Public attention toward the monkeypox disease or mpox and the monkeypox virus has emerged following a series of outbreaks outside of Africa that began in April 2022. The United Kingdom and other European countries have reported cases. There are also reported cases in the United States, Canada, and Australia. This public attention has also resulted in an increased interest in treatment for monkeypox disease and prevention measures, including the availability of vaccines against the monkeypox virus.
Treatment Options for Mpox Disease and Available Vaccines Against Mpox Virus
Treatment Using Antivirals and Supportive Care
An article published in the journal Annals of Internal Medicine noted that there is still no standard-of-care treatment for monkeypox disease although cases in the past have seen positive results from using smallpox antiviral drugs with activity against other orthopoxviruses.
The Best Practice tool of the British Medical Journal also recommends brincidovofir as the first line of antiviral treatment. Originally developed to treat smallpox, ongoing clinical trials have shown that it can also work against a range of viruses and may be used to treat cytomegalovirus, adenovirus, herpes simplex, and ebolavirus infections and related diseases.
Both the European Union and the United States have approved the use of tecovirimat against orthopoxviruses such as smallpox and mpox. It prevents the target virus from leaving an infected cell, thereby preventing it from spreading within the body.
Some cases of monkeypox disease are accompanied by secondary infections caused by bacteria or other viruses. Hence, relevant antibacterial or antiviral medications are also administered to affected patients. For example, for patients who developed varicella zoster infection that causes chickenpox, the antiviral acyclovir may be used.
Of course, aside from administering relevant antiviral medicines, the World Health Organization noted that the clinical care for the disease should revolve around alleviating symptoms, managing complications, and preventing long-term sequelae.
Prevention and Vaccination Against the Virus
The antiviral drug tecovirimat does not only work against an existing mpox virus infection but also has the potential for a variety of uses such as for preventive healthcare, as a post-exposure therapeutic, as well as an adjunct to vaccination. Individuals in communities with documented outbreaks may take this antiviral medicine as part of preventive measures.
Vaccines developed for smallpox and other orthopoxviruses have also been used against monkeypox disease. The live virus smallpox vaccine developed in the 1970s has been reported to be about 85 percent effective in preventing the disease.
A newer two-dose vaccine based on a modified attenuated vaccinia virus is also available. Studies showed that this vaccine is both effective and safe in humans and immunocompromised animals. Findings from a study involving macaques showed that it protected against lethal respiratory challenges caused by the mpox virus.
The U.S. Centers for Disease Control and Prevention recommends that researchers and social workers investigating and working in communities with documented outbreaks should receive the smallpox vaccine to protect them against monkeypox disease.
Healthcare providers are recommended to don a full set of personal protective equipment before attending to an infected person. Patients are recommended to be placed in isolation and a negative air pressure room or at least a private exam room. The CDC does not recommend pre-exposure vaccination for unexposed veterinarians or animal control officers.
FURTHER READINGS AND REFERENCES
- Adalja, A. and Inglesby, T. 2022. “A Novel International Monkeypox Outbreak.” Annals of Internal Medicine. DOI: 7326/m22-1581
- European Medicines Agency. 2022. “Tecovirimat SIGA.” European Medicines Agency. European Medicines Agency, European Union. Available online
- Kantele, A., Chickering, K., Vapalahti, O., and Rimoin, A. W. 2016. “Emerging Diseases—The Monkeypox Epidemic in the Democratic Republic of the Congo.” Clinical Microbiology and Infection. 22(8): 658-659. DOI: 1016/j.cmi.2016.07.004
- The World Health Organization. 2022. “Monkeypox.” Fact Sheets. The World Health Organization. Available online