Created by PRI for the NYC Health Department. Latest editions Tuesdays and Thursdays. While we use the language “MPV”, most sources do not, and readers will see the language fluctuate within the report. For questions and feedback, please email email@example.com
Case Counts/Trends and Large Guidance/Response Changes (Limited by latest reporting)
- GLOBAL: From 1 January through 16 October 2022, a cumulative total of 73 437 laboratory-confirmed cases of monkeypox and 29 deaths have been reported to WHO from 109 countries/territories/areas (hereafter ‘countries’[i]) in all six WHO Regions (Table 1). Since the last edition published on 5 October 2022, 4537 new cases (6.6% increase in total cases), and four new deaths have been reported. In the past seven days, 17 countries reported an increase in the weekly number of cases, with the highest increase (7.7%) reported in Peru. Three new countries Mozambique (n=1,) San Marino (n=1), and Vietnam (n=1) reported its first cases in the past seven days. Overall, 49 countries have not reported new cases for over 21 days, the maximum incubation period of the disease; 10 more countries since the last report. (WHO Sit Rep – Latest 10/19/2022 / Dashboard)
- US: Total confirmed MPV cases: 28,087 (10.26.2022). (full version).
- NY State: As of October 23 2022, a total of 3,712 confirmed orthopoxvirus/monkeypox cases – a designation established by the Centers for Disease Control and Prevention (CDC). (NY Sit Rep and County List)
- Six people who tested positive for monkeypox have died, health departments confirm (CNN) Six people who tested positive for monkeypox – two in New York City, two in Chicago, one in Nevada and one in Maryland – have died, local health departments have confirmed. The New York City Department of Health and Mental Hygiene said it was “deeply saddened by the two reported deaths, and our hearts go out to the individuals’ loved ones and community.”
- Most Hospitalized Monkeypox Patients in the U.S. Were H.I.V.-Positive (NY Times) Of 57 hospitalized patients described in the report, 82 percent had H.I.V. More than two-thirds of the patients were Black and nearly one-quarter were homeless, reflecting racial and economic inequities seen in the outbreak overall.
- Monkeypox emergency orders are set to expire, but eradication isn’t likely (NBC News) Daily cases of the virus in the U.S. have declined eightfold in the last two months, from an average of around 400 on Aug. 19 to fewer than 50 on Wednesday, according to data from the Centers for Disease Control and Prevention. “We don’t want to declare victory prematurely, but it does seem like we are winning,” said Stephen Morse, an epidemiology professor at Columbia University.
- Delhi Monkeypox tally climbs to nine after Nigerian tests positive for virus (The Economic Times) Delhi Monkeypox cases climbed up to nine after another Nigerian citizen tested positive for the virus. This took India’s tally of Monkeypox cases to 19.
Articles by Category
Using Data From a Short Video Social Media Platform to Identify Emergent Monkeypox Conspiracy Theories (Zenone et al., JAMA Network Open)
This qualitative study used real-time data from TikTok, a social media app allowing users to create and share short videos, to proactively identify monkeypox conspiracy theories for public health to debunk before their potential viral spread. To identify emergent conspiracy theories about monkeypox, content and metadata under #monkeypox (864 videos) on the app’s desktop version were collected using the DataMiner website scraper tool and manual retrieval of videos on May 21, 2022. The researchers identified 153 videos with a monkeypox conspiracy theory or theme. In total, videos received 1,485,911, 74,328 likes, 7890 comments, and 13,783 shares. The analysis sorted conspiracy theories into 11 types (please see Table in article). The most prominent were assertions that monkeypox was a planned pandemic introduced for power, control, or money or to instill fear (71 videos [46.4%]); content alleged that monkeypox was a purposeful repeating of COVID-19, intentionally released, or associated with COVID-19 and conspiracy theories such as “the great reset” and “one world order.” 51 videos (33.3%) were related to vaccines and asserted monkeypox was an excuse to administer or mandate vaccines worldwide. Vaccine manufacturers and governments were accused of knowing of an upcoming outbreak or having a role in creating the outbreak. The WHO was accused of involvement in the outbreak as an excuse to pass the May 2022 global pandemic treaty (27 [17.6%]) and erode the sovereignty of countries, override national laws, and seek broader power. The commentary of Bill Gates predicting or addressing the need to prepare for the next pandemic was taken as evidence of his involvement (28 videos [18.3%]). Lastly, several conspiracy theories tied unrelated news events to the cause and/or cover-up of the monkeypox outbreak (e.g., an escape of monkeys in the US). Overall, these results demonstrated the potential use of real-time social media data to identify and understand conspiracy theories before their viral spread.
