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What biological characteristics, preventative measures, and control methods are used to combat monkeypox?


 Researchers have reviewed the epidemiology, clinical manifestation, biological characteristics, pathogenicity, and prevention and control methods for infections caused by the monkeypox virus (MPXV) and published their findings in the journal Virologica Sinica.

The potential threat posed by the MPXV comeback in European countries and other parts of the world to people justifies the necessity for anti-MPXV preventative and control measures as well as tactics to stop MPXV transmission. The healthcare industry must concentrate on MPX and create strategies to lessen the burden of MPX given the rising number of MPX cases around the world.


Concerning the review

Researchers summarized MPXs' epidemiology, biological causes, toxicity, diagnostics, and preventative and therapy approaches in the current review.


MPXV's biological characteristics

MPXV is a member of the Poxviridae family and belongs to the orthopoxvirus genus. It has over 190 open reading frames and double-stranded, linear DNA with inverted terminal repeats (ITRs) at both ends (ORFs). Non-conserved genes found in ITRs are host- and poxvirus-specific and give MPXV the ability to evade the immune system. The core genomic region contains genes that code for replication enzymes and structural proteins.


Cellular surface adsorption, cell membrane fusion, and then viral core penetration make up host invasion. The mature virus (MV) adsorption is mediated by MPXV proteins A27, D8, H3, and A26. H3 and A27 bind with heparan, while D8 and A26 bind with chondroitin and laminin, respectively. The proteins make up the entry fusion complex (EFC), which facilitates core invasion and MPXV replication in the host cytoplasm for the enveloped virus (EV) and MV. Although the virus has been found in salivary gland epithelium and labial sebaceous tissues, MPXV primarily targets lymphoid tissues and encodes proteins like BR-203 and BR-209 that promote MPXV virulence.


MPX's transmission dynamics and epidemiology

The Congo Basin clade and the West African clade, with case fatality rates (CFRs) of 10% and 1%, respectively, have emerged as two MPXV clades. The first human cases of MPX were discovered in the Democratic Republic of the Congo in 1970. (DRC). After that, MPXV became endemic to the DRC area and further expanded over West and Central Africa. The majority of instances mostly involved children under the age of four.

Between 1986 and 1992, fewer cases were seen, and between 1993 and 1995, there were no cases documented. However, from 1996 to 1997 in the DRC, there was a sharp increase in the number of human MPX cases. As a result, MPXV was discovered in the US in 2003, Sudan in 2005, Nigeria in 2006–2007, and by 2022, it had spread to the UK, Singapore, Israel, and a number of other countries.

Despite the fact that many rodent species, including rats and squirrels, are thought to be MPXV hosts, MPXV has been isolated from Cercocebusatys and Funisciurus anerythrus. The main zoonotic transmission routes for human MPX are (infected) animal bites or direct transmission through bodily fluids. A human could contract MPXV by eating diseased animals that were inadequately prepared. Sometimes, human beings can spread MPXV to other people by direct facial contact, respiratory droplets, or clothing or bedding that has been exposed to the virus.


Also possible are placental mother-fetal transmission and sexual transmission. The majority of cases in the recently announced MPX outbreak involved guys who had sex with other men (MSM). Unvaccinated individuals are more vulnerable to MPX. Additionally, people who work in animal breeding facilities, kill wild animals, or adore pets are at a high risk of developing MPX.


Clinical characteristics, diagnosis, and management of MPX Incubation of MPX typically lasts one to two weeks. Herpetic skin lesions with papules, plaques, blisters, pustules, scab formation, and scarring appear after the initial symptoms of influenza. Fatigue, fever, lymphadenopathy, severe headaches, and muscle aches are seen in the MPX prodromal phase (up to day 2). The next phase (days 7 to 21) is characterized by a rash, and the infected person is quite contagious during this time. The two to four week long rash appears on the face, hands, soles, oral mucosal epithelium, genital areas, and conjunctiva.


In order to discriminate between MPXV and other orthopoxviruses, whole-genome sequencing (WGS) is the gold standard; however, real-time polymerase chain reaction (RT-PCR) is favored in everyday practice because to the high cost and restricted availability of WGS. Additionally, methods for finding MPXV DNA, include loop-mediated isothermal amplification (LAMP). Recombinase polymerase amplification (RPA) and restriction length fragment polymorphism (RFLP) can be employed.


Sera from MPX patients can be used to detect anti-MPXV immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies, and MPXV morphology can be examined using electron microscopy (EM). Other methods of detecting MPXV include immunochemistry, multiplexed immunofluorescence imaging, and viral culture.


ACAM 2000 and IMVAMUNE, two smallpox vaccines, have provided immunological protection against MPXV; nevertheless, none of them are approved for use in the general public and are not advised for use in endemic areas. Additionally, the majority of antivirals used to treat MPX are largely supportive therapies. The antiviral action of ST-246 (Tecovirimat) is similar to that of Nioch-14, and it has demonstrated strong activity against the MPXV, cowpox virus, and smallpox virus. In vitro and in vivo MPXV replication has been blocked by brincidofovir and cidofovir derivatives. Additionally, medications such tiazofurin, ribavirin, C3-NPC A, C-CA3-ADO, adenosine N1 oxide, and HPMA (2-hydroxypropyl methacrylate) have shown promise as anti-MPXV treatments against other poxviruses.


Conclusion

To sum up, MPX is the largest disease spreading outside of Africa, yet its severity is very modest. To stop the MPX epidemic and stop future MPX outbreaks, it is crucial to bolster MPX surveillance and raise awareness around the world.

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