Intended for healthcare professionals

Rapid response to:


Why the monkeypox outbreak constitutes a public health emergency of international concern

BMJ 2022; 378 doi: (Published 09 August 2022) Cite this as: BMJ 2022;378:o1978

Rapid Response:

Monkeypox contagion with unrecognized symptoms (ophthalmological) and through animals.

Dear Editor,
A recent article confirms that Monkeypox (MPX) sometimes manifested ocular involvement as the first symptomatology, with the risk of not being correctly identified [1], so we might think that even the ophthalmologists could find themselves facing a case of MPX, having in the eye the first onset symptoms [2].
Disseminating awareness of atypical presentations is of vital clinical importance as failure to recognize MPX infection as a possible differential could pose a major risk to healthcare professionals and other contacts [3].
If to these factors, which make it difficult to think in non-endemic geographic areas to the disease caused by MPX virus, we also add the possibility that there are transmissions of the MPX virus conducted from some animals to humans or from humans to animals [4-6], the problem could really become serious. Above all, in a period of holidays with large movements of people.
[1] Thornhill JP, Barkati S, Walmsley S. et al.; SHARE-net Clinical Group. Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med. 2022 Jul 21. doi: 10.1056/NEJMoa2207323. Epub ahead of print. PMID: 35866746.
[2] Gianni Zuccheri, Minniti Davide; 08 August 2022 Rapid Response: Monkeypox and Ophthalmology
[3] Patel A, Bilinska J, Tam JCH, et al.. Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series. BMJ. 2022 Jul 28;378:e072410. doi: 10.1136/bmj-2022-072410. PMID: 35902115.
[4] 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 Dec 12;9(12):380. doi: 10.3390/v9120380. PMID: 29231870; PMCID: PMC5744154.
[5] McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis. 2014 Jan;58(2):260-7. doi: 10.1093/cid/cit703. Epub 2013 Oct 24. Erratum in: Clin Infect Dis. 2014 Jun;58(12):1792. PMID: 24158414.
[6] Sophie Seang, Sonia Burrel, Eve Todesco, Valentin Leducq et al., Evidence of human-to-dog transmission of monkeypox virus The Lancet August 10, 2022

Competing interests: No competing interests

12 August 2022
Gianni Zuccheri