A comprehensive review of monkeypox virus and mpox characteristics

Mpox: Global epidemic situation and countermeasures

Mpox, is a zoonotic disease caused by the monkeypox virus and is primarily endemic to Africa. As countries gradually stop smallpox vaccination, resistance to the smallpox virus is declining, increasing the risk of infection with mpox and other viruses. On 14 August 2024, the World Health Organization announced that the spread of mpox constituted a public health emergency of international concern. Mpox's transmission routes and symptoms are complex and pose new challenges to global health. Several vaccines (such as ACAM2000, JYNNEOS, LC16m8, and genetically engineered vaccines) and antiviral drugs (such as tecovirimat, brincidofovir, cidofovir, and varicella immunoglobulin intravenous injection) have been developed and marketed to prevent and control this disease. This review aims to introduce the epidemic situation, epidemiological characteristics, physiological and pathological characteristics, and preventive measures for mpox in detail, to provide a scientific basis for the prevention and control of mpox viruses worldwide.

Exploring monkeypox virus antibody levels: insights from human immunological research

Monkeypox(mpox) is a zoonotic disease caused by the monkeypox virus (MPXV), which was previously endemic to West and Central Africa. However, it has recently appeared in several non-endemic countries beyond Africa. On July 23, 202 WHO declared mpox outbreak a public health emergency of international concern, a declaration reaffirmed on August 14, 2024. In this context, understanding the antibody levels of MPXV in the population has become crucial, especially given the historical cross-protection provided by smallpox vaccination. To provide a comprehensive overview of the current understanding of MPXV antibody levels and the protective efficacy of smallpox vaccination, we conducted a review of the existing literature. We reviewed relevant studies published in peer-reviewed journals from 1958 to 2025, focusing on those that reported research on MPXV antibodies and the effects of smallpox vaccination. Here, we review the research progress of MPXV and smallpox virus(VARV) in epidemiology, etiology, mutation and mechanism of virus infection, clinical characteristics and vaccine application. In addition, the differences in MPXV levels in different populations and the cross-protective effect of smallpox vaccine against mpox were also discussed. Our review indicates that MPXV antibody levels are closely related to the level of immunity in the population, particularly among individuals who have received smallpox vaccination. This narrative review aims to synthesize existing evidence on the role of smallpox vaccination in protecting against mpox and to offer evidence-based guidance for public health policy. We aim to establish a theoretical foundation and practical recommendations for future research and mpox prevention strategies.

A comprehensive review of current diagnostic techniques for Monkeypox virus detection

Monkeypox (Mpox) is an infectious disease caused by the Monkeypox virus (MPXV), initially confined to Central and Western Africa, but now spreading globally. The clinical manifestations are often atypical in the current Mpox outbreak, in addition to the critical challenges in MPXV typing and the difficulty in reliably distinguishing between clades. Therefore, diagnosing Mpox based on clinical signs and symptoms only can be challenging. Current treatment is not specific to MPXV and primarily involves supportive care and antiviral drugs that inhibit viral DNA synthesis, such as Tecovirimat and Brincidofovir. This review provides a comprehensive overview of current laboratory techniques for MPXV detection, encompassing both direct and indirect diagnostic methods. It highlights recent advancements, evaluates the strengths and limitations of each approach, and proposes innovative strategies to enhance global diagnostic capabilities, including the potential roles of computational drug discovery and immunoinformatics in designing multi-epitope vaccines targeting MPXV and its variants. The most effective measure to control MPXV spread remains vaccination, timely diagnosis, isolation of infected individuals, maintaining personal hygiene, and avoiding contact with contaminated persons, objects, and animal waste.

Drug screen reveals new potent host-targeted antivirals against Mpox virus

Mpox virus (MPXV), a re-emerging zoonotic threat, has caused outbreaks in non-endemic regions through respiratory, sexual, and close-contact transmission. The increased transmissibility of Clade IIb fueled the 2022 global outbreak, with 2024 Clade Ib spread in the Democratic Republic of Congo further escalating concern. Both outbreaks were declared public health emergencies by the WHO. Although tecovirimat (TPOXX) has been used off-label for Mpox, its limited effectiveness highlights the critical need for newer antivirals for MPXV. We conducted high-throughput antiviral drug screening using a host-directed kinase inhibitor library composed of 2,750 compounds against 2022 Clade IIb MPXV. Our primary screen identified 138 compounds preventing MPXV cytopathic effects, including multiple inhibitors of EGFR, PI3K-mTOR, and Ras/Raf, as well as apoptosis and autophagy regulators. Secondary and tertiary screenings yielded a shortlist of potent, nontoxic antiviral compounds that inhibited MPXV replication. Three selected compounds, IRAK4-IN-6, SM-7368, and KRAS inhibitor-10, reduced MPXV-induced cell death in primary human epidermal keratinocytes. IRAK4-IN-6 and SM-7368 were also found to modulate NF-κB and STING signaling. Furthermore, these compounds were found effective in reducing skin lesions and viral burden in a mouse model of MPXV skin infection. Together, our study reveals new classes of antiviral compounds against MPXV, offering promising candidates for future clinical development.

