Infectious Disease: Monkeypox

Monkeypox Infection Research Paper
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Monkeypox is a viral disease that results from monkeypox virus infection. The infection was discovered in 1959 after monkeys shipped to the Denmark research center from Singapore fell ill. The first case of human infection was affirmed in 1970 following the separation of the virus from a child suspected to be suffering from smallpox in the Democratic Republic of Congo (DRC). With the rate of disease incidents reported outside of sub-Saharan Africa, the virus became endemic in countries within West and Central Africa. Coincident immunity to the monkeypox virus was initially attained with vaccinia immunization. However, monkeypox achieved tremendous clinical relevance due to constant efforts to eradicate smallpox and the subsequent lack of immunization. Moreover, there is the potential for underreporting of monkeypox due to its high prevalence in rural Africa, which translates to an underestimation of the severity of the pathogen (Moore et al., 2023). The United States (U.S.) Centers for Disease Control and Prevention (CDC) noted that there were over 57,995 recorded cases of monkeypox across 100 territories or countries, as shown in Figure 1 below (Huang et al., 2022). This research paper evaluates monkeypox infection in terms of pathophysiology, clinical manifestations, epidemiology, vaccination, diagnosis, and treatment and management, as well as offers a discussion that summarizes the points established in the report.
Figure 1: Monkeypox incidence geographical distribution between January and September 2022 (Huang et al., 2022).
Pathophysiology
After the virus enters the human body via any route (intradermal, nasopharynx, or oropharynx), it replicates at the inoculation point and then advances to localized lymph nodes. Accordingly, viral spread and other organ seeding happen due to the initial viremia. This depicts the illness incubation timescale, which generally lasts seven to fourteen days, with a twenty-one-day upper limit. The symptom onset is linked to secondary viremia, which results in one to two days of prodromal clinical manifestations, including lymphadenopathy and fever, before the appearance of lesions. The infected patient is typically contagious during this timescale. Lesions begin within the oropharynx and then spread to the skin. When lesions appear, serum antibodies can be detected (Moore et al., 2023).
Clinical Manifestations
The signs and symptoms of monkeypox typically begin within three weeks after the individual is exposed to the monkey virus, typically lasting for two to four weeks. Notably, the clinical manifestations of monkeypox are significantly identical to smallpox infection indications. Typically, the infected person manifests flu-like symptoms. The typical initial symptoms include fatigue, backache, muscle aches, headache, and fever (World Health Organization, 2023). Following the onset of lymphadenopathy and fever, rashes will likely appear within one to three days. The patient remains contagious from when the signs and symptoms begin up to when the rash completely heals (Soheili & Nasseri, 2022). The significant distinguishing difference between smallpox and monkeypox is the period when the lymph nodes enlarge, which generally happens early when the fever starts. The fever typically subsides within three days after the rash begins to manifest. Lesions are found on the palms, soles, face, extremities, conjunctivae, cornea, and the oral mucous membrane. The infection typically lasts up to four weeks when the lesions have entirely peeled off (Soheili & Nasseri, 2022).
Epidemiology
As noted earlier, monkeypox was first established in humans in 1970 in the DRC. It later spread to Africa's central and western regions, while its incidence in other continents dramatically escalated. The monkeypox infection median age in Africa increased from four to five years within the 1970s and 80s to ten and twenty-one years of age in the 2000s as well as 2010s. The infection is more prevalent in men in regions outside of Africa. The aggregate case mortality rate was 8.7 percent, which substantially differs by lineage (West African is 3.6 percent while Central African is 10.6 percent) (Moore et al., 2023).
Vaccination
The U.S. Food and Drug Administration has licensed two vaccines for monkeypox infection prevention, including ACAM2000 and JYNNEOS. The World Health Organization (WHO) guidelines for monkeypox prevention indicates that the first-generation vaccines held in some countries' national reserves, linked to smallpox eradication programs, are not recommended because they fail to satisfy current safety requirements. In this vein, the WHO recommends using novel monkeypox vaccines, including JYNNEOS, which is approved for monkeypox prevention. The smallpox vaccine efficacy in monkeypox prevention is at 85 percent based on previous reports from sub-Saharan Africa. The effectiveness of JYNNEOS in monkeypox prevention derives from immunogenicity experimental research and effective data sources from animal research. Regarding pre-exposure prophylaxis, the Advisory Committee on Immunization Practices (ACIP) recommends the selection of personnel, including research laboratory professionals, designated public health response stakeholders, and clinical laboratory professionals whose work exposes them to the monkeypox virus for a vaccination with JYNNEOS or ACAM2000. Regarding post-exposure prophylaxis, the efficacy of the monkeypox vaccine depends on the urgency of administration following exposure to the virus. People who are exposed to the virus and do not receive smallpox immunization within the previous three years meet the requirement for immediate vaccination, especially within four days after exposure (Soheili & Nasseri, 2022). This has proved effective in preventing the onset of clinical manifestations of monkeypox disease.
Diagnosis
Monkeypox diagnosis usually is not clinically differentiated from other related ...