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Clinics in Dermatology (xxxx) xxx, xxx–xxx

Monkeypox: Important Updates and Developments

Edited by Leonard J. Hoenig, MD and Franco Rongioletti, MD

Human monkeypox disease

Gautam Srivastava, MBBS, MS a,∗, Govind Srivastava, MBBS, MD, MNAMS b
a
Faculty of Life Sciences and Education, University of South Wales, United Kingdom
b
Department of Dermatology and Venerology, Skin Institute and School of Dermatology, New Delhi, India

Abstract There has been an alarming rise in human monkeypox cases during these past few months in
countries where the disease is not endemic. The recent COVID-19 pandemic and the connection of the
monkeypox virus with the smallpox-causing variola virus makes it highly likely to be a candidate for an-
other human health emergency. The transmission mode is predominantly via sexual contact, especially
among men who have sex with men (MSM); anogenital lesions are the most typical presentation. Al-
though it is a disease with a self-limiting course, some patients require admission for severe anorectal
pain, pharyngitis, eye lesions, kidney injury, myocarditis, or soft tissue superinfections. Antiviral therapy
has been advocated, of which tecovirimat is promising in patients with comorbidities. Vaccines will be
the mainstay for the present and future control of the disease.
© 2022 The Author(s). Published by Elsevier Inc.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/)

Introduction therapy and vaccine development, are significant in prevent-

When the world is grappling with the mutant SARS-CoV-
19, the multicontinental emergence of hitherto endemic mon-
keypox in human beings is of concern. This is important, con-
sidering the virus is related to the ominous, often fatal var-
iola virus. Since the global eradication of smallpox and the
subsequent cessation of its vaccination program in 1970, the
cross-immunity against monkeypox has been slowly waning
in the world community. The new generation is devoid of this
vital protection. In this scenario, any change in the behavior
and virulence of the monkeypox virus may increase its infec-
tivity and lethal potential. A high degree of suspicion in its
prompt diagnosis, isolation of the patient, a thorough screen-
ing of the contacts, and other preventive measures are urgent
needs. Additional measures, including its effective specific
∗ Corresponding author.
E-mail address: gautamsrivastava3@yahoo.in (G. Srivastava).
ing the poxvirus disease.
Epidemiology
Since the discovery of the monkeypox virus and its isola-
tion from Cynomolgus monkeys in Copenhagen in 1958, this
poxvirus infection has remained a zoonosis,1 being chiefly
confined to African countries. The first human infection due
to the monkeypox virus was recorded in a child in the Demo-
cratic Republic of Congo in 1970. Soon, it was followed
by other sporadic cases from Liberia, Nigeria, and Sierra
Leone.2-5 Since then, human monkeypox infection was oc-
casionally reported in African countries for the next few
decades (Figures 1–7) (Table 1). Unfortunately, there are an
alarming number of human monkeypox cases now reported
from non-African countries.
The first outbreak of human monkeypox was reported in
the Democratic Republic of Congo in 20037 , followed by
the South Sudan in 2005.8 Then there was a lull in human

https://doi.org/10.1016/j.clindermatol.2022.08.009
0738-081X/© 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Please cite this article as: G. Srivastava and G. Srivastava, Human monkeypox disease, Clinics in Dermatology, https://doi.org/10.1016/j.clindermatol.2022.
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2 G. Srivastava and G. Srivastava

Fig. 1 A 7-year-old girl with monkeypox from Equateur Region,

Fig. 2 Rear view.
Zaire. Front view, during day 8 of rash.

monkeypox infections. Similarly, in Nigeria, several cases

were reported from 2017 onward, after the first reported case
39 years ago.9 Outside of Africa, the Midwest states of the
United States recorded 47 cases in 2003, when Gambian
pouch rats were imported as exotic pets from Ghana.10 Soon
after, isolated cases from the United Kingdom, Israel, and
Singapore were reported.11
Beginning on May 7, 2022, a sudden emergence of hu-
man monkeypox was reported from 31 countries outside the
normal monkeypox endemic cases and has increased expo-
nentially to date.12 On June 22, 2022, the World Health Net-
work (WHN) declared the current monkeypox outbreak a
pandemic after confirming 3,417 monkeypox cases across
58 countries and rapidly expanding across multiple conti-
nents.13
A significant feature of these patients indicates that they
are chiefly men who have sex with men (MSM) and live in
urban areas.14 Fortunately, the mortality rates are low, per-
mitting ample time for research about the recent behavior of
this endemic zoonotic disease.

