Monkeypox Virus: A Comprehensive Review

The World Health Organization's (WHO) latest statement has brought the monkeypox virus to the forefront of the global agenda. The world, still recovering from the COVID-19 pandemic, is worried about facing a new health threat. In this comprehensive article, we will provide a detailed review of the monkeypox virus, from its history to its clinical features, transmission routes, treatment and prevention methods. In particular, we will focus on the effects of monkeypox infection during pregnancy and share current research findings.

History of the Monkeypox Virus

The monkeypox virus was first discovered in monkeys in a Danish research laboratory in 1958. However, the first human case of the virus was detected in 1970 in a 9-year-old boy in the Democratic Republic of the Congo (then Zaire). Since then, the virus has remained endemic, mostly in Central and West African countries.

The virus belongs to the genus Orthopoxvirus of the family Poxviridae and is closely related to the smallpox virus. This genetic affinity is the reason why the smallpox vaccine also provides some protection against monkeypox.

Characteristics of the Monkeypox Virus and Ways of Transmission

Monkeypox virus is a zoonotic virus that is mostly transmitted from animals to humans. The main routes of transmission are:

1. Animal-Human Contact:
   • Biting or scratching by infected animals (usually rodents and primates)
   • Direct contact with blood, body fluids or lesions of infected animals
   • Inadequately cooked meat from infected animals
2. Human-Human Contact:
   • Direct contact with skin lesions or body fluids of infected persons
   • Contact with contaminated items (bed linen, clothing, etc.) used by infected persons
   • Close physical contact, especially during sexual intercourse
3. Respiratory Tract:
   • Transmission via large respiratory droplets during prolonged face-to-face contact (less common)
4. Placental Transition:
   • Transmission from a pregnant woman to a fetus (rare but can have serious consequences)

The contagious period of the virus lasts from the onset of symptoms until complete healing of the lesions, which usually takes 2-4 weeks.

Clinical Features and Course of Disease

The incubation period of monkeypox infection is usually between 6-13 days, but can vary between 5-21 days. The course of the disease usually takes place in two stages:

1. Invitation Period (0-5 days):
   • High fever (38.5°C and above)
   • Severe headache
   • Swelling of the lymph nodes (lymphadenopathy)
   • Back pain
   • Muscle aches
   • Intense weakness and fatigue
2. Skin Rash Period (starts after 1-3 days):
   • Fever usually goes down
   • Rashes appear (starting from maculopapular rash and progressing to vesicular and pustular stages)
   • Rashes usually start on the face and spread to other parts of the body
   • Prominent lesions are seen on the palms and soles of the feet
   • Lesions crust and fall off over time (lasts 2-4 weeks)

Monkeypox is usually a self-limiting disease and most cases recover within 2-4 weeks. However, it can be more serious in people with weakened immune systems, children and pregnant women.

Monkeypox Infection in Pregnancy

Monkeypox infection during pregnancy carries serious risks for both mother and fetus. Although available data are limited, the following results have been observed:

1. Miscarriage Risk: Infection, especially in the first trimester, can increase the risk of miscarriage.
2. Fetal Death: Cases of intrauterine fetal death have been reported.
3. Congenital Infection: The virus can cross the placenta and infect the fetus.
4. Preterm Birth The risk of preterm birth may increase.
5. Maternal Mortality: Infection can be more severe and fatal in pregnant women.

A study in the Democratic Republic of Congo reported that two of four infected pregnant women miscarried, one terminated her pregnancy at 18 weeks due to fetal death and only one had a healthy delivery. In this case, virus DNA was detected in the placenta and fetal tissues, suggesting that placental transmission is possible.

Women diagnosed with monkeypox infection during pregnancy require close follow-up and a multidisciplinary approach. Treatment options and risks should be evaluated on a case-by-case basis.

Diagnosis and Diagnostics

The methods used to diagnose monkeypox virus infection are:

1. PCR Testing: The most reliable and widely used method. Viral DNA is detected from samples taken from skin lesions.
2. Antigen Tests: Rapid tests that detect virus antigens are available, but their sensitivity is not as high as PCR.
3. Serological Tests: Used to detect previous infection, but not suitable for acute diagnosis.
4. Electron microscope: It is possible to visualize virus particles in samples taken from skin lesions.
5. Clinical Diagnosis: The presence of characteristic rashes and the epidemiologic link are important for preliminary diagnosis.

Treatment and Management

There is no specific treatment for monkeypox infection and most cases improve with supportive care. Treatment approaches include:

1. Symptomatic Treatment: Antipyretics, painkillers and antihistamines may be used.
2. Fluid Support: Adequate hydration should be ensured, especially during the febrile period.
3. Skin Care: Keeping lesions clean and dry is important to prevent secondary infections.
4. Antiviral Drugs: In severe cases, antivirals such as tecovirimat, brincidofovir or cidofovir may be used.
5. Isolation: Infected persons should be isolated for the duration of the contagious period.
6. Management of Complications: Complications such as secondary bacterial infections, dehydration or pneumonia may require additional treatments.

Prevention and Control Measures

Here are the measures that can be taken to protect against the monkeypox virus:

1. Control of Animal Contact: In endemic areas, contact with wild animals should be avoided.
2. Personal Hygiene: Regular hand washing and disinfection are important.
3. Protective Equipment: Healthcare workers and those in contact with infected persons should wear appropriate personal protective equipment.
4. Isolation and Quarantine: Infected persons and their contacts should be properly isolated.
5. Vaccination: The smallpox vaccine provides cross-protection against monkeypox. It is recommended for high-risk groups.
6. Sexual Health: Safe sexual practices should be practiced during periods of high risk of infection.
7. Travel Precautions: Travelers to endemic areas should take additional precautions.

Conclusion

Monkeypox virus has become an important public health problem with an increasing number of cases worldwide. This infection, which can lead to serious consequences especially in pregnant women and immunocompromised individuals, requires a careful approach and effective control measures.

As scientific research and surveillance efforts continue, public awareness and preparedness of health systems are of utmost importance. Keeping up to date with current information on monkeypox virus and taking the necessary precautions is critical to effectively managing this health threat.

In the presence of any suspicious condition or symptom, it is essential to contact the nearest health facility immediately and follow the guidance of health professionals. Public awareness and individual responsibility will play a key role in controlling the spread of monkeypox virus.