Immunity And The Antiviral Approach Against The Monkeypox Virus

Öz

Human monkeypox is a zoonotic infection caused by the monkeypox virus (MPV), a member of the Orthopox genus in the family Poxviridae among the double-stranded DNA (dsDNA) viruses. It was first described in a nine-month-old baby in the Democratic Republic of the Congo in 1970. Since that time, Poxviridae have resulted in five epidemics in Central and West Africa, and sometimes in Europe and North America. Human infections in endemic regions have been described in association with close contact through hunting and skinning infected animals and or rodent infestations in the home. Human-to-human transmission has also been described in home contacts of index cases, particularly among those not vaccinated against smallpox. Transmission occurs through saliva, respiratory secretions, cutaneous lesions, bodily fluids, or contaminated objects. An increase in hosts susceptible to monkeypox has been observed following the eradication of smallpox and after routine smallpox vaccination. The smallpox vaccine is estimated to provide 85% protection against monkeypox disease. MPV disease resolves with medical treatment in the majority of cases. Clinical care and support therapy must be provided in order to ameliorate symptoms and reduce complications. Patients with gastrointestinal symptoms involving fluid loss, such as vomiting and diarrhea, require oral or intravenous fluid therapy. Appropriate agent-specific antibiotic therapy must be given in case of secondary bacterial infection. Treatment can also be considered for monkeypox infection in atypical regions (such as the mouth, eyes, and genital region). Various medications have been investigated, but their effectiveness remains uncertain. Antivirals thought to be potentially efficacious include tecovirimat (TCV), brincidofovir (BCV), and cidofovir (CDV). Although some experts may recommend dual TCV and CDV therapy in patients with severe disease, TCV is currently the preferred treatment. There are currently two vaccines capable of reducing the risk of MPV disease. Vaccination within 14 days of contact is recommended for individuals with high-risk exposure. Post-expose vaccination is not indicated for individuals with low-risk exposure.

Anahtar Kelimeler

• monkeypox
• treatment
• immunization

Maymun Çiçeği Virüsüne Karşı Antiviral Yaklaşım ve Bağışıklık

Öz

İnsan maymun çiçeği, çift sarmallı DNA (dsDNA) virüslerinin Poxviridae ailesindeki Orthopoxvirus cinsinin bir üyesi olan maymun çiçeği virüsünün neden olduğu zoonotik bir enfeksiyondur. İlk olarak 1970 yılında Demokratik Kongo Cumhuriyeti'nde dokuz aylık bir bebekte tanımlandı. O zamandan beri, Orta ve Batı Afrika'da ve bazen Avrupa ve Kuzey Amerika'da beş salgınla sonuçlandı. Endemik bölgelerdeki insan enfeksiyonları, enfekte hayvanlarla avlanma ve deri yüzme yoluyla yakın temas veya evde kemirgen istilası ile ilişkili olarak tanımlanmıştır. İnsandan insana bulaşma, özellikle çiçek hastalığına karşı aşılanmamış olanlar arasında, indeks vakaların ev temaslılarında da tanımlanmıştır. Bulaşma yolları, tükürük, solunum salgıları, cilt lezyonları, vücut sıvıları veya kontamine cisimlerle temasdır. Çiçek hastalığının eradikasyonundan ve rutin çiçek aşısından sonra Maymun çiçeği hastalığına karşı duyarlı konaklarda artış izlenmiştir. Çiçek aşısının maymun hastalığına karşı %85 koruma sağladığı tahmin edilmektedir. Maymun çiçeği virüsü hastalığı (MÇVH) hastaların çoğunda medikal tedavi ile birlikte iyileşmektedir. Semptomları hafifletmek, komplikasyonları azaltmak için klinik bakım ve destekleyici tedavi verilmelidir. Kusma, ishal gibi sıvı kayıplarının olduğu gastrointestinal semptomları olan hastalara oral ya da intravenöz sıvı tedavisi gerekmektedir. Sekonder bakteriyel enfeksiyon izlendiği durumlarda etkene özgü ve uygun antibiyotik tedavisi verilmelidir. Atipik bölgelerdeki (örneğin ağız, gözler, genital bölge) maymun çiçeği enfeksiyonu için tedavi de düşünülebilir. Bir takım ilaçlar denenmiştir ama etkinliği net değildir. Etkinliği olabileceği düşünülen antiviraller; Tecovirimat (TCV), brincidofovir (BCV) ve cidofovir (CDV)’ dir. Bazı uzmanlar şiddetli hastalığı olan hastalarda TCV ve CDV ile ikili tedavi önerebilse de, şu anda TCV tercih edilen tedavidir. MÇVH riskini azaltabilecek iki mevcut aşı vardır. Yüksek risk maruziyeti olan bireylere temas sonrası 14 gün içinde aşılama önerilir. Maruziyet sonrası aşılama, düşük risk maruziyeti olanlar için endike değildir.

Anahtar Kelimeler

• maymun çiçeği
• tedavi
• bağışıklama

Kaynakça

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