Advances in recognizing, treating, and preventing mpox infection

Background

Monkeypox (mpox) was first isolated in 1958, and since that time, only sporadic human cases have been reported. Mpox is a double-stranded DNA poxvirus of the Orthopox genus whose natural animal reservoir is small rodents. Classification of the virus is divided into clades I and II, with clade II being further subdivided into IIa and IIb. Transmission is most often accomplished through large respiratory droplets or skin-to-skin contact with infectious lesions. Infection typically proceeds in 3 distinct phases (incubation, prodrome, and rash), with the course of the illness extending 2 to 4 weeks. Lymphadenopathy is often a distinguishing finding.

Objective

The emergence and re-emergence of mpox infections in the United States and beyond have underscored the need for continued awareness of transmission patterns, clinical presentation, treatment, and preventative strategies.

Methods

A literature search was conducted for published literature using the keywords "Mpox", "Monkeypox" or "Monkeypox virus", between 1950 and 2023. All manuscript types were included and reviewed for relevant information related to Money pox and its management.

Results

In 2022 and after a span of decades, mpox cases re-emerged in the United States coinciding with reported outbreaks in Europe among men who have sex with men. The 2022 outbreak was distinguished by a pattern of rash where lesions were very commonly sequestered to genital and perianal regions. The clinical course of disease can be complicated by pre-existing immunocompromise including human immunodeficiency virus infection. Although no Food and Drug Administration–approved treatment for mpox exists, some antiviral options are available including tecovirimat. Other less studied but promising alternatives include brincidofovir and vaccinia immune globulin intravenous. Currently, 2 vaccine products are available for the prevention of mpox infection.

Conclusion

The appearance of new mpox infections in 2022 and lingering cases in 2023 underscore the need for continued vigilance against this and other zoonotic disease.