The humanity is in a continuous battle against infectious diseases since long times. After the pandemic of COVID-19 and its drastic health and economic consequences, the world is again witnessing a new health threat that consists on the re-emergence of a zoonotic disease in different non endemic countries: the monkeypox disease [1].
This disease is caused by a Monkeypox virus. A double-stranded DNA virus which belongs to the Orthopoxvirus genus, the Chordopoxvirinae subfamily of the Poxviridae family responsible for multiple diseases in human and animals. Monkeypox virus is one of the four Orthopoxvirus species pathogenic for humans with variola virus, cowpox virus, and vaccinia virus [2, 3].
Despite the name of monkeypox, the natural reservoir of this disease is still unknown. Non-human primates (like monkeys) are one of the main suspected reservoirs in association with other African rodents and mammals [3, 4]. Further studies are however necessitated to identify the virus' reservoir(s) and its main route of its circulation and its conservation in nature. A possible risk factor is eating inadequately cooked meat and other animal products of infected animals [5].
Historically, this viral zoonotic disease was first reported on 1958 from lesions of an imported macaque in a Danish laboratory hence, the name of monkeypox. Later, the first human case was detected in a 9-years child in 1970 in RDC [6]. Since then, thousands of confirmed and misdiagnosed cases in multiple outbreaks were reported in Africa, especially in the Central and Western African countries (Benin, Cameroon, Central African Republic, Cote d’Ivoire, Democratic Republic of the Congo, Gabon, Ghana, Liberia, Nigeria, Republic of the Congo, South Sudan and Sierra Leone) considered currently as an endemic region (Most of cases were reported in the Republic Democratic of Congo). Consequently, two genetic strains of Monkeypox virus have been characterized including the West African and the Central African clade geographically separated with epidemiological and clinical differences. The number of cases and outbreaks is increasing continually in these countries especially since the cessation of the smallpox vaccination in the years 1980s [2, 5, 6].
Out of Africa, the first cases were reported in 2003 in the USA following importation of infected animals from Ghana. Later cases from different countries were also reported including United Kingdom (2018–2019 and 2021) and Singapore (2019) and also in the USA in 2021 [6].
Since May 06, 2022 the world has known the re-emergence of multiple cases in different non-endemic countries with no history of travel to endemic countries. As of November 10, 2022, the number of cases has reached 79,151 confirmed cases [7].
The West African clade was identified as the cause for the first cases reported in non endemic countries. Later, Genome sequencing of strains from confirmed case in Portugal, has shown a close similarity with the strains isolated from exported cases from Nigeria to the United Kingdom and Singapore in 2018 and 2019 [5, 8].
The virus is mainly transmitted from person to person close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding [8].
Clinically, the disease is generally self-limiting with of the formation of lesions, skin nodules or disseminated rash but could be severe in some individuals, like children, pregnant women or immune-deficient persons. The incubation period of Monkeypox is usually from 6 to 13 days but can range from 5 to 21 days. Even, the case fatality rate varied from 3.6–10.6% in the endemic countries, no deaths were reported in the recent outbreaks in the non endemic countries [6, 9].
For instance, no specific treatment or vaccines approved for monkeypox are available. Some antivirals used for smallpox (Tecovirimat, brincidofovir, Cidofovir) and Vaccinia Immune Globulin Intravenous (VIGIV) could be beneficial [10, 11]. Also, vaccines against smallpox have historically, shown a cross-protection against monkeypox. Vaccine JYNNEOS (MVA-BN, ) was approved for monkeypox, in 2019, but it is not yet widely available [11, 12].
In response to this public health threat, the World Health Organization has released a range of recommendations to limit its spread. These recommendations are related to surveillance, case investigation and reporting, contact tracing, risk communication and community engagement, clinical management and infection prevention and control in health care settings [1, 5]. Later, the WHO declared the human monkeypox outbreak as a public health emergency of international concern since July 2022 [13, 14]. The rapid spread of this disease has engendered a significant worry among the public [15] which is due mainly to the lack of knowledge and the embracing of conspiracy beliefs towards emerging viral infections [16]. Additionally, the health authorities are again asked to communicate and convince the population to agree with preventive measures and a probable future vaccination especially after the COVID-19 hard experience.
The present review was conducted to evaluate the level of knowledge and awareness and the attitude toward monkeypox vaccines and the associated factors which will be a start point about human monkeypox knowledge and vaccine acceptance.