Editorial
The rise and fall of mpox
El ascenso y la caída del virus de la viruela del mono
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Ena, R.P. Wenzel" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Ena" "email" => array:1 [ 0 => "ena_jav@gva.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R.P." "apellidos" => "Wenzel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departmento de Medicina Interna, Hospital Marina Baixa, Villajoyosa (Alicante), Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Internal Medicine, Virginia Commonwealth University Health, Richmond, VA, USA" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El ascenso y la caída del virus de la viruela del mono" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The World Health Organization (WHO) director-general declared the mpox outbreak a Public Health Emergency of International Concern on July 23, 2022. As of October 13, 2022, more than 72,000 confirmed cases of monkeypox had been reported across 82 nonendemic countries, with death reported in 28 cases<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. The most affected countries have been the United States of America (27,096 cases (2 fatal)), Brazil (8521 cases (5 fatal)), Spain (7239 cases (2 fatal)), and France (4064 cases).</p><p id="par0010" class="elsevierStylePara elsevierViewall">The WHO implemented a coordinated international response and the measures taken have proven effective in slowing the pace of the outbreak in recent months<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At the beginning of the outbreak, some uncertainties included how exactly the infection was transmitted, how widespread it was likely to become, whether it was a different strain from what was known, and what the utility of a vaccine to mitigate transmission would be<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Early reports describing the epidemiology of mpox indicated that transmission occurred through skin-to-skin contact with infectious lesions. The highest-risk population was determined to be men who acquired the infection through sexual or intimate contact with other men<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>. Having multiple sexual partners was found to be a risk factor for the disease; coinfection with other sexually transmitted diseases was noted in approximately 25% of patients and coinfection with HIV in as many as 41%.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Fewer than 5% of cases have been reported among females, pregnant women, children, and healthcare workers after a percutaneous needle injury.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Molecular analysis of the ongoing 2022 multi-country outbreak comprising the human west African Mpox-1A clade revealed three newly classified lineages (A.1, A.1.1, A.2) and a B1 lineage that emerged in Europe on March 2, 2022<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>. These data suggest that several factors have been involved in the current outbreak dynamics, including the cessation of smallpox vaccination and the spreading of the infection among particular networks.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The United States Food and Drug Administration (FDA) approved the JYNNEOS (Modified Vaccinia Ankara Vaccine, Bavarian Nordic) smallpox vaccine as a potentially helpful vaccine for mpox. Given that the live virus does not replicate in mammalian cells, it is considered safer than the conventional smallpox vaccine.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In May 2022, the United States started distributing the JYNNEOS vaccine as postexposure prophylaxis for individuals with known exposure to mpox. In addition, JYNNEOS was also offered to individuals receiving pre-exposure prophylaxis (PrEP) for HIV/AIDS. A preliminary analysis of JYNNEOS showed an efficacy of 70% for subjects who had received their first dose ≥14 days earlier and an effectiveness of 98% for those who had received their second dose ≥14 days earlier<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tecovirimat is the only drug approved by the European Medicines Agency for the treatment of mpox<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>. Tecovirimat is administrated at a daily dosage of 1200 mg together with a meal. The efficacy of tecovirimat for mpox in humans has been documented in small case series. The most common indication for tecovirimat was mpox in patients with immunosuppression due to underlying conditions or with severe symptomatic disease-causing tonsillar edema and odynophagia, eyelid lesions, or severe rectal pain<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9–11</span></a>. Tecovirimat showed a good safety profile in these small case series, with no significant side effects reported. Clinical improvement coincided with a >2 log drop in monkeypox viremia within seven days<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Uncertainties remain, including the possibility of the virus establishing an animal reservoir outside of Africa, the duration of immunity after one-dose or two-dose vaccine schedules, more precisely the various behaviors in sexual transmission, and understanding alternative transmission pathways.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In summary, we should be prepared to face outbreaks of zoonotic origin since they are a natural part of life on a small planet shared with multiple non-human species. Controlling the current epidemic requires a coordinated effort among countries to implement infection control measures. Fortunately, airborne transmission is not prominent. The key factors behind the current decline in cases have included establishing trust with the at-risk population, encouraging them to change their behaviors and accept a vaccination program, and the availability of active and safe antiviral therapy to treat severe cases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The WHO declaration of monkeypox as a global health emergency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.B. Nuzzo" 1 => "L.L. Borio" 2 => "L.O. 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| Year/Month | Html | Total | |
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| 2023 June | 2 | 0 | 2 |
| 2023 March | 1 | 4 | 5 |
| 2022 December | 3 | 2 | 5 |
