Literature review


How to cite: Gomes CH, Miziara CSMG. Monkeypox and its possible medical and legal consequences. Persp Med Legal Pericia Med. 2023; 8: e230411

The authors inform there is no conflict of interest.


Carlos Henri Gomes(1)

Carmen Silvia Molleis Galego Miziara(1)

(1) Universidade de São Paulo, Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação. São Paulo-SP, Brasil



Introduction: Monkeypox is a disease caused by a virus of the genus Orthopoxvirus of the Poxviridae family, transmitted from animals to humans or between humans. On July 23, 2022, the WHO designated Monkeypox as a Public Health Emergency of International Concern. The consequences of this virus are of medico-legal interest. Objective: To describe and discuss the main health consequences that are of medico-legal interest arising from the Monkeypox disease. Methodology: Narrative review of the literature on Monkeypox in the freely accessible databases Google Scholar, MEDLINE and SciELO without temporal delimitation and including scientific articles obtained in full or from official health websites of the World Health Organization, the Control Center and Disease Prevention from the United States Department of Health and Human Services, as well as from the Brazilian Ministry of Health, followed by a discussion on repercussions of interest to Legal Medicine and Medical Expertise. Conceptual framework: Forensic Medicine lacks understanding of the possible consequences of Monkeypox in their practice, so that studies like this are necessary to aid in their work in favor of social justice. Results: Monkeypox is self-limited in most cases, the main manifestations being fever; chill; adenomegaly; myalgia; and skin rashes. There may also be oral, genital or rectal lesions, from a few to thousands. Common sequelae are permanent scarring in cases of superinfection. Although symptoms of anxiety and depression have been reported, the prevalence of these conditions has not been confirmed. Blindness and varioliform scars are possible sequelae described, but the effects of Monkeypox in the medium and long term still need to be studied. Discussion: The main sequelae found in the literature were scars and blindness. Cases in which there is death or sequelae may generate an allegation of medical malpractice, requiring expert evaluation. Also, in such situations, the patient or his family members may resort to insurance to pay for contracted coverage. The medical expertise will characterize the situation and correlate it with the expected coverage. In order to formalize leave of absence of workers affected by the disease with payment of the corresponding social security benefits, medical expertise will be required. In the event of a disease with a causal link with work, the illness can be equated to an accident at work. The occurrence of blindness can generate sensory impairment compatible with the benefit of continued provision of social assistance. Final considerations: Forensic Medicine and Medical Expertise can provide technical-scientific support for granting benefits or establishing damage and causality in Monkeypox cases. Therefore, expertise can be requested within the criminal, civil, insurance, social security, administrative and labor areas, each with its particularities. Other works that address the possible medico-legal consequences of Monkeypox can contribute to the construction of detailed and specific knowledge for each claim of justice that may arise related to this infection.

Keywords: Forensic Medicine, Monkeypox, Outcomes, Sequelae, Civil Law, Criminal Law;

Bibliographical references

1.McCollum AM, Damon IK (Clin Infect Dis 2013; 58:260-7). Clinical Infectious Diseases. 2014 May 28;58(12):1792–2;

2.NOTA TÉCNICA No 002/2022 SESA/SSVS/GEVS Monkeypox [Internet]. [ 2023 Mar 24]. Disponível em:;

3.OMS declara varíola dos macacos emergência de saúde pública de importância internacional [Internet]. Brasil. 2022 [2023 Mar 24]. Disponível em:;

4.CDC. Mpox in the U.S. [Internet]. Centers for Disease Control and Prevention. 2023. Disponível em:;

5.Trunckle Y, Okamoto C (1 ed). Medicina Legal e Perícias Médicas. Souza, Renee do Ó. 1 ed. Rio de Janeiro, Brasil. Método Essencial; 2022. p. 1,

6.Huhn GD, Bauer AM, Yorita K, Graham MB, Sejvar J, Likos A, et al. Clinical Characteristics of Human Monkeypox, and Risk Factors for Severe Disease. Clinical Infectious Diseases. 2005 Dec;41(12):1742–51;

7.Giulio DBD, Eckburg PB. Human monkeypox: an emerging zoonosis. The Lancet Infectious Diseases [Internet]. 2004 Jan 1;4(1):15–25. Available from:;

8.Minhaj FS. Monkeypox Outbreak — Nine States, May 2022. MMWR Morbidity and Mortality Weekly Report [Internet]. 2022;71(23). Available from:;

9.Thornhill JP, Barkati S, Walmsley S, Rockstroh J, Antinori A, Harrison LB, et al. Monkeypox Virus Infection in Humans across 16 Countries — April–June 2022. New England Journal of Medicine [Internet]. 2022 Jul 21;387(8). Disponível em:;

10.Beer EM, Rao VB. A systematic review of the epidemiology of human monkeypox outbreaks and implications for outbreak strategy. Holbrook MR, editor. PLOS Neglected Tropical Diseases. 2019 Oct 16;13(10):e0007791;

