Versions
- 2024-02-05 (2)
- 2023-08-01 (1)
Keywords
epidemiology
ethics
smallpox
Alastrim
epidemics
Mpox
Abstract
Introduction: In 2022, the appearance of cases of Mpox outside the countries where the disease is endemic, and of some cases of human-to-human transmission, alerted the scientific community to a virus that is closely related to the smallpox virus. Mpox is a zoonosis and can be transmitted to humans. Following the eradication of smallpox in 1980 and the subsequent cessation of smallpox vaccination, it is emerging as the most important orthopoxvirus in terms of public health impact.
Methods: In outlining the current situation of Mpox in the world, the authors frame the virus responsible within a broader reflection on the Orthopoxvirus family, focusing particular attention on the Variola virus, which formerly caused millions of deaths.
Discussion: Since Edward Jenner initiated the practice of vaccination, a progressive and careful vaccination campaign has led to the eradication not only of human smallpox but also of a minor form, called Alastrim, which was caused by the same virus.
The mode of transmission of Mpox has been debated. At first, it seemed that the disease mainly, though not exclusively, affected men who had sex with other men. This conviction has been partially revised and the WHO recently changed the name of the disease from Monkeypox to Mpox, thereby alleviating the stigma involved.
Conclusion: The recent human cases of Mpox have prompted greater surveillance and research into the biology of MPXV and other closely related poxviruses. Studies have focused on the natural history of the virus, its transmission, pathogenesis, host interactions and evolution, and on the development of drugs and vaccines to prevent its spread.
References
Saxena SK, Ansari S, Maurya VK, Kumar S, Jain A, Paweska JT, Tripathi AK, Abdel-Moneim AS. Re-emerging human monkeypox: A major public-health debacle. J Med Virol. 2023 Jan;95(1):e27902. doi: 10.1002/jmv.27902.
World Health Organization WHO. 2022 Mpox (Monkeypox) Outbreak: Global Trends. Available at: https://worldhealthorg.shinyapps.io/mpx_global/. (Accessed on: June 20, 2023).
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, Steffen R. The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis. 2022 Feb 11;16(2): e0010141. doi: 10.1371/journal.pntd.0010141.
Martini M, Bifulco M, Orsini D. Smallpox vaccination and vaccine hesitancy in the Kingdom of the Two Sicilies (1801) and the great modernity of Ferdinand IV of Bourbon: a glimpse of the past in the era of the SARS-COV-2 (COVID-19) pandemic. Public Health. 2022 Dec;213:47-53. doi: 10.1016/j.puhe.2022.09.012.
Jenner E. On the Origin of the Vaccine Inoculation. Med Phys J. 1801;5(28):505-508.
Jenner E. An inquiry into the causes and effects of the variolae vaccinae: a disease discovered in some of the western counties of England, particularly Gloucestershire, and known by the name of the cow pox. Springfield [Mass.]: Re-printed for Dr. Samuel Cooley, by Ashley & Brewer, 1802.
Orsini D., Martini M. From inoculation to vaccination: the fight against smallpox in Siena in the 18th and 19th centuries, Le Infezioni in Medicina, n. 4, 634-641, 2020.
Bifulco M, Di Zazzo E, Pisanti S, Martini M, Orsini D. The nineteenth-century experience of the kingdom of the two Sicilies on mandatory vaccination: An Italian phenomenon? Vaccine. 2022 May 31;40(25):3452-3454. doi: 10.1016/j.vaccine.2022.04.052.
Smith, G.L. (2007). Genus Orthopoxvirus: Vaccinia virus. In: Mercer, A.A., Schmidt, A., Weber, O. (eds) Poxviruses. Birkhäuser Advances in Infectious Diseases. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-7557-7_1.
Ahmed, S.F.; Sohail, M.S.; Quadeer, A.A.; McKay, M.R. Vaccinia-Virus-Based Vaccines Are Expected to Elicit Highly Cross-Reactive Immunity to the 2022 Monkeypox Virus. Viruses 2022, 14, 1960. https://doi.org/10.3390/v14091960.
Donald A. Henderson and Bernard Moss. Smallpox and Vaccinia (Chapter 6). In: Vaccines, 3rd edition. Philadelphia: Saunders; 1999.
Isidro J, Borges V, Pinto M, Sobral D, Santos JD, Nunes A, Mixão V, Ferreira R, Santos D, Duarte S, Vieira L, Borrego MJ, Núncio S, de Carvalho IL, Pelerito A, Cordeiro R, Gomes JP. Phylogenomic characterization and signs of microevolution in the 2022 multi-country outbreak of monkeypox virus. Nat Med. 2022 Aug;28(8):1569-1572. doi: 10.1038/s41591-022-01907-y. Epub 2022 Jun 24. Erratum in: Nat Med. 2022 Oct;28(10):2220-2221. PMID: 35750157; PMCID: PMC9388373.
Dumonteil E, Herrera C, Sabino-Santos G. Monkeypox Virus Evolution before 2022 Outbreak. Emerging Infectious Diseases 2023;29(2):451-453. doi:10.3201/eid2902.220962.
