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array:23 [ "pii" => "S2445146023000675" "issn" => "24451460" "doi" => "10.1016/j.vacune.2023.10.011" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "310" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Vacunas. 2023;24:364-79" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:17 [ "pii" => "S2445146023000687" "issn" => "24451460" "doi" => "10.1016/j.vacune.2023.10.012" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "289" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Vacunas. 2023;24:380-93" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Immuno-informatics design of a multimeric epitope peptide-based vaccine against dengue virus serotype-2" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => 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structure of the constructed vaccine.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mohamed Sheik Tharik Abdul Azeeze, Rajaguru Arivuselvam" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Mohamed Sheik Tharik" "apellidos" => "Abdul Azeeze" ] 1 => array:2 [ "nombre" => "Rajaguru" "apellidos" => "Arivuselvam" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146023000687?idApp=UINPBA00004N" "url" => "/24451460/0000002400000004/v2_202401230726/S2445146023000687/v2_202401230726/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S2445146023000663" "issn" => "24451460" "doi" => "10.1016/j.vacune.2023.10.010" "estado" => "S300" "fechaPublicacion" => "2023-10-01" "aid" => "283" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Vacunas. 2023;24:358-63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "CHECKvacc (HOV3, CF33-hNIS-anti-PD-L1), the next medical revolution against cancer" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "358" "paginaFinal" => "363" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "CHECKvacc (HOV3, CF33-hNIS-anti-PD-L1), la siguiente revolución médica contra el cáncer" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1216 "Ancho" => 2008 "Tamanyo" => 231913 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Schematic showing mechanism of action of CF33-hNIS-antiPDL1.<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ali Adel Dawood" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Ali Adel" "apellidos" => "Dawood" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445146023000663?idApp=UINPBA00004N" "url" => "/24451460/0000002400000004/v2_202401230726/S2445146023000663/v2_202401230726/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "The global spread of human monkeypox virus: Challenges and opportunities for prevention" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "364" "paginaFinal" => "379" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Muhammad Safdar, Shafeeq Ur Rehman, Furqan Shafqat, Muhammad Shan, Samiha S. Khan, Faiz-ul Hassan, Hafiz Khawar Ali, Mehmet Ozaslan" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Muhammad" "apellidos" => "Safdar" "email" => array:1 [ 0 => "msafdar@cuvas.edu.pk" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "Shafeeq Ur" "apellidos" => "Rehman" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Furqan" "apellidos" => "Shafqat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 3 => array:3 [ "nombre" => "Muhammad" "apellidos" => "Shan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 4 => array:3 [ "nombre" => "Samiha S." "apellidos" => "Khan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] 5 => array:3 [ "nombre" => "Faiz-ul" "apellidos" => "Hassan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 6 => array:3 [ "nombre" => "Hafiz Khawar" "apellidos" => "Ali" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "af0020" ] ] ] 7 => array:3 [ "nombre" => "Mehmet" "apellidos" => "Ozaslan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "af0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Breeding and Genetics, Cholistan University of Veterinary & Animal Sciences-Bahawalpur, Bahawalpur, Pakistan" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Department of Microbiology, Cholistan University of Veterinary & Animal Sciences-Bahawalpur, Bahawalpur, Pakistan" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Faisalabad Medical University (FMU), Faisalabad, Pakistan" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Department of Molecular Biology, Virtual University of Pakistan, Lahore, Pakistan" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Department of Biology, Division of Molecular Biology and Genetics, Gaziantep University, Gaziantep, Turkey" "etiqueta" => "5" "identificador" => "af0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La propagación mundial del virus humano de la viruela del mono: desafíos y oportunidades para la prevención" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1020 "Ancho" => 1417 "Tamanyo" => 112547 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">The current regional distribution of monkeypox cases.<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">An orthopoxvirus, which seldom sickens people, is the cause of monkeypox. Rodents are assumed to be intricate in the transmission of the virus, although the precise reservoir is yet unclear. The virus was initially revealed in monkeys kept in captivity for scientific studies in 1958.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> Monkeypox virus (MPXV), a member of the Poxviridae family and a close cousin of the variola virus is the culprit behind monkeypox.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> MPXV is largely prevalent in sub-Saharan Africa and is thought to be not particularly infectious.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> Surprisingly, 110 countries have reported more than 87 000 cases of monkeypox from January 1, 2022 to April 26, 2023.<a class="elsevierStyleCrossRef" href="#bb0865"><span class="elsevierStyleSup">173</span></a> It is quite uncommon that there have been so many instances worldwide, even though some cases have been documented since 2003.<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Since MPXV has a high mortality rate of 1% and 11%,<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> spreading the disease might worsen the current global health crisis. In addition to the continuing SARS-CoV-2 epidemic, the rapid rise in monkeypox cases has generated fresh worries around the globe. The cause of the remarkable rise in MPXV transfer from person to person is unknown.<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">6–8</span></a> Monitoring MPXV's genetic characteristics and researching the molecular processes underpinning the virus' rapid spread is thus crucial and urgent.</p><p id="p0015" class="elsevierStylePara elsevierViewall">The Central African (Congo Basin) and West African viral clades are reported as being genetically diverse.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a> Four cases of monkeypox related to travel have been identified in the UK since 2018, and 3 further cases have since been transmitted. The US, Singapore, and Israel have also reported<a class="elsevierStyleCrossRef" href="#bb0050"><span class="elsevierStyleSup">10</span></a> sporadic instances of imported illnesses. Monkeypox is believed to take around 12 days to incubate (range 5–24 days).<a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a> Encephalitis, subsequent skin infections, pneumonia, and eye diseases resulting in blindness are serious infection-related symptoms. Populations at higher risk include newborns, kids, and those who are immunocompromised.<a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">The World Health Organization (WHO) announced a multi-nation monkeypox epidemic in May 2022.<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a> As of April 26, 2023, more than 87 000 laboratory-confirmed monkeypox cases have been recorded worldwide since the epidemic began, with 20 fatalities attributable to the illness.<a class="elsevierStyleCrossRef" href="#bb0865"><span class="elsevierStyleSup">173</span></a> The rapid speed of the epidemic has increased public worry about the potential of the spread of another viral pandemic.<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> Monkeypox virus (MPXV), the disease's primary cause, has been discovered for over 60 years.<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> Two outbreaks of an illness resembling pox occurred in the summer and fall of 1958 among <span class="elsevierStyleItalic">Macaca fascicularis</span> monkeys kept at Staten’s Serum Institut in Copenhagen, Denmark, according to a study published in 1959.<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> These outbreaks were related to the monkeypox poxvirus, a recently identified poxvirus. Monkeypox outbreaks within captive monkeys have since been discovered in zoos and labs.<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> A 9-month-old infant in the Democratic Republic of the Congo was the first person to be found to have human MPXV infection in 1970.<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> Since then, Central and Western Africa have been reported to have endemic monkeypox zoonosis.<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> Person-to-person transfer of MPXV has been documented in endemic nations in Central Africa before the current epidemic in 2022.<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> The 2003 epidemic in the United States (US) is a significant instance of a monkeypox outbreak recorded in non-endemic nations and mostly connected to imported animals from the endemic areas.<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> The experience with the epidemics of monkeypox brought attention to the worldwide significance of this newly developing zoonosis.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> The increasing number of monkeypox outbreaks seen over the last 40 years is attributed to several reasons.