The agent

The monkeypox virus (MPV) is a large (200-250 nanome-

ters), brick-shaped, linear double-stranded DNA virus
enveloped with lipoproteins and belonging to the Or-
Fig. 3 The old scar on the arm is not due to vaccination.5

Please cite this article as: G. Srivastava and G. Srivastava, Human monkeypox disease, Clinics in Dermatology, https://doi.org/10.1016/j.clindermatol.2022.
08.009
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Human monkeypox disease
Fig. 4 Heavy concentration of lesions on the hands, inguinal lymphadenopathy, and pustules on genitalia.5
thopoxvirus genus of the Poxviridae family. This genus has
more than 10 member species that are genetically and anti-
genically related (Table 2).
The immunity against one species cross-protects against
all other species of this genus. MPV is divided into two genet-
ically distinct clades (Table 3). The human MPV infections
outside Africa have been caused by the West African clade,
as confirmed by PCR and genetic sequencing.17
Transmission is via contact with infected animals, their
body fluids, lesion materials, and respiratory droplets.
Human-to-human transmission can occur through prolonged
close contact. Sexual transmission among humans is another
possibility, as the current outbreak chiefly involves MSM.
The risk factors include non-smallpox-vaccinated patients,
people with comorbidities including HIV, and occupational
workers dealing with infected animals or humans.18
Clinical features
After an incubation period ranging from 7 to 21 days (mean:
13 days), the human monkeypox infection exhibits a brief
prodromal stage, followed by a characteristic eruption. Pro-
dromal features include fever, malaise, and lymphadenopa-
thy. The dermatitis is monomorphic, being in the same stage
of development, starting with macules, then papules, vesi-
cles, and finally pustules6 , 19-22 (Figure 8). In a week or so,
the pustules crust and peel off23 (Figure 9) (Table 4). The
Congo Basic clade is associated with a more severe illness
and a higher mortality rate than the West African clade, es-
pecially if there is a comorbidity, including HIV9.
The recent human MPV infection outbreak has been ob-
served across 16 countries outside the endemic African re-
gion.27 There have been several clinical digressions from the
Please cite this article as: G. Srivastava and G. Srivastava, Human monkeypox disease, Clinics in Dermatology, https://doi.org/10.1016/j.clindermatol.2022.
08.009
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3
conventional infection, including a single genital lesion pre-
sentation and a significant rectal/mucosal affliction (Table 5).
Out of 528 total patients, 70 required hospital admission: 21
for management for severe anorectal pain, 18 for soft tissue
superinfection, 13 for infection control purposes, 5 for se-
vere pharyngitis, and 2 for eye lesions, kidney injury, and
myocarditis. No death was reported. A July 20, 2022 com-
munication of the Centre for Infectious Disease Research and
Policy (CIDRAP) has recorded five deaths in African nations
among 14,000 worldwide cases of recent human MPV infec-
tion.28
Transmission in children can occur through feeding, hold-
ing, cuddling, and fomites, as well as from toys.29 , 30 The
recent monkeypox affliction of two children in the United
States is concerning. Both have received antiviral therapy,
recommended by the CDC, as children under 8 years of age
are considered at a higher risk.30 , 31
Diagnosis
Monkeypox infection can be confirmed through using PCR
for monkeypox DNA from the patient’s specimen. Or-
thopoxviruses in the specimen can be visualized using elec-
tron microscopy; viral culture isolation can also be un-
dertaken. Immunohistochemical staining for Orthopox viral
antigens, serum studies for anti-Orthopoxvirus IgM (for re-
cent infection), and anti-Orthopoxvirus IgG (for prior expo-
sure/vaccination) are other important laboratory studies.32
The differential diagnoses include chickenpox, measles,
secondary syphilis, hand-foot-mouth disease, and infectious
mononucleosis. Genital human monkeypox can be confused
with chancroid, donovanosis, and other nonvenereal genital
ulcers.24 , 32
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4 G. Srivastava and G. Srivastava

Fig. 5 Swollen lower face and neck due to cervical and submandibular lymphadenopathy.5

