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Recently, we are experiencing rapid globalization of the monkeypox virus (MPXV) in a short period of time. Monkeypox is still endemic in African countries until 2022. Since May 2022 cases of monkeypox have been reported from non-endemic countries, which is the largest outbreak of monkeypox disease ever recorded in non-endemic countries. The virus has spread unprecedentedly to nearly 100 countries, infecting more than 50,000 people. This massive outbreak constitutes a Public Health Emergencies of International Concern (PHEIC).
The initial cluster of cases in the 2022 monkeypox outbreak appeared in the United Kingdom, of which patients had a history of travel to Nigeria. In turn, later confirmed cases are not associated with travel to monkeypox-endemic countries. Since then, cases have been reported in an increasing number of countries and regions, mainly in Africa, Europe, the Americas, Oceania, and now Asia as well. This outbreak marks the first widespread transmission of monkeypox outside of Central and West Africa.
Fig. 1 The distribution and number of confirmed monkeypox cases worldwide. (OurWorldInData.org, accessed on 14 October 2022)
The 2022 outbreak initially has a different mode of transmission compared with previous monkeypox outbreaks outside of Africa. The virus is more likely to be transmitted through close contact, with sexual activity being the most common route during transmission. And most cases occurred in males.
Unusual Aspects of the 2022 Monkeypox Outbreak
Dramatic increase in cases in a short period of time. In recent years, monkeypox epidemics in endemic countries in Africa have been the norm and have not shown signs of significant activity. However, since the first case was reported in the UK in May 2022, there has been a rapid increase in confirmed cases in non-endemic countries.
The geographical area involved is significantly larger than before. The 2022 monkeypox outbreak has now involved more than 100 countries and regions, including Europe, Asia, America, Oceania, and Africa outside of endemic countries. Meanwhile, cases are clearly concentrated in Europe.
Most infections come from human-to-human transmission. The vast majority of cases do not have a direct epidemiological link to countries where monkeypox is endemic. The outbreak achieves international transmission between countries through human-to-human transmission, which has never happened before.
Unidentified sources of infection. Previous cases of monkeypox in non-endemic countries with pathways of introduction out of Africa are well known. However, this outbreak had a few positive cases with a history of African sojourn but was not associated with other cases.
Comparison of MPXV from the 2017 Nigeria Outbreak and the 2022 Outbreak
Fig. 2 Phylogenetic tree of some selected MPXV genomes in 2017 and 2022. (Wassenaar T M, et al., 2022)
The current monkeypox outbreak is not only the largest known outbreak to date caused by a strain belonging to the West African evolutionary clade, but also has significantly different clinical and epidemiological characteristics compared with previous outbreaks of this virus. These differences may be attributed to recent changes in the viral genome.
The 2017 Nigeria Outbreak
The 2022 Outbreak
Phylogeny of genome
The 2017 isolates are clustered together.
The 2022 isolates have slightly more variability, but are all found on one major branch.
The number of repeat units at a given location is shared between the 2017 and 2022 genomes.
The two repetitive sequences with a consistent number of conserved sequences in the 2022 genome are both located in the intergenic region.
The genomes are broadly similar to those of previous isolates from the same region.
Discovery of non-synonymous mutations that may lead to changes in protein function.
To better identify and control the current monkeypox outbreak, it is critical to explore the origin of the 2022 epidemic MPXV and its strains through phylogenetic analysis.
Creative Biolabs specializes in monkeypox research, so if your lab or company needs the latest research platform, please contact us.
Yao K H. Learning from the past: the history of human monkeypox and the atypical multi-country outbreak in 2022. Chinese Journal of Contemporary Pediatrics, 2022;24(7):717-727.
Wassenaar T M, et al. Comparison of Monkeypox virus genomes from the 2017 Nigeria outbreak and the 2022 outbreak. Journal of Applied Microbiology, 2022.