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> One of them is the enhanced vulnerability to monkeypox infection when the smallpox immunization program was discontinued.<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> It has been demonstrated that smallpox immunization gives around 85% efficiency in preventing monkeypox.<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> In areas plagued by poverty and societal upheavals like civil wars, the widespread use of animals as a protein source poses a further risk since they might operate as MPXV reservoirs.<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Greater human density, the convenience of travel, and ecological and environmental variables (such as the destruction of tropical rainforests) with a higher risk of exposure to reservoir animals are additional factors associated with establishing monkeypox epidemics.<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">It is currently unknown how the development of the nucleic acid secondary structure has affected viral biology, despite several mutation analyses of the changing MPXV genomes. For instance, the non-canonical secondary RNA structure is known as the RNA G-quadruplex (RG4).<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> In RG4, the quadruplex structure is formed by stacking 2–3 layers of Hoogsteen hydrogen-bonded G-tetrads. RG4 has been suggested as a potential antiviral target for therapeutic use.<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> Given that MPXV comprises 190 coding genes and a double-stranded DNA genome of around 197 kb, it is most probable that these genes' mRNAs include functioning RG4 structures. The possibility that the RG4 regulates MPXV biological activities and the connection between RG4 motifs and the development of the MPXV genome is of major interest and significance.<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> Therefore, this review provides a total analysis of human monkeypox, which is caused by the monkeypox virus. It covers various aspects, such as the origins of the virus, how it is transmitted, its pathogenesis, the immune responses it triggers, genetic variations, evolutionary adaptations, and potential strategies for treatment, so that government and competent authorities can implement guidelines for researchers and public.</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Origin</span><p id="p0030" class="elsevierStylePara elsevierViewall">Laboratory cynomolgus and rhesus monkeys primarily brought to Copenhagen, Denmark, from Singapore, had the first recorded case of monkeypox in 1958.<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a> When they arrived in Denmark, they got the vesicular disease, which led to the isolation of a double-stranded DNA virus from the genus Orthopoxvirus.<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> Monkeypox virus was a distinct orthopoxvirus similar to but different from smallpox virus. Various outbreaks occurred between 1959 and 1962 in various US research sites.<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> In 1964, an outbreak in a zoo in Rotterdam made many animals sick, and some died. Giant anteaters, orangutans, gorillas, chimpanzees, gibbons, and marmosets were among the affected species.<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a></p><p id="p0035" class="elsevierStylePara elsevierViewall">A Gambian rat, a shrew, 3 rope squirrels, and a sooty mangabey monkey are the only 6 wild species captured in Africa that have provided the virus. Most of these species seemed in good health except for a sickly squirrel (<span class="elsevierStyleItalic">Funisciurus anerythrus</span>).<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a> Antibodies have been found in more samples, primarily in African squirrels and Cercopithecus, despite the elusiveness of viral existence in wild animals.<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> Thus, non-human primates seem to be accidental hosts, and the natural host is probably a rodent or rodent-like species.<a class="elsevierStyleCrossRef" href="#bb0190"><span class="elsevierStyleSup">38</span></a> Rope squirrels (Funisciurus spp.), Gambian squirrels (Heliosciurus spp.), African dormice (Graphiurus spp.), Gambian giant pouched rats (Cricetomys spp.), and prairie dogs (Cynomis spp.) are only a few of the rodent species that may be experimentally infected by MPXV.<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> More research is required to determine which species are the natural reservoirs and how the virus spreads in nature since some of these species have asymptomatic infections.<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> The wide range of animals that MPXV may infect proves that it has a broad host range, in contrast to the smallpox virus, which primarily infected humans, and that no species should be ignored as potentially being included in its epidemiological cycle.<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a></p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Epidemiology</span><p id="p0040" class="elsevierStylePara elsevierViewall">Since humans first contacted the virus via close interaction with sick animals thousands of years ago, monkeypox has likely been a problem in sub-Saharan Africa.<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a> After smallpox was eradicated in 1970, it became clear that smallpox-like illnesses were still occurring in rural areas, leading to the identification of monkeypox as a novel disease.<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a> In 1958, State Serum Institutes in Copenhagen, Denmark, and Africa<a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a> identified the monkeypox virus in laboratory monkeys used for research. Monkeypox became a disease of public health concern after the first outbreak in the USA, which was associated with infected pet prairie dogs.<a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> It was believed that local prairie dogs kept with rodents from Ghana in Western Africa were the primary source of the outbreak since most infected people became ill after interacting with pet prairie dogs.<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a> A spike in cases of monkeypox in the US Midwest in the summer of 2003 had been reported.<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a> Since 2003, several instances of monkeypox have been recorded in several nations, with Nigeria seeing the greatest outbreak in 2017.<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a></p><p id="p0045" class="elsevierStylePara elsevierViewall">According to the authors of an epidemiological modelling study, monkeypox's R0 value, also known as the reproductive ratio or the disease's transmission level, ranges from 1.10 to 2.40 in countries with limited exposure to orthopoxvirus species.<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a> In the case of imported animals, this number indicates that a monkeypox outbreak is imminent.<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a> The stated R0 shows that each infected person has the capacity to infect 1 to 2 more individuals, as previously indicated. An infected person must take additional precautions to socially isolate and quarantine themselves due to the virus's potential for transmission.</p><p id="p0050" class="elsevierStylePara elsevierViewall">As of July 1, 2022, the Centers for Disease Control and Prevention (CDC) has reported 5783 confirmed cases of monkeypox globally.<a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a> A total of 87 078 cases of monkeypox have been reported worldwide as per Centers for Disease Control and Prevention (CDC) till April 26, 2023,<a class="elsevierStyleCrossRef" href="#bb0870"><span class="elsevierStyleSup">174</span></a> as shown in <a class="elsevierStyleCrossRefs" href="#t0005">Tables 1 and 2</a>. The regional prevalence of the cases worldwide is shown graphically in <a class="elsevierStyleCrossRef" href="#f0005">Fig. 1</a>. The western hemisphere and European regions account for most monkeypox cases.<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a> According to recent studies, the United Kingdom has the most instances in Europe. The median age of confirmed monkeypox cases is 31.<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a> The absence of cross-protective immunity is further emphasized because this population was only born after the smallpox immunization program was terminated.<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a> Additionally, monkeypox occurs more often in men, although the exact reason is unclear.<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a></p><elsevierMultimedia ident="t0005"></elsevierMultimedia><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="f0005"></elsevierMultimedia></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">MPXV pathogenesis</span><p id="p0055" class="elsevierStylePara elsevierViewall">The route the virus used to cause the initial infection significantly affects how the orthopoxvirus infection manifests clinically in a vertebrate host.<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a> Following ingesting an infected person's bodily fluids or inhaling aerosolized respiratory secretions, the oral/respiratory cavity is a potentially typical entry channel for various orthopoxviruses, including the highly transmissible MPXV and VARV.<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> Before infecting the mucosae of the oral and respiratory tracts, the virus primarily targets the lower, middle, and upper airway epithelium.<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> No oropharyngeal lesions are present during this asymptomatic stage of the virus.<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a> The spread of the virus is aided by the infection of nearby tissue-inhabitant immune cells, possibly including antigen-presenting cells like dendritic cells, monocytes, B cells, and macrophages.