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Review
. 2022 Jul 17;23(14):7866.
doi: 10.3390/ijms23147866.

Monkeypox: A New Threat?

Dorota Kmiec  1 , Frank Kirchhoff  1
Affiliations
Review

Monkeypox: A New Threat?

Dorota Kmiec et al. Int J Mol Sci. .

Abstract

The global vaccination programme against smallpox led to its successful eradication and averted millions of deaths. Monkeypox virus (MPXV) is a close relative of the Variola (smallpox) virus. Due to antigenic similarity, smallpox vaccines cross-protect against MPXV. However, over 70% of people living today were never vaccinated against smallpox. Symptoms of monkeypox (MPX) include fever, head- and muscle ache, lymphadenopathy and a characteristic rash that develops into papules, vesicles and pustules which eventually scab over and heal. MPX is less often fatal (case fatality rates range from <1% to up to 11%) than smallpox (up to 30%). MPXV is endemic in sub-Saharan Africa, infecting wild animals and causing zoonotic outbreaks. Exotic animal trade and international travel, combined with the increasing susceptibility of the human population due to halted vaccination, facilitated the spread of MPXV to new areas. The ongoing outbreak, with >10,000 cases in >50 countries between May and July 2022, shows that MPXV can significantly spread between people and may thus become a serious threat to public health with global consequences. Here, we summarize the current knowledge about this re-emerging virus, discuss available strategies to limit its spread and pathogenicity and evaluate its risk to the human population.

Keywords: 2022 MPXV outbreak; MPXV; emerging viruses; monkeypox; zoonosis.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Countries with confirmed (red) or suspected (pink) MPX cases during the 2022 non-endemic outbreak. Regions, where MPX was endemic prior to 2022, are shown in black. The map includes cases reported until 12 July 2022 [8]. The base layer map was obtained from https://commons.wikimedia.org/wiki/File:BlankMap-World.svg (accessed on 1 July 2022).
Figure 2
Figure 2
Phylogenetic tree of orthopoxvirus genomes. Reference genomes and MPXV genomes from the non-endemic 2022 outbreak (shown in red) as well as travel-associated cases detected in recent years (light blue). West African (dark blue) and Congo Basin (green) clades are indicated. Vaccinia (VACV) and Variola (VARV) viruses are shown in purple. Aligned sequences were obtained from the NCBI virus database. Genbank accession numbers are shown in the brackets. The tree was generated using ngphylogeny.fr and visualized using iTOL online tools (itol.embl.de/) (both accessed on 1 July 2022).
Figure 3
Figure 3
Structure of enveloped extracellular virions (EEV) and intracellular mature virions (IMV). See text for further details.
Figure 4
Figure 4
Replication cycle of a poxvirus. Key events are outlined: attachment (1), entry (2), early viral gene transcription and translation (3), DNA replication (4), intermediate and late transcription and translation (5), assembly (6), morphogenesis (7), envelopment by intracellular membranes (8) and budding (10). See text for further details.
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