Monkeypox virus infection in HIV-1- coinfected patients previously vaccinated against smallpox: A series of 4 cases from Portugal

Monkeypox is a zoonotic orthopoxvirus that incidentally causes disease in humans similar to smallpox, although with lower mortality. This virus is endemic to western and central Africa, with outbreaks in occidental countries related to exotic pet trade and international travel. Coincident immunity to monkeypox virus was previously achieved with vaccinia virus vaccination; however, eradicating smallpox and subsequent lack of vaccination efforts paved the way for monkeypox to gain clinical relevance. Clinically, initial manifestations include fever, headache, myalgia, fatigue and lymphadenopathy. After 1–2 days, skin and mucosal umbilicated lesions develop with subsequent centrifugal dissemination. Since early May 2022, many countries in Europe, Australia and the United States have reported an increasing number of monkeypox cases, configuring an outbreak with public health implications.1 Portugal is one of the most affected countries, with numerous confirmed cases. Sequencing of the virus has been achieved in Portugal, suggesting this virus belongs to the West African clade of monkeypox virus. (...)