Table 1.

Monkeypox factsheet

Type of virusOrthopoxvirus: double-stranded DNA virus
EpidemiologyPrior to 2022:
  • confirmed cases in 11 countries, the majority of which occurred in the Democratic Republic of the Congo. Other countries include Benin, Cameroon, Central African Republic, Gabon, Cote d'Ivoire, Liberia, Nigeria, the Republic of the Congo, Sierra Leone and South Sudan

  • imported confirmed cases in USA, UK, Singapore and Israel.

2022 outbreak:
  • confirmed cases in 100 countries across the globe with further cases in other countries likely to occur.

  • vast majority of cases occurring in GBMSM.

Transmission
  • Direct contact with infected material (eg lesions or bed linen).

  • Respiratory transmission.

  • Transmission during sexual contact (precise mechanism remains unclear).

  • Animal to human spread: direct contact with blood, bodily fluids or lesions.

Skin manifestations
  • Typical lesions: from macules, then papules, then vesicles and then pustules that eventually scab over and resolve.

  • Number of lesions may vary from single lesions to hundreds of lesions.

  • Can occur anywhere on body (genital and perianal lesions common in 2022 outbreak).

  • Oropharyngeal and other mucosal lesions are now well described.

Systemic symptoms
  • Fever, lethargy, myalgia, arthralgia, headache, sore throat and lymphadenopathy

Complications
  • Severe pain, proctitis, penile swelling, abscesses, airway compromise, secondary bacterial infection, pneumonitis, encephalitis and keratitis.

Mortality rate
  • West African clade (previous outbreaks) = 3.6%.

  • Central African clade = 10.6%.

  • 2022 outbreak <0.01%.

Treatment
  • Treatment largely supportive: management of symptoms and complications.

  • Brincidofovir and tecovirimat have both been used previously and in the current outbreak.

Prevention
  • Self-isolation for patients at home.

  • Strict infection control measures within healthcare institutions.

  • Third generation smallpox vaccine as pre-exposure prophylaxis to at-risk individuals and post-exposure prophylaxis to those with significant exposure history.

  • GBMSM = gay, bisexual or other men who have sex with men.