<a class="elsevierStyleCrossRefs" href="#bb0260"><span class="elsevierStyleSup">52–55</span></a> There is debate about how orthopoxviruses move from the primary infection site to surrounding draining lymph nodes. For instance, it has been found that murine dendritic cells infected with VACV move from the lung epithelium to draining lymph nodes, possibly contributing to the virus' dissemination.<a class="elsevierStyleCrossRef" href="#bb0280"><span class="elsevierStyleSup">56</span></a> Conversely, it has been demonstrated that human monocyte-derived dendritic cell VACV infection is abortive, limiting dendritic cell maturation and migratory ability and disputing dendritic cells' role played in aiding the early lymphatic dissemination of VACV.<a class="elsevierStyleCrossRefs" href="#bb0285"><span class="elsevierStyleSup">57–59</span></a> Significantly, the rapid dissemination of VACV to draining lymph nodes within hours of inoculation demonstrates how direct viral access to lymphatic vessels acts as a spreading mechanism<a class="elsevierStyleCrossRef" href="#bb0300"><span class="elsevierStyleSup">60</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0305"><span class="elsevierStyleSup">61</span></a> as shown in <a class="elsevierStyleCrossRef" href="#f0010">Fig. 2</a>.</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0060" class="elsevierStylePara elsevierViewall">Orthopoxviruses replicate rapidly in lymphoid tissues after infecting neighboring draining lymph nodes. According to clinical research on human monkeypox, primary MPXV replication occurs in the throat and neck lymphoid tissues.<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> Research showing aerosolized MPXV infection in cynomolgus macaques demonstrated that the tonsils, mandibular lymph nodes, and mediastinal lymph nodes were active sites of early viral replication.<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> Poxvirus tropism in lymphoid tissue has been associated with the infection of macrophages/monocytes, dendritic cells, activated T cells, and B cells; these cells may also be MPXV targets.<a class="elsevierStyleCrossRef" href="#bb0310"><span class="elsevierStyleSup">62</span></a> Nevertheless, significant natural killer cell aggregation and proliferation were seen in the lymph nodes near the inoculation site during experimental MPXV non-human primates (NHPs) infection. It is still unclear exactly how these mechanisms affect lymph node swelling during a natural MPXV infection.<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a></p><p id="p0065" class="elsevierStylePara elsevierViewall">After causing low-grade primary viraemia in lymphoid tissues, orthopoxviruses may spread to other organs through the lymphohematogenous pathway.<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a> In experimental mousepox models, the liver and spleen are the main sites of infection after initial lymphatic dissemination.<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a> The spread of the virus to the intestines, kidneys, lungs, skin, and other organs occurs when the virus infects these organs and causes a second significant viraemia wave, which is thought to be caused by infected cells.<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a> An NHP model of aerosolized MPXV infection yielded similar results. The liver contained viral antigens, particularly in Kupffer cells, a highly specialized macrophage.<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> Although to a lower amount, antigen was also found in hepatocytes. Additionally, human MPXV infection has been associated with an enlarged spleen and liver.<a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a> It is believed that lymphoid organs, including the bone marrow and spleen, support viral replication, even though there is limited evidence that the liver is involved in VARV infection.<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a></p><p id="p0070" class="elsevierStylePara elsevierViewall">Orthopoxviruses are present in the small dermal blood vessels, contributing to skin lesions and skin infections.<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a> The virus's entry route into the upper skin layers, which lack lymphatic and blood vessels, remains unknown. Langerhans cells and other migratory skin dendritic cells may also be responsible because of their known susceptibility to VACV infection.<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> Dendritic cells, macrophages, and CD3<span class="elsevierStyleSup">+</span> T cells have been detected around the infectious pustule.<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a> In the context of MPXV infection, it is critical to understand the role of skin-infiltrating CD3<span class="elsevierStyleSup">+</span> T cells, particularly in cytotoxic T lymphocyte responses associated with improved virus control in vaccinated rhesus macaques.<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> Significantly, during MPXV, infection in the esophagus, trachea, pharynx, larynx, tongue, and epithelial lesions (enanthema) develop into ulcers that release infectious viral particles into the saliva.<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a></p><p id="p0075" class="elsevierStylePara elsevierViewall">Infection may also get through the skin. It has been suggested that migratory antigen-presenting cells may help viruses spread through the lymphatic by infecting antigen-presenting cells that reside in tissue such as monocytes, dendritic cells, macrophages, and Langerhans cells as well as dermal keratinocytes and fibroblasts.<a class="elsevierStyleCrossRef" href="#bb0300"><span class="elsevierStyleSup">60</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0350"><span class="elsevierStyleSup">70</span></a> However, recent research suggests that VACV may inhibit dendritic cells from migrating the skin to draining lymph nodes in a mouse model of orthopoxvirus skin infection.<a class="elsevierStyleCrossRef" href="#bb0355"><span class="elsevierStyleSup">71</span></a> The Zika virus may also spread to the lymphatics by other processes, such as direct lymphatic vascular access, which has been shown in skin infection models of the virus.<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a></p><p id="p0080" class="elsevierStylePara elsevierViewall">Since MPXV was recently discovered in the semen of 3 male cases in Italy,<a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a> it has been hypothesized that monkeypox may be sexually transmitted.<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a> A preferential MPXV tropism in the testes may also be shown by cases of monkeypox that only manifest as genital lesions. As an immune-privileged tissue, the testes may serve as a site for latent MPXV infection, although further research is needed.<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a> However, recent research on animals indicated that the associated VACV demonstrates tropism for ovarian and testicular tissues.<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> Additionally, it has been shown that the MPXV virus sheds in faeces, and contact with the rectal mucosa may increase the chance of transmission.<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> These tissues have been identified as a possible reservoir for the human immunodeficiency virus type 1 (HIV-1) in patients.<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a> A recent study found that MSM had a significantly different immunological milieu of the rectal mucosa from heterosexual individuals, with a greater level of immune activities indicative of mucosal damage.<a class="elsevierStyleCrossRef" href="#bb0390"><span class="elsevierStyleSup">78</span></a> Immune cells may be drawn in due to this state, making them easier for infectious pathogens to target, as seen with HIV-1.<a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a> This may also true for the infection and transmission of MPXV in MSM. Monkeypox has not evolved into a sexually transmitted disease, even though MPXV may spread via any intimate contact with the pustules that signify monkeypox.<a class="elsevierStyleCrossRef" href="#bb0400"><span class="elsevierStyleSup">80</span></a></p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Diagnostic manifestation</span><p id="p0085" class="elsevierStylePara elsevierViewall">The diagnostic manifestation of the monkeypox virus, an orthopoxvirus genus member, is comparable to that of smallpox.<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0405"><span class="elsevierStyleSup">81</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a> Human incubation lasts between 7 and 14 days, although it may last between 5 and 20 days.<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a> A feverish regimen lasting 1–4 days is the first sign of sickness, followed by headache, muscle pain, backache, occasional weariness, sweating, fatigue, and the cutaneal presentation. Rash symptoms often appear 1–3 days after a temperature has first been detected, and itchy rash can show up on the face, within the jaw, on the feet and hands on the thorax, on the genitalia, on the anus, and in the eyes. The rash may occasionally appear first, then subsequent complications. The quantity of lesions varies. Lesions start as a flat rash (macula), then they rise from the skin (papules), and finally, they fill with clear liquid to give them a "vesicle" appearance. "Pustules" develop when the clear liquid inside the vesicles turns yellow. With the crusts falling off, pustules, crusts, and lesions vanish. Patients are regarded as non-infectious once the crust has fallen off. People with weakened immune systems have more severe illness symptoms. Scarring from the rash results from an infection that occurs most frequently. But more severe side effects, such as respiratory distress and bronchopneumonia, can develop, according to human research on monkeypox released in 2009. Ocular abnormalities can develop, resulting in eye scarring and possibly permanent visual impairment (<a class="elsevierStyleCrossRef" href="#f0015">Fig. 3</a>). They can also have serious consequences and ramifications, which are more common in unimmunized individuals than in immunized ones.