[04.20] Agents of Emerging Infections_ Monkeypox V2.2.pdf

Mpox virus

What is the etiology of Mpox disease?

enveloped, double-stranded DNA virus

What is the structure and genetic material of the Mpox virus?

Orthopoxvirus

To which genus does the Mpox virus belong?

Poxviridae

To which family does the Mpox virus belong?

Mpox virus

What is the more politically correct term for the monkeypox virus?

Clade one (I)

Which distinct genetic clade of the monkeypox virus is responsible for the disease in Central Africa (Congo basin)?

Clade two (II)

Which distinct genetic clade of the monkeypox virus is isolated in West Africa?

Clade I

Which clade of Mpox virus is described as more transmissible and causing more severe disease?

Clade IIa and Clade IIb

What two subclades from Clade II were recognized during the 2022 global outbreak?

1970

In what year was the Mpox virus first recognized as a human pathogen?

Democratic Republic of the Congo

In what country was the Mpox virus first recognized as a human pathogen?

20-fold rise

What was the approximate increase in the incidence of Mpox in the Democratic Republic of Congo from 2005 to 2007?

Lack of prior smallpox vaccination (persons younger than 40 to 50), living in forested areas, male sex, and age less than 15 years

Name two identified risk factors for the rise in Mpox incidence in the Democratic Republic of Congo (2005-2007).

Nigeria

In which country was an outbreak in 2017 attributed to travel from endemic areas?

Benin, Cameroon, Central African Republic, Democratic Republic of Congo (DRC), Gabon, Ghana (only in animals), Ivory Coast, Liberia, Nigeria, Republic of the Congo, Sierra Leone, and South Sudan

Name four countries WHO identified as endemic for Mpox in 2022.

Ghana

Which endemic country in 2022 was identified as having Mpox only in animals?

May 2022

When was the recent outbreak of Mpox first recorded in Europe?

not associated with recent travel to endemic areas or close contact with a person known to have Mpox

What was notable about the initial cases of the 2022 Mpox outbreak in Europe regarding travel history?

men who have sex with other men (MSM)

In which demographic did most cases of the 2022 Mpox outbreak occur, leading to a hypothesis about spread?

July 23, 2022

When did the WHO declare the outbreak of Mpox as a public health emergency of international concern?

99,518

What was the total number of confirmed Mpox cases globally as of August 6, 2024?

Clade II

Which monkeypox virus clade mainly spread outside of Africa, predominantly among men who have sex with men through sexual contact?

Sweden and Thailand

Name two countries outside of Africa that have had imported cases of Clade Ib?

90%

What percentage of the confirmed Mpox cases in Africa does the Democratic Republic of Congo (DRC) report?

Clade Ia

Which clade is reported in most provinces of DRC?

Clade Ib

Which clade is reported in South and North Kivu of DRC, as well as a few cases in Kinshasa?

Burundi

Which East African country is the most affected by the Clade Ib linked to DRC?

Central African Republic and Republic of Congo

Name two countries in Central Africa most affected by Clade Ia with animal-to-human and human-to-human transmission.

Nigeria and Côte d'Ivoire

Name two countries in West Africa most affected by Clade II, with relatively fewer sporadic cases?

South Africa

Which country in Southern Africa reported Clade IIb, with an epidemiological picture similar to countries outside Africa?

Clade Ib

Which clade emerged in 2023 and has been spreading through sustained human-to-human transmission in Eastern DRC since September 2023?

0.7%

What is the current estimated Case Fatality Ratio for Clade Ib in DRC (available data from South Kivu for Epi Weeks 1-34)?

Burundi, Rwanda, Kenya, Uganda, Sweden, and Thailand

Name three countries, besides DRC, where Clade Ib has been detected?

August 14, 2024

When did the WHO Director-General declare a public health emergency of international concern for the upsurge of Mpox under IHR?

August 2025

Until when were the standing recommendations for Mpox, issued in August 2023, extended for all state parties?

