaks.
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                Author and article information

                Contributors
                Journal
                New Microbes New Infect
                New Microbes New Infect
                New Microbes and New Infections
                Elsevier
                2052-2975
                20 May 2023
                June 2023
                20 May 2023
                : 53
                : 101154
                Affiliations
                [a ]Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Fethi Sekin City Hospital, Elazig, Turkey
                [b ]Clinica Especializada “CONDESA” Mexico City, Mexico & Research and Advisory, Houston, TX, USA
                [c ]Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
                [d ]Clinica Especializada “CONDESA” Mexico City, USA
                [e ]Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties - Infectious Disease Unit, Policlinico ‘P. Giaccone’, University of Palermo, Palermo, Italy
                [f ]Department of Pulmonary and Critical Care, San Juan City Hospital, San Juan, PR, USA
                [g ]Infectious Diseases Unit, Centro Hospitalar Tamega e Sousa, Penafiel, Portugal
                [h ]Dr.Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
                [i ]Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Czech Republic
                [j ]National Institute of Hematology and Infectious Diseases, Budapest, Hungary
                [k ]Unit of Infectious Diseases, Santa Chiara Hospital, Trento, Italy
                [l ]Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt
                [m ]National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
                [n ]Department of Infectious Diseases, Botucatu Medical School, UNESP, Sao Paulo, Brazil
                [o ]Secretaria de Salud - Gobierno Autonomo Municipal de Cochabamba, Bolivia
                [p ]Servicio Departamental de Salud, Cochabamba, Bolivia
                [q ]KCU Sarajevo, Bosnia and Herzegovina
                [r ]Department of Infectious Diseases, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
                [s ]Department of Medicine, Federal Teaching Hospital, Ido- Ekiti, Nigeria
                [t ]Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
                [u ]Hospitals Management Board, Ekiti State, Nigeria
                [v ]Department of Biological Sciences, Njala University, Sierra Leone
                [w ]Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
                [x ]Pasteur Institute, Paris, France
                [y ]Department of Dermatology, Sapienza University of Rome, Rome, Italy
                [z ]Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de Las Americas-Institución Universitaria Visión de Las Américas, Pereira, Risaralda, Colombia
                [aa ]Master of Clinical Epidemiology and Biostatistics, Universidad Científica Del Sur, Lima, Peru
                [ab ]Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, P.O. Box 36, Lebanon
                [ac ]ID-IRI Lead Coordinator, Ankara, Turkey
                Author notes
                []Corresponding author. guldeneser@ 123456gmail.com
                Article
                S2052-2975(23)00073-2 101154
                10.1016/j.nmni.2023.101154
                10227417
                37260588
                ef21e83f-bcf4-40dd-93b0-1fa59f76a281
                © 2023 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 18 March 2023
                : 10 May 2023
                : 12 May 2023
                Categories
                Original Article

                mpox,outbreak,smallpox vaccine,hiv-infected mpox
                mpox, outbreak, smallpox vaccine, hiv-infected mpox

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