Mpox in pregnancy: Unraveling the maternal-fetal risks of a re-emerging disease, a narrative review

Mpox has re-emerged, particularly with the spread of Clade Ib in 2024 and recent outbreaks have raised concerns about its impact on pregnant women. Limited data suggest increased risks of adverse outcomes such as stillbirths and miscarriages, but understanding of mpox in pregnancy remains incomplete. A narrative review of literature was conducted, focusing on maternal-fetal transmission and the implications of different MPXV clades. The spread of Clade Ib, first identified in 2023, has heightened concerns about vertical transmission, particularly in rural African regions where access to diagnostic tools and treatments is limited. The risk of vertical transmission has become a pressing concern, considering the high transmission rates of Clade Ib. Despite limited data, maternal-fetal transmission has been documented, with serious fetal outcomes such as stillbirths and hydrops fetalis. Continued research and surveillance are critical to developing effective clinical guidelines and public health interventions, especially for managing mpox in pregnancy.

Harnessing Nanohybridized Niclosamide for Precision Mpox Therapeutics

Niclosamide, initially developed as an anthelmintic, has recently emerged as a potential antiviral, showing efficacy against diverse viral threats, including Mpox. As the global health landscape faces recurrent Mpox outbreaks, repurposing niclosamide through advanced material strategies offers promising therapeutic avenues. This article explores the antiviral mechanisms of niclosamide, focusing on how innovative nano-hybrid formulations enhance its bioavailability and pharmacological performance. By leveraging nanohybridization, niclosamide's limitations-such as poor solubility and bioavailability-are addressed, enabling targeted delivery and sustained release. Early preclinical studies reveal that niclosamide disrupts Mpox replication and entry processes, suggesting its utility as a therapeutic option against poxvirus infections. Looking forward, further in vitro, animal models, and clinical investigations are essential to optimize its application and dosing for Mpox. With continued development in advanced materials, nanohybrid niclosamide could become a critical tool in managing Mpox and related viral threats, offering an accessible, cost-effective option for outbreak preparedness.

Clade Ia Monkeypox Virus Linked to Sexual Transmission, Democratic Republic of the Congo, August 2024

Several concurrent mpox outbreaks are ongoing in the Democratic Republic of the Congo. We report a case of severe clade Ia mpox in an adult woman with indeterminate HIV status who died 16 days after symptom onset. She self-identified as a sex worker and had spent time in the capital city, Kinshasa.

Isolation and Characterization of E8 Monoclonal Antibodies from Donors Vaccinated with Recombinant Vaccinia Vaccine with Efficient Neutralization of Authentic Monkeypox Virus

BACKGROUND/OBJECTIVES

Monkeypox, twice declared a public health emergency of international concern by the WHO, currently lacks approved targeted therapeutics. This study focused on the development of monkeypox virus (MPXV) E8-specific human monoclonal antibodies (mAbs) derived from recipients of the recombinant vaccinia vaccine (rTV), with subsequent evaluation of their cross-neutralizing activity against orthopoxviruses, including the vaccinia virus (VACV) and MPXV.

METHODS

Three mAbs (C5, C9, and F8) were isolated from rTV vaccinees. Structural mapping characterized their binding domains on the MPXV E8 and VACV D8 proteins. Neutralization potency was assessed against the VACV TianTan strain and MPXV clade IIb. A combo was further evaluated in a VACV-infected mice model for clinical recovery and viral load reduction. Complement-dependent enhancement mechanisms were also investigated in vitro.

RESULTS

C9 targets the virion surface region of E8 and both the virion surface region and intravirion region of D8, showing cross-neutralization activity against the MPXV (IC50 = 3.0 μg/mL) and VACV (IC50 = 51.1 ng/mL) in vitro. All three antibodies demonstrated potent neutralization against the VACV in vitro: C5 (IC50 = 3.9 ng/mL), C9 (IC50 = 51.1 ng/mL), and F8 (IC50 = 101.1 ng/mL). Notably, complement enhanced neutralization against the VACV by >50-fold, although no enhancement was observed for the MPXV. In vivo administration accelerated clinical recovery by 24 h and achieved significant viral clearance (0.9-log reduction).

