Monkeypox Disease: Emerging Threats and Challenges to Global Public Health
Keywords:
tecovirimat, Monkeypox, virus, mucous membranes, human, symptomsAbstract
Background: Monkeypox (Mpox) is a zoonotic disease caused by the monkeypox virus (MPXV). It is primarily endemic to Central and West Africa, and global outbreaks are raising public health concerns. Transmission occurs via contact with infected animals, humans, or contaminated materials, and clinical manifestations range from mild fever and rash to severe systemic complications.
Objective: In this review epidemiology, pathophysiology, treatment strategies, and ongoing research efforts related to Mpox.
Methods: This review examines recent case studies, available antiviral therapies, vaccine efficacy, and ongoing clinical trials, highlighting key advancements and gaps in Mpox management.
Epidemiology: Initially endemic to Africa, Mpox spread globally in 2022, demonstrating its potential for widespread transmission.
Pathophysiology: The virus enters via skin or mucous membranes, replicates locally, and spreads via viremia, causing systemic symptoms and complications.
Treatment: Antiviral agents like tecovirimat, brincidofovir, and cidofovir show promise, while vaccines (e.g., JYNNEOS™, ACAM2000®) offer ~80% cross-protection.
Case Studies: Presentations vary, with severe outcomes in immunocompromised patients and antiviral-resistant cases.
Clinical Trials: Ongoing studies aim to optimize antivirals and vaccines (e.g., Tecovirimat, LC16m8, and MVA-BN).
Conclusion:
Mpox presents significant diagnostic and therapeutic challenges, particularly in high-risk populations. Advancements in antiviral agents, vaccines, and supportive care are critical for effective management and containment of the disease. Further research and public health measures are essential to mitigate its impact.
How to cite this article:
Jaiswal N K, Bhatia K, Kumar D, Kamal R, Singh
P. Monkeypox Disease: Emerging Threats and
Challenges to Global Public Health. Rec Trends
Pharm Tech IndI 2025 7(1): 18-30.
References
Saied AA, Dhawan M, Metwally AA, Fahrni ML, Choudhary P, Choudhary OP. Disease History, Pathogenesis, Diagnostics, and Therapeutics for Human Monkeypox Disease: A Comprehensive Review. Vaccines (Basel). 2022;10(12).
Zahmatyar M, Fazlollahi A, Motamedi A, Zolfi M, Seyedi F, Nejadghaderi SA, et al. Human monkeypox: history, presentations, transmission, epidemiology, diagnosis, treatment, and prevention. Frontiers in Medicine. 2023;10:1157670.
Martín-Delgado MC, Sánchez FJM, Martínez-Sellés M, García JMM, Guillén SM, Rodríguez-Artalejo F, et al. Monkeypox in humans: a new outbreak. Revista Española de Quimioterapia. 2022;35(6):509.
Acharya A, Kumar N, Singh K, Byrareddy SN. "Mpox in MSM: Tackling Stigma, Minimizing Risk Factors, Exploring Pathogenesis, and Treatment Approaches". Biomedical Journal. 2024:100746.
Yinda CK, Morris DH, Fischer RJ, Gallogly S, Weishampel ZA, Port JR, et al. Stability of Monkeypox Virus in Body Fluids and Wastewater. Emerg Infect Dis. 2023;29(10):2065-72.
Rodríguez-Cuadrado FJ, Nájera L, Suárez D, Silvestre G, García-Fresnadillo D, Roustan G, et al. Clinical, histopathologic, immunohistochemical, and electron microscopic findings in cutaneous monkeypox: A multicenter retrospective case series in Spain. J Am Acad Dermatol. 2023;88(4):856-63.
Jansen BJ, Liang H, Ye J. International Conference on Cognitive Based Information Processing and Applications (CIPA 2021): Volume 2: Springer Nature; 2021.
Malik S, Ahmad T, Ahsan O, Muhammad K, Waheed Y. Recent developments in pox prevention and treatment options. Vaccines. 2023;11(3):500.
