Iranian Journal of Medical Sciences

Document Type : Review Article


1 Department of Nursing, School of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

2 Department of Pharmaceutical Health Services Research Center, School of Pharmacy, University of Maryland, Baltimore, MD, USA

3 NC Medical College, Panipat, Haryana, India

4 Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

5 Student Research Committee, School of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran



Monkeypox is an infectious and contagious zoonotic disease caused by the Orthopoxvirus species and was first identified in Africa. Recently, this infectious disease has spread widely in many parts of the world. Fever, fatigue, headache, and rash are common symptoms of monkeypox. The presence of lymphadenopathy is another prominent and key symptom of monkeypox, which distinguishes this disease from other diseases and is useful for diagnosing the disease. This disease is transmitted to humans through contact with or eating infected animals as well as objects infected with the virus. One of the ways to diagnose this disease is through PCR testing of lesions and secretions. To prevent the disease, vaccines such as JYNNEOS and ACAM2000 are available, but they are not accessible to all people in the world, and their effectiveness and safety need further investigation. However, preventive measures such as avoiding contact with people infected with the virus and using appropriate personal protective equipment are mandatory. The disease therapy is based on medicines such as brincidofovir, cidofovir, and Vaccinia Immune Globulin Intravenous. The injectable format of tecovirimat was approved recently, in May 2022. Considering the importance of clinical care in this disease, awareness about the side effects of medicines, nutrition, care for conjunctivitis, skin rash, washing and bathing at home, and so on can be useful in controlling and managing the disease.


  1. Joob B, Wiwanitkit V. Monkeypox: revisit of the old threat and emerging imported cases. Medical Journal of Dr DY Patil University. 2022;15:457-9. doi: 10.4103/mjdrdypu.mjdrdypu_440_22.
  2. Rao AK, Petersen BW, Whitehill F, Razeq JH, Isaacs SN, Merchlinsky MJ, et al. Use of JYNNEOS (Smallpox and Monkeypox Vaccine, Live, Nonreplicating) for Preexposure Vaccination of Persons at Risk for Occupational Exposure to Orthopoxviruses: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:734-42. doi: 10.15585/mmwr.mm7122e1. PubMed PMID: 35653347; PubMed Central PMCID: PMCPMC9169520
  3. Shanmugaraj B, Khorattanakulchai N, Phoolcharoen W. Emergence of monkeypox: Another concern amidst COVID-19 crisis. Asian Pacific Journal of Tropical Medicine. 2022;15:193-5. doi: 10.4103/1995-7645.346081.
  4. Adalja A, Inglesby T. A Novel International Monkeypox Outbreak. Ann Intern Med. 2022;175:1175-6. doi: 10.7326/M22-1581. PubMed PMID: 35605243.
  5. Adegboye OA, Eugenia Castellanos M, Alele FO, Pak A, Ezechukwu HC, Hou K, et al. Travel-Related Monkeypox Outbreaks in the Era of COVID-19 Pandemic: Are We Prepared? Viruses. 2022;14. doi: 10.3390/v14061283. PubMed PMID: 35746754; PubMed Central PMCID: PMCPMC9228578.
  6. Kumar N, Acharya A, Gendelman HE, Byrareddy SN. The 2022 outbreak and the pathobiology of the monkeypox virus. J Autoimmun. 2022;131:102855. doi: 10.1016/j.jaut.2022.102855. PubMed PMID: 35760647; PubMed Central PMCID: PMCPMC9534147.
  7. Otu A, Ebenso B, Walley J, Barcelo JM, Ochu CL. Global human monkeypox outbreak: atypical presentation demanding urgent public health action. Lancet Microbe. 2022;3:e554-e5. doi: 10.1016/S2666-5247(22)00153-7. PubMed PMID: 35688169; PubMed Central PMCID: PMCPMC9550615.
  8. Gong Q, Wang C, Chuai X, Chiu S. Monkeypox virus: a re-emergent threat to humans. Virol Sin. 2022;37:477-82. doi: 10.1016/j.virs.2022.07.006. PubMed PMID: 35820590; PubMed Central PMCID: PMCPMC9437600.
