This lecture is presented by our volunteer Sajid Ali Shah, he is from Islamabad, Pakistan, and he is covering the topic Decoding the Monkeypox Virus : From Discovery to Prevention. For video: https://youtu.be/-RT2UvTerBc

1. Decoding the Mpox
Virus: From Discovery
to Prevention
Presented
by
Sajid Ali Shah

2. The Mpox
Introduction
 Mpox ( monkeypox) is a rare disease caused by a virus.
 It is a zoonotic virus belonging to the Orthopox genus.
 It is a linear double-stranded DNA virus belonging to the Poxviridae family that has been listed by the WHO in
its list of diseases with epidemic or pandemic potential.
 The subset includes Smallpox (variola), Vaccinia, and Cowpox viruses
 It leads to rashes and flu-like symptoms. Like the better-known virus that causes smallpox.
 There are two known types (clades) of mpox virus
 One that originated in Central Africa (Clade I) and one that originated in West Africa (Clade II).
 The current world outbreak (2022 to 2023) is caused by Clade IIb, a subtype of the less severe West African clade.
 Mpox spreads through close contact with someone who’s infected. You can also get it from an infected animal.

3. Introduction…
 How common is mpox?
 Mpox is rare. But the number of cases is increasing in Africa, as well as in regions that haven’t seen these
infections before.
 Where else is mpox found?
 For decades, mpox was mostly seen in Africa. But it’s occasionally found in other countries, including the
United States.
 In the summer of 2021, a case of mpox was found in a U.S. resident who had traveled from Nigeria to the
United States. Then, 2022 brought outbreaks to regions outside of Africa, including Europe, the Americas and
Australia.
 Who does mpox affect?
 Anyone can get mpox. In Africa, most cases are among children under 15 years of age.
 While outside of Africa, the disease appears to be more common in men who have sex with men (MSM), but
there are numerous cases in people who don’t fall into that category.

4. Discovery of Mpox
 Monkeypox virus (MPXV) was identified in 1958 during outbreaks of a pox-like disease in monkeys
kept for research in a research center in Denmark, hence the disease name “monkeypox” (MPX).
 The first reported human case of mpox was a nine-month-old boy in the Democratic Republic of the
Congo (DRC, 1970).
 The patient, developed tell-tale signs of MPX including fever and a pox-like rash which developed
into haemorrhagic lesions that crusted over and healed over the next 2 weeks.
 Despite the initial recovery, the patient succumbed to secondary infections and died in the hospital.

5. Mpox Outbreaks
 After 1970, mpox occurred sporadically in Central and East Africa (clade I) and West
Africa (clade II).
 Within the next decade, additional MPX cases, mainly among children (83% of all cases),
have been identified in the Democratic Republic of the Congo (DRC) as well as four
additional Central and West African countries: Liberia, Sierra Leone, Nigeria and Ivory
Coast.
 In the 1970s and 80s, most of the reported cases occurred in DRC, with an estimated 11%
case fatality rate (CFR) among those who had not received a smallpox vaccination.
 The first outbreak of MPXV in humans outside of Africa was documented in 2003 in the
United States and linked to imported wild animals (clade II) from Ghana.
 Since 2005, thousands of suspected cases are reported in the DRC every year

6. Mpox Outbreaks
 In 2017, mpox re-emerged in Nigeria and continues to spread between people across the country and in travelers
to other places.
 In recent years, a few small clusters and single MPX cases were identified in the UK (2018 and 2019), Israel
(2018), Singapore (2019) and the US (2021), all linked to travel to Nigeria, which has experienced re-emergence of
MPX and reported over 500 suspected cases since 2017
 In May 2022, an outbreak of mpox appeared suddenly and rapidly spread across Europe, the Americas and
then all six WHO regions, with 110 countries reporting about 87 thousand cases and 112 deaths.
 The global outbreak has affected primarily (but not only) gay, bisexual, and other men who have sex with men
and has spread person-to-person through sexual networks.
 In 2022, the mpox outbreaks occurred in refugee camps in the Republic of the Sudan by Clade I MPXV .

