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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">On May 21&#44; the World Health Organization &#40;WHO&#41; announced the emergence of 92 confirmed cases of monkeypox in 12 countries outside of the endemic areas in central and western Africa<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Uncertainties include exactly how it has been transmitted&#44; how widespread it is likely to become&#44; whether it has a significant mutation from earlier strains&#44; and if a vaccine will be necessary for control&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Monkeypox is an infection caused by the monkeypox virus&#44; a member of the family <span class="elsevierStyleItalic">Poxviridae</span> and the genus <span class="elsevierStyleItalic">Orthopoxvirus</span>&#46; This genus also includes the smallpox virus with its variants <span class="elsevierStyleItalic">Variola major</span> and <span class="elsevierStyleItalic">Variola minor</span>&#8212;a disease eradicated in 1980&#8212;&#44; vaccinia virus&#44; and cowpox virus&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Monkeypox virus was discovered in 1958 in Copenhagen when two outbreaks of pustular disease occurred in monkeys in captivity there for research<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; The first human case was described in 1970 in the Democratic Republic of the Congo<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Since then&#44; cases have been described in countries of Sub-Saharan Africa and Central Africa&#46; Two different clades are recognized&#58; a West African clade with more benign symptoms and a mortality rate of 1&#37; and a Central African clade with greater severity and mortality rate of 10&#37;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In a study of family outbreaks of patients with monkeypox infection in the Democratic Republic of the Congo&#44; the risk factors for acquiring the infection were bed-sharing or using the same cutlery&#46; No animal reservoirs could be identified<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; A cluster of cases in the United States in 2003&#44; traced to exposure to exotic pets imported from Africa&#44; showed rodents can become infected and transmit the infection to humans<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The infection of the animals caused necrotizing pneumonia&#44; conjunctivitis&#44; and mouth ulcers&#46; In people who had close contact with infected animals and their family members&#44; the infection caused fever&#44; vesiculopustular rash&#44; pharyngeal pain&#44; myalgia&#44; headache&#44; and adenopathies&#46; The incubation period was six days &#40;range 1&#8211;11 days&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46; Symptoms usually last two to four weeks&#46; There were no deaths&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The recently described outbreak of human monkeypox virus infection showed that most cases occurred in men who have sex with men&#46; The cases have not been severe and the clade involved is the West African variant&#46; In Spain&#44; around one hundred cases have been confirmed&#44; some linked to an outbreak in a sauna in Madrid&#46; The United Kingdom&#44; Spain&#44; and Portugal are the European countries with the greatest number of confirmed cases&#46; Cases have also been described in the United States&#44; Canada&#44; and Australia<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Carlos III Health Institute &#40;ISCIII&#44; for its initials in Spanish&#41; in Spain has prepared a document for the early detection and treatment of patients with monkeypox disease<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; The confirmatory diagnosis is made by PCR in samples of skin lesions &#40;vesicular fluid&#44; exudates&#44; or scabs&#41;&#46; Preventive measures currently include contact &#40;personal protective equipment&#41; and respiratory isolation &#40;surgical mask&#41;&#59; use of a single room&#59; washing clothes in a standard washing machine with detergent and water at 60&#8239;&#176;C&#59; use of a dishwasher or washing dishes by hand with soap&#59; and treating contaminated surfaces or objects with a detergent or sodium hypochlorite &#40;1&#58;100 bleach&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Vaccination against traditional smallpox with Jynneos&#8482;&#44; also known as Imvamune&#8482; or Imvanex&#8482; &#40;Bavarian Nordik&#44; Denmark&#41;&#44; demonstrates protection against monkeypox virus infection&#46; Spain is preparing to administer this vaccine to close contacts of confirmed cases<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; It is a nonreplicating live variant of the vaccinia virus&#44; the only vaccine currently approved for the prevention of monkeypox&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The drug tecovirimat has been approved for treatment of this infection in the European Union and the United States&#46; Cidofovir and brincidofovir are two antivirals that have shown <span class="elsevierStyleItalic">in vitro</span> activity against poxvirus&#44; although it is not known if an infected person could benefit from this treatment&#46; Negotiations in Spain are underway to acquire tecovirimat&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This outbreak of monkeypox virus infection is striking as it has emerged in several geographically separated countries and areas&#46; Transmission is likely from person to person and there is no evidence that animals are involved&#46; Although most cases have arisen in men who have sex with men&#44; it is unclear whether sexual contact is necessary for transmission&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">With the summer months approaching and increased social contact&#44; it is likely that the epidemic could spread&#46; In the meantime&#44; we expect that sequencing of the viruses will give insights into how much identity there is among patient strains and if there are mutant variants that transmit the virus more effectively&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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Editorial
Monkeypox: A poxvirus emerges once again
Viruela del mono: un poxvirus emerge nuevamente
J. Enaa,
Corresponding author
ena_jav@gva.es

Corresponding author.
, R.P. Wenzelb
a Departmento de Medicina Interna, Hospital Marina Baixa, Alicante, Spain
b Departamento de Medicina Interna, Virginia Commonwealth University Health, Richmond, VA, USA

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