Monkeypox, Covid-19, and Heart in 2022 Volume 48- Issue 3

Fariba Yazdanpanah*

• Department of Internal Medicine, University of Maryland Capital Region Medical Center, USA

Received: January 24, 2023;   Published: February 02, 2023

*Corresponding author: Fariba Yazdanpanah, University of Maryland Capital Region Medical Center Department of Internal Medicine, 901 Harry S Truman Drive North Largo, USA

DOI: 10.26717/BJSTR.2023.48.007642

Abstract PDF

A new outbreak of Monkeypox with novel cardiac presentations raises new concerns about the prevention, diagnosis, and management of this challenging healthcare system problem. Given the concurrent COVID-19 pandemic that also affects the cardiovascular system, this article highlights the interaction between these two infectious diseases and their impact on the heart.

Keywords: Covid-19; Cardiac; Heart; Monkeypox; Myocarditis; Pericarditis; Prevention; Vaccine

Abbreviations: MPX: Monkeypox, ACIP: Advisory Committee on Immunization Practices

The Monkeypox (MPX) outbreak has occurred in 2022 while the global challenge of the COVID-19 pandemic that began in December 2019 has not been fully contained. MPX virus is a zoonotic linear, double-stranded DNA virus, a member of the Orthopoxvirus genus in the family Poxviridae [1]. MPX was first presented in the United States in 2003 after the importation of African rodents for the pet trade and led to 37 human cases [2]. Before 2022, cardiac involvement by the MPX virus had only been reported in samples from prairie dogs following experimental MPX infection [3]. However, novel data indicate that the MPX outbreak in 2022 has new clinical features consistent with cardiac involvement in the form of myocarditis as well as pericarditis in humans, either through direct infection or vaccination [4-8]. To date, various new vaccines against COVID-19 have been developed and released including Pfizer- BioNTech, Moderna, Johnson & Johnson, Oxford/AstraZeneca, Bharat Biotech, Sinopharm, Sinovac while the only available vaccines for protection against MPX are classic smallpox vaccines: JYNNEOS^TM and ACAM2000®.

JYNNEOS^TM is a live, replication-incompetent vaccine and ACAM2000® is a live, replication- competent vaccine [9]. Recommendations founded by Advisory Committee on Immunization Practices (ACIP) suggest that primary vaccination with ACAM2000® is contraindicated in individuals with ≥3 known major cardiac risk factors including hypertension, diabetes, hypercholesterolemia, heart disease at age ≤50 years in a first-degree relative, and smoking. However, in patients with known underlying heart diseases such as coronary artery disease or cardiomyopathy, both primary and revaccination with ACAM2000® are contraindicated [10]. On the other hand, several studies highlight the risk of post-vaccination myocarditis, pericarditis, or myopericarditis following mRNA COVID-19 and smallpox vaccines, particularly after vaccination with ACAM2000® [11-12]. In light of these findings, ACIP recommends a 4-week interval between MPX vaccination with JYNNEOS^TM or ACAM2000® and prior to receiving the mRNA COVID-19 vaccines, primarily in adolescent and young adult males [10].

Although MPX and COVID-19 both originate from two different virus families, due to their co-occurrence in the same period and common cardiac involvement either through direct infection or vaccination, it is helpful for healthcare providers to be aware of the novel aspects of these new challenges to the health system and their potential interaction with each other in order to select and combine appropriate practical strategies in terms of prevention, diagnosis, and treatment of MPX and COVID-19 diseases to provide proper and quality care to patients.

None.

All authors declare no conflict of interest.

1. Srivastava G, Srivastava G (2022) Human monkeypox disease. Clinics in Dermatology 40(5): 604-612.
2. Weiner ZP, Salzer JS, LeMasters E, Ellison JA, Kondas AV, et al. (2019) Characterization of Monkeypox virus dissemination in the black-tailed prairie dog (Cynomys ludovicianus) through in vivo bioluminescent imaging. PLoS One 14(9): e0222612.
3. Xiao SY, Sbrana E, Watts DM, Siirin M, da Rosa AP, et al. (2005) Experimental infection of prairie dogs with monkeypox virus. Emerg Infect Dis 11(4): 539-545.
4. Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, et al. (2022) Monkeypox Virus Infection in Humans across 16 Countries - April-June 2022. N Engl J Med 387(8): 679-691.
5. Pinho AI, Braga M, Vasconcelos M, Oliveira C, Santos LD, et al. (2022) Acute Myocarditis: A New Manifestation of Monkeypox Infection? JACC Case Rep 4(21): 1424-1428.
6. Rodriguez-Nava G, Kadlecik P, Filardo TD, Ain DL, Joseph D Cooper, et al. (2022) Myocarditis Attributable to Monkeypox Virus Infection in 2 Patients, United States, 2022. Emerg Infect Dis 28(12): 2508-2512.
7. Brouillard P, Valin-Thorburn A, Provost Y, Chakravarti A, Honos G, et al. (2022) Monkeypox associated myocarditis: A case report. IDCases 30: e01628.
8. Shaik TA, Voloshyna D, Nasr TH, Makki A, Kosuru SH, et al. (2022) Monkeypox-Associated Pericarditis: A Maiden Case. Cureus. 14(9): e29638.
9. Rizk J G, Lippi G, Henry B M, Forthal D N, Rizk Y (2022) Prevention and Treatment of Monkeypox. Drugs 82(9): 957-963.
10. Rao AK, Petersen BW, Whitehill F, Razeq JH, Isaacs SN, et al. (2022) 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 71(22): 734-742.
11. Parmar K, Subramanyam S, Del Rio-Pertuz G, Sethi P, Argueta-Sosa E (2022) Cardiac Adverse Events after Vaccination-A Systematic Review. Vaccines (Basel) 10(5): 700.
12. Nalca A, Zumbrun EE (2010) ACAM2000: the new smallpox vaccine for United States Strategic National Stockpile. Drug Des Devel Ther 4: 71-79.