Monkeypox as an emerging global health threat during the COVID- 19 time

Dear Editor

Monkeypox is currently an emerging infectious disease in the world. Symptoms are similar to Variola virus or smallpox and further symptoms include maculopapular rash, particularly on the palms of the hand and soles of the feet, and adenopathy [1] (See Fig. 1). In 1970, Monkeypox was first identified as a human disease in the Democratic Republic of Congo (DRC). West Africa is home to other genetic groups of the monkeypox virus [2]. Monkeypox belongs to Poxviridae, sub-family chordopoxvirinae, genus orthopoxvirus, species Monkeypox virus [MPXV]. The monkeypox virus appears relatively large (200–250 nm) under an electron microscope. Poxviruses are brick-shaped, with a lipoprotein envelope encasing a linear double-stranded DNA genome. Poxvirus genomes contain all the replication, transcription, assembly, and egress proteins and rely on host ribosomes for mRNA translation [3]. MPXV is spread to humans through direct contact with infected animals or bodily fluids or respiratory droplets from infected people, resulting in secondary transmission [4]. DNA isolation in viral culture or a polymerase chain reaction (PCR) test from a patient's specimen can confirm the diagnosis of Monkeypox.

Fig. 1.

The mode of transmission and symptoms of Monkeypox.

Conversely, tests that can be sufficiently diagnostic include serum studies for anti-orthopoxvirus IgG and IgM, immunohistochemical staining for orthopoxvirus antigens, and electron microscopy visualization [3]. In 2003, 93 cases of Monkeypox were reported in the United States [5]. Monkeypox had also spread throughout southeast and southern Nigeria. From September 2017 to the end of April 2022, Nigeria reported 558 suspected cases with 231 confirmed, and more cases came from the rural parts of Nigeria [6].

The world is still combating COVID-19 when another emerging disease has started to put stress on the human race. Also, not to forget that COVID-19 has not ended yet, and further waves are expected worldwide. Almost 20 non-endemic countries, with no continent untouched, have reported over 200 laboratory-confirmed or suspected cases till May 27, 2022 [7]. Belgium is the first country to declare a monkeypox quarantine [8]. Multiple US health experts believe that Monkeypox has a 0% chance of getting converted into a pandemic of the magnitude of COVID-19 due to the lack of novelty of this virus, being comparatively less deadly and less contagious [9]. Added to these facts is the availability of vaccines for Monkeypox. Monkeypox can be transmitted through sexual intercourse and in recent reports it has been noted that the prevalence is higher in the UK among bisexual men and the Gay community [10,11]. However, the WHO has warned to not undermine the situation, with the world already on the backfoot due to the COVID-19 pandemic, droughts, famines, climate change issues, the Russo-Ukrainian war, and humanitarian crises in Afghanistan, Ethiopia, Somalia, South Sudan, Syria, Ukraine and Yemen [12].

What have we learnt from the COVID 19 pandemic? Can this knowledge be used to address and control the monkeypox viral outbreak better? Creating a separate Incidence-Mortality database similar to the COVID-19 database is essential. Although there are no specific treatment options for Monkeypox [13], outbreaks can be controlled, mainly due to the smallpox vaccine, as the viruses that cause Monkeypox and smallpox are related. They have cross-immunization, which implies that immunity to one imparts immunity to the other [14]. Drugs like Cidofovir, Brincidofovir (CMX001), Tecovirimat (ST-246), and Vaccinia Immuno Globulin (VIG) are given to the patients. JYNNEOS™ (Imvamune or Imvanex) is known to prevent both smallpox and Monkeypox (85% effective). ACAM2000, a live vaccine, is also under trial [15]. A mass vaccination program should be started as we have seen that mass vaccination has helped the world combat COVID 19. Every country should make an app based on vaccination information and adverse effects. Monkeypox Vaccines can be given in the COVID 19 vaccination centers, and vaccine centers can be put in every 500 m. For old aged and disabled people, health workers can distribute the vaccines in the house. Kids are more susceptible, so they should be vaccinated first. The old aged people who haven't received the smallpox vaccine prior should get priority in the vaccination program. Programs on public awareness to highlight the importance of vaccinations are much needed. From COVID 19, we have learnt about the rapid mutations in the viruses, so emergency approval of new vaccines is important. More types of vaccines and drug trials are essential. The availability of the medicines should be increased. Cidofovir, CMX001, ST-246, and VIG have no proven efficacy against Monkeypox, but there is in-vitro and animal evidence of its activity against poxviruses [15]. We can use computational biology to inhibit the possible proteins with a drug. Proper prevention is also vital– one should avoid contact with dead or sick animals, materials in contact with a sick animal, and isolation of cases; proper hygiene maintenance and personal protective equipment (PPE) should be brought into practice. In the red light areas, regular health checkup is needed. A regular checkup is also needed in the bisexual community and gay community as the reports are highlighting the higher incidence rate among them. A contact tracing app should be created for Monkeypox. The general public should be made aware of the circulation of the virus in the environment and preventive measures that need to be taken. All types of guidelines based on precocious steps should be taken during travels. Mass testing should be substantial. All kinds of media should be employed for this purpose, and similar strategies like that of COVID-19 can be employed here also. In COVID 19 times, much fake news were circulated on social media. Governments should strictly address these issues. Countries that have still not registered cases should also maintain a precautionary stance and prepare themselves to encounter this virus.

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Each of the authors confirm that this manuscript has not been previously published or posted in a preprint and is not currently under consideration by any other journal. Additionally, all of the authors have substantially contributed to conducting the underlying research and drafting this manuscript. None of the authors have any conflict of interest, financial or otherwise. All the authors have no fundings.

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