Monkeypox Information and Resources

Publications

August 12, 2022

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022

Among U.S. monkeypox cases with available data, 99% occurred in men, 94% of whom reported recent male-to-male sexual or close intimate contact; racial and ethnic minority groups appear to be disproportionately affected. Clinical presentations differed from typical monkeypox, with fewer persons experiencing prodrome and more experiencing genital rashes.

August 11, 2022

How does monkeypox spread? What scientists know

Prolonged contact, especially with a person’s skin lesions, is emerging as the top transmission route. As global monkeypox cases continue to soar, researchers are learning more about how the disease is spreading. Early predictions that the virus transmits primarily through repeated skin-to-skin contact between people have largely borne out, according to a tranche of new studies.

August 8, 2022

Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study

In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak.

August 5, 2022

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022

Among U.S. monkeypox cases with available data, 99% occurred in men, 94% of whom reported recent male-to-male sexual or close intimate contact; racial and ethnic minority groups appear to be disproportionately affected. Clinical presentations differed from typical monkeypox, with fewer persons experiencing prodrome and more experiencing genital rashes.

Interim Guidance for Prevention and Treatment of Monkeypox in Persons with HIV Infection — United States, August 2022

CDC has developed clinical considerations for prevention and treatment of monkeypox in persons with HIV infection, including pre-exposure and postexposure prophylaxis with JYNNEOS vaccine, treatment with tecovirimat, and infection control.

August 4, 2022

Breakthrough infections after post-exposure vaccination against Monkeypox

Between May 27th and July 13th, 2022, 276 individuals received one dose of IMVANEX®with a median delay of 11 days [IQR 8-14] after exposure with a confirmed Monkeypox patient. Mode of exposure was droplets for 240 patients (91%), indirect contact for 189 (71%) and unprotected sexual intercourse for 146 (54%). Most of the patients were men (91%, n=250) and men who have sex with men (88%, n=233). The vaccine was well tolerated with no severe adverse event. Among the 276 vaccinated individuals, 12 (4%) had a confirmed Monkeypox breakthrough infection with no severe infection. Ten out of 12 patients developed a Monkeypox infection in the five days following vaccination and two had a breakthrough infection at 22 and 25 days.

August 3, 2022

Tecovirimat and the Treatment of Monkeypox — Past, Present, and Future Considerations

We recognize that monkeypox can cause severe disease and that tecovirimat has been shown to have efficacy in animal models of monkeypox and an acceptable safety profile in healthy people. Therefore, while RCTs are under development, the Centers for Disease Control and Prevention (CDC) and the FDA have worked together to streamline the expanded-access process by reducing paperwork and data collection,5 and we will continue to fine-tune these mechanisms with input from health care providers using this process. In parallel, we believe that it remains critical to conduct RCTs in the United States to determine whether tecovirimat is a safe and effective treatment for monkeypox disease, especially given the disease’s clinical presentation in the current outbreak. As was the case with antiretrovirals for HIV in the 1980s, without data from RCTs, we will not know whether tecovirimat would benefit, harm, or have no effect on people with monkeypox disease. The CDC, the FDA, and the NIH will continue to work together to provide access to tecovirimat for compassionate use while appropriately evaluating its safety and efficacy in RCTs.

August 2, 2022

Monkeypox virus isolation from a semen sample collected in the early phase of infection in a patient with prolonged seminal viral shedding

The patient was a 39-year-old man, who travelled in Austria during the first 2 weeks of May, 2022. He self-identified as an MSM and sex worker and reported condomless sexual intercourse with several male partners during the previous month. The patient was HIV-infected, treated with dolutegravir and lamivudine, with viral suppression and immune recovery, and reported a history of sexually transmitted infections. He was admitted to the hospital 5 days after symptom onset. His symptoms included fever, followed by the appearance of clustered itchy papular lesions in the anal region and single lesions on the head, thorax, legs, arms, hand, and penis. The patient reported one dose of smallpox vaccination during childhood, more than 30 years earlier. He did not receive any current treatment for monkeypox virus infection.

July 30, 2022

Monkeypox: a global wake-up call

WHO's declaration on July 23 that the current monkeypox outbreak constitutes a Public Health Emergency of International Concern (PHEIC) was unprecedented. It is the seventh such declaration, but the first made against the advice of a majority of the emergency committee (nine were against, six were for). Dr Tedros’ decision is a brave one. It needs to serve as a global wake-up call. The question is whether it will prompt the escalated efforts required to control the outbreak.