11.Sepehrinezhad A, Ashayeri Ahmadabad R, Sahab-Negah S. Monkeypox virus from neurological complications to neuroinvasive properties: current status and future perspectives. Journal of Neurology. 2022 Aug 21;

12.Badenoch JB, Conti I, Rengasamy ER, Watson CJ, Butler M, Hussain Z, et al. Neurological and psychiatric presentations associated with human monkeypox virus infection: A systematic review and meta-analysis. eClinicalMedicine [Internet]. 2022 Sep 8 [ 2022 Sep 26];101644. Disponível em:;

13.Reynolds MG, McCollum AM, Nguete B, Shongo Lushima R, Petersen BW. Improving the Care and Treatment of Monkeypox Patients in Low-Resource Settings: Applying Evidence from Contemporary Biomedical and Smallpox Biodefense Research. Viruses [Internet]. 2017 Dec 12;9(12). Disponível em:;

14.World Health Organization. Monkeypox [Internet]. World Health Organization; 2022. Disponível em:;

15.McCollum AM, Damon IK. Human Monkeypox. Clinical Infectious Diseases. 2013 Oct 24;58(2):260–7;

16.Singhal T, Kabra SK, Lodha R. Monkeypox: A Review. Indian Journal of Pediatrics. 2022 Aug 10;89(10):955–60;

17.CDC. Mpox in the U.S. [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2023 Mar 25]. Available from:;

18.Adler H, Gould S, Hine P, Snell LB, Wong W, Houlihan CF, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. The Lancet Infectious Diseases. 2022 May;22(8).;

19.Benites-Zapata VA, Ulloque-Badaracco JR, Alarcon-Braga EA, Hernandez-Bustamante EA, Mosquera-Rojas MD, Bonilla-Aldana DK, et al. Clinical features, hospitalisation and deaths associated with monkeypox: a systematic review and meta-analysis. Annals of Clinical Microbiology and Antimicrobials [Internet]. 2022 Aug 10;21(1):36. Disponível em:;

20.Ogoina D, Iroezindu M, James HI, Oladokun R, Yinka-Ogunleye A, Wakama P et al. Clinical Course and Outcome of Human Monkeypox in Nigeria. Clin Infect Dis. 2020 Nov 5;71(8):e210-e214. doi: 10.1093/cid/ciaa143. PMID: 32052029;23.

21.Moschese D, Giacomelli A, Beltrami M, Pozza G, Mileto D, Reato S et al. Hospitalisation for monkeypox in Milan, Italy. Travel Med Infect Dis. 2022 Sep-Oct;49:102417. doi: 10.1016/j.tmaid.2022.102417. Epub 2022 Aug 4. PMID: 35934310;

22.Hércules, Hygino de Carvalho (2 ed). Medicina Legal: texto e atlas. Hygino de Carvalho Hércules.2 ed. São Paulo, Brasil. Editora Atheneu. 2014. p.13;

23.Decreto-Lei nº 2.848, de 7 de Dezembro de 1940. Código Penal. Subchefia para Assuntos Jurídicos. Casa Civil. Presidência da República.  (Dez.7. 1940). [Online]. 2022. [2022 October 05], Disponível em:;

24.Sah R, Abdelaal A, Reda A, Katamesh BE, Manirambona E, Abdelmonem H, et al. Monkeypox and Its Possible Sexual Transmission: Where Are We Now with Its Evidence? Pathogens. 2022 Aug 17;11(8):924;

25.Lei nº10.406, de 10 de Janeiro de 2022. Institui o Código Civil. Subchefia para Assuntos Jurídicos. Casa Civil. Presidência da República. (Jan. 10. 2022). [Online]. 2022. [2022 October 05], Disponível em;

26.França, GV (10 ed), Direito Médico. França GV. Rio de Janeiro, Brasil. 2010. Forense;

27.Grange, P. Papillon, F. Erreus médicales. 2008. Paris: Nil;

28.Nota Técnica nº 002/2022 SESA/SSVS/GEVS. Secretaria da Saúde. Governo do Estado do Espírito Santo. [Online]. 2022. [2022 October 05], Disponível em;

29.Decreto nº 3.048, de 6 de Maio de 1999. Aprova o Regulamento da Previdência Social, e dá outras previdências. Subchefia para Assuntos Jurídicos. Casa Civil. Presidência da República. (Maio. 6. 1999). [Online]. 2022. [2022 October 05], Disponível em;

30.Cunha BE. Monkeypox in the United States. AAOHN Journal. 2004 Apr;52(4):164–8.;

31.Brasil. Lei Orgânica nº 8.742, de 7 de Dezembro de 1993. Dispõe sobre a organização da Assistência Social e dá outras providências. Subchefia para Assuntos Jurídicos. Casa Civil. Presidência da República. Diário Oficial da União 1993; 8 dez. [Online].2022. [October 05], Disponível em:;