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bb0425"><span class="elsevierStyleSup">85–91</span></a> A characteristic that distinguishes monkeypox from smallpox is lymphadenopathy. It usually happens when the fever starts, a day or two before the rashes begin, or infrequently when the rash starts. In particular, the lymph nodes often expand in the neck, face, and groin. Additionally, those exposed may experience larynx irritation, coughing, and/or oral rash.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0460"><span class="elsevierStyleSup">92</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0465"><span class="elsevierStyleSup">93</span></a> Abnormalities and inflammatory responses of the pharynx, conjunctival, and vaginal mucosae have been noted,<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bb0460"><span class="elsevierStyleSup">92–94</span></a> despite non-specific clinical presentations. It can be challenging for clinicians unfamiliar with disorders that can imitate monkeypox to distinguish among illnesses caused by viruses, bacteria, or anything else because the majority of these early signs can be found in a variety of viral and non-viral diseases. These factors make laboratory diagnosis crucial.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0055"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0470"><span class="elsevierStyleSup">94</span></a> The current diagnosis methods for detection of monkeypox virus are available (<a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>).</p><elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Immune enhancement against monkeypox virus</span><p id="p0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Resistance to MPXV</span>. Despite the virus being known for a long time, nothing is known about human immunity to MPXV infection. As a result, research with VACV and related orthopoxvirus ruses is frequently used to infer how MPXV interacts with the host immune system. The potential mechanisms of host protection against MPXV are highlighted in the following sections, and the immune evasion tactics used by MPXV during active infection are also covered. <span class="elsevierStyleItalic">Innate defence mechanisms against MPXV</span>. Innate immune cells often serve as the initial protective barrier after an active viral infection, although certain viruses also employ these cells as targets. Monocytes are the first cells that poxviruses target, according to several in vitro and in vivo studies.<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0475"><span class="elsevierStyleSup">95</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0480"><span class="elsevierStyleSup">96</span></a> It has been proposed that early identification of poxvirus antigens in monocytes and neutrophils is a reliable indicator of MPXV lethality.<a class="elsevierStyleCrossRef" href="#bb0485"><span class="elsevierStyleSup">97</span></a> Susceptible monocytes are aggressively attracted to infection sites, and CD14<span class="elsevierStyleHsp" style=""></span>+ monocytes are markedly expanded in the lungs of cynomolgus macaques who develop viral pneumonia after MPXV infection.<a class="elsevierStyleCrossRef" href="#bb0490"><span class="elsevierStyleSup">98</span></a> Inflammatory mouse monocytes that are additionally shown to be permissive to VACV replication and potentially serve as viral carriers are CD45<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>CD11b<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>GR-1int cells.<a class="elsevierStyleCrossRef" href="#bb0305"><span class="elsevierStyleSup">61</span></a></p><p id="p0095" class="elsevierStylePara elsevierViewall">Furthermore, it was claimed that VACV growth and dispersion were made possible by normal prime M2-like macrophages.<a class="elsevierStyleCrossRef" href="#bb0495"><span class="elsevierStyleSup">99</span></a> These basic macrophages developed actin tails, cell connections, lamellipodia, and highly branched features after infection with VACV, suggesting they may help the virus spread.<a class="elsevierStyleCrossRef" href="#bb0495"><span class="elsevierStyleSup">99</span></a> However, it was also shown that phagocytic cell depletion did not stop the spread of VACV<a class="elsevierStyleCrossRef" href="#bb0500"><span class="elsevierStyleSup">100</span></a> in infected mice, indicating that other immune cells besides monocytes and macrophages are able to aid in virus propagation. However, Ly6G<span class="elsevierStyleHsp" style=""></span>+ monocytes and Ly6G<span class="elsevierStyleHsp" style=""></span>+ neutrophils of Ly6G<span class="elsevierStyleHsp" style=""></span>+ innate immune cells, invading and controlling virus-infected tissues have been their responsibility, thereby reducing viral tissue damage<a class="elsevierStyleCrossRef" href="#bb0305"><span class="elsevierStyleSup">61</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0500"><span class="elsevierStyleSup">100</span></a> A study that discovered a link between moribundity in MPXV-infected mice and low blood neutrophil counts<a class="elsevierStyleCrossRef" href="#bb0505"><span class="elsevierStyleSup">101</span></a> provided indirect confirmation of our findings. It is also important to note that the immune system only stops localized pathogenicity and cell damage when deployed to the sites of infection and does not prevent the transmission of the virus, necessitating a systemic immune response.<a class="elsevierStyleCrossRef" href="#bb0510"><span class="elsevierStyleSup">102</span></a></p><p id="p0100" class="elsevierStylePara elsevierViewall">Natural killer cells, similar to monocytes, are crucial for the innate immune system and can control the immune response.<a class="elsevierStyleCrossRef" href="#bb0515"><span class="elsevierStyleSup">103</span></a> Natural killer cell counts dramatically increase in lymph nodes and peripheral blood in MPXV-infected rhesus macaques.<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> Prior to this fast expansion, MPXV infection dramatically reduced the ability of the different natural killer cell subsets to migrate, which negatively impacted their ability to enter lymphoid and/or inflammatory tissues.<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> On these cells, it was also noted that chemokine receptors CCR5, CCR6, CCR7, and CXCR3, were downregulated.<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> Additionally, it was shown that blood lost the capacity to release TNF and IFN and degranulate, and natural killer cells were removed from lymph nodes.<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> Although there was no association between natural killer cell counts and viral clearance and activity in this NHP model,<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0520"><span class="elsevierStyleSup">104</span></a> in CAST/EiJ mice, the significance of natural killer cells in regulating MPXV virus pressure was shown. Due to a lack of natural killer cells, this strain is more prone to orthopoxvirus infection.<a class="elsevierStyleCrossRef" href="#bb0525"><span class="elsevierStyleSup">105</span></a> Even with CD8<span class="elsevierStyleHsp" style=""></span>+ and CD4<span class="elsevierStyleHsp" style=""></span>+ T cell depletion, deadly MPXV infection in CAST/EiJ mice can be prevented by IL-15 therapy.<a class="elsevierStyleCrossRef" href="#bb0525"><span class="elsevierStyleSup">105</span></a> Because IL-15 therapy has been shown to temporarily boost the count of IFN-secreting CD8<span class="elsevierStyleHsp" style=""></span>+ T cells and natural killer cells, it follows that the increased natural killer cells used to be essential for the protective immune response.<a class="elsevierStyleCrossRef" href="#bb0530"><span class="elsevierStyleSup">106</span></a></p><p id="p0105" class="elsevierStylePara elsevierViewall">Whereas host immunization is necessary to fight infections, abnormal immunological signaling can negatively impact the course of an infection. In a different study, CCL2, CCL4, IL-6, IL-8, and IFN levels were considerably within 4 days after infection, heightened in cynomolgus macaques infected with VARV.<a class="elsevierStyleCrossRef" href="#bb0520"><span class="elsevierStyleSup">104</span></a> Due to monocytic cell-associated viraemia,<a class="elsevierStyleCrossRef" href="#bb0520"><span class="elsevierStyleSup">104</span></a> which is induced by these cytokines, virus dispersion may be exacerbated. The macaques succumbed to VARV infection eventually, and it's important to note that high amounts of these cytokines may have caused a "cytokine storm" that ultimately killed them.<a class="elsevierStyleCrossRef" href="#bb0520"><span class="elsevierStyleSup">104</span></a> Likewise, it was discovered that MPXV-infected cynomolgus macaques<a class="elsevierStyleCrossRef" href="#bb0490"><span class="elsevierStyleSup">98</span></a> had higher levels of IL-2, IL-6, IL-8, IL-1RA, sCD40L, IFN, CCL2, CCL5 (also known as RANTES), G-CSF, and GM-CSF. Additionally, a relative expansion of CD14<span class="elsevierStyleHsp" style=""></span>+ monocytes (0.97- to 16.3-fold) was noted after the acute stage, indicating that the overall immunological environment promoted monocyte growth and recruitment after MPXV infection.<a class="elsevierStyleCrossRef" href="#bb0490"><span class="elsevierStyleSup">98</span></a></p><p id="p0110" class="elsevierStylePara elsevierViewall">By suppressing inflammatory and antiviral immunological responses, VACV can avoid immune responses,<a class="elsevierStyleCrossRef" href="#bb0290"><span class="elsevierStyleSup">58</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0535"><span class="elsevierStyleSup">107</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0540"><span class="elsevierStyleSup">108</span></a> and MPXV may employ a strategic approach to undermine innate immunity.