Monkeypox virus particle, colored transmission electron micrograph (TEM). Monkeypox is a poxvirus that was identified in Cynomolgus monkeys in 1958 and then in humans in 1970. The virus consists of a DNA (deoxyribonucleic acid) core in a protein coat, or capsid, surrounded by an envelope. The proteins allow the particles to enter and leave host cells. The virus reproduces by entering cells and hijacking their biochemical machinery, producing many copies of itself. Monkeypox is zoonotic, passing from animals (such as rodents) to humans and vice versa. Human infections are often caused by animal bites or from direct contact with infected bodily fluids. There is no proven safe treatment or vaccine for monkeypox (as of 2008). Magnification: x125,000 when printed 10 centimeters tall.


Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, MONKEYPOX occurs in Central and West African countries. Two distinct clades are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.



It is one of the viral zoonotic diseases that originate in tropical rainforests of Central and West Africa (World Health Organization, 2020). While the disease has a significant fatality rate of 10%, as you note, I believe that it is one of the least known diseases. Still, it is pretty insightful to know that it closely resembles smallpox, which has since been eradicated (World Health Organization, 2020). You have used the disease outbreak incidence in Nigeria to exemplify how stigma by healthcare professionals and community members can derail efforts to combat health crises and how effective health communication can reduce this stigma.

When facts-based information about a disease, including its causes, transmission, safety, preventive measures, and cure, is made available to healthcare professionals, patients, their families, and the community, fear, and panic associated with ignorance and uncertainty are alleviated. Consequently, little room is left for stigma to thrive and bar healthcare professionals from extending the proper care to patients, patients seeking care, and family members and the community supporting them.

Currently, there are no proven treatments specifically for monkeypox. Instead, cases of monkeypox can be treated with medical countermeasures designed for the closely related smallpox virus. There are currently three smallpox vaccines that could be used in the US, 2 of which are licensed for smallpox, and the other could be used for smallpox under an investigational new drug (IND) protocol. The two licensed vaccines for smallpox are JYNNEOSTM (also known as Immune or Imvanex) and ACAM2000®, of which JYNNEOSTM is also approved for monkeypox.



Clinical Criteria

  • New rash (any of the following)
    • Macular
    • Papular
    • Vesicular
    • Pustular
    • Generalized or localized
    • Discrete or confluent
  • Fever (either of the following)
    • Subjective
    • The measured temperature of ≥100.4° F [>38° C]
  • Other signs and symptoms:
    • Chills and sweats
    • New lymphadenopathy (periauricular, axillary, cervical, or inguinal)

Epidemiologic Criteria

Within 21 days of illness onset:

  • Report having had contact with a person or people who have a similar-appearing rash or received a diagnosis of confirmed or probable monkeypox OR
  • Is a man who regularly has close or intimate in-person contact with other men, including through an online website, digital application (“app”), or social event (e.g., a bar or party) OR
  • Traveled to a country with confirmed cases of monkeypox AND at least one of the above criteria OR
  • Traveled to a country where MPXV is endemic OR
  • Contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.)

Exclusion Criteria

A case may be excluded as a possible, probable, or confirmed monkeypox case if:

  • An alternative diagnosis* can fully explain the illness OR
  • An individual with symptoms consistent with monkeypox but who does not develop a rash within five days of illness onset OR
  • A case where specimens do not demonstrate the presence of orthopoxvirus or monkeypox virus or antibodies to orthopoxvirus as described in the laboratory criteria

†Categorization may change as the investigation continues (e.g., a patient may go from PUI to probable)

* The rash associated with monkeypox can be confused with other diseases that are more commonly encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella-zoster). Historically, sporadic reports of patients co-infected with monkeypox virus and other infectious agents (e.g., varicella-zoster, syphilis).


Guidelines to diagnose:

Person Under Investigation

Persons under investigation (PUI) are individuals who are reported as suspicious but have not been tested in an LRN laboratory. This includes cases on which health departments have been consulted because of clinician concerns.

Possible Case

Meets one of the epidemiologic criteria AND has a fever or new rash AND at least one other sign or symptom with onset 21 days after last exposure meeting epidemiologic criteria

Probable Cause

Meets one of the epidemiologic criteria AND has a new rash with or without fever AND at least one other sign or symptom with onset 21 days after last exposure meeting epidemiologic criteria


Demonstration of detectable levels of anti-orthopoxvirus IgM antibody during the period of 4 to 56 days after rash onset

Confirmed Orthopoxvirus Case

Meets possible case definition AND

Demonstration of orthopoxvirus DNA by polymerase chain reaction testing of a clinical specimen OR demonstration of the presence of orthopoxvirus using immunohistochemical or electron microscopy testing methods

Confirmed Monkeypox Case

Meets possible case definition AND

Demonstration of monkeypox virus DNA presence by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen OR isolation of monkeypox virus in culture from a clinical sample.

Recommendations for Clinicians

Human-to-human transmission is limited, with the longest documented chain of information being six generations. The last person infected in this chain was six links away from the original sick person. It can be transmitted through contact with bodily fluids, skin lesions, or internal mucosal surfaces, such as mouth or throat, respiratory droplets, and contaminated objects.

Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. The best diagnostic specimens are directly from the rash – skin, fluid, crusts, or biopsy where feasible. Antigen and antibody detection methods may not be helpful as they do not distinguish between orthopoxviruses.

1-monkeypox-virus-particle-tem-hazel-appleton-centre-for-infectionshealth-protection-agency.jpg (836×900)

Fig: The monkeypox virus, shown in a colored electron micrograph, typically spreads by skin-to-skin contact or respiratory droplets.



  1. CDC. (2022)
  2. The Johns Hopkins Center for Health Security. (2022)
  3. WHO. (2022).



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