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Human monkeypox disease 5

Fig. 7 Same patient, 16 months after the initial illness. Hyper-

Fig. 6 Lesions on lips, tongue, and eyelids.
pigmentation of lesions with shallow pitting scars, most prominent
over the bridge of the nose.5
Table 1 Laboratory confirmed human monkeypox cases.6
Management
Year Duration Number of cases

1970-2000 30 y <1000 There is no specific clinically-proven therapy for monkey-

2000-2009 10 y >10,000 pox disease. Tecovirimat (S.T.-246 and Brincidofovir are the
2010-2019 10 y >8000 two antiviral preparations approved by the US Food and Drug
2020-April 2022 2 y 4 mo 10,545 Administration (FDA) for smallpox. Their use in human
May 2022-July 2022 3 mo >16,000 monkeypox has insufficient data but suggests that Tecovir-
imat is more effective than Brincidofovir.33

Table 2 Poxvirus group members.15

Species Infection

Variola-vaccinia viruses Variola major (smallpox)Variola minorVacciniaCowpoxMonkeypoxRabbitpoxBuffalopox

Orf-like viruses Milker’s nodulesContagious pustular dermatitis (Orf)Bovine papular stomatitis
Avian poxviruses Canarypox
Fowlpox
Pigeonpox
Turkeypox
Myxoma-fibroma viruses Rabbit myxoma
Rabbit fibroma
Squirrel fibroma
Hare fibroma
Unclassified Molluscum contagiosum
Entomopox

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6 G. Srivastava and G. Srivastava

Fig. 8 (A) Oral lesions (right tonsil) visible already at the patient’s first presentation. (B-D) Both patients developed 10 to 12 initially
vesicular, later pustular skin lesions distributed over the entire body. Many of these lesions were umbilicated, and all were at the same general
stage of development. The typical septate structure of pox lesions became apparent upon opening the lesions.22

Fig. 9 Photographs of the penile ulcer and the skin lesions. Non-tender ulcer on the dorsum of the penile shaft, measuring 7 mm in diameter
with central umbilication. Erythematous, maculopapular lesions appeared on the upper back and proceeded down the body. The red-colored
line indicates the period of fever (≥37.5°C).23

The preventive measures include isolation of the patient,
keeping lesions covered, proper, and disposing of infectious
materials with appropriate precautions. Contact tracing and
monitoring for a reasonable duration will assist in controlling
the spread of the disease.25 , 33
A concerted two-decade effort of the United States gov-
ernment to develop antivirals and next-generation vaccines
against smallpox resulted in two FDA-approved antivirals
and two next-generation vaccines (Table 6).
1. The first next-generation smallpox vaccine called
ACAM-2000 is similar to the discontinued Dryvax vac-
cine, known to generate long-lasting immunity34 , 35 and
provides 85% protection against human monkeypox.36
2. The second next-generation smallpox vaccine is MVA-
BN (JYNNEOS in the United States), manufactured
with the Modified Vaccinia Ankara strain and ad-
ministered by two subcutaneous injections, 4 weeks
apart.37 While the former vaccine is contraindicated
in pregnancy, atopic dermatitis, and various immune
deficiencies, the latter displayed no serious adverse
events and no risk of inadvertent inoculation and auto-
inoculation.6 , 18 , 37 The MVA-BN vaccine is approved

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Human monkeypox disease 7

Table 3 Strains of monkeypox virus.15 , 16

Strains Virulence Human case fatality

The Congo Basin clade (Central African) High 10.6%

The West African clade Low 3.6%

Table 4 Natural history of human monkeypox.6 , 9 , 24 - 26

Stage Infectivity Clinical features Duration

Incubation period Noninfectious Asymptomatic 7-21 d(Mean: 13 d)

Prodrome Infectious • Fever 1-3 d
• Lymphadenopathy:Periauricular,
cervical,axillary, and inguinal
• Myalgia
• Fatigue
Prodrome Infectious • Fever 1-3 d
• Lymphadenopathy:
Periauricular, cervical,
axillary, and inguinal.
• Myalgia
• Fatigue
Infectious
Infectious
Non-infectious

Table 5 Salient characteristics of the current human MPV outbreak (n = 528).27

Parameter Features

Sex Exclusively men (men = 527, trans/nonbinary = 1)