July 29, 2022

Ophthalmic manifestation of monkeypox infection

A 39-year-old, White, bisexual male attended our sexual health clinic with proctitis and a cluster of vesicles (2–3 mm) in the anal region, which had presented 3 days previously. He declared having had multiple unprotected sexual encounters and being on pre-exposure prophylaxis for HIV prevention since 2019. Over the previous 3 weeks, he had travelled to France and Germany, before returning to Italy.

July 28, 2022

Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series

The median age of participants was 38 years. All 197 participants were men, and 196 identified as gay, bisexual, or other men who have sex with men. All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%). 170 (86.3%) participants reported systemic illness. The most common systemic symptoms were fever (n=122, 61.9%), lymphadenopathy (114, 57.9%), and myalgia (n=62, 31.5%). 102/166 (61.5%) developed systemic features before the onset of mucocutaneous manifestations and 64 (38.5%) after (n=4 unknown). 27 (13.7%) presented exclusively with mucocutaneous manifestations without systemic features. 71 (36.0%) reported rectal pain, 33 (16.8%) sore throat, and 31 (15.7%) penile oedema. 27 (13.7%) had oral lesions and 9 (4.6%) had tonsillar signs. 70/195 (35.9%) participants had concomitant HIV infection. 56 (31.5%) of those screened for sexually transmitted infections had a concomitant sexually transmitted infection. Overall, 20 (10.2%) participants were admitted to hospital for the management of symptoms, most commonly rectal pain and penile swelling.

July 22, 2022

EMA recommends approval of Imvanex for the prevention of monkeypox disease

The CHMP based their recommendation on data from several animal studies which showed protection against the monkeypox virus in non-human primates vaccinated with Imvanex. The CHMP considered that the effectiveness of Imvanex in the prevention of monkeypox disease in humans could be inferred from these studies. To confirm the effectiveness of the vaccine against monkeypox, the company will collect data from an observational study that will be carried out during the ongoing monkeypox outbreak in Europe.

July 21, 2022

Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022

In this case series, monkeypox manifested with a variety of dermatologic and systemic clinical findings. The simultaneous identification of cases outside areas where monkeypox has traditionally been endemic highlights the need for rapid identification and diagnosis of cases to contain further community spread.

July 18, 2022

Clinical Presentation and Virological Assessment of Confirmed Human Monkeypox Virus Cases in Spain : A Prospective Cohort Study

In our study cohort, monkeypox caused genital, perianal, and oral lesions and complications like proctitis and tonsillitis. Because of the variability of clinical presentations clinicians should have a low threshold for suspicion of the disease. Compared to pharyngeal swabs, lesion swabs show much higher viral loads, suggesting close contact is likely to be the dominant transmission route in the current outbreak.

July 14, 2022

Frequent detection of monkeypox virus DNA in saliva, semen, and other clinical samples from 12 patients, Barcelona, Spain, May to June 2022 separator

MPX virus transmission dynamics, similarly to other newly emerging viral infections, may need to be addressed under multidisciplinary approaches. Our results contribute to an improved understanding of a likely complex transmission puzzle and underline other immediate areas for research such as the infectivity of bodily fluids, the frequency of secondary and asymptomatic cases or the impact of social and behavioural factors affecting viral transmission. Our results may be valuable as well for diagnostic testing algorithms and public health interventions.

July 1, 2022

Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis

Monkeypox virus infection was confirmed in 54 individuals, all identifying as men who have sex with men (MSM), with a median age of 41 years (IQR 34–45). 38 (70%) of 54 individuals were White, 26 (48%) were born in the UK, and 13 (24%) were living with HIV. 36 (67%) of 54 individuals reported fatigue or lethargy, 31 (57%) reported fever, and ten (18%) had no prodromal symptoms. All patients presented with skin lesions, of which 51 (94%) were anogenital. 37 (89%) of 54 individuals had skin lesions affecting more than one anatomical site and four (7%) had oropharyngeal lesions. 30 (55%) of 54 individuals had lymphadenopathy. One in four patients had a concurrent STI. Five (9%) of 54 individuals required admission to hospital, mainly due to pain or localised bacterial cellulitis requiring antibiotic intervention or analgesia. We recorded no fatal outcomes.

June 29, 2022

MONKEYPOX CASE STUDY - CDC Emergency Preparedness

This is a technical presentation intended for healthcare professionals and contains graphic images that might not be appropriate for some audiences. It is a CDC COCA call presentation made on June 29, 2022.

