The resurgence of monkeypox in 2017 after 39 years without a reported case in Nigeria, and the export of monkeypox from Nigeria to other parts of the world, in 2018 and 2019, respectively, have raised concerns that the viruses may have emerged to fill the ecological and immunological niche vacated by the smallpox virus. Since the eradication of smallpox in 1980 and the cessation of routine smallpox vaccination thereafter, the potential for an increase in monkeypox cases has been monitored. Since then, two distinct clades have emerged: a milder strain from West Africa and a more severe strain from Central Africa. Animal-to-human infection occurs through direct or indirect contact with bodily fluids, through handling, biting, or scratching. Transmission from person to person can occur through respiratory droplets or direct or indirect contact with bodily fluids, injured material, and contaminated surfaces. There are no specific treatments for patients with a monkeypox virus infection. However, minor outbreaks have been controlled with smallpox vaccines, antivirals, and immune globulin. Prevention and management of monkeypox is similar to that of other orthopoxvirus infections, and all confirmed cases of orthopoxvirus infection should be treated as monkeypox until proven otherwise.
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