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MM250H1 (Immunity and Infection): Science & Society Paper – Winter 2023
IMM250H1 Winter 2023
Immunity and Infection
Topic: “Monkeypox Virus: The New Old Outbreak?”

Living through the COVID-19 pandemic over the past couple of years has well acquainted even the least
scientifically inclined individual as to what makes an outbreak.

In April 2022, the monkeypox virus (MPXV) entered the international stage. Before this time, monkeypox
(MPX) was rarely seen outside its endemic regions of west and central Africa. Animal reservoirs in endemic
areas primarily include small rodents, and viral transmission to humans and non-human primates usually
occurs by direct contact with blood, bodily fluids, or lesions of infected animals. Human-to-human transmission
occurs from close contact with respiratory secretions, skin lesions of an infected person, or recently
contaminated objects. The usual mild symptoms of MPX resolve in a self-limiting way within a month in
immunocompetent people. In vulnerable populations, including children, the elderly, pregnant women, and
immunocompromised individuals, the disease can be more severe or even deadly.

Despite this general mild disease severity, the recent emergence of MPX in non-endemic regions has become
a cause for global concern. Currently, according to the World Health Organization, there are just under 50,000
cases of MPX in over 90 countries worldwide. Interestingly, being a zoonotic disease, no animal reservoir for
MPXV has yet been identified in non-endemic regions, and incidence does not appear to be linked with travel
history to endemic regions. By the time MPX was declared a worldwide public health concern, inter-human
transmission chains may have already become established, so tracking down the primary source of the 2022
outbreak could be impossible. However, a pattern that has emerged is that MPX appears to overwhelmingly
occur in one specific demographic: men who have sex with men (MSM).

Regardless of everything we do not know about MPX in non-endemic regions, we do know that the current
outbreak will continue to grow if the spread of disease in those most at risk is not limited. To accomplish this,
what needs to be done in terms of education (especially without stigmatization of MSM communities),
research, and treatment? Can lessons from the COVID-19 pandemic be applied to curb the spread of MPX?

Format: 5-6 pages long (max 1800 words); double-spaced; 1-inch margins; 12 pt Times. Your paper can refer
to any assigned course content (required/recommended readings (e.g., papers, textbook), references provided
on slides) or additional references you find on your own. Please do not reference lecture slides. We require a
reference list and in-text citations in Vancouver style (see more at http://advice.writing.utoronto.ca/using-
sources/documentation/).

Assignment Content

The assignment can be approached in several ways, including (but not limited to):
1. Focus on the clinical manifestations and pathogenesis of MPX. What is known about the origins of
the virus that causes this neglected zoonotic disease and how does MPXV relate to other “pox” viruses,
such as smallpox? Where is it endemic and are there any differences in the virus that caused the
current outbreak in non-endemic regions? You should include a discussion of how the disease
progresses in general and high-risk populations and what that might mean in terms of diagnosis,
treatment, and spread prevention.
2. Focus on current human-to-human transmission chains in non-endemic regions. What is it about
MPXV that might make it more transmissible in non-endemic regions? We know that MSM communities
are more likely to become infected; how do we help control the spread of MPX in these communities
and protect high risk individuals without generating unwarranted stigma and fear in the general public
(akin to the HIV/ AIDS epidemic in the 1980s)?
IMM250H1 (Immunity and Infection): Science & Society Paper – Winter 2023
3. Focus on epidemiological factors determining MPX occurrence rates, its distribution and control of
spread in endemic compared to non-endemic regions. Do historical trends match what we are currently
seeing? Discuss the factors that might be contributing to changes in the epidemiology of MPX.
4. Focus on the treatment and prevention of MPX. We know symptoms are generally mild and self-
resolving in most people but what are the available therapies for individuals who develop severe
disease? What can be done to protect people from infection in the first place? Does an MPX vaccine
exist, or can we leverage our knowledge of mRNA vaccine technology developed against COVID-19 to
MPX?
5. A ‘holistic approach’ where any combination of 2 to 3 of the above points are all explored in some
depth, as per word limits.

— Your paper will be assessed using the criteria indicated in the rubric on the next page —