Cover Image

An Overview of Monkey-pox Disease

Lord Tertese Angahar


Monkeypox is a rare self-limiting viral zoonosis (a virus transmitted to humans from animals) with symptoms in humans similar to those seen in the past in smallpox patients, although less severe. Monkeypox virus (MPV) causes monkeypox disease. The virus belongs to the family: Poxviridae; Subfamily: Chordopoxvirinae; Genus: Orthopoxvirus. MPV was first identified in laboratory monkeys at State Serum Institute in Copenhagen, in 1958.  The first human case of MPV was detected in 1970, in Zaire (Democratic Republic of the Congo—DRC) after smallpox eradication in the country. The primary disease symptoms include: Demonstration of  characteristic prodromal illness for 2 days before the onset of rash with fever, malaise, and lymphadenopathy by most patients. Almost 90% of patients infected with monkeypox develop lymphadenopathy, which is the key feature distinguishing human monkeypox from smallpox. Typical monkeypox rash begins as maculopapular lesions of 2-5 mm in diameter; the rash becomes generalized in distribution in most cases, spreading in centrifugal pattern. Skin lesions progress from papules to vesicles, and pustules followed by umbilication, scabbing, and desquamation over a period of 14-21 days. Skin lesions are observed on mucous membrane, in the mouth, on tongue, and on genitalia. Monkey pox disease mortality rate in Africa is about 10%. The most recent outbreak of Monkeypox disease occurred in 2017, in Nigeria. This paper is a comprehensive review of the: pathology, pathogenesis, epidemiology, signs and symptoms, diagnoses and prevention of monkeypox disease.


Orthopoxvirus; Lymphadenopathy; Rodents; Exposure routes; Extracutaneous; Infection

Full Text:



Jezek Z and Fenner F. Human monkeypox. Monographs in Virology.1988, 17:140

Arita I., Jezek Z., Khodakevich L., and Ruti K. Human monkeypox: a newly emerged orthopoxvirus zoonosis in the tropical rain forests of Africa. Am. J. Trop Med Hyg. 1985.34:781-789

Jezek Z, KhodakevichLN, and SzczeniowskiMV. Human monkey pox: its clinico-epidemiological characteristics. ZhMikrobiolEpidemiolImmunobiol. 1988, 6:23-30

Fields BN, Knipe DM, Howley PM, Chanock RM, Melnick JL, Monath TP, Roizman B and Straus SE. Fields Virology, 3rd Ed. 1995. Lippincott, Williams and Wilkins, Philadelphia, USA

Damon IK. Status of human monkeypox: clinical disease, epidemiology and research. Vaccine. 2011, 29, D54-D59

Zuckerman AJ, Banatvala JE, Pattison JR, Griffiths PD, Schoub BD. Principles and practice of clinical virology5th ed. 2005:884

Dubois ME, SlifkaMK. Retrospective analysis of monkeypox infection. Emerg Infect Dis. 2008, 14.4:592-9

Realegeno S, PuschnikAS, Kumar A, and Goldsmith C. Monkeypox virus host factor screen in haploid cells identifies essential role of GARP complex in extracellular virus formation. J Virol. 2017, ii: JVI.00011-17

Jezek, Z, Szczeniowski, M., Paluku, K.M and Mutombo, M. Human monkeypox: clinical features of 282 patients. J Infect Dis. 1987, 156:293-298

Morand A, Delaigue S, and MorandJ.J. Review of poxvirus: emergence of monkeypox. Med Sante Trop. 2017.27:29-39

Meyer, H., Perrichot, M and Stemmler, M. Outbreaks of disease suspected of being due to human monkeypox virus infection in the Democratic Republic of Congo in 2001. ClinMicrobiol. 2002. 40:2919-2921

American Veterinary Medical Association [AVMA] . Monkeypox backgrounder [online]. AVMA;. Available at:* Accessed Apr. 8, 2017

Li D, Wilkins K, McCollum AM, Osadebe L, Kabamba J, Nguete B, Likafi T, Balilo MP, Lushima RS, Malekani J, Damon IK, Vickery MC, Pukuta E, Nkawa F, Karhemere S, Tamfum JM, Okitolonda EW, Li Y, Reynolds MG.Evaluation of the GeneXpert for Human Monkeypox Diagnosis. The American Journal of Tropical Medicine and Hygiene. 2017, 96:405-410

Guarner J, Johnson BJ, Paddock CD, ShiehWJ, Goldsmith CS, Reynolds MG, Damon IK, RegneryRL and ZakiSR. Veterinary Monkeypox Virus Working Group. Monkeypox transmission and pathogenesis in prairie dogs. Emerg Infect Dis. 2004, 10(3):426-31

Cohen J. Is an old virus up to new tricks? Science. 1997,277(5324):312-3

Reynolds MG and Damon IK. Outbreaks of human monkeypox after cessation of smallpox vaccination. Trends Microbiol. 2012, 20:80-87