  9. Heymann DL, Simpson K. The Evolving Epidemiology of Human Monkeypox: Questions Still to Be Answered. J Infect Dis. 2021;223:1839-41. doi: 10.1093/infdis/jiab135. PubMed PMID: 33871010.
  10. McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014;58:260-7. doi: 10.1093/cid/cit703. PubMed PMID: 24158414.
  11. Quarleri J, Delpino MV, Galvan V. Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries. Geroscience. 2022;44:2095-103. doi: 10.1007/s11357-022-00611-6. PubMed PMID: 35726117; PubMed Central PMCID: PMCPMC9208705.
  12. Cheema AY, Ogedegbe OJ, Munir M, Alugba G, Ojo TK. Monkeypox: a review of clinical features, diagnosis, and treatment. Cureus. 2022;14. doi: 10.7759/cureus.26756.
  13. Brown K, Leggat PA. Human Monkeypox: Current State of Knowledge and Implications for the Future. Trop Med Infect Dis. 2016;1. doi: 10.3390/tropicalmed1010008. PubMed PMID: 30270859; PubMed Central PMCID: PMCPMC6082047.
  14. Fatima N, Mandava K. Monkeypox-a menacing challenge or an endemic? Annals of Medicine and Surgery. 2022;79:103979. doi: 10.1016/j.amsu.2022.103979.
  15. Parvin R, Ali A, Nagy A, Zhu Z, Zhao S, Paul A, et al. Monkeypox virus: A comprehensive review of taxonomy, evolution, epidemiology, diagnosis, prevention, and control regiments so far. Ger. J Microbiol. 2022;2:1-15. doi: 10.51585/gjm.2022.2.0014.
  16. Pal M, Singh R, Gutama KP, Savalia C, Thakur R. Human monkeypox: an emerging and re-emerging infectious viral disease. Acta Scientific Microbiology (ISSN: 2581-3226). 2022;5:146-50. doi: 10.31080/ASMI.2022.05.1045.
  17. Harapan H, Ophinni Y, Megawati D, Frediansyah A, Mamada SS, Salampe M, et al. Monkeypox: A Comprehensive Review. Viruses. 2022;14. doi: 10.3390/v14102155. PubMed PMID: 36298710; PubMed Central PMCID: PMCPMC9612348.
  18. Petersen E, Kantele A, Koopmans M, Asogun D, Yinka-Ogunleye A, Ihekweazu C, et al. Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention. Infect Dis Clin North Am. 2019;33:1027-43. doi: 10.1016/j.idc.2019.03.001. PubMed PMID: 30981594; PubMed Central PMCID: PMCPMC9533922.
  19. Rao A, Mena LA, Petersen B. Monkeypox: updates about clinical diagnosis and treatment. Clinician Outreach and Communication Activity. 2022.
  20. Petersen E, Zumla A, Hui DS, Blumberg L, Valdoleiros SR, Amao L, et al. Vaccination for monkeypox prevention in persons with high-risk sexual behaviours to control on-going outbreak of monkeypox virus clade 3. Int J Infect Dis. 2022;122:569-71. doi: 10.1016/j.ijid.2022.06.047. PubMed PMID: 35788415; PubMed Central PMCID: PMCPMC9534076.
  21. Radix M, Hoffmann CJ, Gonzalez CJ. Monkeypox Vaccination in Adults With HIV. 2022.
  22. Administration [Internet]. Package Insert - JYNNEOS. c2021. Avialable from:
  23. Overton ET, Lawrence SJ, Wagner E, Nopora K, Rosch S, Young P, et al. Immunogenicity and safety of three consecutive production lots of the non replicating smallpox vaccine MVA: A randomised, double blind, placebo controlled phase III trial. PLoS One. 2018;13:e0195897. doi: 10.1371/journal.pone.0195897. PubMed PMID: 29652929; PubMed Central PMCID: PMCPMC5898760.