Sex orientation Homosexual = 509 (96%), heterosexual = 9 (2%), bisexual = 10 (2%)
HIV status HIV positive = 218 (41%)
Concomitant STI Present in 109 (29%) patients among 377 (screened)
Suspected route oftransmission Sexual close contact = 504 (95%), nonsexual close contact = 4
(1%),household/unknown = 20 (4%)
Clinical features Dermatitis = 500 (95%), fever = 330 (62%), lymphadenopathy = 295 (56%),
lethargy = 216 (41%), myalgia = 165 (31%), headache = 145 (27%),
pharyngitis = 113 (21%), anorectal pain/proctitis = 75 (14%)
Site of skin lesions Anogenital region = 383 (73%), trunk and extremities = 292 (55%), face =
134 (25%), palm and soles = 51 (10%)
Characters of skin Dermatitis (vesicular = 291, macular = 19) = 310 (62%), single ulcer = 54
lesions (n = 500) (11%), multiple ulcers = 95 (19%)
Mucosal lesions (n = 217) Only anogenital regions = 148 (68%), only oropharyngeal region = 50(23%), both
anogenital and oropharyngeal regions = 16 (7%), nasal/eyes = 3
Site of positive viralPCR Anogenital region/skin = 512 (97%), nose/throat swab = 138 (26%),blood = 35
(7%), semen = 29 (5%), urine = 14 (3%)

in the United States for use against both smallpox and
monkeypox. Tt still requires clinical trials for human
efficacy.37
Among 528 human monkeypox patients in one report.27
23 (5%) were given antiviral therapy or vaccinia immune
globulin with a favorable response. Tecovirimat (TPOXX
or ST246) inhibits the spread of the virus by inhibiting
the viral envelope protein VP37, thus blocking the final
steps in the viral maturation and its release from infected
cells.
The CDC-held Emergency Access Investigational New
Protocol allows the use of Tecovirimat for non-variola or-
thopoxvirus infections such as monkeypox. The protocol
also includes an allowance for opening an oral capsule and
mixing its contents with liquid or soft food for pediatric pa-

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8 G. Srivastava and G. Srivastava

Table 6 Management of human monkeypox disease.38-41

Mode Interventions

Prevention By prior immunization with available smallpox vaccines

1. JYNNEOSTM (MVA-BN, IMAVAMUNE, IMVANEX)
2. ACAM 2000®
3. Newer APSV (Avantis Pasteur Smallpox Vaccine)
Prophylaxis 1. Pre-exposure: Vaccinating select people at risk for occupational exposure.
2. Post-exposure: Vaccination within 4 d of exposure to the virus to prevent or minimize the development
of the disease.
Antiviral therapy 1. Tecovirimat: (oral or intravenous) Adults 600 mg, twice daily; children 13-25 kg 200 mg, twice daily;
children 25-40 kg, 400 mg twice daily. The duration of treatment is 14 d.
2. Brincidofovir: (Oral suspension) Adults (>48 kg) 200 mg, once weekly for two doses; children (>10
kg) 4 mg/kg, once weekly for two doses.
3. Cidofovir: (Intravenous) 5 mg/kg, once weekly for 2 wk, followed by 5 mg/kg, once every other week.
4. Vaccinia immune globulins (intravenous): 6000 U/kg as soon as Symptoms appear. Repeat dose
required based on response to Treatment and severity of symptoms.

tients weighing less than 13 kg. Cidofovir and Brincidofovir
work by inhibiting viral DNA polymerase, the latter being
more effective in controlling MPV infection.38
Conclusions
During the last 2 years, scientists, health care personnel,
and world authorities have coordinated, promptly combat-
ing, and curtailing any future epidemic or pandemic. Our pre-
ventive strategy can allay apprehensions, anxiety, morbidity,
mortality, and resources. Instead of an alarm, a rational sci-
entific approach can help halt the spread from infected areas
to other noninfected safe zones.
Conflict of interest
The authors declare no conflict of interest.
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 [mNS;6 September 2022;3:45]]
Monkeypox: Important Updates and Developments
Edited by Leonard J. Hoenig, MD and Franco Rongioletti, MD
Human monkeypox disease
Gautam Srivastava, MBBS, MSa,∗, Govind Srivastava, MBBS, MD, MNAMSb
a Faculty of Life Sciences and Education, University of South Wales, United Kingdom
b Department of Dermatology and Venerology, Skin Institute and School of Dermatology, New Delhi, India