Sexual contact, Household contact, Health facility contact, and Fomites

Name four multiple modes of transmission identified globally for Mpox.

Clade I

Which clade is more severe and is rapidly spreading in DRC and other countries like Burundi, Kenya, Rwanda, and Uganda?

Clade II

Which clade circulates globally?

9

How many cases were reported in the Philippines earlier than this year, likely linked to the 2022 Mpox outbreak?

5

How many confirmed cases were reported in the Philippines since August 14, 2024, that were all Clade II?

community transmission is apparent

What does the reporting of 5 confirmed Clade II cases in the Philippines since August 14, 2024, indicate?

MSM (3 cases), Pediatric (1 case), and Female (1 case)

What were the patient profiles for the 5 confirmed Clade II cases in the Philippines since August 14, 2024?

6-13 days

What is the usual incubation period for Mpox?

5-21 days

What is the range for the incubation period of Mpox, described as 1 to 3 weeks?

0-5 days

What is the duration of the invasion period of Mpox?

Fever, headache, and myalgia

Name two non-specific signs and symptoms of the Mpox invasion period.

Lymphadenopathy

What is the distinctive feature of Mpox, compared to other similar diseases?

1-3 days from start of fever

When does the skin eruption period of Mpox typically begin?

Macules -> papules -> vesicles -> pustules -> crusts

What is the usual progression of Mpox lesions/rash?

Face (95%), Palms/soles (75%), and Oral mucous membrane (70%)

Name two areas where the Mpox rash is most dense/present, along with their percentages.

Genitalia (30%) and Conjunctivae (20%)

Name two areas where the Mpox rash may appear, along with their percentages.

rash

What symptom will most individuals with Mpox develop?

prodromal (flu-like symptoms)

What symptoms can preempt the rash, usually 1-3 days before the rash appears?

No fever, pustule with central umbilication, classic rash progression may not be present, or rash comes first before the prodromal symptoms

Name two examples of atypical Mpox presentations.

molluscum contagiosum

What other skin condition does the pustule with central umbilication in Mpox resemble, as described by the Doc?

one stage of the lesions

How many stages of lesions are usually found in a single individual with Mpox?

Varicella

Which disease is characterized by lesions in different stages of evolution, unlike Mpox?

self-limited

How is Mpox usually characterized in terms of its progression?

2-4 weeks

How long do Mpox symptoms typically last?

Secondary bacterial infections, Sepsis, Pneumonia

Name two complications of Mpox listed in the source.

1-3 days before rash

When does fever usually appear in Mpox, according to the DOH table?

Lesions often in one stage of development

How is the appearance of Mpox lesions described, compared to chickenpox and measles?

Slow

How is the development of Mpox lesions described, compared to chickenpox and measles?

More dense on face; Present on palms and soles

How is the distribution of Mpox rash described, compared to chickenpox and measles?

Up to 10%

What is the reported death rate for Monkeypox, according to the DOH table?

Absent

Is lymphadenopathy typically present or absent in Chickenpox, according to the DOH table?

Rare

What is the reported death rate for Chickenpox, according to the DOH table?

98%

What percentage of the 528 monkeypox infections in the Thornhill et al (2022) study were found in gay or bisexual men?

41%

What percentage of the Mpox infections in the Thornhill et al (2022) study also had HIV?

sexual activity

What was the suspected transmission route for 95% of infections in the Thornhill et al (2022) study?

rash (95%)

What was the most common symptom reported in the Thornhill et al (2022) study?

anogenital lesions (73%) and mucosal lesions (41%)

Name two types of lesions reported, besides generalized rash, in the Thornhill et al (2022) study.

29%

What percentage of persons in the Thornhill et al (2022) study had a concomitant STI?

29/32 persons

In how many persons was Mpox virus DNA detected in semen in the Thornhill et al (2022) study?