<a class="elsevierStyleCrossRef" href="#bb0545"><span class="elsevierStyleSup">109</span></a> Future research should determine the functional connections among immune cells and cytokine profiles. Given that immune mediators commonly promote contact between immune cells, understanding the pathophysiology and exploring immunological implications of immunity during MPXV invasion is necessary.<a class="elsevierStyleCrossRef" href="#bb0550"><span class="elsevierStyleSup">110</span></a></p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">B cell and antibody protection</span><p id="p0115" class="elsevierStylePara elsevierViewall">The successful worldwide vaccination program that employed a live attenuated VACV vaccine to eliminate pox<a class="elsevierStyleCrossRef" href="#bb0555"><span class="elsevierStyleSup">111</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0560"><span class="elsevierStyleSup">112</span></a> was the first example of the significance of B cells and immunoglobulins against poxviruses. Other evidence supports the efficacy of vaccinia immune globulin (VIG), derived from vaccination recipients' blood shielding close family members of smallpox patients from infection.<a class="elsevierStyleCrossRef" href="#bb0480"><span class="elsevierStyleSup">96</span></a> Rhesus macaques were saved from a deadly MPXV infected by VACV-specific B cell antibodies.<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> It is significant because epidemiological research has further shown that poxviruses are being treated by VACV vaccines, such as MPXV.<a class="elsevierStyleCrossRef" href="#bb0565"><span class="elsevierStyleSup">113</span></a> In several cases, the immunization-induced VACV-specific antibodies levels and memory B cells lasted more than 50 years.<a class="elsevierStyleCrossRef" href="#bb0570"><span class="elsevierStyleSup">114</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0575"><span class="elsevierStyleSup">115</span></a> A correlate of protection proposed to offer protective immunity against smallpox,<a class="elsevierStyleCrossRef" href="#bb0500"><span class="elsevierStyleSup">100</span></a> neutralizing antibodies with titers higher than 1:32, were only present in 50% of those with vaccinations older than 20 years following vaccination.<a class="elsevierStyleCrossRef" href="#bb0475"><span class="elsevierStyleSup">95</span></a> Cross-protective immunity to monkeypox is expected to deteriorate over time as well.</p></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">T cell immunity</span><p id="p0120" class="elsevierStylePara elsevierViewall">Strengthening memory and transforming memory B cells to secretory cells of antibodies are 2 functions of particularly T follicular helper cells and CD4<span class="elsevierStyleHsp" style=""></span>+ T cells.<a class="elsevierStyleCrossRef" href="#bb0550"><span class="elsevierStyleSup">110</span></a> After receiving the VACV vaccine, the half-life of memory CD4<span class="elsevierStyleHsp" style=""></span>+ T cells is believed to be between 8 and 15 years, with a maximum lifespan of 5 decades.<a class="elsevierStyleCrossRef" href="#bb0575"><span class="elsevierStyleSup">115</span></a> Following activation, CD4<span class="elsevierStyleHsp" style=""></span>+ T lymphocytes that are specific for VACV were able to produce IFN and TNF.<a class="elsevierStyleCrossRef" href="#bb0495"><span class="elsevierStyleSup">99</span></a> There was, however, no evidence of a connection between anti-VACV antibody titers and the quantity of virus-specific CD4<span class="elsevierStyleHsp" style=""></span>+ T cells.<a class="elsevierStyleCrossRef" href="#bb0575"><span class="elsevierStyleSup">115</span></a> In comparison, it was discovered that the quantity of CD4<span class="elsevierStyleHsp" style=""></span>+ T cells was crucial in triggering a defence mechanism for deadly MPXV infectious diseases in rhesus macaques immunized with VACV.<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> The CD4<span class="elsevierStyleHsp" style=""></span>+ T cell count of macaques infected with the Simian immunodeficiency virus (SIV) was 700 cells mm<span class="elsevierStyleSup">-3</span> and did not develop a serious illness.<a class="elsevierStyleCrossRef" href="#bb0580"><span class="elsevierStyleSup">116</span></a></p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Genomic variations in monkeypox virus</span><p id="p0125" class="elsevierStylePara elsevierViewall">Orthopoxvirus members have ><span class="elsevierStyleHsp" style=""></span>90% sequence identity in open reading frames (ORFs) and are genetically and antigenically related.<a class="elsevierStyleCrossRef" href="#bb0585"><span class="elsevierStyleSup">117</span></a> Evolutionary alterations in these viruses are being fueled mostly by the increasing number of they have lost genes at the very tips of their genomes.<a class="elsevierStyleCrossRef" href="#bb0590"><span class="elsevierStyleSup">118</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0595"><span class="elsevierStyleSup">119</span></a> Host-species-induced specific influence may hasten these changes.<a class="elsevierStyleCrossRef" href="#bb0590"><span class="elsevierStyleSup">118</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0595"><span class="elsevierStyleSup">119</span></a> Another argument for the virus' increased capacity to infect and spread to humans is variations in gene copy number.<a class="elsevierStyleCrossRef" href="#bb0600"><span class="elsevierStyleSup">120</span></a> The nearly 190 unique open reading frames (ORFs), all have more than 60 codons, are found in the DNA genome of the hMPXV and are 197 kb long.<a class="elsevierStyleCrossRef" href="#bb0590"><span class="elsevierStyleSup">118</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0605"><span class="elsevierStyleSup">121</span></a> At nucleotide locations 56 000–120 000, the basic encoding sequence (CRS), which is highly conserved, is surrounded by erratic endings that include inverted terminal repeats (ITRs).<a class="elsevierStyleCrossRef" href="#bb0595"><span class="elsevierStyleSup">119</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0605"><span class="elsevierStyleSup">121</span></a> The hMPXV genome's ITR region contains at least 4 recognized ORFs.<a class="elsevierStyleCrossRef" href="#bb0605"><span class="elsevierStyleSup">121</span></a> The Central African/Congo Basin (CA) and West African (WA) clades are the 2 described subclades of the hMPXV. In an initiative to adhere to quality standards and depart from denigrating and exclusionary terminology often affiliated with geographical locations, governments, economies, and individuals, requests have been made to rename the 2 clades as Clade 1 (CA) and Clades 2 and 3 (WA), similar to SARS-COV-2 (Covid-19).<a class="elsevierStyleCrossRef" href="#bb0610"><span class="elsevierStyleSup">122</span></a> Therefore, the lineage responsible for the present epidemic in the Global North and Europe has been suggested to be identified as hMPXV.B.1.<a class="elsevierStyleCrossRef" href="#bb0610"><span class="elsevierStyleSup">122</span></a> Even though there is evidence that the WA clade is associated with a milder strain of the illness with reduced mortality and less visible human–human spread, the CA clade has an estimated case mortality of 10% in non-vaccinated persons with known human–human transmission.<a class="elsevierStyleCrossRef" href="#bb0615"><span class="elsevierStyleSup">123</span></a> According to genomic comparison studies, there is a variation in nucleotides among the 2 clades of organisms of 0.55–0.56%.<a class="elsevierStyleCrossRef" href="#bb0620"><span class="elsevierStyleSup">124</span></a> The WA clade has 171 functionally distinct genes, compared to the CA clade, which has 173. There was no discernible variation in the transcriptional regulatory sequences between the 2 clades, which shared 170 orthologs in terms of proteins and were found to be 99.4% similar.<a class="elsevierStyleCrossRef" href="#bb0620"><span class="elsevierStyleSup">124</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0625"><span class="elsevierStyleSup">125</span></a> The D14R gene, which codes for MOPICE, a significant anti-inflammatory substance that the hMPXV WA clade lacks, is another essential gene that plays a role in the differential in illness among clades.<a class="elsevierStyleCrossRef" href="#bb0620"><span class="elsevierStyleSup">124</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0630"><span class="elsevierStyleSup">126</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0635"><span class="elsevierStyleSup">127</span></a> There are still many candidates to be discovered. Thus, these genes are not the only ones contributing to virulence. From the 2022 outbreak, 4 of the hMPXV isolates (Germany, USA, Portugal, and Belgium) have recently had their genomes released online by various research teams.<a class="elsevierStyleCrossRefs" href="#bb0640"><span class="elsevierStyleSup">128–130</span></a> On <a href="https://nextclade.org/monkeypox">https://nextclade.org/monkeypox</a>, an assembled form of the sequences for visualization will be accessible and retrieved on May 29, 2022. A first genomic comparison suggests a very substantial skew in base mutations, specifically from Cytosine (C) to Thymine (T) and from Guanine (G) to Adenine (A). These mutations are thought to be caused by the cytidine deaminase enzyme APOBEC3 (Apolipoprotein B Editing Complex).<a class="elsevierStyleCrossRef" href="#bb0655"><span class="elsevierStyleSup">131</span></a> A phylogenetic analysis of viral strains from 2015 to 2022 revealed a 30-T base-long section in the center of the viral sequence; its role hasn't yet been established.<a class="elsevierStyleCrossRef" href="#bb0660"><span class="elsevierStyleSup">132</span></a></p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Evolution of monkeypox virus</span><p id="p0130" class="elsevierStylePara elsevierViewall">The first evidence of evolution within the 2022 sequences was shown by Isidro et al., who found that 7 SNPs resulted in 3 sub-lineages, one of which had a sub-cluster with a 913 bp frameshift loss in the MPXV-UK-P2-010 gene.