Abstrak
Telah terjadi peningkatan kasus Cacar Monyet yang mengkhawatirkan selama beberapa bulan
terakhir ini di negara-negara dimana penyakit ini tidak endemik. Pandemi Covid-19 yang terjadi baru-baru
ini dan hubungannya dengan Virus Monkeypox – penyebab virus cacar variola kemungkinan membuatnya
menjadi kandidat untuk dijadikan sebagai keadaan darurat pada kesehatan manusia. Cara penularannya
didominasi melalui kontak seksual terutama pada laki-laki yang berhubungan sesama jenis (Homoseksual)
dimana lesi anogenital merupakan presentasi gejala klinis yang paling khas. Meskipun penyakit ini dapat
sembuh sendiri, beberapa pasien memerlukan perawatan intensif untuk gejala klinis nyeri anorektal yang
berat, faringitis, lesi mata, cedera ginjal, miokarditis atau infeksi jaringan lunak. Terapi antivirus
menggunakan Tecovirimat telah dianjurkan terutama untuk pasien dengan komobiditas. Vaksin menjadi
andalan pengendalian penyakit ini untuk ke depannya.

Pendahuluan
Ketika dunia sedang bergulat dengan mutasi SARS-CoV 19, kemunculan secara multibenua dari
endemik Monkeypox pada manusia sampai sekarang menjadi perhatian. Ini penting, mengingat virus ini
tidak menyenangkan dan terkait dengan virus variola yang fatal. Sejak pemberantasan cacar secara global
dan penghentian program vaksinasi pada tahun 1970, kekebalan silang terhadap cacar monyet perlahan-
lahan berkurang dalam masyarakat global. Generasi masyarakat yang sekarang tidak memiliki perlindungan
terhadap virus Monkeypox. Dalam skenario ini, setiap perubahan perilaku dan virulensi dari virus
Monkeypox dapat meningkatkan infektivitas dan potensi menyebabkan kematian. Tingkat kecurigaan yang
tinggi dalam diagnosa dini, isolasi pasien, penyaringan kontak langsung secara menyeluruh dan tindakan
pencegahan lainnya sangat mendesak untuk dibutuhkan. Tindakan tambahan, termasuk terapi spesifik
yang efektif dan pengembangan vaksin, sangat penting dalam mencegah Poxvirus.

Epidemiologi
Sejak ditemukannya virus Cacar Monyet yang diisolasi dari monyet Cynomolgus di Kopenhagen
pada tahun 1958, infeksi Poxvirus menjadi zoonosis terutama di negara-negara Afrika. Infeksi Monkeypox
pada manusia pertama kali tercatat pada seorang anak di Republik Demokratik Kongo di tahun 1970.
Kemudian diikuti kasus sporadis dari Liberia, Nigeria, dan Sierra Leone. Sejak itu, infeksi Cacar Monyet pada
manusia terkadang dilaporkan di negara-negara Afrika sampai beberapa tahun dekade. Sayangnya
sekarang ada jumlah kasus Cacar Monyet manusia yang mengkhawatirkan dilaporkan dari negara non-
Afrika.
Wabah pertama Cacar Monyet manusia dilaporkan di Republik Kongo pada tahun 2007, diikuti oleh
Sudan Selatan pada tahun 2005. Demikian pula di Nigeria, beberapa kasus dilaporkan dari 2017 dan
seterusnya, setelah kasus pertama dilaporkan pada 39 tahun yang lalu. Di luar Afrika, Negara bagian
Midwest Amerika Serikat mencatat 47 kasus pada tahun 2003, ketika Gambia mengimpor tikus kantong
sebagai hewan peliharaan eksotis dari Ghana. Segera setelah kasus tersebut, kasus terisolasi dilaporkan
dari Inggris, Israel dan Singapura.
Mulai tanggal 7 Mei 2022, kemunculan Cacar Monyet secara tiba-tiba dilaporkan dari 31 negara di
luar kasus endemik Cacar Monyet dan telah meningkat hingga saat ini. Pada 22 Juni 2022, World Health
Network (WHN) menyatakan wabah Cacar Monyet sebagai pandemi setelah mengkonfirmasi 3.417 kasus di
58 negara dan berkembang pesat di berbagai benua.
Sebuah data yang signifikan dari pasien menunjukkan bahwa sebagian besar adalah laki-laki yang
berhubungan sesama jenis (Homoseksual) dan masyarakat yang tinggal di perkotaan. Tingkat kematian dari
penyakit ini cukup rendah dan memungkinkan adanya waktu untuk melakukan penelitian tentang perilaku
penyakit zoonosis endemik yang baru-baru ini.