7. Signs and symptoms
 Mpox causes signs and symptoms which usually begin within a
week but can start 1–21 days after exposure. Symptoms typically last
2–4 weeks but may last longer in someone with a weakened immune
system.
 Common symptoms are:
 rash
 fever
 sore throat
 headache
 muscle aches
 back pain
 low energy
 swollen lymph nodes.

8. Signs and symptoms
 The rash begins as a flat sore which develops into a blister filled with liquid and may be
itchy or painful. As the rash heals, the lesions dry up, crust over and fall off.
 Some people may have one or a few skin lesions and others have hundreds or more. These
can appear anywhere on the body such as the:
 palms of hands and soles of feet
 face, mouth and throat
 groin and genital areas
 anus.
 Some people also have painful swelling of their rectum or pain and difficulty when peeing.
 People with mpox are infectious and can pass the disease into others.

9. Complications
 Children, pregnant people and people with
weak immune systems are at risk for
complications from mpox.
 Bacterial superinfection of skin
 Permanent skin scarring
 Hyperpigmentation or hypopigmentation
 Permanent corneal scarring (vision loss)
 Pneumonia
 Dehydration (vomiting, diarrhea,
decreased oral intake due to painful oral
lesions, and insensible fluid loss from
widespread skin disruption)
 Sepsis
 Encephalitis
 Death
 Pain or difficulty swallowing,
 Myocarditis
 Proctitis
 Balanitis
 Urethritis

10. How does the mpox virus spread?

11. How does the mpox virus spread?
 The virus spreads through close contact with an infected animal or person.
 The mpox virus spreads from person to person through:
 Direct contact with mpox rash and scabs from a person with mpox, as well as contact with their saliva,
upper respiratory secretions (snot, mucus), and areas around the anus, rectum, or vagina
 Oral, anal, or vaginal sex, or touching the genitals (penis, testicles, labia, and vagina) or anus of a person
with mpox
 Hugging, massage, and kissing
 Extended close contact (more than four hours) with respiratory droplets from an infected person
 Clothes, sheets, blankets or other materials that have been in contact with rashes or body fluids of an
infected person.
 Mpox virus can be spread to the fetus during pregnancy or to the newborn by close contact during and after
birth.
 Mpox spreads from an animal to a person through:
 Animal bites or scratches.
 Products, such as skins or furs, made of infected animals.
 Direct contact with body fluids or rashes of animals with mpox.

12. Structure of Mpox Virus
MPXV virions are barrel- or oval-shaped particles, with an average size of ~280 nm × 220 nm].

13. Virus Genome and
Morphology
 The MPXV genome encompasses ~197,000 bp and
includes hairpin termini as well as >190 non-
overlapping open reading frames (ORFs).
 The highly conserved central coding region of the
genome is flanked by variable ends that contain
inverted terminal repeats.
 At least 90 ORFs are known to be essential for
poxvirus replication and morphogenesis..
 MPXV virions contain over 30 structural and
membrane viral proteins as well as virus-
encoded DNA-dependent RNA polymerase and
associated transcriptional enzymes
 Poxvirus particles have two mature forms,
 both of which can mediate infection: extracellular
enveloped virus (EEV) and the intracellular
mature virus (IMV) released during cell lysis

14. Life cycle
 Replication cycle of a Mpoxvirus.
 attachment
 entry
 early viral gene transcription and
translation
 DNA replication
 intermediate and late transcription
and translation
 assembly
 morphogenesis envelopment by
intracellular membranes
 budding

15. Diagnosis
 Identifying mpox can be difficult as other infections and conditions can look similar.
 It is important to distinguish mpox from chickenpox, measles, bacterial skin infections, scabies, herpes,
syphilis, other sexually transmissible infections, and medication-associated allergies.
 Someone with mpox may also have another sexually transmissible infection such as herpes. Alternatively, a
child with suspected mpox may also have chickenpox
 For these reasons, testing is key for people to get treatment as early as possible and prevent further spread.
 Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for mpox.
 The best diagnostic specimens are taken directly from the rash – skin, fluid or crusts – collected by
vigorous swabbing.
 In the absence of skin lesions, testing can be done on oropharyngeal, or rectal swabs.
 Testing blood is not recommended. Antibody detection methods may not be useful as they do not
distinguish between different orthopox viruses.