Pain management, Soft-tissue superinfection, Pharyngitis limiting oral intake, Eye lesions, Acute kidney injury, Myocarditis, and Infection-control purposes

Name three reasons for hospitalization of Mpox patients in the Thornhill et al (2022) study.

Pain management - mostly for severe anorectal pain (21)

What was the most common reason for hospitalization in the Thornhill et al (2022) study that required symptomatic relief?

until rash has fully healed and formation of a fresh layer of skin is noted

When does the contagiousness of Mpox stop?

Direct contact with blood, bodily fluids, skin lesions, or eating inadequately cooked meat

Name two ways Mpox can be transmitted from animals to humans.

Respiratory secretions (droplet), skin lesions (direct contact), contaminated objects (direct contact), mother-placenta-fetus (congenital monkeypox), and intimate contact (direct contact)

Name three ways Mpox can be transmitted from human to human.

Sexual intercourse, Hugging, massage, and kissing, and Prolonged face-to-face contact

Name two activities constituting intimate contact that can transmit Mpox.

Scratches or bites from infected animals

What is another mode of transmission for Mpox, besides animal-to-human and human-to-human?

sexual contact and direct skin-skin contact with rash lesions

Name two transmission scenarios classified as YES for Mpox transmission.

semen or vaginal fluids, and contact with people who are infected with monkeypox but have no symptoms

Name two transmission scenarios classified as Under Investigation for Mpox transmission.

Pakikipagsiksikan (Crowding), Matagalang pakikisalamuha sa iba (Prolonged intimate contact), Pakikipagtalik (Sexual contact), Pagmamasahe ng katawan (Massaging), Pakikipaghalikan (Kissing), and Pakikipagyakapan (Hugging)

Name three activities, besides sexual contact, that increase one’s exposure to Mpox according to DOH guidelines.

0.6%

What percentage of the total confirmed cases (16,969) reported by PAHO (Aug 2, 2022) were minors (less than 18 years old)?

61%

What percentage of minors (<18 years old) with Mpox reported by PAHO were male?

11-17 years old

Which age group accounted for 51% of minors with Mpox in the PAHO data?

less than 8 years old, immunocompromised, and existing skin conditions (e.g. eczema)

Name three groups of children/adolescents with Mpox who are at higher risk for a severe course.

Encephalitis, Cellulitis, Pneumonia, Sepsis, Abscess, Airway obstruction, Keratitis, and Corneal scarring

Name three rare complications of Mpox in children.

Contact with contaminated material

What was the most common transmission route in the study of pediatric patients in Spain, with distribution in the adolescent age half?

Household contact

What transmission route was observed in 75% of pediatric patients younger than 4 years of age in the Spain study?

Sexual close contact

What transmission route was observed in the adolescent age group in the pediatric study in Spain?

Skin lesion

What specimen type was used for detection in the pediatric Mpox cases in Spain?

low

Is the risk for children to contract Mpox considered high or low?

unexplained acute rash and one or more specific signs/symptoms like headache, acute onset of fever (greater than 38.5 degrees C), myalgia, back pain, asthenia, or lymphadenopathy

What are the two main requirements for a suspected case of monkeypox?

Varicella zoster, Herpes zoster, Measles, Herpes simplex, and Bacterial skin infections

Name three common causes of acute rash that must not explain the clinical picture for a suspected case of Mpox.

an epidemiological link to a probable or confirmed case in the 21 days before symptom onset, reported travel history to a Mpox endemic country in the 21 days before symptom onset, multiple sexual partners in the 21 days before symptom onset, or hospitalization due to the illness

Name two criteria that elevate a suspected case to a probable case.

21 days

What is the maximum incubation period of the Mpox virus, used as the timeframe for epidemiological linking and travel history?

laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA

What is required to confirm a Mpox case?

real-time polymerase chain reaction (PCR) and/or whole genome sequencing (WGS)

Name the two laboratory methods used for confirmatory testing of Mpox virus DNA.