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.