  24. Greenberg RN, Kennedy JS. ACAM2000: a newly licensed cell culture-based live vaccinia smallpox vaccine. Expert Opin Investig Drugs. 2008;17:555-64. doi: 10.1517/13543784.17.4.555. PubMed PMID: 18363519; PubMed Central PMCID: PMCPMC9491136.
  25. Rizk JG, Lippi G, Henry BM, Forthal DN, Rizk Y. Prevention and Treatment of Monkeypox. Drugs. 2022;82:957-63. doi: 10.1007/s40265-022-01742-y. PubMed PMID: 35763248; PubMed Central PMCID: PMCPMC9244487.
  26. Petersen BW, Harms TJ, Reynolds MG, Harrison LH. Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses - Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015. MMWR Morb Mortal Wkly Rep. 2016;65:257-62. doi: 10.15585/mmwr.mm6510a2. PubMed PMID: 26985679.
  27. Administration [Internet]. ACAM2000 Product Insert. c2018. Avialable from:
  28. Farahat RA, Rackimuthu S, Umar TP, Siddiqui JA, Shrestha AB, Essar MY. Preparedness of South East Asia countries in view of monkeypox emergence: A call for action. Lancet Reg Health Southeast Asia. 2022;6:100074. doi: 10.1016/j.lansea.2022.100074. PubMed PMID: 36249534; PubMed Central PMCID: PMCPMC9534127.
  29. Clinician Outreach and Communication [Internet]. Vaccine Considerations. c2022. Avialable from:
  30. Durski KN, McCollum AM, Nakazawa Y, Petersen BW, Reynolds MG, Briand S, et al. Emergence of Monkeypox - West and Central Africa, 1970-2017. MMWR Morb Mortal Wkly Rep. 2018;67:306-10. doi: 10.15585/mmwr.mm6710a5. PubMed PMID: 29543790; PubMed Central PMCID: PMCPMC5857192.
  31. Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26:782-5. doi: 10.3201/eid2604.191164. PubMed PMID: 32023204; PubMed Central PMCID: PMCPMC7101111.
  32. Clinician Outreach and Communication [Internet]. Prevention. [Updated July 11, 2022]. Available from:
  33. Rao AK, Schulte J, Chen TH, Hughes CM, Davidson W, Neff JM, et al. Monkeypox in a Traveler Returning from Nigeria - Dallas, Texas, July 2021. MMWR Morb Mortal Wkly Rep. 2022;71:509-16. doi: 10.15585/mmwr.mm7114a1. PubMed PMID: 35389974; PubMed Central PMCID: PMCPMC8989376.
  34. Titanji BK, Tegomoh B, Nematollahi S, Konomos M, Kulkarni PA. Monkeypox: A Contemporary Review for Healthcare Professionals. Open Forum Infect Dis. 2022;9:310. doi: 10.1093/ofid/ofac310. PubMed PMID: 35891689; PubMed Central PMCID: PMCPMC9307103.
  35. Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022;22:1153-62. doi: 10.1016/S1473-3099(22)00228-6. PubMed PMID: 35623380; PubMed Central PMCID: PMCPMC9300470
  36. Russo AT, Berhanu A, Bigger CB, Prigge J, Silvera PM, Grosenbach DW, et al. Co-administration of tecovirimat and ACAM2000 in non-human primates: Effect of tecovirimat treatment on ACAM2000 immunogenicity and efficacy versus lethal monkeypox virus challenge. Vaccine. 2020;38:644-54. doi: 10.1016/j.vaccine.2019.10.049. PubMed PMID: 31677948; PubMed Central PMCID: PMCPMC6954297.
  37. Mucker EM, Goff AJ, Shamblin JD, Grosenbach DW, Damon IK, Mehal JM, et al. Efficacy of tecovirimat (ST-246) in nonhuman primates infected with variola virus (Smallpox). Antimicrob Agents Chemother. 2013;57:6246-53. doi: 10.1128/AAC.00977-13. PubMed PMID: 24100494; PubMed Central PMCID: PMCPMC3837858.
  38. Organization WH. WHO advisory committee on variola virus research: report of the twenty-second meeting. Geneva 4-5 November 2020. 2021.