Breman JG, Kalisa R, Steniowski MV,Zanotto E, Gromyko AI and Arita L. Human monkeypox 1970-74. Bull. WHO. 1980, 58:165-182

Landyi ID, Ziegler P and Kima A. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo (DRC). Bulletin World Health Organization. 1972, 46:593-597

Centers for Disease Control and Prevention [CDC]. Basic information about monkeypox [online]. Available at: Accessed March12, 2018 2018

Fairley CK and Miller E. Varicella-Zoster virus epidemiology - A changing scene? Journal of Infectious Diseases. 1996, 174 (S3):S314-S319

Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis. LancetInfectious Diseases. 2004, 4.1:15-25

Hutson CL, Carroll DS and Self J. Dosage comparison of Congo Basin and West African strains of monkeypox virus using a prairie dog animal model of systemic orthopoxvirus disease. Virology.2010, 402:72-82

WHO. Human Monkeypox, 1970-79. Bulletin of the World Health Organization. 1980, 58:165-182

Hutin YJ, Williams RJ, Malfait P, Pebody R, Loparev VNandRopp SL. Outbreak of human monkeypox, Democratic Republic of Congo, 1996 to 1997. Emerg Infect Dis. 2001, 7:434-438

Centers for Disease Control and Prevention [CDC].Monkeypox infections in animals: updated interim guidance for persons who have frequent contact with animals (pet owners, pet shop owners and employees, animal rescuers, animal handlers, and animal control officers [online]. Available at: Accessed April 5, 2018

Reed KD, Melski JW, Graham MB, Regnery RL, Sotir MJ and Wegner MV. The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004, 350:342-350

Sejvar JJ, ChowdaryY, Schomogyi M, Stevens J, Patel J and Karem K. Human monkeypox infection: a family cluster in the midwestern United States. J Infect Dis. 2004, 190:1833-1840

NCDC.Weekly Epidemiological Report. Nigeria Centre for Disease Control Vol 7, N0 40, 20th Oct, 2017. 2017B

NCDC. Interim National Guidelines for Monkeypox Outbreak Response. Abuja, Federal Ministry of Health - Nigeria Centre for Disease Control. 2017A

Likos AM, Sammons SA, Olson VA, Frace AM and Olsen-Rasmussen JG. A tale of two clades: monkeypox viruses. J Gen Virol. 2005, 86:2661-2672

Khodakevich, L., Jezek, Z. and Kinzanzka, K. Isolation of monkeypox virus from wild squirrel infected in nature. Lancet. 1986, 1(8472):98-9

Reynolds MG, Yorita KL, Kuehnert MJ, Davidson WB, Huhn GD and Holman R. Clinical manifestations of human monkeypox influenced by route of infection. J Infect Dis.2006, 194:773-780

Marennikova SS, ŠeluhinaEM, Mal’cevaNN and Ladnyj ID. Poxviruses isolated from clinically ill and asymptomatically infected monkeys and a chimpanzee. Bulletin of the World Health Organization. 1972, 46:613-620

Centers for Disease Control and Prevention. Update: multistate outbreak of monkeypox – Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin. Morb Mortal Wkly Rep.2003, 52:642-646

Pattyn SR. Monkeypoxvirus infections. Rev Sci Tech. 2000. 19:92-97

Learned LA, Reynolds MG, WassaDW, Li Y, Olson VA, Karem K, Stempora LL, Braden ZH and Damon IK. Extended interhuman transmission of monkeypox in a hospital community in the Republic of the Congo 2003. Am J Trop Med Hyg.2005, 73(2):428-34

Esposito JJ and Knight JC. Orthopox virus DNA: a comparison of restriction profiles and maps. Virology. 1985, 143:230-251

Reynolds MG, Cono J, Curns A, Holman RC, Likos A and Regnery R. Human monkeypox. Lancet Infect Dis. 2004, 4(10):604-5

Iizuka I, Ami Y, Suzaki Y, and Nagata N. A Single Vaccination of Nonhuman Primates with Highly Attenuated Smallpox Vaccine, LC16m8, Provides Long-term Protection against Monkeypox. J. Infect. Dis. 2016, 255:904-910

Mahendra P, Fisseha M, and Venkataramana K. Epidemiology, Diagnosis, and Control of Monkeypox Disease: A comprehensive Review. American Journal of Infectious Diseases and Microbiology, 2017, 5(2): 94-99

Jezek Z, Marennikova SS, Murtumbo M, Nakano JH, PalukuKM and Szczeniowski M. Human monkeypox: a study of 2510 contacts of 214 patients. J Infect Dis. 1986, 154:551-5

Gispen R, and Brand-Saathof B. Three specific antigens produced in vaccinia, variola, and monkeypox infections. J Infect Dis. 1974, 129:289-95

Nalca A, Rimoin AW, Bavari S, Whitehouse CA. Reemergence of monkeypox: prevalence, diagnostics, and countermeasures. Clin Infect Dis. 2005, 41.12:1765-71


  • There are currently no refbacks.

AJCMicrob (ISSN 2572-5815) Copyright © 2012-2020. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States