Global Monkeypox Outbreaks Spur Drug Research for the Neglected Disease

In 2018, physicians in the UK administered an investigational smallpox drug called brincidofovir to 3 patients with monkeypox virus infections stemming from a large outbreak in Nigeria. Before then, monkeypox had never been encountered in Europe.

June 28, 2022

Does it matter who is spreading monkeypox?

Recently, many cases of monkeypox were reported worldwide. Although most of these cases seem to be associated with the community of men who have sex with men (MSM), not all of them are. Cases with west and central African monkeypox virus clades have been rising in the past 20 years. The current spread, due to the less transmissible and less virulent west African clade, was unexpected because observations on earlier outbreaks, mostly in African villages, indicated that monkeypox outbreaks are self-limiting. In technical terms, the basic reproduction number (R0) was less than 1. R0 is the average number of secondary cases produced by a single case during the whole infectious period in a community without immunity and without interventions. The low transmissibility, obviously, must have changed during this current emergence of cases. Whether this change was due to mutations in the virus or due to a different type and frequency of contacts is interesting, but not necessarily relevant when contemplating how to stop the outbreak. The main question simply is how to reduce the average number of secondary cases per infected person to below 1. In this context, it also does not matter whether the infection mainly spreads within an MSM community or finds its way into other groups of the population. We can only speculate about the current value of R0 for monkeypox.

June 13, 2022

Monkeypox in 2022—What Clinicians Need to Know

Monkeypox virus was first isolated in 1958 from monkeys at the Statens Serum Institut in Copenhagen, Denmark—thus its name; however, the natural host of monkeypox virus also includes rope squirrels, tree squirrels, Gambian pouched rats, and dormice. As with many zoonoses, this poxvirus is transmitted incidentally to humans when they encounter infected animals. The first known human case of monkeypox was recorded in 1970 in the Democratic Republic of the Congo.

June 9, 2022

What Is Monkeypox?

JAMA Monkeypox Patient Page

May 26, 2022

Monkeypox outbreak questions intensify as cases soar

With the COVID-19 pandemic still raging, a second public health threat has the world on high alert: a global outbreak of monkeypox. As of 26 May, two dozen countries in the Americas, Europe, North Africa, the Middle East, and Australia had reported more than 350 suspected and confirmed cases of the disease, a much milder cousin of smallpox, the deadly scourge that the World Health Organization (WHO) deemed eradicated in 1980. A disproportionate number of cases are in men who have sex with men (MSM), an unusual twist given that researchers have never convincingly shown sexual transmission occurs in monkeypox.

May 19, 2022

First draft genome sequence of Monkeypox virus associated with the suspected multi-country outbreak, May 2022 (confirmed case in Portugal)

On May 19th, Portugal had already registered more than 20 laboratory confirmed cases of monkeypox and several samples were already subjected to laboratory procedures towards the determination of the virus genome sequence. Here we report the release of the first draft genome sequence of the monkeypox virus associated with this major outbreak affecting multiple countries worldwide. This sequence (Monkeypox_PT0001_2022.zip (52.1 KB)) was obtained from a swab collected on May 4th from skin lesions from a male patient. A first rapid phylogenetic analysis of the draft genome (Figure 1) indicates that the 2022 virus belongs to the West African clade and is most closely related to viruses associated with the exportation of monkeypox virus from Nigeria to several countries in 2018 and 2019, namely the United Kingdom, Israel and Singapore (4, 5). This preliminary data and analysis will be soon updated upon the release of new genome data, which will be important to elucidate the origin and international spread of the currently circulating virus.

May 24, 2022

Clinical features and management of human monkeypox: a retrospective observational study in the UK

We reviewed all cases since the inception of the HCID (airborne) network between Aug 15, 2018, and Sept 10, 2021, identifying seven patients. Of the seven patients, four were men and three were women. Three acquired monkeypox in the UK: one patient was a health-care worker who acquired the virus nosocomially, and one patient who acquired the virus abroad transmitted it to an adult and child within their household cluster. Notable disease features included viraemia, prolonged monkeypox virus DNA detection in upper respiratory tract swabs, reactive low mood, and one patient had a monkeypox virus PCR-positive deep tissue abscess. Five patients spent more than 3 weeks (range 22–39 days) in isolation due to prolonged PCR positivity. Three patients were treated with brincidofovir (200 mg once a week orally), all of whom developed elevated liver enzymes resulting in cessation of therapy. One patient was treated with tecovirimat (600 mg twice daily for 2 weeks orally), experienced no adverse effects, and had a shorter duration of viral shedding and illness (10 days hospitalisation) compared with the other six patients. One patient experienced a mild relapse 6 weeks after hospital discharge.