Agen
Virus Monkeypox (MPV) adalah virus DNA rantai ganda linier berukuran 200-250 nm, berbentuk
bata, diselimuti dengan lipoprotein dan milik genus Orthopoxvirus dari keluarga Poxviridae. Genus ini
memiliki lebih dari 10 spesies yang terkait secara genetik dan antigenik
Jenis Infeksi
Virus Variola Variola mayor (cacar), Cowpox, Monkeypox, Rabbitpox, Buffalopox
Virus mirip ORF Nodul Milker, Contagious Dermatitis Pustular (ORF), Stomatitis popular pada Sapi
Virus cacar burung Cacar kenari, cacar unggas, cacar merpati, cacar kalkun
Virus myxoma-fibroma Myxoma kelinci, Fibroma kelinci, Fibroma tupai
Tidak terklasifikasi Moluskum kontagiosum, Entomopox

Kekebalan terhadap spesies virus ini memiliki perlindungan silang terhadap semua spesies lain dari genus
virus ini. MPV dibagi menjadi dua clade yang berbeda secara genetik. Infeksi MPV manusia di luar Afrika
disebabkan oleh clade Afrika Barat, sebagaimana dikonfirmasi secara PCR dan sekuensing genetik.
Penularan melalui kontak langsung dengan hewan terinfeksi, cairan tubuh, bahan lesi dan droplet
pernafasan. Penularan antar manusia dapat terjadi melalui kontak langsung pada jarak dekat. Penularan
melalui kontak seksual sangat memungkinkan, karena wabah ini melibatkan kaum Homoseksual. Faktor
resiko termasuk pasien yang tidak divaksinasi cacar, orang dengan komorbiditas termasuk HIV dan pekerja
yang berurusan dengan hewan atau manusia yang terinfeksi.
Gejala Klinis
Setelah masa inkubasi berkisar antara 7- 21 hari (rata-rata 13 hari), infeksi Cacar Monyet manusia
menunjukkan gambaran singkat tahap prodromal yaitu demam, malaise dan limfodenopati. Dermatitis
monomorfik dengan tahap perkembangan dimulai dengan makula, papula, vesikula dan akhirnya menjadi
pustula. Dalam seminggu atau lebih, pustula berubah menjadi kerak dan mengelupas. Clade Kongo
dikaitkan dengan kejadian penyakit yang lebih parah dan tingkat kematian yang lebih tinggi dibanding clade
Afrika Barat, terutama jika ada penyakit sertaan termasuk HIV.
Wabah infeksi MPV manusia baru-baru ini telah diamati di 16 negara di luar wilayah endemik Afrika.
Ada perubahan gejala klinis yang muncul yang tidak terdapat pada infeksi konvensional, termasuk lesi
genital dan nyeri rektal/mukosa yang signifikan. Dari 528 total pasien, 70 memerlukan rawat inap
diantaranya 21 untuk nyeri anorektal, 18 untuk infeksi jaringan lunak, 13 untuk di isolasi, 5 untuk faringitis
berat dan 2 untuk lesi mata, cedera ginjal dan miokarditis. Tidak ada kematian yang dilaporkan, pada 20 Juli
2022 dari Centre for Infectious Disease Research and Policy (CIDRAP) telah mencatat 5 kematian di negara-
negara Afrika di antara 14.000 kasus infeksi MPV manusia di seluruh dunia.
Penularan pada anak dapat terjadi melalui pemberian makan, aktivitas menggendong, memeluk,
muntahan serta mainan. Penderitaan Cacar Monyet baru-baru ini dirasakan dua anak di Amerika Serikat
dengan kondisi mengkhawatirkan. Keduanya sudah menerima terapi Antivirus, sesuai rekomendasi CDC
yaitu anak dibawah 8 tahun dianggap beresiko lebih tinggi terhadap infeksi MPV manusia.

