International Journal of Community Medicine and Public Health

Karama RS et al. Int J Community Med Public Health. 2023 Apr;10(4):1609-1615

http://www.ijcmph.com

pISSN 2394-6032 | eISSN 2394-6040

Review Article

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20230951

Re-emergence of human monkeypox 2022: its ecology and public health significance-short review article

Rahama Sanusi Karama1*, Ajoke Akinola1, John Kama2

1Department of Public Health, School of Allied Health Sciences, Noida International University-Gautam Budh Nagar Delhi-NCR, India

2Department of Internal Medicine, Ivanofrankivsk National Medical University, Ivanofrankivsk, Ukraine

Received: 23 February 2023

Accepted: 16 March 2023

*Correspondence:

Dr. Rahama Sanusi Karama,

E-mail: dr.rahamasanusikarama@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Monkeypox virus (MPXV) is one of Orthopoxvirus subfamily, it’s refers to a zoonotic disease caused by MPXV. Human monkeypox, on the other hand, has a much lower morbidity and fatality rate than smallpox. Reference to the current resurgence, monkeypox outbreaks have been reported over the past 5 decades, 10 countries in Africa was initially discovered to be affected by the outbreak and subsequently 4 countries apart from Africa. Additionally, re-emergence of monkeypox in African countries, especially Nigeria about forty 40 years of the initial outbreak, midst 2010-2019. Climate change, deforestation, lack of proper health and research advance infrastructure among the society and uncontrol intake of bush meat in the African countries could have been the reason for the recent re-emergence of monkeypox within the communities. Public health significance of monkeypox outbreak could be the factors related to the vulnerability of the population towards MPXV when smallpox vaccination was stopped. Due to the rapid global outreach of monkeypox endemic, it should be therefore considered as a very serious re-surging pathogen in the world. However, detail and proper observational research could bring more light on the influence of MPXV on overall human population, together with the advancement in qualitative and quantitative of outbreak data collection, research in the current situation is crucial and need an emergency treat in order to encourage the researchers to improve more findings on the monkeypox outbreak, which will subsequently enhances appropriate case management and public health response.

Keywords: Human monkeypox, Re-emergence, Ecology, Public health

INTRODUCTION

Monkeypox virus (MPV) remains to hide in the equatorial rainforests of Central and West Africa over forty years after smallpox was eradicated.1 And Monkeypox is however, a common zoonotic viral infection that occur as a consequence of MPXV, which belongs to the Orthopoxvirus genus, which also included smallpox, cowpox, and vaccinia viruses. The illness was firstly discovered in science laboratory monkeys in 1958, were as the very first human case was detected in a boy child of 9-month of age in the Democratic Republic of Congo in 1970. (DRC). Human monkeypox (MPV) is a smallpox-like disease distinguished by a prodromal phase of pyroxia and exhaustion followed by vesiculopustular skin eruption that develop. Human monkeypox, on the other hand, has a much lower morbidity and fatality rate than smallpox.2

When a person contacted the virus from an animal, a human, or any infected object, the disease can be transmitted. The virus route of transmission is through broken skin, the respiratory system, or mucosal membranes (despite being not apparent) (eyes, nose, or mouth). Bites or scratches, wild meat preparation, coming in direct contact with bodily fluids or erupted material, or indirect contact with lesion material, like through contaminated bedding, can all result in animal-to-human transmission.3 More than 90% of monkeypox illnesses are found and recording the highest number of cases in the Congo Basin, with the DRC. Cases of monkeypox were only recorded on a sporadic basis in the bordering Republic of the Congo, mostly in the rural, highly wooded regions close to the DRC border, were humans are regularly in touch with wild animals. In 2003, 2007, and 2010, monkeypox epidemic transpired in the Likouala department, in the Northern portion of the Republic of Congo, during which the factor was closely interconnected to MPXV reported in the DRC.4

The significance of MPXV in terms of public health, there are 3 factors that condition the chances of transmission of MPXV to human.1 Food concoction methods: The importance of food concoction methods in the infection of human. The dietary habits of the Bumba and Ikela zones different from those of the Tshela zone. In the farmer, rats, that are collected by youngsters as young as 5-6 years old, account for 60 to 85% of all wild beast caught by the bucolic people which are often eaten raw. After the age of nine or ten years, youngsters follow their parents and prepare meats. Children in Bas-Zaire, on the contrary, begin trapping animals in the wild around the ages of between 12-13, and tiny mammals are uncommon target. Furthermore, raw meat intake is uncommon, owing to improved general education.2 The secondary factor related to the vulnerability of the population as a whole towards the MPXV and vaccination against the smallpox disease, when smallpox vaccination was stopped.3 Human-to-human transmission. The transmissibility of the MPXV among humans counts to the third factor that is affecting the human monkeypox incidence.5 Approximately 200-250 nanometer in size via electron microscope. Pox viruses are coated with lipoprotein envelope containing linear double stranded DNA, various complications like pneumonia, encephalitis, sepsis, permanent skin and corneal scarring and eventually death can result from monkey pox infection.5

