14. Clinical management, prevention, and treatment for the Mpox virus
Fortunately, the clinical course of Mpox infections is usually mild and self-limiting. As a result, it infrequently justifies specialised therapy, and instead, treatment is typically supportive. Supportive therapy includes things like analgesics for pain, antipyretics for fever, and antibiotics for subsequent bacterial infections. Yet some people could require a certain kind of treatment. For those with serious illnesses, immunocompromised people, pregnant women, and youngsters, specific therapies can be required 57,58. The treatment and immunisations created to combat smallpox have shown some success against the Mpox virus because of the similarities between Mpox and smallpox. There is, however, little evidence to support this claim59.
Mpox disease is not curable, however, research on treating smallpox indicates that vaccinia vaccinations, tecovirimat, vaccinia immune globulin (IVG), and cidofovir might be beneficial60. Cidofovir is an antiviral drug that inhibits viral DNA polymerase and exerts antiviral activity against a variety of viruses. It is usually administered intravenously with fluid administration and probenecid. Although cidofovir has the potential to cause nephrotoxicity (kidney toxicity), a modified version called CMX-001 has been developed that is not nephrotoxic. In addition, CMX-001 exhibits antiviral activity against numerous orthopoxvirus species. ST-246 is an agent that is administered orally and targets the intracellular release of the virus. It has shown promising results against several orthopoxviruses, including the variola virus that causes smallpox. By inhibiting the release of viral particles from infected cells, ST -246 helps to contain the spread of infection. The European Medicines Agency (EMA) authorised the usage of tecovirimat for treating measles in 2022, reported by the World Health Organization’s61. It was first created as a smallpox remedy. Because tecovirimat is currently not widely available, any usage of it needs to be carefully supervised. By blocking viral DNA polymerase, cidofovir has antiviral efficacy against some viruses62. It has been observed that tecovirimat is particularly sensitive to several orthopoxviruses, including variola, cowpox, vaccinia, rabbitpox, ectromelia, and Mpox. For the treatment of Mpox, tecovirimat, an oral inhibitor of intracellular viral release, may be beneficial 63,64. These antiviral agents have been studied in various combinations, such as with vaccinia immunoglobulin, which is used to treat serious adverse events associated with smallpox vaccination clinical trials. The combination of these drugs has the potential to effectively treat orthopoxvirus infections.
Notwithstanding the recommended course of treatment, supportive and symptomatic therapy is the backbone of treating a Mpox virus infection. It’s crucial to realize that the only established treatment for Mpox is treating symptoms and preventing complications. Given the outbreak of Mpox in 2022 and the current Mpox cases worldwide, more research must be done before any treatment or vaccine can be created65.
To prevent infection with the Mpox virus, certain precautions can be taken. This includes, but is not limited to: (1) consciously avoiding encounters with animals suspected to be Mpox virus carriers, especially in regions where the Mpox virus is prevalent; (2) placing ill people in a room with negative pressure to prevent the virus from spreading from one person to another; (3) isolating and euthanizing the animals suspected to be the virus reservoirs; (4) avoiding contact with any objects that have come into contact with ill animals or people; and (5) avoiding contact with (5) Frontline personnel caring for Mpox virus-infected patients and other high-risk individuals who are expected to interact with infected individuals should wear the appropriate personal protective equipment (PPE) designed to protect against airborne infectious agents, such as N-95 masks, fully covered water-resistant gowns, and double-layered gloves. 66,67.
Research has shown that smallpox vaccination offers a reliable defence against illnesses caused by Mpox and other orthopoxviruses68. When administered early in the incubation phase, it can postpone the start of disease or minimise the severity of the illness.
However, patients who have impaired immune systems face the risk of suffering serious side effects69,70. Mpox has become more prevalent since smallpox was eradicated in 1980 as a result of the end of immunisation initiatives to prevent viral illnesses. The attenuated strains used in the next-generation smallpox vaccines, including ACAM2000 (this is live vaccinia virus), LC16m8 (this one is attenuated vaccinia virus) and Modified Vaccinia Ankara (is also attenuated vaccinia virus) not only have a better safety profile than the first- and second-generation smallpox vaccines, but they also successfully stimulate the production of antibodies in atopic and immunocompromised patients71-75. The live smallpox vaccination ACAM2000 has the benefit of being delivered in a single dosage. This medication is not recommended since it can proliferate in the cells of immunocompromised people. Furthermore, pregnant women and anyone with eczema or atopic dermatitis should not be vaccinated. A small number of vaccinated people may experience cardiac problems. Increased lesioning at the location of immunisation is normal and should be expected. The LC16m8 vaccine is an attenuated smallpox virus vaccine.
IMVAMUNE, a modified live attenuated vaccine, has fewer adverse effects and a safer profile than ACAM2000. Known as IMVAMUNE in the US and IMVANEX in Europe, it has limited replication ability, making it suitable for all adults, including those with weakened immune systems. Even after two doses of the live ACAM2000 vaccine, no skin lesions appear at the vaccination site 76.
Given the global impact of monkeypox virus (MPV), particularly in the context of the COVID -19 era, it is imperative that national and international research efforts be intensified. These efforts should focus on identifying virulence markers of the disease, understanding the factors that influence MPV evolution, which include both host and viral factors, investigating human behaviours that contribute to zoonotic spillover events, finding surrogates for asymptomatic infections, and examining the determinants of immunity for both the virus and the host. The goal of this research is to prevent MPV from filling the ecological gap left by the eradication of Variola major virus (VARV) and potentially evolving into a more dangerous pathogen. To achieve this, preventive epidemiological surveillance of MPV in endemic and high-risk areas, particularly in Nigeria, is essential. This surveillance should be conducted routinely and not only in response to outbreaks. Support the inclusion of routine and regular epidemiological surveillance of MPV in humans and animals in existing surveillance systems, such as the Surveillance Outbreak Response Management and Analysis System (SORMAS). This would allow early detection and effective management of monkeypox epidemics 77. The Sewer Coronavirus Alert Network (SCAN) was established in 2020 to test wastewater samples for COVID-19 virus presence. Since June 2022, it has expanded to include Monkeypox Virus (MPXV) detection in water plants. Combining this network with phylogenomic analysis could provide insights into MPXV’s spread and evolution. Although criticized for being reactive, SCAN has proven effective in anticipating virus spread, enabling frontline workers to control outbreaks and prevent a potential new Monkeypox outbreak.