Addressing the 2022

Monkeypox outbreak


In May 2022, multiple outbreaks of infection by monkeypox were reported in non-endemic areas, such as Europe and the United States. Although monkeypox infection is not life-threatening, the rapid spread of the virus in areas without a history of community transmission raised the awareness of health authorities, which launched public health dictates for containing the outbreaks.

Early evidence tells us that monkeypox infection is behaving different than previous outbreaks. Based on the need to fully understand the infection to make evidence-based decisions on the public health control of the infection, we are working to contribute to the existing evidence gaps, such as transmission dynamics, clinical presentations, diagnostic tools, and vaccine response and immunology.

Selected Publications

  • Suñer C, Ubals M, Tarín-Vicente EJ, Mendoza A, Alemany A, Hernández-Rodríguez Á, et al. Viral dynamics in patients with monkeypox infection: a prospective cohort study in Spain. The Lancet Infectious Diseases. 2023. [ DOI | ePrint ]

    BackgroundMonkeypox DNA has been detected in skin lesions, saliva, oropharynx, urine, semen, and stool of patients infected during the 2022 clade IIb outbreak; however, the viral dynamics within these compartments remain unknown. We aimed to characterise the viral load kinetics over time in various parts of the body.

  • Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS, et al. Mpox in people with advanced HIV infection: a global case series. The Lancet. 2023. [ DOI | ePrint ]

    BackgroundPeople living with HIV have accounted for 38?50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3).

  • Mitjà O, Ogoina D, Titanji BK, Galvan C, Muyembe JJ, Marks M, et al. Monkeypox. The Lancet. 2022. [ DOI | ePrint ]

    Monkeypox is a zoonotic illness caused by the monkeypox virus, an Orthopoxvirus in the same genus as the variola, vaccinia, and cowpox viruses. Since the detection of the first human case in the Democratic Republic of the Congo in 1970, the disease has caused sporadic infections and outbreaks, mainly restricted to some countries in west and central Africa. In July, 2022, WHO declared monkeypox a Public Health Emergency of International Concern, on account of the unprecedented global spread of the disease outside previously endemic countries in Africa and the need for global solidarity to address this previously neglected disease. The 2022 outbreak has been primarily associated with close intimate contact (including sexual activity) and most cases have been diagnosed among men who have sex with men, who often present with novel epidemiological and clinical characteristics. In the 2022 outbreak, the incubation period ranges from 7 days to 10 days and most patients present with a systemic illness that includes fever and myalgia and a characteristic rash, with papules that evolve to vesicles, pustules, and crusts in the genital, anal, or oral regions and often involve the mucosa. Complications that require medical treatment (eg, antiviral therapy, antibacterials, and pain control) occur in up to 40% of patients and include rectal pain, odynophagia, penile oedema, and skin and anorectal abscesses. Most patients have a self-limited illness; between 1% and 13% require hospital admission (for treatment or isolation), and the case-fatality rate is less than 01%. A diagnosis can be made through the presence of Orthopoxvirus DNA in PCRs from lesion swabs or body fluids. Patients with severe manifestations and people at risk of severe disease (eg, immunosuppressed people) could benefit from antiviral treatment (eg, tecovirimat). The current strategy for post-exposure prophylaxis or pre-exposure prophylaxis for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.

  • Thornhill JP, Palich R, Ghosn J, Walmsley S, Moschese D, Cortes CP, et al. Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series. The Lancet. 2022. [ DOI | ePrint ]

    BackgroundBetween May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78?000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors.

  • Ubals M, Tarín-Vicente EJ, Oller X, Mendoza A, Alemany A, Hernández-Rodríguez Á, et al. Evaluating the accuracy of self-collected swabs for the diagnosis of monkeypox. Clin Infect Dis. 2022. [ DOI | ePrint ]

    We evaluated the accuracy of patient-collected skin lesions, oropharyngeal, and rectal swabs amongst 50 individuals enrolled in a study of monkeypox viral dynamics. We found that the performance of self-collected samples was similar to that of physician-collected samples, suggesting that self-sampling is a reliable strategy for diagnosing monkeypox.

  • Tarín-Vicente EJ, Alemany A, Agud-Dios M, Ubals M, Suñer C, Antón A, et al. Clinical presentation and virological assessment of confirmed human monkeypox virus cases in Spain: a prospective observational cohort study. The Lancet. 2022;400(10353):661--669. [ DOI | ePrint ]

    In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain.

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