<a class="elsevierStyleCrossRef" href="#bb0665"><span class="elsevierStyleSup">133</span></a> Before enhanced human-to-human transmission, gene reductions in MPXV in Central Africa were discovered.<a class="elsevierStyleCrossRef" href="#bb0595"><span class="elsevierStyleSup">119</span></a> After sequencing, it is difficult to assemble the short tandem repeats at locations 70–500 and 197 600–197 2007–68, but they are crucial for distinction. Consistencywise, most sequences completed so far utilize Oxford Nanopore Technology (ONT), with a few coming from Illumina.<a class="elsevierStyleCrossRef" href="#bb0670"><span class="elsevierStyleSup">134</span></a> A patient from Germany was reported to be co-infected from distinct lineages, although within-host evolution has not yet been discovered.<a class="elsevierStyleCrossRef" href="#bb0675"><span class="elsevierStyleSup">135</span></a></p><p id="p0135" class="elsevierStylePara elsevierViewall">Congo Basin (CB) and West African (WA) are the 2 clades into which MPXV strains are divided. The first-known human case of MPX was caused by the more pathogenic CB clade (CFR up to 11%), mostly in the DRC and its neighboring countries.<a class="elsevierStyleCrossRef" href="#bb0095"><span class="elsevierStyleSup">19</span></a> The WA clade, which is known for having lower CFR, is responsible for the continuing 2022 epidemic as well as the earlier minor outbreaks in Texas (2003), the United Kingdom (2018 and 2021), Singapore (2019), and Israel (2018–2019).<a class="elsevierStyleCrossRefs" href="#bb0680"><span class="elsevierStyleSup">136–138</span></a> Two different viral lineages were identified by phylogenetic analysis of the sequenced MPXV genomes from the present epidemic. Most strains from the 2022 non-endemic epidemic belong to the same subclade (B.1) and most likely originated from the same place.<a class="elsevierStyleCrossRef" href="#bb0695"><span class="elsevierStyleSup">139</span></a> This pedigree is closely tied to a single incident involving a Nigerian traveler to Maryland in 2021. Only 2 strains of the second lineage (A.2) have been found yet in the US, and they have 80 nucleotide variations apart from the other 2022 MPXV sequences, which points to a distinct viral introduction event.<a class="elsevierStyleCrossRef" href="#bb0690"><span class="elsevierStyleSup">138</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0700"><span class="elsevierStyleSup">140</span></a></p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Potential therapeutic strategies</span><p id="p0140" class="elsevierStylePara elsevierViewall">Monkeypox sickness is largely managed symptomatically, with complications managed and long-term effects avoided. To increase general recovery, fluid intake and proper nutrition are required.<a class="elsevierStyleCrossRef" href="#bb0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0705"><span class="elsevierStyleSup">141</span></a> Early in 2022, Tecovirimat, a medication first investigated and created for smallpox, received approval for MPXV in a few nations; nonetheless, it is not yet generally accessible.<a class="elsevierStyleCrossRef" href="#bb0705"><span class="elsevierStyleSup">141</span></a> In animal tests, the antiviral medications Cidofovir and Brincidofovir, also created for treating smallpox and function by preventing viral DNA polymerase, have revealed their effectiveness.<a class="elsevierStyleCrossRefs" href="#bb0710"><span class="elsevierStyleSup">142–144</span></a> However, there is insufficient information on their efficacy in treating human monkeypox.<a class="elsevierStyleCrossRef" href="#bb0720"><span class="elsevierStyleSup">144</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0725"><span class="elsevierStyleSup">145</span></a></p><p id="p0145" class="elsevierStylePara elsevierViewall">Additionally, research on monoclonal antibody combinations is ongoing. The US Food and Drug Administration has authorized vaccinia immunoglobulins (VIGs), which has shown modest effectiveness against additional orthopoxviruses.<a class="elsevierStyleCrossRef" href="#bb0730"><span class="elsevierStyleSup">146</span></a> Although further research is required, VIG contributes to post-exposure prophylaxis and lessens the severity of the illness.<a class="elsevierStyleCrossRef" href="#bb0720"><span class="elsevierStyleSup">144</span></a> As of right now, MPX is not specifically treated.<a class="elsevierStyleCrossRef" href="#bb0705"><span class="elsevierStyleSup">141</span></a> The CDC advises giving the smallpox vaccination after 4 days of revelation to potentially avoid the illness from occurring and within 2 weeks to lessen the severity of symptoms.<a class="elsevierStyleCrossRef" href="#bb0705"><span class="elsevierStyleSup">141</span></a> First- and second-generation smallpox vaccinations are ineffective in immunocompromised people, and vaccinia immune globulin is used instead.<a class="elsevierStyleCrossRef" href="#bb0735"><span class="elsevierStyleSup">147</span></a> Tecovirimat and brnincidofovir are FDA-passed antivirals used for treating smallpox that can be used to treat MPX, although no trials have been done to support this.<a class="elsevierStyleCrossRef" href="#bb0735"><span class="elsevierStyleSup">147</span></a> Cidofovir, CMX-001, and ST-246 are other promising antivirals.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a></p><p id="p0150" class="elsevierStylePara elsevierViewall">A vaccine that does not have these risk categories and can be easily delivered to children would be excellent for usage in locations where monkeypox is prevalent.<a class="elsevierStyleCrossRef" href="#bb0740"><span class="elsevierStyleSup">148</span></a></p><p id="p0155" class="elsevierStylePara elsevierViewall">There is no vaccination that satisfies these requirements, although several next-generation vaccinations go in the right direction. An attenuated strain of the vaccinia virus called modified vaccinia Ankara (MVA) cannot fully replicate in mammalian cells. When the monkeypox virus was administered in fatal dosages to primate models, MVA demonstrated protection.<a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0745"><span class="elsevierStyleSup">149</span></a> However, the protection offered by this vaccination has not been seen in monkeys with substantially compromised T-cell activity. Another vaccination modified to stop viral replication is LC16m8, which has been demonstrated in non-human primates to protect against severe monkeypox sickness. More than 50 000 students in Japan received the LC16m8 vaccine, and minimal side effects were observed.<a class="elsevierStyleCrossRef" href="#bb0750"><span class="elsevierStyleSup">150</span></a></p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Conclusion</span><p id="p0160" class="elsevierStylePara elsevierViewall">It is widely accepted that many viruses have existed in their natural reservoirs for a very long time. The constant spread of viruses from natural hosts to humans and other animals is largely due to human activities. Data collected on origin, transmission, pathogenesis, genetic evolution, and therapeutic prevention have shown that monkeypox threats to human beings shortly. The rapid proliferation of the monkeypox virus raises many questions, whether the mutation or any other mechanisms drive its development. Therefore, government and health authorities must develop and implement guidelines for researchers and the public to develop new drugs and vaccines to reduce the spread rate of the monkeypox virus.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:17 [ 0 => array:3 [ "identificador" => "xres2078653" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "as0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1773367" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1773368" "titulo" => "Palabras Clave" ] 3 => array:3 [ "identificador" => "xres2078654" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "as0010" ] ] ] 4 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "s0010" "titulo" => "Origin" ] 6 => array:2 [ "identificador" => "s0015" "titulo" => "Epidemiology" ] 7 => array:2 [ "identificador" => "s0020" "titulo" => "MPXV pathogenesis" ] 8 => array:2 [ "identificador" => "s0025" "titulo" => "Diagnostic manifestation" ] 9 => array:2 [ "identificador" => "s0030" "titulo" => "Immune enhancement against monkeypox virus" ] 10 => array:2 [ "identificador" => "s0035" "titulo" => "B cell and antibody protection" ] 11 => array:2 [ "identificador" => "s0040" "titulo" => "T cell immunity" ] 12 => array:2 [ "identificador" => "s0045" "titulo" => "Genomic variations in monkeypox virus" ] 13 => array:2 [ "identificador" => "s0050" "titulo" => "Evolution of monkeypox virus" ] 14 => array:2 [ "identificador" => "s0055" "titulo" => "Potential therapeutic strategies" ] 15 => array:2 [ "identificador" => "s0060" "titulo" => "Conclusion" ] 16 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-09" "fechaAceptado" => "2023-07-06" "PalabrasClave" => array:1 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1773367" "palabras" => array:5 [ 0 => "Monkeypox" 1 => "Pathogenesis" 2 => "Transmission" 3 => "Genetic mutations" 4 => "Health precautions" ] ] 1 => array:4 [ "clase" => "jel" "titulo" => "Palabras Clave" "identificador" => "xpalclavsec1773368" "palabras" => array:5 [ 0 => "Viruela del simio" 1 => "Patogénesis" 2 => "transmisión" 3 => "Mutaciones Genéticas" 4 => "Precauciones de salud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">This review comprehensively analyses human monkeypox caused by the monkeypox virus (MPXV), including its origins, transmission, pathogenesis, immune responses, genetic variations, evolutionary changes, and potential therapeutic strategies. The MPXV belongs to the Poxviridae family and is responsible for the zoonotic viral disease known as human monkeypox (MPX). A multi-nation monkeypox epidemic was declared by the WHO in May 2022, with over 64 290 laboratory-confirmed cases recorded worldwide in several non-endemic countries. Symptoms of MPX include fever, headache, muscular aches, lymphadenopathy, and a recognizable rash that progresses into papules, vesicles, and pustules before finally scabbing over and healing. MPXV is endemic to sub-Saharan Africa, affecting wild animals and resulting in zoonotic epidemics. Delayed vaccination, commerce in exotic animals, international travel, and increased human sensitivity have contributed to the spread of MPXV to new locations. The smallpox vaccination may provide cross-protection against MPXV due to antigenic similarities. Basic health precautions should be followed, including frequent handwashing, nose and mouth covering when coughing, and avoiding ill individuals and overcrowded areas. Safe sexual practices are also recommended in countries reporting monkeypox transmission. Although vaccines are available, but they are limited. The review highlights the need for effective preventive and therapeutic strategies to manage human monkeypox.