Lu J, Xing H, Wang C, Tang M, Wu C, Ye F, et al. Mpox (formerly monkeypox): pathogenesis, prevention, and treatment. Signal Transduction and Targeted Therapy. 2023;8(1):458.
Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2020;5(5):Cd011621.
Liatsos GD. Controversies' clarification regarding ribavirin efficacy in measles and coronaviruses: Comprehensive therapeutic approach strictly tailored to COVID-19 disease stages. World J Clin Cases. 2021;9(19):5135-78.
Li Y, Olson VA, Laue T, Laker MT, Damon IK. Detection of monkeypox virus with real-time PCR assays. J Clin Virol. 2006;36(3):194-203.
Velu PD, Sipley J, Marino J, Ghanshani S, Lukose G, Cong L, et al. Evaluation of a Zoonotic Orthopoxvirus PCR Assay for the Detection of Mpox Virus Infection. J Mol Diagn. 2023;25(10):740-7.
40th International Symposium on Intensive Care & Emergency Medicine 2021. Critical Care. 2021;25(1):383.
Kdolsky R. 17 th European Congress of Trauma and Emergency Surgery. Eur J Trauma Emerg Surg. 2016;42(2):S9-S245.
Reilly CE. Communications of the European neurological society. Springer; 2011.
Dunn R, Voleti S, Rowley S, Mackintosh C, Aqel B, Mathur A, et al. Risk factors associated with urgent surgical reintervention due to postoperative hemorrhage after orthotopic liver transplantation. Journal of Liver Transplantation. 2022;8:100124.
Daher A, Balfanz P, Cornelissen C, Müller A, Bergs I, Marx N, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respiratory medicine. 2020;174:106197.
Roshdi AM, Hassan OAA, Ahmed MB, Abd-EL Azeem AS. Evaluation of the impact of an acute single paracetamol overdose on renal functions and serum electrolytes. Minia Journal of Medical Research. 2024;35(2):72-9.
Masood S, Alkubaisi NA, Aslam M, Salman M, Baraka MA, Mustafa ZU, et al., editors. Knowledge of Human Monkeypox Infection among Final Year Medical, Pharmacy, and Nursing Students: A Multicenter, Cross-Sectional Analysis from Pakistan. Healthcare; 2023: MDPI.
Naseer MM, Afzal M, Fatima T, Nabiha SM, Rafique H, Munir A. Human monkeypox virus: a review on the globally emerging virus. Biomed Lett. 2024;10:26-41.
Hirschmann J, Everett ED. Haemophilus influenzae infections in adults: report of nine cases and a review of the literature. Medicine. 1979;58(1):80-94.
Basgoz N, Brown CM, Smole SC, Madoff LC, Biddinger PD, Baugh JJ, et al. Case 24-2022: a 31-year-old man with perianal and penile ulcers, rectal pain, and rash. New England Journal of Medicine. 2022;387(6):547-56.
Basu I, Perry M. Initial Assessment of the “Head and Neck” Patient. Diseases and Injuries to the Head, Face and Neck: A Guide to Diagnosis and Management. 2021:57-134.
Price N, Klein JL. Infectious diseases and emergencies. Oxford Desk Reference: Acute Medicine. 2016:263.
Menezes YR, Miranda ABd. Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: first death report in Brazil. Revista da Sociedade Brasileira de Medicina Tropical. 2022;55:e0392-2022.
Rao K, Priya N, Umadevi H, Smitha T. Molluscum contagiosum. J Oral Maxillofac Pathol. 2013;17(1):146-7.
Hanson D, Diven DG. Molluscum contagiosum. Dermatology online journal. 2003;9(2).
Manion M, Sereti I. A 34-Year-Old Man With HIV/AIDS and a Cavitary Pulmonary Lesion. Chest. 2021;160(1):e35-e8.
Jia L, Yan B, Fang Y, Yang X, Jia H, Zhang M, et al. Cases of Monkeypox show highly overlapping co-infection with HIV and syphilis. Frontiers in Public Health. 2024;11:1276821.
Wong L, Gonzales-Zamora JA, Beauchamps L, Henry Z, Lichtenberger P. Clinical presentation of Monkeypox among people living with HIV in South Florida: a case series. Le Infezioni in Medicina. 2022;30(4):610.
Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, et al. Monkeypox in humans: a new outbreak. Rev Esp Quimioter. 2022;35(6):509-18.
Khattak S, Rauf MA, Ali Y, Yousaf MT, Liu Z, Wu D-D, et al. The monkeypox diagnosis, treatments and prevention: A review. Frontiers in cellular and infection microbiology. 2023;12:1088471.
Quarleri J, Delpino MV, Galvan V. Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries. GeroScience. 2022;44(4):2095-103.
Venkatesan P. Monkeypox transmission-what we know so far. Lancet Respir Med. 2022;10(11):e101.
Titanji BK, Tegomoh B, Nematollahi S, Konomos M, Kulkarni PA. Monkeypox: A Contemporary Review for Healthcare Professionals. Open Forum Infectious Diseases. 2022;9(7).
Koenig KL, Beÿ CK, Marty AM. Monkeypox 2022 Identify-Isolate-Inform: A 3I Tool for frontline clinicians for a zoonosis with escalating human community transmission. One Health. 2022;15:100410.
Amer F, Khalil HES, Elahmady M, ElBadawy NE, Zahran WA, Abdelnasser M, et al. Mpox: Risks and approaches to prevention. Journal of Infection and Public Health. 2023;16(6):901-10.
Taha AM, Katamesh BE, Hassan AR, Abdelwahab OA, Rustagi S, Nguyen D, et al. Environmental detection and spreading of mpox in healthcare settings: a narrative review. Frontiers in Microbiology. 2023;14.
Harapan H, Ophinni Y, Megawati D, Frediansyah A, Mamada SS, Salampe M, et al. Monkeypox: A Comprehensive Review. Viruses. 2022;14(10).
Khattak S, Rauf MA, Ali Y, Yousaf MT, Liu Z, Wu DD, et al. The monkeypox diagnosis, treatments and prevention: A review. Front Cell Infect Microbiol. 2022;12:1088471.
Islam MA, Mumin J, Haque MM, Haque MA, Khan A, Bhattacharya P, et al. Monkeypox virus (MPXV): A Brief account of global spread, epidemiology, virology, clinical features, pathogenesis, and therapeutic interventions. Infectious Medicine. 2023;2(4):262-72.
Bryer J, Freeman EE, Rosenbach M. Monkeypox emerges on a global scale: A historical review and dermatologic primer. J Am Acad Dermatol. 2022;87(5):1069-74.
Alakunle E, Kolawole D, Diaz-Cánova D, Alele F, Adegboye O, Moens U, et al. A comprehensive review of monkeypox virus and mpox characteristics. Frontiers in Cellular and Infection Microbiology. 2024;14.
Zebardast A, Latifi T, Shafiei-Jandaghi N-Z, Gholami Barzoki M, Shatizadeh Malekshahi S. Plausible reasons for the resurgence of Mpox (formerly Monkeypox): an overview. Tropical Diseases, Travel Medicine and Vaccines. 2023;9(1):23.
Chauhan RP, Fogel R, Limson J. Overview of Diagnostic Methods, Disease Prevalence and Transmission of Mpox (Formerly Monkeypox) in Humans and Animal Reservoirs. Microorganisms. 2023;11(5):1186.
Precious ND, Agboola P, Oluwatimilehin O, Olakunle OK, Olaniyi P, Adiatu AI, et al. Re-emergence of monkeypox virus outbreak in Nigeria: epidemic preparedness and response (Review-Commentary). Ann Med Surg (Lond). 2023;85(8):3990-6.
Mohanto S, Faiyazuddin M, Dilip Gholap A, Jc D, Bhunia A, Subbaram K, et al. Addressing the resurgence of global monkeypox (Mpox) through advanced drug delivery platforms. Travel Medicine and Infectious Disease. 2023;56:102636.
Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, et al. Monkeypox. Lancet. 2023;401(10370):60-74.
