Mpox unveiled: Global epidemiology, treatment advances, and prevention strategies

Abstract

Mpox (monkeypox), caused by the monkeypox virus (MPXV), is a zoonotic disease from the Poxviridae family, closely related to smallpox. It presents with high fever, rash, and pustules, with human-to-human transmission first reported in the Democratic Republic of Congo in 1970. Historically, such transmissions were rare, but since 2022, an alarming global surge in infections began, originating in the United Kingdom. By mid-2024, 99,176 cases and 208 deaths were reported in 116 countries, prompting the World Health Organization (WHO) to declare Mpox a Public Health Emergency of International Concern (PHEIC) twice, in 2022 and 2024. Although vaccines for smallpox have shown partial efficacy against MPOX, viral transmission persists, and there is no specific therapy or vaccine developed solely for Mpox. Current treatments rely on therapies designed for smallpox, including antivirals like tecovirimat, brincidofovir, and cidofovir. The aim of this review is to provide an updated overview of the epidemiology, clinical presentation, and management strategies of MPOX. We discuss recent progress in diagnosis, treatment, and vaccine development while addressing key prevention strategies. Mpox risk remains high in regions like the Democratic Republic of Congo, moderate in other African countries, and lower globally, particularly among men who have sex with men (MSM), where sexual transmission predominates. Diagnosis is based on clinical presentation, confirmed by PCR testing of skin lesions or swabs, while HIV testing is recommended for adults with Mpox. Preventive measures, including isolation and the use of personal protective equipment (PPE), are essential, alongside the use of two available vaccines, Jynneos and ACAM2000, which show partial efficacy against Mpox.

Keywords: Clades; Monkey pox; PHEIC; Rash; Zoonoses.

Fig. 1

The life cycle of the MPXV within human cells. Unlike many DNA viruses, Mpox completes its entire replication cycle in the cytoplasm, as it encodes all the necessary enzymes for DNA replication and protein synthesis, eliminating the need for nuclear entry. Viral particles are assembled into mature intracellular viruses and released as extracellular enveloped viruses during cell lysis.

Fig. 2

Countries reporting the highest number of recent Mpox cases (all clades). Adapted from WHO Global Mpox trends, updated 25 March 2025. Data as of 28 February 2025 [21].

Fig. 3

Genomic epidemiology of Mpox viruses across clades. Built with https://nextstrain.org/mpox. This visualisation illustrates the global distribution and phylogenetic relationships of mpox virus genomes, highlighting the major clades (Clade I and Clade II, including sublineages). Data shown includes 610 publicly available genomes, with the latest update on 2025-03-30. Clade I (formerly Congo Basin clade) is associated with higher virulence and is predominantly found in Central Africa, while Clade II (formerly West African clade) has spread internationally since 2022, with multiple sublineages now circulating globally. Enabled by genomic data from GenBank and visualized through real-time phylogenetic tracking.

Fig. 4

Sample collection should be performed using only sterile synthetic polyester, nylon, or Dacron swabs. Cotton swabs should not be used. The personnel must use personal protective equipment. Taking two swabs from each lesion, ideally from different body areas or lesions with different characteristics (e.g., two swabs per lesion, with samples taken from 2 to 3 lesions). Each lesion should be thoroughly swabbed to collect sufficient viral DNA while avoiding contaminating the gloves. The figure was made with the assitance of Artificial Inteligence.