16. Treatment
 Treatment for most people with mpox is aimed at relieving symptoms.
 Care may include managing skin damage from the mpox rash, drinking enough liquids to help
keep stool soft, and pain management.
 If you have mpox, isolate at home in a separate room from family and pets until your rash and
scabs heal.
 There is no specific treatment approved for mpox. Health care professionals may treat mpox
with some antiviral drugs used to treat smallpox, such as tecovirimat (TPOXX) or brincidofovir
(Tembexa).
 For those unlikely to respond to the vaccine, a health care professional may offer vaccinia
immune globulin.
 Getting an mpox vaccine can help prevent infection.
 The vaccine should be given within 4 days of contact with someone who has mpox.

17. Vaccines
 Mpox vaccines are currently only recommended for people who’ve been exposed to, or are likely to be exposed to, mpox.
You might be at higher risk of exposure if;
 You’ve been in close contact with someone with mpox.
 Someone you’ve had sex with in the past two weeks has been diagnosed with mpox.
 You’ve had sex at a sex club, bathhouse or other commercial sex venue in the past six months.
 You’ve had sex at an event or location where mpox was spreading.
 You have a sex partner who’s been in any of the above situations.
 You expect to be in one of the above situations.
 If you’re a man who has sex with men, a transgender person or a nonbinary person,
 Been diagnosed with one or more sexually transmitted infections in the past six months.
 Had sex with more than one person in the past six months.
 It’s important to get vaccinated before or as soon as possible after exposure
 Health workers are also at a risk of exposure

18. Other ways to prevent mpox
 In addition to vaccines, other ways to help prevent the spread of mpox include:
 Avoiding contact with infected animals (especially sick or dead animals).
 Avoiding contact with bedding and other materials contaminated with the virus.
 Thoroughly cooking all foods that contain animal meat or parts.
 Washing your hands frequently with soap and water.
 Avoiding contact with people who may be infected with the virus.
 Practicing safe sex, including the use of condoms and dental dams.
 Wearing a mask that covers your mouth and nose when around others.
 Cleaning and disinfecting frequently touched surfaces.
 Using personal protective equipment (PPE) when caring for people infected with the virus.

19. How do you take care of yourself?
 If you have mpox symptoms, there are over-the-counter (OTC) medications that can help you feel better, including:
 Pain relievers and fever reducers. Medicines like ibuprofen and acetaminophen can help relieve your symptoms.
 Oatmeal baths. Soaking in a warm bath with colloidal oatmeal can relieve the dry, itchy feeling that comes with
skin rashes.
 Isolate yourself if you’re infected. Avoid contact with others until all of your lesions have scabbed.
 Cover single or local ulcers or sores. Use gauze or bandages to limit the spread to others and the environment.
 Take good care. It’s important to stay home and rest when you’re sick, wear a mask around others and drink plenty
of fluids.
 Avoid contact with pets (especially rodents).
 When should you see your healthcare provider?
 Call your healthcare provider if you:
 Feel sick with fever, aches or swollen lymph nodes.
 Have a new rash or sores.
 Have been in close contact with a person who’s infected.

20. References
 https://my.clevelandclinic.org/health/diseases/22371-
monkeypox#:~:text=Mpox%2C%20formerly%20called%20monkeypox%2C%20is,can%20take%20w
eeks%20to%20clear.
 https://www.webmd.com/a-to-z-guides/monkeypox-what-know
 https://www.cdc.gov/poxvirus/mpox/if-sick/what-to-do.html
 https://www.who.int/news-room/fact-sheetsdetail/monkeypox
 https://encyclopedia.pub/entry/25338
 https://guardian.ng/news/monkeypox-spreads-in-lagos-six-other-states-cases-rise-to-31/
 https://www.frontiersin.org/articles/10.3389/fimmu.2023.1132250/full

21. Thank you