Martínez-Fernández DE, Fernández-Quezada D, Casillas-Muñoz FAG, Carrillo-Ballesteros FJ, Ortega-Prieto AM, Jimenez-Guardeño JM, et al. Human Monkeypox: A Comprehensive Overview of Epidemiology, Pathogenesis, Diagnosis, Treatment, and Prevention Strategies. Pathogens. 2023;12(7).
Qudus MS, Cui X, Tian M, Afaq U, Sajid M, Qureshi S, et al. The prospective outcome of the monkeypox outbreak in 2022 and characterization of monkeypox disease immunobiology. Frontiers in Cellular and Infection Microbiology. 2023;13.
Ganapthy D, Sekaran S, Rajamani Sekar SK. Monkeypox treatment options: current status of antiviral drugs - a correspondence. Int J Surg. 2023;109(3):562-3.
de la Calle-Prieto F, Estébanez Muñoz M, Ramírez G, Díaz-Menéndez M, Velasco M, Azkune Galparsoro H, et al. Treatment and prevention of monkeypox. Enferm Infecc Microbiol Clin (Engl Ed). 2023;41(10):629-34.
Shamim MA, Padhi BK, Satapathy P, Veeramachaneni SD, Chatterjee C, Tripathy S, et al. The use of antivirals in the treatment of human monkeypox outbreaks: a systematic review. International Journal of Infectious Diseases. 2023;127:150-61.
Akash S, Hossain A, Hossain MS, Rahman MM, Ahmed MZ, Ali N, et al. Anti-viral drug discovery against monkeypox and smallpox infection by natural curcumin derivatives: A Computational drug design approach. Frontiers in Cellular and Infection Microbiology. 2023;13.
Russo AT, Grosenbach DW, Chinsangaram J, Honeychurch KM, Long PG, Lovejoy C, et al. An overview of tecovirimat for smallpox treatment and expanded anti-orthopoxvirus applications. Expert Rev Anti Infect Ther. 2021;19(3):331-44.
Imran M, Alshammari MK, Arora MK, Dubey AK, Das SS, Kamal M, et al. Oral Brincidofovir Therapy for Monkeypox Outbreak: A Focused Review on the Therapeutic Potential, Clinical Studies, Patent Literature, and Prospects. Biomedicines. 2023;11(2).
Shamim MA, Satapathy P, Padhi BK, Veeramachaneni SD, Akhtar N, Pradhan A, et al. Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis. Frontiers in Pharmacology. 2023;14.
Yu J, Raj SM. Efficacy of three key antiviral drugs used to treat orthopoxvirus infections: a systematic review. Global Biosecurity. 2019;1(1):28-74.
Kampf G. Efficacy of biocidal agents and disinfectants against the monkeypox virus and other orthopoxviruses. Journal of Hospital Infection. 2022;127.
Alakunle E, Kolawole D, Diaz-Cánova D, Alele F, Adegboye O, Moens U, et al. A comprehensive review of monkeypox virus and mpox characteristics. Front Cell Infect Microbiol. 2024;14:1360586.
Prévost J, Sloan A, Deschambault Y, Tailor N, Tierney K, Azaransky K, et al. Treatment efficacy of cidofovir and brincidofovir against clade II Monkeypox virus isolates. Antiviral Research. 2024;231:105995.
De Clercq E. Cidofovir in the treatment of poxvirus infections. Antiviral Res. 2002;55(1):1-13.
Andrei G, Snoeck R. Cidofovir Activity against Poxvirus Infections. Viruses. 2010;2(12):2803-30.
Andrei G, Snoeck R. Cidofovir Activity against Poxvirus Infections. Viruses. 2010;2:2803-30.
Bruno G, Buccoliero GB. Antivirals against Monkeypox (Mpox) in Humans: An Updated Narrative Review. Life. 2023;13(10):1969.
Carmine AA, Brogden RN, Heel RC, Speight TM, Avery GS. Trifluridine: a review of its antiviral activity and therapeutic use in the topical treatment of viral eye infections. Drugs. 1982;23(5):329-53.
Petrillo F, Petrillo A, Sasso FP, Schettino A, Maione A, Galdiero M. Viral Infection and Antiviral Treatments in Ocular Pathologies. Microorganisms. 2022;10(11):2224.