Diagnosa
Infeksi Cacar Monyet dapat dikonfirmasi menggunakan PCR untuk DNA Monkeypox dari spesimen
pasien. Virus Orthopox dalam spesimen dapat divisualisasikan menggunakan mikroskop elektron dan
isolasi kultur virus juga dapat dilakukan. Pewarnaan immunohistokimia untuk antigen virus Orthopox dan
studi serum untuk anti-Orthopoxvirus Ig-M (untuk kasus penyakit yang baru terjadi sekarang) dan anti-
Orthopoxvirus Ig-G (untuk kasus penyakit/vaksinasi sebelumnya) merupakan studi laboratorium yang
penting untuk dilakukan.
Diagnosis banding meliputi cacar air, campak, sifilis sekunder, penyakit tangan-kaki-mulut dan
penyakit menular mononukleosis. Cacar Monyet manusia dapat membingungkan dengan chancroid,
donovanosis (Granuloma inguinale) dan penyakit luka lainnya yang menyerang alat genital.

Pengendalian
Tidak ada terapi spesifik yang terbukti secara klinis untuk penyakit Cacar Monyet. Tecovirimat dan
Brincidofovir adalah dua jenis antivirus yang disetujui oleh US Food and Drug (FDA) untuk cacar.
Penggunaan pada infeksi MPV manusia tidak memiliki data yang mencukupi tetapi menunjukkan bahwa
Tecovirimat lebih efektif daripada Brincidofovir.
 Tindakan pencegahan termasuk isolasi pasien, menjaga lesi tetap tertutup, dan membuang bahan
infeksius dengan SOP yang tepat. Penelusuran kontak dan pemantauan dalam jangka waktu tertentu akan
membantu mengendalikan penyebaran penyakit.
Upaya bersama selama dua dekade dari pemerintah Amerika Serikat untuk mengembangkan
antivirus dan vaksin terhadap cacar menghasilkan dua antivirus yang disetujui FDA dan dua vaksin generasi
terbaru.
1. Vaksin cacar generasi pertama yang disebut ACAM-2000 mirip dengan vaksin Dryvax yang dihentikan
penggunaannya, yang diketahui menghasilkan kekebalan jangka panjang dan memberikan perlindungan
85% terhadap Cacar Monyet manusia.
2. Vaksin cacar generasi kedua adalah MVA BN (JYNNEOS di Amerika Serikat), diproduksi menggunakan
strain Modified Vaccinia Ankara yang diaplikasikan dengan dua suntikan subkutan, dengan jarak
penyuntikan 4 minggu.
Sementara vaksin sebelumnya dikontra indikasikan pada kehamilan, dermatitis atopik dan berbagai
defisiensi imun, yang terakhir tidak menunjukkan efek samping yang serius.
Di antara 528 pasien Cacar Monyet manusia dalam satu laporan (5%) diberikan terapi antivirus atau
vaksin immunoglobulin dan memberikan respon yang baik. Tecovirimat (TPOXX atau ST246) menghambat
penyebaran virus dengan menghambat protein amplop virus VP37 , sehingga menghalangi langkah-langkah
dalam pematangan virus dan pelepasannya dari sel yang terinfeksi.
Protokol Baru Investigas Akses Darurat yang diadakan CDC memungkinkan penggunaan Tecovirimat
untuk infeksi non-variola orthopoxvirus seperti Monkeypox. Protokol ini meliputi prosedur untuk membuka
kapsul obat dan mencampurkan isinya ke makanan cair atau makanan lunak untuk pasien pediatrik (anak-
anak) dengan berat badan kurang dari 13kg. Cidofovir dan Brincidofovir bekerja dengan menghambat DNA
polimerase virus, yang terbaru dalam efektivitas mengendalikan infeksi MPV.

Kesimpulan
Selama 2 tahun terakhir, para ilmuwan, personel perawat kesehatan dan otoritas dunia telah
berkoordinasi, segera memerangi dan membatasi epidemi atau pandemi di masa depan. Strategi
pencegahan kami dapat menghilangkan kekhawatiran, kecemasan, morbiditas, mortalitas dan sumber
daya. Pendekatan ilmiah yang rasional dapat membantu menghentikan penyebaran dari daerah yang
terinfeksi ke zona yang tidak terinfeksi.