Evaluation and validation of an RT-PCR assay for specific detection of Monkeypox virus (MPXV) (Mondolfi et al., Journal of Medical Virology)
Monkeypox virus (MPXV) is a zoonotic Orthopoxvirus within the Poxviridae family. MPXV is endemic to Central and West Africa. However, the world is currently witnessing an international outbreak with no clear epidemiological links to travel or animal exposure and with ever-increasing numbers of reported cases worldwide. The objective of the study was to evaluate and validate a new, sensitive and specific real-time PCR-assay for MPXV diagnosis in humans and compare the performance of this novel assay against a Food & Drug Administration (FDA)- cleared pan-Orthopox RT-PCR assay. The researchers determined specificity, sensitivity, and analytic performance of the PKamp™ Monkeypox Virus RT-PCR assay targeting the viral F3L-gene. In addition, they further evaluated MPXV-PCR-positive specimens by viral culture, electron microscopy, and viral inactivation assays. The limit of detection was established at 7.2 genome copies/reaction, and MPXV was successfully identified in 20 clinical specimens with 100% correlation against the reference method with 100% sensitivity and specificity. These results demonstrated the validity of this rapid, robust, and reliable RT-PCR assay for specific and accurate diagnosis of MPXV infection in human specimens collected both as dry swabs and in viral transport media. This assay has been approved by NYS Department of Health for clinical use.
Risk of Monkeypox virus (MPXV) transmission through the handling and consumption of food (Chaix et al., Microbial Risk Analysis)
Monkeypox (MPX) is a zoonotic infectious disease caused by Monkeypox virus (MPXV), an enveloped DNA virus belonging to the Poxviridae family and the Orthopoxvirus genus. Since early May 2022, a growing number of human cases of Monkeypox have been reported in non-endemic countries, with no history of contact with animals imported from endemic and enzootic areas, or travel to an area where the virus usually circulated before May 2022. This qualitative risk assessment aimed to investigate the probability that MPXV transmission occurs through food during its handling and consumption. The risk assessment used “top-down” (based on epidemiological data) and “bottom-up” (following the agent through the food chain to assess the risk of foodborne transmission to human) approaches, which were combined. The “top-down” approach first concluded that bushmeat was the only food suspected as a source of contamination in recorded cases of MPXV, by contact or ingestion. The “bottom-up” approach then evaluated the chain of events required for a human case to become ill after handling or consuming food. This approach involves several conditions: i) the food must be contaminated with MPXV (naturally, by an infected handler or after contact with a contaminated surface); ii) the food must contain viable virus when it reaches the handler or consumer; iii) the person must be exposed to the virus and; iv) the person must be infected after exposure. Throughout the risk assessment, some data gaps were identified and highlighted. The conclusions of the top-down and bottom-up approaches are consistent and suggest that the risk of transmission of MPXV through food is hypothetical and that such an occurrence was never reported. In case of contamination, cooking (e.g., 12 minutes at 70°C) could be considered effective in inactivating Poxviridae in foods. Recommendations for risk management are proposed. To our knowledge, this is the first risk assessment performed on foodborne transmission of MPXV.
Here, the authors report the first imported case of monkeypox in the mainland of China on September 16, 2022. A 29-year-old salesman of Chinese nationality visited Germany during September 2–8, 2022, and had MSM behavior in Berlin on September 2. He subsequently traveled to Spain, and then returned Chongqing Municipality, China on September 14, 2022. The man suffered from dry and itchy throat and had a fever on September 9 with red rashes and pustules displayed on his right thigh. On September 11, he visited a private clinic and took anti-inflammatory medication. On September 14, he was isolated in a COVID-19 quarantine spot in Chongqing. He self-reported that he displayed monkeypox-like clinical manifestations and was then identified as a suspected case of monkeypox by Chongqing CDC. Clinical specimens, including blister fluid, nasopharyngeal and oropharyngeal swabs, and a blood sample were collected on September 14, and the primary screening of MPXV based qPCR showed positive results among these specimens, which were then sent to China CDC on September 16. Several qPCR and whole genome sequencing were performed. The qPCR results showed that monkeypox genome and West Africa strain was detected as positive in the specimens of the case. In addition, the swab of blister fluid was directly used for transmission electron microscopy. The result revealed that typical mulberry-shaped particles were visualized with diameters ranging from 150 to 200 nm, a characteristic of MPXV. Gene sequencing suggests that MPXV strain in this case (China-CQ202209) belongs to B.1 branch of the West African linage, and it was highly homologous to strains from Germany collected on June 21, 2022 (GISAID ID: EPI_ISL_13889435). These results confirmed the first imported monkeypox case in the mainland of China, making this the fifth confirmed monkeypox infection in humans reported in China. Other imported cases of monkeypox human infection were reported in Taiwan, China and Hong Kong Special Administrative Region, China.