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Esta revisión analiza exhaustivamente la viruela del simio humana causada por el virus de la viruela del simio (MPXV), incluidos sus orígenes, transmisión, patogenia, respuestas inmunitarias, variaciones genéticas, cambios evolutivos y posibles estrategias terapéuticas. El MPXV pertenece a la familia Poxviridae y es responsable de la enfermedad viral zoonótica conocida como viruela del simio humano (MPX). La OMS declaró una epidemia multinacional de viruela del simio en mayo de 2022, con más de 64 290 casos confirmados por laboratorio registrados en todo el mundo en varios países no endémicos. Los síntomas de la MPX incluyen fiebre, dolor de cabeza, dolores musculares, linfadenopatía y un sarpullido reconocible que progresa a pápulas, vesículas y pústulas antes de finalmente formar costras y sanar. El MPXV es endémico del África subsahariana, afecta a los animales salvajes y provoca epidemias zoonóticas. La vacunación tardía, el comercio de animales exóticos, los viajes internacionales y el aumento de la sensibilidad humana han contribuido a la propagación del MPXV a nuevos lugares. La vacunación contra la viruela puede proporcionar protección cruzada contra MPXV debido a similitudes antigénicas. Se deben seguir las precauciones básicas de salud, incluido lavarse las manos con frecuencia, cubrirse la nariz y la boca al toser y evitar personas enfermas y áreas superpobladas. También se recomiendan prácticas sexuales seguras en los países que informan sobre la transmisión de la viruela del simio. Aunque las vacunas están disponibles, su disponibilidad es limitada. La revisión destaca la necesidad de estrategias preventivas y terapéuticas eficaces para controlar la viruela del simio humano.</p></span>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1020 "Ancho" => 1417 "Tamanyo" => 112547 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">The current regional distribution of monkeypox cases.<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a></p>" ] ] 1 => array:8 [ "identificador" => "f0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1381 "Ancho" => 1417 "Tamanyo" => 129536 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">The pathogenesis of monkeypox, from initial infection to clinical manifestation.</p>" ] ] 2 => array:8 [ "identificador" => "f0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1016 "Ancho" => 1535 "Tamanyo" => 200162 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Stages of the vesiculopustular rash in monkeypox patients.</p>" ] ] 3 => array:8 [ "identificador" => "t0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Sr.# \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reports on monkeypox infections</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Reference \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1970–1999 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2000–2018 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2019–2021 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2022–2023 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pakistan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sri Lanka \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 suspected but 2 confirmed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Republic of Congo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110 (11 confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (suspected) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1238 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0755"><span class="elsevierStyleSup">151–153</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gabon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (1 confirmed, 1970–1990) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0770"><span class="elsevierStyleSup">154–156</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cameroon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1970<span class="elsevierStyleBold">–</span>1990), 4 (1 confirmed, 1991<span class="elsevierStyleBold">–</span>1999) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (28, 29, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0745"><span class="elsevierStyleSup">149</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0785"><span class="elsevierStyleSup">157</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0790"><span class="elsevierStyleSup">158</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central African Republic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (confirmed, 1970–1990) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 (29 confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (28, 29, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0405"><span class="elsevierStyleSup">81</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0795"><span class="elsevierStyleSup">159</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0800"><span class="elsevierStyleSup">160</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Democratic Republic of Congo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">386 (1970–1990), 511 (1991–1999) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not fully enumerable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">200 (suspected) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">439 (30, 31, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0805"><span class="elsevierStyleSup">161</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0810"><span class="elsevierStyleSup">162</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (37 confirmed, 10 probable) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 344 (32, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0815"><span class="elsevierStyleSup">163</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0820"><span class="elsevierStyleSup">164</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nigeria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (3 confirmed, 1970–1990) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">244 (101 confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 (45 confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">829 (33, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0785"><span class="elsevierStyleSup">157</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0825"><span class="elsevierStyleSup">165</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0830"><span class="elsevierStyleSup">166</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ivory Coast \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (confirmed, 1970–1990) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0835"><span class="elsevierStyleSup">167</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">South Sudan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 (10 confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No information available \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (34, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0840"><span class="elsevierStyleSup">168</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sierra Leone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (confirmed, 1970–1990) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0825"><span class="elsevierStyleSup">165</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0845"><span class="elsevierStyleSup">169</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0850"><span class="elsevierStyleSup">170</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liberia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (confirmed, 1970–1990) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (confirmed) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (35, 36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0405"><span class="elsevierStyleSup">81</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0825"><span class="elsevierStyleSup">165</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0855"><span class="elsevierStyleSup">171</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">European regions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 881 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">African Region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1477 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">South East Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Region of Americas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Western Pacific Region \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">406 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRefs" href="#bb0865"><span class="elsevierStyleSup">173–185</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bangladesh \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">? \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3441947.