Reddy JC, Rapuano CJ. Current Concepts in the Management of Herpes Simplex Anterior Segment Eye Disease. Current Ophthalmology Reports. 2013;1(4):194-203.
Kumar V, Malhotra S. ChemInform Abstract: Synthesis of Nucleoside-Based Antiviral Drugs in Ionic Liquids. Bioorganic & medicinal chemistry letters. 2008;18:5640-2.
Shearer JD, Siemann L, Gerkovich M, House RV. Biological activity of an intravenous preparation of human vaccinia immune globulin in mouse models of vaccinia virus infection. Antimicrob Agents Chemother. 2005;49(7):2634-41.
Shamim MA, Satapathy P, Padhi BK, Veeramachaneni SD, Akhtar N, Pradhan A, et al. Pharmacological treatment and vaccines in monkeypox virus: a narrative review and bibliometric analysis. Front Pharmacol. 2023;14:1149909.
Natami M, Gorgzadeh A, Gholipour A, Fatemi SN, Firouzeh N, Zokaei M, et al. RETRACTED ARTICLE: An overview on mRNA-based vaccines to prevent monkeypox infection. Journal of Nanobiotechnology. 2024;22(1):86.
Shearer J, Siemann L, Gerkovich M, House R. Biological Activity of an Intravenous Preparation of Human Vaccinia Immune Globulin in Mouse Models of Vaccinia Virus Infection. Antimicrobial agents and chemotherapy. 2005;49:2634-41.
DeLaurentis CE, Kiser J, Zucker J. New Perspectives on Antimicrobial Agents: Tecovirimat for Treatment of Human Monkeypox Virus. Antimicrob Agents Chemother. 2022;66(12):e0122622.
Almehmadi M, Allahyani M, Alsaiari AA, Alshammari MK, Alharbi AS, Hussain KH, et al. A Glance at the Development and Patent Literature of Tecovirimat: The First-in-Class Therapy for Emerging Monkeypox Outbreak. Viruses. 2022;14(9):1870.
Imran M, Alshammari MK, Arora MK, Dubey AK, Das SS, Kamal M, et al. Oral Brincidofovir Therapy for Monkeypox Outbreak: A Focused Review on the Therapeutic Potential, Clinical Studies, Patent Literature, and Prospects. Biomedicines. 2023;11(2):278.
Araf Y, Nipa JF, Naher S, Maliha ST, Rahman H, Arafat KI, et al. Insights into the Transmission, Host Range, Genomics, Vaccination, and Current Epidemiology of the Monkeypox Virus. Veterinary Medicine International. 2024;2024(1):8839830.
Poland GA, Kennedy RB, Tosh PK. Prevention of monkeypox with vaccines: a rapid review. Lancet Infect Dis. 2022;22(12):e349-e58.
Akter F, Hasan TB, Alam F, Das A, Afrin S, Maisha S, et al. Effect of prior immunisation with smallpox vaccine for protection against human Mpox: A systematic review. Rev Med Virol. 2023;33(4):e2444.
Aljabali AAA, Obeid MA, Nusair MB, Hmedat A, Tambuwala MM. Monkeypox virus: An emerging epidemic. Microbial Pathogenesis. 2022;173:105794.
Maredia H, Sartori-Valinotti JC, Ranganath N, Tosh PK, O'Horo JC, Shah AS. Supportive Care Management Recommendations for Mucocutaneous Manifestations of Monkeypox Infection. Mayo Clin Proc. 2023;98(6):828-32.
Hung YP, Lee CC, Lee JC, Chiu CW, Hsueh PR, Ko WC. A brief on new waves of monkeypox and vaccines and antiviral drugs for monkeypox. J Microbiol Immunol Infect. 2022;55(5):795-802.
Chandran D, Nandanagopal V, Gopan M, Megha K, Sankar CH, Aslam MM, et al. Major advances in monkeypox vaccine research and development–an update. J Pure Appl Microbiol. 2022;16(suppl 1):3083-95.