First Detection of Monkeypox Virus Genome in Sewersheds in France: The Potential of Wastewater-Based Epidemiology for Monitoring Emerging Disease (Wurtzer et al., Environmental Science & Technology Letters)
A monkeypox virus outbreak has been spreading in multiple nonendemic countries since May 2022. The atypical clinical profile of patients has led to a very likely underestimation of the number of cases at the beginning of the epidemic. The detection and quantification of the Monkeypox virus genome in sewersheds in Paris (France) correlated temporally with the identification of the first case of infection and the spread of the disease within the population connected to the sewage system.
Monkeypox: Immune response, vaccination and preventive efforts (Ophinni et al., Narra J 2022)
Infectious threats to humans are continuously emerging. The 2022 worldwide monkeypox outbreak is the latest of these threats with the virus rapidly spreading to 106 countries by the end of September 2022. The burden of the ongoing monkeypox outbreak is manifested by 68,000 cumulative confirmed cases and 26 deaths. Although monkeypox is usually a self-limited disease, patients can suffer from extremely painful skin lesions and complications can occur with reported mortalities. The antigenic similarity between the smallpox virus (variola virus) and monkeypox virus can be utilized to prevent monkeypox using smallpox vaccines; treatment is also based on antivirals initially designed to treat smallpox. However, further studies are needed to fully decipher the immune response to monkeypox virus and the immune evasion mechanisms. In this review we provide an up-to-date discussion of the current state of knowledge regarding monkeypox virus with a special focus on innate immune response, immune evasion mechanisms and vaccination against the virus.
Lack of clinical evidence of antiviral therapy for human monkeypox: A scoping review (Kuroda et al., Journal of Infection and Chemotherapy)
Since May 2022, many human monkeypox cases have been reported from non-endemic countries. This systematic review aimed to evaluate and summarize the existing research on the efficacy and safety of tecovirimat, brincidofovir, and cidofovir for patients with monkeypox. We searched studies that reported the efficacy and adverse events of tecovirimat, brincidofovir, or cidofovir for patients with human monkeypox in several databases including preprint servers. Only five studies were included. The efficacy and adverse events were assessed in only five and four patients, respectively. Regarding tecovirimat, all two patients recovered from monkeypox. One had no adverse event and the other has no description of an adverse event. Regarding brincidofovir, all three patients recovered from monkeypox but all of them had increased alanine transaminase, and one had nausea and abdominal discomfort. There was no study on treatment with cidofovir. Based on past studies and our results, tecovirimat might be the best choice due to ease of administration (oral drug), fewer side effects, and past treatment results for human monkeypox administration. However, very few studies were included in this scoping review. Therefore, further studies are needed to assess their efficacy and safety as possible treatments for human monkeypox.
Monkeypox virus vaccine evolution and global preparedness for vaccination (Chakraborty et al., International Immunopharmacology)
The recent emergence of monkeypox (MPX) has created a global threat. The number of infected and suspected cases of MPX is increasing in different parts of the world, especially in non-African countries. However, vaccines are available to fight against this disease. It has been observed that smallpox vaccines can be used to protect against MPX. The present article highlights the significant points and various issues for vaccines and vaccinations that should be considered related to MPX. This paper illustrates current vaccines for smallpox that can be utilized to protect against MPX infection. The article also describes the different significant research on MPXV, especially smallpox vaccines, and its outcome in MPX infection. We have also tried to depict the smallpox vaccination eradication model through the statistical interface using smallpox eradication data from Central and West Africa between 1967 and 1972. We suggest that these models might be helpful for the eradication of MPX in the middle to low-economic countries. Simultaneously, we have also discussed vaccination preparedness in different countries like the USA, UK, Canada, Denmark, Germany, etc. Our report might be helpful to scientists and policymakers in understanding the vaccines and vaccination against MPX and formulating effective strategies to fight against the disease.
Poxviruses and the immune system: Implications for monkeypox virus (Saghazadeh et al, International Immunopharmacology)
Poxviruses (PXVs) are mostly known for the variola virus, being the cause of smallpox; however, re-emerging PXVs have also shown a great capacity to develop outbreaks of pox-like infections in humans. The situation is alarming; PXV outbreaks have been involving both endemic and non-endemic areas in recent decades. Stopped smallpox vaccination is a reason offered mainly for this changing epidemiology that implies the protective role of immunity in the pathology of PXV infections. The immune system recognizes PXVs and elicits responses, but PXVs can antagonize these responses. Here, we briefly review the immunology of PXV infections, with emphasis on the role of pattern-recognition receptors, macrophages, and natural killer cells in the early response to PXV infections and PXVs’ strategies influencing these responses, as well as taking a glance at other immune cells, which discussion over them mainly occurs in association with PXV immunization rather than PXV infection. Throughout the review, numerous evasion mechanisms are highlighted, which might have implications for designing specific immunotherapies for PXV in the future.