  39. Organization WH [Internet]. Mpox (monkeypox). c2022. Available from:
  40. FDA Uf. Amoxicillin; Clarithromy-Cin; Vonoprazan Fumarate. Pharmacy Today. 2022;28:12-4. doi: 10.1016/j.ptdy.2022.11.028.
  41. Russo AT, Grosenbach DW, Chinsangaram J, Honeychurch KM, Long PG, Lovejoy C, et al. An overview of tecovirimat for smallpox treatment and expanded anti-orthopoxvirus applications. Expert Rev Anti Infect Ther. 2021;19:331-44. doi: 10.1080/14787210.2020.1819791. PubMed PMID: 32882158; PubMed Central PMCID: PMCPMC9491074.
  42. Grosenbach DW, Honeychurch K, Rose EA, Chinsangaram J, Frimm A, Maiti B, et al. Oral Tecovirimat for the Treatment of Smallpox. N Engl J Med. 2018;379:44-53. doi: 10.1056/NEJMoa1705688. PubMed PMID: 29972742; PubMed Central PMCID: PMCPMC6086581.
  43. Kabuga AI, El Zowalaty ME. A review of the monkeypox virus and a recent outbreak of skin rash disease in Nigeria. J Med Virol. 2019;91:533-40. doi: 10.1002/jmv.25348. PubMed PMID: 30357851.
  44. Fowotade A, Fasuyi T, Bakare R. Re-emergence of monkeypox in Nigeria: A cause for concern and public enlightenment. African Journal of Clinical and Experimental Microbiology. 2018;19:307-13. doi: 10.4314/ajcem.v19i4.9.
  45. Alakunle E, Moens U, Nchinda G, Okeke MI. Monkeypox Virus in Nigeria: Infection Biology, Epidemiology, and Evolution. Viruses. 2020;12. doi: 10.3390/v12111257. PubMed PMID: 33167496; PubMed Central PMCID: PMCPMC7694534.
  46. Organization WH [Internet]. Clinical Management and Infection Prevention and Control for Monkeypox. c2022. Available from:
  47. Label [Internet]. US: FDA. [Cite 2021 12, June]. Available from:
  48. Hostetler KY, Beadle JR, Trahan J, Aldern KA, Owens G, Schriewer J, et al. Oral 1-O-octadecyl-2-O-benzyl-sn-glycero-3-cidofovir targets the lung and is effective against a lethal respiratory challenge with ectromelia virus in mice. Antiviral Res. 2007;73:212-8. doi: 10.1016/j.antiviral.2006.10.009. PubMed PMID: 17123638; PubMed Central PMCID: PMCPMC1859865.
  49. Israely T, Paran N, Lustig S, Erez N, Politi B, Shafferman A, et al. A single cidofovir treatment rescues animals at progressive stages of lethal orthopoxvirus disease. Virol J. 2012;9:119. doi: 10.1186/1743-422X-9-119. PubMed PMID: 22709563; PubMed Central PMCID: PMCPMC3409050.
  50. Rice AD, Adams MM, Lampert B, Foster S, Robertson A, Painter G, et al. Efficacy of CMX001 as a prophylactic and presymptomatic antiviral agent in New Zealand white rabbits infected with rabbitpox virus, a model for orthopoxvirus infections of humans. Viruses. 2011;3:63-82. doi: 10.3390/v3020063. PubMed PMID: 21369346; PubMed Central PMCID: PMCPMC3045966.
  51. Krecmerova M, Majer P, Rais R, Slusher BS. Phosphonates and Phosphonate Prodrugs in Medicinal Chemistry: Past Successes and Future Prospects. Front Chem. 2022;10:889737. doi: 10.3389/fchem.2022.889737. PubMed PMID: 35668826; PubMed Central PMCID: PMCPMC9163707.
  52. Li G, De Clercq E. A medicinal chemist who reshaped the antiviral drug industry: John Charles Martin (1951-2021). Med Res Rev. 2022;42:647-53. doi: 10.1002/med.21858. PubMed PMID: 34636044.
