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Quo Vadis, Monkeypox?

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University of Oslo
University of Oslo

Video at https://www.youtube.com/watch?v=f8HRluqOqDg 🙈🙉🙊 We discuss the clinical features on the basis of a case series from the U.K. and then have a Q&A with pox virologist and UpToDate author on the topic, Dr. Stuart Isaacs. Discussant: Stuart N. Isaacs, MD; Perelman School of Medicine at the University of Pennsylvania Host: Benjamin P. Geisler, MD MPH Recording date: May 30, 2022 0:00 Intro 1:09 Outline and Study Type 2:13 Background 5:31 Case Series 11:39 Q&A w/ Dr. Isaacs References: -Case series: Adler H et al. Lancet ID online early doi: 10.1016/S1473-3099(22)00228-6 -Comparison to Covid-19 case report/series: Rothe C et al N Engl J Med. 382(10); 970-1 doi: 10.1056/NEJMc2001468 https://pubmed.ncbi.nlm.nih.gov/32003... -Dr. Isaac’s UpToDate article: -Microbe.TV: This Week in Virology (TWiV) Special: Monkeypox clinical update with Dr. Daniel Griffin https://www.youtube.com/watch?v=dMiT7... -Program for Monitoring Emerging Diseases (ProMED) Monkeypox update (06), 30 May 2022: https://promedmail.org/ -Centre for Infectious Disease Research and Policy (CIDRAP): WHO says monkeypox containable, but nations should be on alert. https://www.cidrap.umn.edu/news-persp... -Phylogenetic trees: Hendrickson RC et al. Viruses 2010(2); 1933-67. doi: 10.3201/eid2409.171283 https://pubmed.ncbi.nlm.nih.gov/30124... -Virion schematics: ViralZone, from https://commons.wikimedia.org/wiki/Fi... -Discussion of on-going MPXV genome sequencing: https://virological.org/t/discussion-... -Genomic epidemiology of monkeypox virus: https://nextstrain.org/monkeypox?l=clock #monkeypox #virus

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Quo Vadis, Monkeypox?
Host: Benjamin P. Geisler, MD MPH Discussant: Stuart N. Isaacs, MD
Outline 1. Background 2. Case series (clinical features/management) 3. Q&A w/ Dr. Isaacs
Rothe C et al N Engl J Med. 382(10); 970-1
1. Background • Neglected tropical disease • Zoonosis of an orthopoxvirus • Reservoir: rodents? • Transmission via direct skin contact or droplets (≥3h within 6’) • Mortality: Central African > West-African clade (10% vs. <5%) • Now: >300 cases in >20 countries • One case at MGH; <10 HCWs vaccinated with Jynneos® • Clinical features/management → case series Sources: Dr. Isaac’s UpToDate article; Microbe.TV: This Week in Virology (TWiV); Program for Monitoring Emerging Diseases (ProMED); CIDRAP (Centre for Infectious Disease Research and Policy)
By Sequence Extromelia Cowpox (Ger/Brighton) Tatera/camelpox, variola Monkeypox Cowpox (GRI) Vaccinia By Gene Content Extromelia Cowpox Horsepox Vaccinia Variola Tatera/camel/monkeypox Hendrickson RC et al. Viruses 2010(2); 1933-67.
By Sequence Extromelia Cowpox (Ger/Brighton) Tatera/camelpox, variola Monkeypox Cowpox (GRI) Vaccinia By Gene Content Extromelia Cowpox Horsepox Vaccinia Variola Tatera/camel/monkeypox Hendrickson RC et al. Viruses 2010(2); 1933-67.
Source: ViralZone/WikiPedia
1. Background • Neglected tropical disease • Zoonosis of an orthopoxvirus • Reservoir: rodents? • Transmission via direct skin contact or droplet (≥3h within 6’) • Mortality: Central African > West-African clade (10% vs. <5%) • Now: >300 cases in >20 countries • One case at MGH; <10 HCWs vaccinated with Jynneos® • Clinical features/management → case series Sources: Dr. Isaac’s UpToDate article; Microbe.TV: This Week in Virology (TWiV); Program for Monitoring Emerging Diseases (ProMED); CIDRAP (Centre for Infectious Disease Research and Policy)
2. Case Series
Quo Vadis, Monkeypox?
Methods • All subsequent cases managed through the High Consequence Infectious Diseases (airborne) network in Liverpool, London, and Newcastle in the U.K. 8/2018-9/2021 • N=7 • Description of clinical features; PCR from ulcerated skin lesion; blood, nose/throat, and urine; and response to off-label antivirals
Results – Baseline Characteristics
Results – Clinical Features
Results – Clinical Features
Results – Clinical Features
Results – Clinical Features
Results – Clinical Features
Results – Treatment
Take-Aways (From the Case Series) • Direct contact, for example during or before/after sexual intercourse, seems to be necessary for most transmissions • Lesions on mucus membranes may also cause droplet transmission • Skin lesions may (at first) be subtle, look at the entire integument incl. palms and soles; PCR various tissues and fluids • Brincidofovir may cause LFT elevation and may have to be stopped • If severe pain, look for a deep abscess • PPE and contact tracing per infection control • Involve (sub)specialized teams
3. Q&A w/ Dr. Isaacs
Discussant: Stuart N. Isaacs, M.D. • Attended Brandeis and Yale School of Medicine • Trained at Temple, NIH NIAID, and Tufts • Heads a pox laboratory at Penn • Associate Professor at the Perelman School of Medicine • Various leadership positions, incl. Associate Dean • ID Attending at Philadelphia VA Medical Center
Quo Vadis, Monkeypox?
Quo Vadis, Monkeypox?
Quo Vadis, Monkeypox?
Quo Vadis, Monkeypox?

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Quo Vadis, Monkeypox?

  • 2. Host: Benjamin P. Geisler, MD MPH Discussant: Stuart N. Isaacs, MD
  • 3. Outline 1. Background 2. Case series (clinical features/management) 3. Q&A w/ Dr. Isaacs
  • 4. Rothe C et al N Engl J Med. 382(10); 970-1
  • 5. 1. Background • Neglected tropical disease • Zoonosis of an orthopoxvirus • Reservoir: rodents? • Transmission via direct skin contact or droplets (≥3h within 6’) • Mortality: Central African > West-African clade (10% vs. <5%) • Now: >300 cases in >20 countries • One case at MGH; <10 HCWs vaccinated with Jynneos® • Clinical features/management → case series Sources: Dr. Isaac’s UpToDate article; Microbe.TV: This Week in Virology (TWiV); Program for Monitoring Emerging Diseases (ProMED); CIDRAP (Centre for Infectious Disease Research and Policy)
  • 6. By Sequence Extromelia Cowpox (Ger/Brighton) Tatera/camelpox, variola Monkeypox Cowpox (GRI) Vaccinia By Gene Content Extromelia Cowpox Horsepox Vaccinia Variola Tatera/camel/monkeypox Hendrickson RC et al. Viruses 2010(2); 1933-67.
  • 7. By Sequence Extromelia Cowpox (Ger/Brighton) Tatera/camelpox, variola Monkeypox Cowpox (GRI) Vaccinia By Gene Content Extromelia Cowpox Horsepox Vaccinia Variola Tatera/camel/monkeypox Hendrickson RC et al. Viruses 2010(2); 1933-67.
  • 9. 1. Background • Neglected tropical disease • Zoonosis of an orthopoxvirus • Reservoir: rodents? • Transmission via direct skin contact or droplet (≥3h within 6’) • Mortality: Central African > West-African clade (10% vs. <5%) • Now: >300 cases in >20 countries • One case at MGH; <10 HCWs vaccinated with Jynneos® • Clinical features/management → case series Sources: Dr. Isaac’s UpToDate article; Microbe.TV: This Week in Virology (TWiV); Program for Monitoring Emerging Diseases (ProMED); CIDRAP (Centre for Infectious Disease Research and Policy)
  • 12. Methods • All subsequent cases managed through the High Consequence Infectious Diseases (airborne) network in Liverpool, London, and Newcastle in the U.K. 8/2018-9/2021 • N=7 • Description of clinical features; PCR from ulcerated skin lesion; blood, nose/throat, and urine; and response to off-label antivirals
  • 13. Results – Baseline Characteristics
  • 20. Take-Aways (From the Case Series) • Direct contact, for example during or before/after sexual intercourse, seems to be necessary for most transmissions • Lesions on mucus membranes may also cause droplet transmission • Skin lesions may (at first) be subtle, look at the entire integument incl. palms and soles; PCR various tissues and fluids • Brincidofovir may cause LFT elevation and may have to be stopped • If severe pain, look for a deep abscess • PPE and contact tracing per infection control • Involve (sub)specialized teams
  • 21. 3. Q&A w/ Dr. Isaacs
  • 22. Discussant: Stuart N. Isaacs, M.D. • Attended Brandeis and Yale School of Medicine • Trained at Temple, NIH NIAID, and Tufts • Heads a pox laboratory at Penn • Associate Professor at the Perelman School of Medicine • Various leadership positions, incl. Associate Dean • ID Attending at Philadelphia VA Medical Center

Editor's Notes

  1. Without further due..