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Reports on monkeypox cases in different countries from 1970 to 2023.</p>" ] ] 4 => array:8 [ "identificador" => "t0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">WHO region \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Confirmed cases \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deaths \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">South East Asia Region</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thailand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eastern Mediterranean Region</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Qatar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">United Arab Emirates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Saudi Arabia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Morocco \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sudan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">African Region</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nigeria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">157 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ghana \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liberia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">South Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cameroon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1477 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Western Pacific Region</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New Zealand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Singapore \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Philippines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Republic of Korea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Japan \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">406 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="30" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">European Region</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Germany \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2887 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Andorra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Croatia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Georgia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hungary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ireland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bosnia and Herzegovina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Czechia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">France \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2239 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gibraltar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">505 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4577 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Türkiye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Denmark \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">108 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Belgium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">482 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Romania \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2759 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Slovenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Latvia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyprus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Greece \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Israel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Luxembourg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Netherlands \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">959 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Czechia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Austria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Montenegro \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Portugal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">710 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 881 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="18" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">American Region</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barbados \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Canada \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">957 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Venezuela (Bolivarian Republic of) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Martinique \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Argentina \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bolivia (Plurinational State of) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dominican Republic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jamaica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Saint Martin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peru \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">340 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brazil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1721 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Costa Rica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Panama \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uruguay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Colombia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mexico \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">United States of America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7510 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2023 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3441946.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Monkeypox confirmed cases in different WHO regions and countries from January 1, 2022 to August 7, 2022<a class="elsevierStyleCrossRef" href="#bb0860"><span class="elsevierStyleSup">172</span></a> and April 28, 2023.<a class="elsevierStyleCrossRef" href="#bb0930"><span class="elsevierStyleSup">186</span></a></p>" ] ] 5 => array:8 [ "identificador" => "t0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sr# \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic methods \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Description \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">References \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polymerase chain reaction (PCR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detects and amplifies specific DNA sequences of the monkeypox virus in a patient sample, providing a highly sensitive and specific result. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0935"><span class="elsevierStyleSup">187</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Enzyme-linked immunosorbent assay (ELISA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detects specific monkeypox virus antigens or antibodies in patient blood samples using antigen–antibody reactions. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0940"><span class="elsevierStyleSup">188</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunohistochemistry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Identifies the presence of monkeypox virus antigens in tissue samples by using antibodies that bind to specific viral proteins. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0945"><span class="elsevierStyleSup">189</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electron microscopy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Visualizes the monkeypox virus particles directly using an electron microscope, providing a detailed morphology of the virus. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0950"><span class="elsevierStyleSup">190</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Serological testing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detects the presence of monkeypox virus-specific antibodies in patient serum samples, indicating a past or current infection. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><a class="elsevierStyleCrossRef" href="#bb0955"><span class="elsevierStyleSup">191</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3441948.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Diagnostic methods for detection of monkeypox virus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:191 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A pox-like disease in cynomolgus monkeys" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ …5] ] ] ] ] ] 1 => array:3 [ "identificador" => "bb0010" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An update of orthopoxvirus molecular evolution" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/v14020388" "Revista" => array:6 [ …6] ] ] ] ] ] 2 => array:3 [ "identificador" => "bb0015" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human monkeypox" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/cit703" "Revista" => array:7 [ …7] ] ] ] ] ] 3 => array:3 [ "identificador" => "bb0020" "etiqueta" => "[4]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exportation of monkeypox virus from the African continent" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/infdis/jiaa559" "Revista" => array:7 [ …7] ] ] ] ] ] 4 => array:3 [ "identificador" => "bb0025" "etiqueta" => "[5]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ …4] ] ] ] ] ] 5 => array:3 [ "identificador" => "bb0030" "etiqueta" => "[6]" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "S. Kumar, G. Subramaniam, K. Karuppanan, Human monkeypox outbreak in 2022, J Med Virol" ] ] ] 6 => array:3 [ "identificador" => "bb0035" "etiqueta" => "[7]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "What to know about monkeypox" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2022.9499" "Revista" => array:6 [ …6] ] ] ] ] ] 7 => array:3 [ "identificador" => "bb0040" "etiqueta" => "[8]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monkeypox: a potential global threat?" 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