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Review
. 2023 May 11;41(20):3171-3177.
doi: 10.1016/j.vaccine.2023.04.010. Epub 2023 Apr 21.

Monkeypox (Mpox) requires continued surveillance, vaccines, therapeutics and mitigating strategies

Rachel L Roper  1 , Alfredo Garzino-Demo  2 , Carlos Del Rio  3 , Christian Bréchot  4 , Robert Gallo  5 , William Hall  6 , José Esparza  5 , Marvin Reitz  5 , Raymond F Schinazi  7 , Mark Parrington  8 , James Tartaglia  9 , Marion Koopmans  10 , Jorge Osorio  11 , Andreas Nitsche  12 , Tan Boon Huan  13 , James LeDuc  14 , Antoine Gessain  15 , Scott Weaver  16 , Suresh Mahalingam  17 , Alash'le Abimiku  5 , Anders Vahlne  18 , Joaquim Segales  19 , Linfa Wang  20 , Stuart N Isaacs  21 , Albert Osterhaus  22 , Richard H Scheuermann  23 , Grant McFadden  24
Affiliations
Review

Monkeypox (Mpox) requires continued surveillance, vaccines, therapeutics and mitigating strategies

Rachel L Roper et al. Vaccine. .

Abstract

The widespread outbreak of the monkeypox virus (MPXV) recognized in 2022 poses new challenges for public healthcare systems worldwide. With more than 86,000 people infected, there is concern that MPXV may become endemic outside of its original geographical area leading to repeated human spillover infections or continue to be spread person-to-person. Fortunately, classical public health measures (e.g., isolation, contact tracing and quarantine) and vaccination have blunted the spread of the virus, but cases are continuing to be reported in 28 countries in March 2023. We describe here the vaccines and drugs available for the prevention and treatment of MPXV infections. However, although their efficacy against monkeypox (mpox) has been established in animal models, little is known about their efficacy in the current outbreak setting. The continuing opportunity for transmission raises concerns about the potential for evolution of the virus and for expansion beyond the current risk groups. The priorities for action are clear: 1) more data on the efficacy of vaccines and drugs in infected humans must be gathered; 2) global collaborations are necessary to ensure that government authorities work with the private sector in developed and low and middle income countries (LMICs) to provide the availability of treatments and vaccines, especially in historically endemic/enzootic areas; 3) diagnostic and surveillance capacity must be increased to identify areas and populations where the virus is present and may seed resurgence; 4) those at high risk of severe outcomes (e.g., immunocompromised, untreated HIV, pregnant women, and inflammatory skin conditions) must be informed of the risk of infection and be protected from community transmission of MPXV; 5) engagement with the hardest hit communities in a non-stigmatizing way is needed to increase the understanding and acceptance of public health measures; and 6) repositories of monkeypox clinical samples, including blood, fluids, tissues and lesion material must be established for researchers. This MPXV outbreak is a warning that pandemic preparedness plans need additional coordination and resources. We must prepare for continuing transmission, resurgence, and repeated spillovers of MPXV.

Keywords: Anti-virals; Monkeypox; Orthopoxvirus vaccine; Poxvirus; Smallpox vaccine; Vaccine; mpox.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rachel Roper reports financial support was provided by East Carolina University. Rachel Roper reports a relationship with East Carolina University that includes: employment and non-financial support. Rachel Roper has patent #Patent No 8202521 issued to East Carolina Univeristy. Roper serves as a reviewer for Vaccine, but not in an editorial role. (R Roper) Tartaglia, James is an employee of Sanofi and holds stock options.

Figures

Fig. 1
Fig. 1
Dotplots comparing viral genomes at each nucleotide position. In each plot, the first virus name shown is plotted horizontally with the first nucleotide position on the left, and the second viral genome named is plotted vertically with the first nucleotide at the top. Genome sequences are vaccinia ACAM2000, Variola major India 3 1967, MPX monkeypox Cop58, Modified Vaccinia Ankara MVA-1721, and Molluscum contagiosum virus. Genome nucleotide identity is indicated by a diagonal line.
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