MONKEYPOX: Why monkeypox remains a threat

While on January 1, 2023, the World Health Organization (WHO) recorded, over the year 2022, a cumulative total of 83,943 laboratory-confirmed cases of monkeypox (mpox) and 75 deaths worldwide, that the trend evolution of the epidemic remains uncertain, this team of virologists from Sun Yat-sen University (Guangzhou) warns, in the journal Biosafety and Health, about the capacity of the monkeypox virus (MPXV) to evolve extremely quickly and to the danger what could this virus used as a biological warfare agent represent?

As of September 1, 2022, the World Health Organization (WHO) has designated the global outbreak of monkeypox a public health emergency of international concern (USPPI) on the same level as smallpox and COVID-19.

As of January 1, 2023, with more than 4,000 cases, France is one of the 10 countries that have reported the highest cumulative number of cases in the world: United States: 29,603, Brazil: 10,498, Spain: 7,496, France: 4,114 , Colombia: 4,021, United Kingdom: 3,730, Germany: 3,676, Peru: 3,643, Mexico: 3,637 and Canada: 1,460.

These 10 countries alone account for 86% of reported cases worldwide.

The spread of monkeypox is more of a threat than ever

According to the Chinese team reviewing here the characteristics of the monkeypox virus, including its pathogenicity, transmissibility, epidemiological data, and the evolution of the virus while the COVID-19 pandemic is not yet under control, the spread of monkeypox poses a real threat.

Real global strategies are urgently needed, which, in an already pandemic and international communications context, would reduce the threat to global health and biosecurity.

Thus, researchers raise awareness of the great efforts needed in surveillance, research and prevention of monkeypox, in order to stay, unlike the fight against SARS-CoV-2, one step ahead of the MPXV virus. Among the major global measures suggested:

• the creation of a global biosecurity network for monkeypox: while they exist in most countries, monkeypox surveillance networks remain fragile and imperfect in many countries, in particular due to the still limited transmission of MPXV, moderate symptoms and lack of data on potential reservoir species. On great progress has been made in surveillance networks, particularly under the aegis of the WHO, these networks still allow the rarer infectious diseases to pass through;
• the implementation of barrier measures in addition to the strengthening of surveillance, such as detection tests for MPXV at customs and other entry and exit points and the improvement of the surveillance and control of imported animals is also suggested;
• more research is needed on the variability, pathogenicity and transmissibility of MPXV. A better understanding of the naturally adaptive evolution of monkeypox also remains necessary. To date, note the authors, there are few studies on the multiple functions of genes, on the mechanisms of infection, on the processes of interhuman transmission as well as on antigenic shift. Thus, the reasons for the diversity in pathogenicity between the 2 documented clades of MPXV remain poorly understood.

The message is still not to underestimate the threat posed by monkeypox, at the time of the 6th Chinese wave of COVID-19.