OUTBREAKS OF MONKEYPOX IN HUMANS

Table 1 and 2; the distribution of confirmed cases country wise is shown in Figure 1.6

From 21 May, 13:00, 92 science laboratories confirmed cases, and 28 doubted cases of monkeypox with ongoing investigations, have been reported to WHO from 12 Member States that are not endemic for MPXV, across three WHO locations (Table 2, Figure 1). There was no associated mortality reported to date.7

Figure 1: The geographical distribution showing the confirmed and suspected cases of monkeypox in non-endemic regions between 13th to 21st May 2022, as at 13:00.7
Figure 1: The geographical distribution showing the confirmed and suspected cases of monkeypox in non-endemic regions between 13th to 21st May 2022, as at 13:00.7
Table 1: The cases of human monkeypox reported in the world between 1970 till 2018.6
Table reproduced from source PDF page 2, part 1 of 2
Table reproduced from source PDF page 3, part 2 of 2

LITERATURE REVIEW

The data presented in this study was abstracted from a popular search engines accomplished in the month of May 2022. Search engines such as Google Scholar and PubMed Central. In PubMed Central 86 articles returned 9 were abstracted with reference to keywords similarities those published within the last 5 years and Google Scholar 144 articles returned, using keywords related to reemergence of human monkeypox its public health significance 11 articles were returned for inclusion. That included 21 studies collectively. All included papers were done within 2017 to 2022 and published in English to response the research question of this study. Original articles, text books and review works are the articles included in this paper. These articles were compiled, transmission mode, and further tabulated and grouped into symptoms, risk factors or behaviors and treatment in

Table 3. Study result revealed several modes of transmission ranging from human-to-human and animal-to-human (zoonotic transmission). Fever onset and lymphadenopathy were shown to be initial symptoms of monkeypox which however, distinguishes it from that of smallpox. Sharing dish with infected patient and sleeping together were revealed to be risk behaviors that will lead one to get infected with disease. Similarly, comparing this with zoonotic transmission, sleeping, touching and living near forest also identified as some risk factors of contracting the disease. Vaccination and antivirals reported in many studies to have impact in prevention against any form of orthopoxviral. Furthermore, importance of this antivirals further discussed about how it proved to be effective among individuals.

MONKEYPOX: TRANSMISSION MODE

There are typically 2 common and possible means of MPXV mode of transmission; animals-to-human transmission and human-to-human transmission. Human-to-human transmission; consists of respiratory droplets and exposure with infected person body liquids, meeting infected person’s accessories/environment, inter-human transmission has been found to have contact association with infected patient’s skin lesion. This is evidence-based report on Central Africa clade were inter-human spread reported to be more, this is however, in contrast to West African clade.8,9

Animal-to-human transmission; (zoonotic transmission), the viral hosts are classified based on their model hosts, “the rope squirrels, tree squirrels, followed by Gambian pouched rats, non-human primates as well as the dormice”.10 Animal to human transmission transpires through direct contact with the company of any of previously mentioned natural viral hosts of MPXV/by anyways consumption of any of hosts. However, animal-to-human transmission might happen via unmediated contact with infected animal body fluids, blood, and injection of mucocutaneous lesion of an infected zoonotic host.9,11

Table 2: The cases of monkeypox upsurge in non-endemic countries reported to WHO between 13 to 21 May 2022 as at 13:00.
Table reproduced from source PDF page 3
Table 3: Symptoms.
Table reproduced from source PDF page 4

DISCUSSION

The initial monkeypox outbreak that involved human beings in the United States of America in the year 2003, might aid in structuring response to the essential query presented in this paper.23,24 There are ascending worries relating to the geographical escalate and greater upburst of monkeypox worldwide. Reference to the current situation, monkeypox outbreaks have been reported over the past 5 decades, the initial outbreak was recovered in 10 African countries and subsequently 4 countries apart from Africa. Additionally, the resurgence of MPXV in African countries, especially Nigeria about 40 years of the initial outbreak, around 2010-2019 there was a report for the disease re-emergence in Sierra Leone and Liberia that is about 4 decades after the outbreak. It was revealed that, the first outbreaks of monkeypox emerged inside the Republic of Congo in the year 2000 to 2009 while in South Sudan the outbreak emerged in 2005 respectively.25

