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      Monkey pox resurgence in South Asia: Pakistan’s 2024 case highlights global health challenges

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          Abstract

          The World Health Organization (WHO) has issued a serious worldwide notice regarding Monkey pox (Mpox), designating it as a public health emergency. Mpox, which began from West and Central Africa, has since migrated to non-endemic areas, such as South Asia. In 2024, Pakistan reported the first incidence of the disease, which was connected to a visitor from Saudi Arabia. The virus, which was previously primarily harming youth in Africa, is increasingly impacting a wider demographic, especially adults and men who have sex with other men (MSM) which usually are occurring in sexual health clinics. Engaging in sexual intercourse, inhaling droplets, and coming into contact are the three ways that the disease escalates. The risk is highest in underprivileged communities that are often stigmatized and have little access to primary healthcare. Antivirals such as brincidofovir, cidofovir, and tecovirimat are now used in treatment; in an emergency, vaccinations like JYNNEOS and Vaccinia Immune Globulin Intravenous (VIGIV) are also available. In regions where vaccine supplies are scarce, targeted and ring vaccination programs are essential. To cease the transmission of Mpox and lessen its effects on public health, increased surveillance, travel restrictions, and focused preventative efforts are crucial to aid non endemic countries from these catastrophes.

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          Monkeypox: epidemiology, pathogenesis, treatment and prevention

          Monkeypox is a zoonotic disease that was once endemic in west and central Africa caused by monkeypox virus. However, cases recently have been confirmed in many nonendemic countries outside of Africa. WHO declared the ongoing monkeypox outbreak to be a public health emergency of international concern on July 23, 2022, in the context of the COVID-19 pandemic. The rapidly increasing number of confirmed cases could pose a threat to the international community. Here, we review the epidemiology of monkeypox, monkeypox virus reservoirs, novel transmission patterns, mutations and mechanisms of viral infection, clinical characteristics, laboratory diagnosis and treatment measures. In addition, strategies for the prevention, such as vaccination of smallpox vaccine, is also included. Current epidemiological data indicate that high frequency of human-to-human transmission could lead to further outbreaks, especially among men who have sex with men. The development of antiviral drugs and vaccines against monkeypox virus is urgently needed, despite some therapeutic effects of currently used drugs in the clinic. We provide useful information to improve the understanding of monkeypox virus and give guidance for the government and relative agency to prevent and control the further spread of monkeypox virus.
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            Efficacy of delayed treatment with ST-246 given orally against systemic orthopoxvirus infections in mice.

            ST-246 was evaluated for activity against cowpox virus (CV), vaccinia virus (VV), and ectromelia virus (ECTV) and had an in vitro 50% effective concentration (EC50) of 0.48 microM against CV, 0.05 microM against VV, and 0.07 microM against ECTV. The selectivity indices were >208 and >2,000 for CV and VV, respectively. The in vitro antiviral activity of ST-246 was significantly greater than that of cidofovir, which had an EC50 of 41.1 microM against CV and 29.2 microM against VV, with selectivity indices of >7 and >10, respectively. ST-246 administered once daily by oral gavage to mice infected intranasally with CV beginning 4 h or delayed until 72 h postinoculation was highly effective when given for a 14-day duration using 100, 30, or 10 mg/kg of body weight. When 100 mg/kg of ST-246 was administered to VV-infected mice, a duration of 5 days was sufficient to significantly reduce mortality even when treatment was delayed 24 h postinoculation. Viral replication in liver, spleen, and kidney, but not lung, of CV- or VV-infected mice was reduced by ST-246 compared to levels for vehicle-treated mice. When 100 mg/kg of ST-246 was given once daily to mice infected by the intranasal route with ECTV, treatment for 10 days prevented mortality even when treatment was delayed up to 72 h after viral inoculation. Viral replication in target organs of ECTV-infected mice was also reduced.
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              Monkeypox – An emerging pandemic

              Monkeypox–a zoonotic disease caused by the monkeypox virus, an orthopoxviruses family member. Recently monkeypox cases are increasing at an alarming rate in the US and worldwide. Health care professionals should keep a high index of suspicion for the disease in anyone with new onset fever, a vesicular or pustular rash with central umbilication, and lymphadenopathy. Such patients should be isolated at home or the hospital to prevent secondary transmission. The cases are typically self-limited, and most people only need home supportive care. However, as recommended by CDC, immunocompromised patients, pregnant patients, and children younger than eight years should be offered pre- or post-exposure prophylaxis with vaccines. The current outbreak explicitly targets a cohort of homosexual and gay patients. The role of sexual transmission of the virus needs to be explored further. Patients with severe symptoms or respiratory complications can also be treated with antivirals such as tecovirimat (TPOXX) and brincidofovir or with intravenous vaccinia immune globulin (VIGIV).
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                MS9
                Annals of Medicine and Surgery
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2049-0801
                February 2025
                11 February 2025
                : 87
                : 2
                : 1082-1084
                Affiliations
                [a ]Shaikh Khalifa bin Zayed Al Nayhan Medical and Dental College, Lahore, Pakistan
                [b ]Department of Medical Biophysics, University of Toronto, Toronto, Canada
                [c ]Department of Research, Medical Research Circle (MedReC), Goma, DR Congo
                Author notes
                [* ]Corresponding author. Address: Department of Research, Medical Research Circle (MedReC), Kyeshero Lusaka rue 218, Postal code 73, Bukavu, Gisenyi, Goma, North Kivu, DR Congo. Tel.: +243 825177370. E-mail: aymarakilimali@ 123456gmail.com (A. Akilimali).
                Article
                AMSU-D-24-02602 00090
                10.1097/MS9.0000000000002950
                11918799
                40110317
                51907690-e76d-4f81-8f78-3016c3177983
                Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                : 12 December 2024
                : 05 January 2025
                Categories
                Correspondence
                Custom metadata
                TRUE

                monkey pox,mpox,outbreak,public health,south asia
                monkey pox, mpox, outbreak, public health, south asia

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