Monkeypox Disease with a Focus on the 2022 Outbreak; a Narrative Review

Abstract

Monkeypox is a zoonotic disease caused by a double-stranded DNA virus belonging to the genus Orthopoxvirus. Despite being endemic in Central and West Africa, the disease has received relatively little research attention until recent times. As the Coronavirus disease 2019 (COVID-19) pandemic continues to affect the world, the rising number of monkeypox cases in non-endemic countries has further stoked global public health concerns about another pandemic. Unlike previous outbreaks outside Africa, most patients in the present outbreak had no history of travel to the endemic regions. The overwhelming majority of patients were initially identified amongst homosexual men, who had attended large gatherings. Mutations in the coding regions of the viral genome may have resulted in fitness adaptation, enhancement of immune evasion mechanisms, and more efficient transmissibility of the 2022 monkeypox virus. Multiple factors such as diminished cross-protective herd immunity (cessation of smallpox vaccination), deforestation, civil war, refugee displacement, farming, enhanced global interconnectedness, and even climate change may facilitate the unexpected emergence of the disease. In light of the increasing number of cases reported in the present outbreak, healthcare professionals should update their knowledge about monkeypox disease, including its diagnosis, prevention, and clinical management. Herein, we provide an overview of monkeypox, with a focus on the 2022 outbreak, to serve as a primer for clinical practitioners who may encounter the disease in their practice.

Keywords: Diagnosis; Disease Outbreaks; Monkeypox; Therapeutics; Vaccination.

Figure 1

A global map of confirmed monkeypox cases as of September 26, 2022. Countries with confirmed cases are as follows: Andorra (n = 4), Argentina (n = 326), Aruba (n = 3), Australia (n = 135), Austria (n = 307), Bahamas (n = 2), Bahrain (n = 1), Barbados (n = 1), Belgium (n = 757), Benin (n = 3), Bermuda (n = 1), Bolivia (n = 164), Bosnia and Herzegovina (n = 3), Brazil (n = 7300), Bulgaria (n = 6), Cameroon (n = 8), Canada (n = 1389), Central African Republic (n = 8), Chile (n = 783), China (n = 1), Colombia (n = 1653), Costa Rica (n = 4), Croatia (n = 29), Cuba (n = 2), Curaçao (n = 3), Cyprus (n = 5), Czechia (n = 66), Democratic Republic of the Congo (n = 195), Denmark (n = 183), Dominican Republic (n = 31), Ecuador (n = 93), Egypt (n = 1), El Salvador (n = 4), Estonia (n = 11), Finland (n = 33), France (n = 3970), Georgia (n = 2), Germany (n = 3601), Ghana (n = 84), Gibraltar (n = 6), Greece (n = 72), Greenland (n = 2), Guadeloupe (n = 1), Guatemala (n = 18), Guyana (n = 2), Honduras (n = 6), Hong Kong (n = 1), Hungary (n = 77), Iceland (n = 12), India (n = 12), Indonesia (n = 1), Iran (n = 1), Ireland (n = 178), Israel (n = 250), Italy (n = 842), Jamaica (n = 14), Japan (n = 4), Jordan (n = 1), Latvia (n = 5), Lebanon (n = 11), Liberia (n = 3), Lithuania (n = 5), Luxembourg (n = 55), Malta (n = 33), Martinique (n = 1), Mexico (n = 1367), Moldova (n = 2), Monaco (n = 3), Montenegro (n = 2), Morocco (n = 3), Netherlands (n = 1221), New Caledonia (n = 1), New Zealand (n = 9), Nigeria (n = 277), Norway (n = 91), Panama (n = 13), Paraguay (n = 1), Peru (n = 2311), Philippines (n = 4), Poland (n = 173), Portugal (n = 917), Qatar (n = 5), Republic of the Congo (n = 5), Romania (n = 39), Russia (n = 2), Saint Martin (n = 1), Saudi Arabia (n = 8), Serbia (n = 40), Singapore (n = 19), Slovakia (n = 14), Slovenia (n = 46), South Africa (n = 5), South Korea (n = 2), Spain (n = 7083), Sudan (n = 7), Sweden (n = 186), Switzerland (n = 503), Taiwan (n = 3), Thailand (n = 8), Turkey (n = 1), Ukraine (n = 3), United Arab Emirates (n = 16), United Kingdom (n = 3585), United States (n = 25161), Uruguay (n = 6), Venezuela (n = 5). [according to the data obtained from https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html]

Figure 2

Cumulative number of confirmed cases (a) and deaths (b) related to the monkeypox as of September 26, 2022 [according to the data obtained from https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html]

Figure 3

Clinical symptoms of the 2022 monkeypox disease. [according to the data obtained from https://www.cdc.gov/poxvirus/monkeypox/response/2022/demographics.html ]