Ultimately, in the year 2003, the first case of monkeypox imported to the United State of America was via rodents from Ghana, which was counted as first zoonotic transmission that subsequently led to animal-to-human transmission, and about 47 cases were confirmed.25 In the year 2018-2021, adults proceeding to Israel, the United Kingdom, Singapore, and the United States from Nigeria, was diagnosed with MPXV.26-31 These mentioned cases were skeptical to be the result of zoonotic transmission (animal-to-human transmission). During the rampant flow of smallpox, at that time no cases of monkeypox were announced. One of the reasons for that could have been the indistinguishable features of the two diseases (smallpox and monkeypox), or simply because the world put more priority over the smallpox or ultimately could have been due to deficiency of science laboratory corroboration of the etiologic factor that guides to supposition of smallpox.32 As shown in some documented data, vaccination of smallpox was found to be nearly protective against monkeypox up to 85%.33

According to the study model of modelling human-to-human transmission of the monkeypox, it was reported that since about 85% of the population were immunized against monkeypox, the monkeypox outbreak could not have commenced in the Republic of Congo between the year 1980 and 1984 respectively. In sequence to these years, monkeypox was noticed as an infrequent disease in the population, transpiring only occasionally. However, afterwards, the DRC has announced the rapid expansion of monkeypox human-to-human transmission.34 A notable challenge faced by the health care workers, those working in the rural Republic of Congo and additional poor resource settings is how to supply proper and basic care for patients with monkeypox with a recommended evidence-based treatment protocol, including the basic supportive therapies were a concern.35

Current evidence supporting the rapid rise of monkeypox over time was most persistent in the Republic of Congo were other diseases remain at constant, while the monkeypox incidence rises over time.36 The current outbreak of monkeypox is among the reported increased resurgence outside the Republic of Congo, this therefore suggest that the incidence has arised over a broader geographical extend. With the lack of surveillance prior, presently there have been a few remarkable advances in the scrutiny systems, this is succeeding a joint external evaluation assessment by the global health security agenda, as well as some developments in laboratory capacity, it is however improbable supportive cause for the changes observed in the epidemiology of monkeypox.36 Being MPXV an orthopoxviral family, it is however evident to have a risk to the general populations especially the endemic areas, and of course in children as it is evidently seen during the recent pandemic of coronavirus, how the disease produces a prospective health risk on overall children development, health intervention for further research and betterment of informed information, education and counseling of the parent about their children’s health is highly magnificent.37,38 Therefore, a significant developments in qualitative and quantitative of outbreak data collection is crucial and need an emergency treat in order to encourage the researchers to improve more findings on the monkeypox outbreak, which will subsequently enhances appropriate case management and public health reaction.

Limitations

the finding presented in this paper may not be generalized globally due to its short review nature. Study bias was observed as more priority in terms of health care support was shown to the endemic areas in lieu to general population. In addition, lack of qualitative and quantitative data source is observed during the initial endemic in the republic of congo which could had been tackle as well as improve for the betterment of preventing the population as a whole. The up to date data could have aid within the advancement of a standard rules for prophylaxis as well as management/treatment of the monkeypox disease in an infected patient. However, clear focus and proper discussion about importance of qualitative and quantitative research aspect on monkeypox should be put into consideration, as there is currently a very limited details on the outcome of monkeypox disease on gravid women and their unborn children. Eventually, this could therefore aid in promoting people’s knowledge on the necessary preventive measures against the monkeypox disease. In a nutshell, nothing was mentioned about comparison of monkey pox infection among various age groups. There was also no citation or situation in which monkeypox was co-management with any other disease simultaneously.

CONCLUSION

The recent monkeypox reemergence could be due to climate change, deforestation, lack of proper health and research advance infrastructure among the society and uncontrol intake of bush meat in the African countries that may have produced an ecological and immunological recess for MPXV to resurge in the African countries. The MPX reemergence has proved that the virus cannot be confined to the upsurge geographical locations, as cases of travelers from Ghana and Nigeria have reported positive to the United States, United Kingdom, Singapore and Israel in recent years. It is recommended that epidemiological surveillance of MPXV in humans should be performed on a frequent basis and not just for the seek of response to an outbreak. However, due to the rapid global outreach of monkeypox endemic, it should be therefore considered as a very serious re-surging pathogen in the world. One of the major concerns among the health care professionals is human-to-human monkeypox transmission, and it is also a worry between the household members.

Proper observational research could bring more light on the influence of MPXV on overall human health, it should also shed light on detail route of transmission in both human-to-human and zoonotic transmission, the clinical features, the rate of re-emergence, the health consequences, the chances of secondary viral infections, the rate of mortality and prevalence of potential complications. This could aid in treatment or supportive care, optimizing the nature of the disease and curative measures of either the monkeypox or smallpox emergency.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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