  53. Meaney-Delman DM, Galang RR, Petersen BW, Jamieson DJ. A Primer on Monkeypox Virus for Obstetrician-Gynecologists: Diagnosis, Prevention, and Treatment. Obstet Gynecol. 2022;140:391-7. doi: 10.1097/AOG.0000000000004909. PubMed PMID: 36356237; PubMed Central PMCID: PMCPMC9377490.
  54. Koenig KL, Bey CK, Marty AM. Monkeypox 2022 Identify-Isolate-Inform: A 3I Tool for frontline clinicians for a zoonosis with escalating human community transmission. One Health. 2022;15:100410. doi: 10.1016/j.onehlt.2022.100410. PubMed PMID: 36249992; PubMed Central PMCID: PMCPMC9534172.
  55. Tiecco G, Degli Antoni M, Storti S, Tomasoni LR, Castelli F, Quiros-Roldan E. Monkeypox, a Literature Review: What Is New and Where Does This concerning Virus Come From? Viruses. 2022;14. doi: 10.3390/v14091894. PubMed PMID: 36146705; PubMed Central PMCID: PMCPMC9501516.
  56. Reynolds MG, McCollum AM, Nguete B, Shongo Lushima R, Petersen BW. Improving the Care and Treatment of Monkeypox Patients in Low-Resource Settings: Applying Evidence from Contemporary Biomedical and Smallpox Biodefense Research. Viruses. 2017;9. doi: 10.3390/v9120380. PubMed PMID: 29231870; PubMed Central PMCID: PMCPMC5744154.
  57. Daskalakis D, McClung RP, Mena L, Mermin J, Centers for Disease C, Prevention’s Monkeypox Response T. Monkeypox: Avoiding the Mistakes of Past Infectious Disease Epidemics. Ann Intern Med. 2022;175:1177-8. doi: 10.7326/M22-1748. PubMed PMID: 35709341.
  58. Organization WH. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. Geneva: World Health Organization; 2013.
  59. Hughes C, McCollum A, Pukuta E, Karhemere S, Nguete B, Lushima RS, et al. Ocular complications associated with acute monkeypox virus infection, DRC. International Journal of Infectious Diseases. 2014;21:276-7. doi: 10.1016/j.ijid.2014.03.994.
  60. Semba RD. The ocular complications of smallpox and smallpox immunization. Arch Ophthalmol. 2003;121:715-9. doi: 10.1001/archopht.121.5.715. PubMed PMID: 12742852.
  61. Altmann S, Brandt CR, Murphy CJ, Patnaikuni R, Takla T, Toomey M, et al. Evaluation of therapeutic interventions for vaccinia virus keratitis. J Infect Dis. 2011;203:683-90. doi: 10.1093/infdis/jiq103. PubMed PMID: 21278209; PubMed Central PMCID: PMCPMC3072718.
  62. Hashmi MF, Gurnani B, Benson S, Price KL. Conjunctivitis (Nursing). Florida: StatPearls; 2021.
  63. Berche P. Life and death of smallpox. Presse Med. 2022;51:104117. doi: 10.1016/j.lpm.2022.104117. PubMed PMID: 35143880.
  64. Chowdhury SR, Datta PK, Maitra S. Monkeypox and its pandemic potential: what the anaesthetist should know. Br J Anaesth. 2022;129:e49-e52. doi: 10.1016/j.bja.2022.06.007. PubMed PMID: 35803753; PubMed Central PMCID: PMCPMC9628951.
  65. Tan E, Braithwaite I, McKinlay CJD, Dalziel SR. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3:e2022398. doi: 10.1001/jamanetworkopen.2020.22398. PubMed PMID: 33125495; PubMed Central PMCID: PMCPMC7599455
  66. Hammond NE, Boyle M. Pharmacological versus non-pharmacological antipyretic treatments in febrile critically ill adult patients: a systematic review and meta-analysis. Aust Crit Care. 2011;24:4-17. doi: 10.1016/j.aucc.2010.11.002. PubMed PMID: 21168342.
  67. Clinician Outreach and Communication [Internet]. Isolation & Infection Control at Home. [Update August 11, 2022]. Available from: