It belongs to the genus Orthopoxvirus in the family Poxviridae. It is one of the human orthopoxviruses that includes variola, cowpox, and vaccinia viruses.

With The advent of monkeypox presents a new medical threat to the global community. As of today more than 500 cases of monkey pox have been reported in over 30 countries all over the world. India has not yet recorded any case.

The term 'monkeypox' was coined in 1958 after two outbreaks of a pox-like illness occurred in study colonies of monkeys, thus the name 'monkeypox'. The first human case of monkeypox was documented in the Democratic Republic of the Congo (DRC) in 1970, at a time of increased efforts to eradicate smallpox.

Since then, cases of monkeypox have been documented in numerous other central and western African nations. Cases of human monkeypox outside of Africa have been related to foreign travel or imported animals.

Clinical manifestations of monkeypox mimic those of smallpox, an Orthopoxvirus disease linked to monkeypox that has been eliminated.

Smallpox was more transmissible and often lethal, as around 30 per cent of victims succumbed. The final instance of spontaneously acquired smallpox occurred in 1977, and the disease was proclaimed eliminated globally in 1980 after a global vaccination and containment effort.

All nations have discontinued regular smallpox immunisation using vaccinia-based vaccinations for at least 40 years. Since immunisation also provided protection against monkeypox in the west and central Africa, unvaccinated populations are now more vulnerable to infection with the monkeypox viru

Transmission from animals to humans

1. Typically, the virus is transmitted by contact with an infected animal's body secretions or a bite.
2. Humans and monkeys are accidental hosts; the reservoir is unknown but presumably rodents. Accidental importation of infected rodents from Western Africa into the United States led to the first human monkeypox illnesses in the Western Hemisphere.

Based on data from an epidemic in the United States in 2003, the route of infection and degree of exposure (e.g., bite wound vs contact with an infected animal) might impact the severity of clinical signs of monkeypox infection.

Transmission from human to human 

1. Large respiratory droplets may play a role in human-to-human transmission.
2. Transmission may also occur by contact with infected skin lesions or lesion debris.
3. For droplet transmission, continuous face-to-face contact may be necessary (e.g., within a 6-foot radius for 3 hours in the absence of personal protective equipment [PPE]).

Clinical presentation and symptoms

1. The symptoms of monkeypox in people are comparable to but less severe than those of smallpox.
2. The first symptoms of monkeypox include fever, headache, muscular pains, and fatigue. The primary distinction between smallpox and monkeypox symptoms is that monkeypox produces lymphadenopathy, while smallpox does not.
3. The incubation period (time from infection to onset of symptoms) for monkeypox ranges from 5 to 21 days but is typically 7 to 14 days.

The sickness starts with:

• Fever
• Headache
• Muscle pains
• Backache
• Lymph node enlargement
• Chills
• Exhaustion

Rashes arise within a few days (sometimes longer) following the patient's fever, and they tend to start on the face before spreading to other regions of the body.

Typically, the disease lasts two to four weeks. Monkeypox has been linked to the mortality of up to 10% of those who catch it in Africa.

The clinical characteristics of monkeypox are useful in establishing the diagnosis; nevertheless, laboratory confirmation is required to distinguish this illness from those caused by other possible aetiologies.

Prevention

To prevent the spread of monkeypox, there are a variety of interventions that may be implemented:

1. Stay away from animals that may carry the infection (including animals that are sick or that have been found dead in areas where monkeypox occurs).
2. Avoid coming into touch with any things, including bedding, that has been in contact with a sick animal.
3. Isolate sick individuals from others who may be susceptible to infection.
4. After having contact with sick animals or people, it is necessary to practice proper hand hygiene. For instance, washing your hands with soap and water or using a hand sanitiser containing alcohol.
5. When caring for patients, personal protection equipment (PPE) must be worn.

Vaccination

As a result of vaccinia virus immunisation, monkeypox illness may be less severe in those who previously had the smallpox vaccine. A modified vaccinia Ankara (MVA) vaccine (marketed as Imvamune and Jynneos) was authorised in September 2019 for the protection of smallpox and monkeypox.

Several observational studies have shown that smallpox vaccination is around 85 per cent effective in preventing monkeypox. Therefore, previous immunisation against smallpox may result in a lesser disease. Typically, a scar on the upper arm indicates that a person has been vaccinated against smallpox.

The original (first-generation) smallpox vaccinations are not accessible to the general population at this time. Some laboratory or health employees may have gotten a more modern smallpox vaccination to protect them in the case of occupational exposure to orthopoxviruses.

In 2019, a vaccine based on an Ankara strain of modified attenuated vaccinia virus was authorised for the prevention of monkeypox. This vaccination requires two doses, and its availability remains restricted. Due to the cross-protection given by the immune response to orthopoxviruses, smallpox and monkeypox vaccines are formulated with the vaccinia virus.

Patient management

Supportive care 

1. The majority of people have mild diseases and improve without treatment.
2. Hospitalisation for intravenous hydration may be necessary for those who have risk factors for dehydration (e.g. nausea and vomiting, dysphagia).
3. The critically sick patient must get supportive care until he or she recovers from the infection.
4. Care for monkeypox must be adjusted to ease symptoms, manage complications, and avoid long-term problems.
5. Fluids and food should be provided to patients in order to preserve their nutritional state.
6. As directed, secondary bacterial infections should be treated.
7. The European Medical Association (EMA) approved tecovirimat, an antiviral drug designed for smallpox, for monkeypox in 2022, based on findings from animal and human research. It is not widely accessible yet.

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