World Health Organization (WHO). WHO Director-General's statement at the press conference following IHR Emergency Committee regarding the multi-country outbreak of monkeypox - 23 July 2022. Available at: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-the-press-conference-following-IHR-emergency-committee-regarding-the-multi--country-outbreak-of-monkeypox--23-july-2022. (Accessed on: June 20, 2023).
World Health Organization WHO. 2022 Mpox (monkeypox). Available at: https://www.who.int/health-topics/monkeypox#tab=tab_1. (Accessed on: June 20, 2023).
Antinori A, Mazzotta V, Vita S, Carletti F, Tacconi D, Lapini LE, D'Abramo A, Cicalini S, Lapa D, Pittalis S, Puro V, Rivano Capparuccia M, Giombini E, Gruber CEM, Garbuglia AR, Marani A, Vairo F, Girardi E, Vaia F, Nicastri E; INMI Monkeypox Group. Epidemiological, clinical and virological characteristics of four cases of monkeypox support transmission through sexual contact, Italy, May 2022. Euro Surveill. 2022 Jun;27(22):2200421. doi: 10.2807/1560-7917.ES.2022.27.22.2200421.
Oriol Mitjà, Dimie Ogoina, Boghuma K Titanji, Cristina Galvan, Jean-Jacques Muyembe, Michael Marks, Chloe M Orkin. Monkeypox. The Lancet 2023, Volume 401, ISSUE 10370, P60-74. https://doi.org/10.1016/S0140-6736(22)02075-X.
World Health Organization (WHO). WHO recommends new name for monkeypox disease. 28 November 2022. Available at: https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease. (Accessed on: June 20, 2023).
Cho CT, Wenner HA. Monkeypox virus. Bacteriol Rev. 1973 Mar;37(1):1-18. doi: 10.1128/br.37.1.1-18.1973. PMID: 4349404; PMCID: PMC413801.
Breman JG, Kalisa R, Steniowski MV, Zanotto E, Gromyko AI, Arita I. Human monkeypox, 1970-79. Bull World Health Organ. 1980;58(2):165-182. pmid:6249508.
Marennikova SS, Seluhina EM, Mal'ceva NN, Cimiskjan KL, Macevic GR. Isolation and properties of the causal agent of a new variola-like disease (monkeypox) in manBull World Health Organ 1972 46599611.
Jezek Z, Fenner F. Melnick JL. Human monkeypox. Monographs in virology 1988 Vol. 17Basel, SwitzerlandKarger.
Gross E. Update on emerging infections: news from the Centers for Disease Control and prevention. Update: Multistate outbreak of monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. Annals of Emergency Medicine. 2003 Nov;42(5):660-2; discussion 662- 4. DOI: 10.1016/s0196064403008199.
Bunge EM, Hoet B, Chen L, Lienert F, Weidenthaler H, Baer LR, et al. (2022) The changing epidemiology of human monkeypox-A potential threat? A systematic review. PLoS Negl Trop Dis 16(2): e0010141. https://doi.org/10.1371/journal.pntd.0010141.
World Health Organization. Regional Office for Africa. Weekly bulletin on outbreak and other emergencies: Week 4: 18–24 January. World Health Organization, Regional Office for Africa. 2021. Available at: https://apps.who.int/iris/handle/10665/338891. (Accessed on: June 20, 2023).
World Health Organization. Regional Office for Africa. Weekly bulletin on outbreak and other emergencies: Week 4: 17–23 January. World Health Organization, Regional Office for Africa. 2022. Available at: https://apps.who.int/iris/handle/10665/351164. (Accessed on: June 20, 2023).
Mukerji BK. A Case of Alastrim (Kaffir Pox). Ind Med Gaz. 1924 Feb;59(2):89-90. PMID: 29007324; PMCID: PMC5172660.
Maccallum WG, Moody LM. Alastrim in Jamaica. American Journal of Epidemiology 1921; 1(4):388-409. https://doi.org/10.1093/oxfordjournals.aje.a118044.
Chauvet S. L’Alastrim. Una nuova malattia eruttiva. La Rassegna di clinica, Terapia e Scienze affini 1924; XXIII (3): 123.
Shchelkunov SN, Totmenin AV, Loparev VN, Safronov PF, Gutorov VV, Chizhikov VE, Knight JC, Parsons JM, Massung RF, Esposito JJ. Alastrim smallpox variola minor virus genome DNA sequences. Virology. 2000 Jan 20;266(2):361-86. doi: 10.1006/viro.1999.0086.
Jonathan B. Tucker, Scourge: The Once and Future Threat of Smallpox, Grove Press, 2002, pp. 117–118.
Parodi A, Martini M. History of vaccine and immunization: Vaccine-hesitancy discussion in Germany in XIX century. Vaccine. 2023 Mar 17;41(12):1989-1993. doi: 10.1016/j.vaccine.2023.02.029. Epub 2023 Feb 17. PMID: 36803870.