Monkeypox Virus (MPXV) or Mpox

Characteristics
Morphology	Monkeypox virus (MPXV), now written as Mpox is a 200 to 250 nm brick-shaped enveloped virus with characteristic surface tubules and a dumbbell-shaped core component. The Mpox genome consists of linear double-stranded DNA. Monkeypox virus is antigenically related to the variola and vaccinia viruses. Mpox is a 200 to 250 nm brick- shaped enveloped virus with characteristic surface tubules and a dumbbell-shaped core component
Growth Conditions	Cell Culture, Vero and MK2 cell lines can be used (37°C, 5% C02)

Characteristics

Morphology

Monkeypox virus (MPXV), now written as Mpox is a 200 to 250 nm brick-shaped enveloped virus with characteristic surface tubules and a dumbbell-shaped core component. The Mpox genome consists of linear double-stranded DNA. Monkeypox virus is antigenically related to the variola and vaccinia viruses. Mpox is a 200 to 250 nm brick- shaped enveloped virus with characteristic surface tubules and a dumbbell-shaped core component

Growth
Conditions

Cell Culture, Vero and MK2 cell lines can be used (37°C, 5% C02)

Health Hazards
Host Range	Humans, squirrels, non-human primates, black-tailed prairie dogs, African brush-tailed porcupines, rats, and shrews
Modes of Transmission	Transferred from infected animals through a bite or through direct contact with the infected animal's blood, body fluids, or lesions. Transferred from human-to-human via the respiratory tract, by direct contact with body fluids of an infected person, or with virus-contaminated objects
Signs and Symptoms	Symptoms of Mpox are similar to but milder than the symptoms of smallpox. Mpox begins with fever, headache, muscle aches, and exhaustion. The main difference between symptoms of smallpox and Mpox is that the latter causes lymph nodes to swell (lymphadenopathy).
Infectious Dose	Unknown
Incubation Period	The incubation period is usually 7−14 days

Medical Precautions/Treatment
Prophylaxis	None publically available; vaccines can be used for prophylaxis
Vaccines	Smallpox vaccine provides substantial protection against Mpox (approximately 85% effective). Attenuated live virus vaccines against Mpox are also available
Treatment	There are no licensed antiviral drugs available to treat Mpox infection; instead, treatment is supportive
Surveillance	Monitor for symptoms (unexplained fever, rash, or prominent lymphadenopathy) and confirm by laboratory diagnosis using virus isolation, PCR-based assays, haemagglutination inhibition assays, electron microscopy, ELISA, Western blotting, or immunohistochemistry
GWU Requirements	Report all incidents to the Office of Risk Management as well as the Office of Research Safety (ORS) IMMEDIATELY FOLLOWING THE OCCURRENCE.

Containment
BSL-2+/ABSL-2+	Risk Group 3 classification is applied to Mpox. BSL-2 facilities with BSL-3 practices are advised if vaccinated personnel perform laboratory work with Mpox in infectious materials or infected animals.
BSL-3/ABSL-3	BSL-3 facilities, equipment, and operational practices for work involving regulated infectious materials or cultures. ABSL-3 practices, containment equipment, and facilities are recommended for Mpox work in experimentally or naturally infected animals.

Spill Procedures
Small Spills (<1 liter)	If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup. Mpox exposure via aerosol transmission is common, so caution should be taken during a spill outside of a BSC. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against enveloped viruses (bleach, glutaraldehyde), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.
Large Spills	Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Spill Procedures

Small Spills (<1 liter)

If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup.

Mpox exposure via aerosol transmission is common, so caution should be taken during a spill outside of a BSC. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against enveloped viruses (bleach, glutaraldehyde), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.

Large Spills

Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Exposure Procedures
Mucus Membrane	Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposure	Wash area with soap and water for 15 minutes.
Reporting	Report ALL injuries to the PI immediately and reported to the Office of Risk Management at [email protected] IMMEDIATELY FOLLOWING THE OCCURRENCE. Exposures that involve a bloodborne-pathogen or recombinant DNA also need to be reported to the Office of Research Safety at [email protected]. If the injury requires immediate medical attention, call GWPD at 202-994-6111 or call 911.
Medical Monitoring	Seek immediate medical evaluation, treatment, and post exposure follow-up at the Employee Health Office at GWU Hospital (900 23rd St., NW, Suite G-1090, Phone: 202-715-4275). Students should go to the Students Health Office at Marvin Center. After hours treatment can be received at the GWU hospital emergency room.

Stability
Disinfection	Susceptible to 10% bleach, chloroxylenol-based household disinfectants, glutaraldehyde, formaldehyde, and paraformaldehyde
Inactivation	Orthopoxviruses are inactivated by heat (autoclaving and incineration)
Survival Outside Host	Stable at ambient temperatures when dried, found in animal remains

Personal Protective Equipment (PPE)
Minimum PPE Requirements	At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with Mpox. Additional PPE may be required depending on lab specific SOPs. Higher containment levels will require donning scrubs and wearing respiratory protection.
Additional Precautions	Due to the modes of transmission, respirators may be required when working with Mpox. Fit testing and training is required. Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Wash hands with soap and water after removing gloves.

References
References
CDC (https://www.cdc.gov/poxvirus/monkeypox/index.html) BMBL 6th Edition (https://www.cdc.gov/labs/BMBL.html) Canadian PHAC (https://www.canada.ca/en/public-health/services/laboratory-biosafety-bi…) Gene expression profiling of monkeypox virus-infected cells reveals novel interfaces for host-virus interactions (https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-7-173)