CONCLUSIONS

E8-targeting mAbs exhibited broad-spectrum neutralization against orthopoxviruses, demonstrating therapeutic potential against both historical (VACV) and emerging (MPXV) pathogens. However, MPXV's resistance to complement-dependent enhancement highlights the necessity for pathogen-adapted optimization. These findings establish E8 as a critical conserved target for pan-poxvirus VACV and MPXV countermeasure development.

Recent Advances in Mpox Epidemic: Global Features and Vaccine Prevention Research

Monkeypox (mpox) is a zoonotic disease (zoonose) caused by the monkeypox virus (MPXV). MPXV, a member of the Orthopoxviridae family, is categorized into two clades, Central Africa (I) and West Africa (II), each of which is further subdivided into subclades a and b. Clade I generally causes more serious illness and higher mortality rates, while Clade II results in milder illness. Historically, mpox epidemics were localized to specific regions and countries in Africa. Since 2022, the mpox epidemic, fueled by MPXV Clade IIb, has swiftly spread across various nations and regions, jeopardizing public health and safety. However, starting in 2024, Clade Ib gradually replaced Clade IIb. The notable genetic variation in Clade Ib may provide MPXV with new opportunities to evade the immune system and adapt to hosts. According to the World Health Organization (WHO), from 1 January 2022, to 24 November 2024, there were 117,663 confirmed cases and 2 probable cases, resulting in 263 deaths across 127 Member States in all six WHO regions. As of 9 January 2025, 12 countries outside Africa have reported imported MPXV Clade Ib cases, with secondary cases emerging in the United Kingdom, Germany, and China. Due to the incomplete development of a vaccine specifically for MPXV, the smallpox vaccine remains in use for preventing mpox or for emergency vaccination post-exposure. Therefore, the persistent spread of mpox is still a major concern, requiring greater awareness and vaccination efforts in populations at high risk. This paper aims to summarize the etiological characteristics, epidemic situation, and vaccine prevention efforts for mpox, offering a reference for managing this serious epidemic and ensuring effective scientific prevention and control.

Portable molecular diagnostic platform for rapid point-of-care detection of mpox and other diseases

The World Health Organization's designation of mpox as a public health emergency of international concern in August 2024 underscores the urgent need for effective diagnostic solutions to combat this escalating threat. The rapid global spread of clade II mpox, coupled with the sustained human-to-human transmission of the more virulent clade I mpox in the Democratic Republic of Congo, highlights a critical gap in point-of-care diagnostics for this emergent disease. In response, we developed Dragonfly, a portable molecular diagnostic platform for point-of-care use that integrates power-free nucleic acid extraction (<5 minutes) with lyophilised colourimetric LAMP chemistry. The platform demonstrated an analytical limit-of-detection of 100 genome copies per reaction for monkeypox virus, effectively distinguishing it from other orthopoxviruses, herpes simplex virus, and varicella-zoster virus. Clinical validation on 164 samples, including 51 mpox-positive cases, yielded 96.1% sensitivity and 100% specificity for orthopoxviruses, and 94.1% sensitivity and 100% specificity for monkeypox virus. Here, we present a rapid, accessible, and robust point-of-care diagnostic solution for mpox, suitable for both low- and high-resource settings, addressing the global resurgence of orthopoxviruses in the context of declining smallpox immunity.

The resurgence of monkeypox clade Ib: a global health emergency and concern

The resurgence of monkey pox (mpox) virus clade Ib, which was declared a global health emergency in August 2024, poses a significant threat worldwide. Initially contained through public health measures, the increased transmissibility of clade Ib strains compared with that of previous strains has led to a rapid rise in cases, particularly in Central Africa. The resurgence highlights disparities in diagnostic capabilities and healthcare infrastructure, leading to underreporting in resource-limited regions. New variants could evade immunity, necessitating continued vaccination efforts for high-risk groups. This review discusses the epidemiological situation, recent outbreaks, clinical features, and public health response, emphasizing the urgent need for global coordination in diagnostic, prevention, and treatment strategies.

Psychosocial impact and stigma on men who have sex with men due to monkeypox

Background

The recent Monkeypox (Mpox) outbreak has disproportionately affected men who have sex with men (MSM), amplifying stigma and discrimination. While prior research examined media portrayals and public perceptions, little is known about MSM's direct experiences. To address this gap, we assess discrimination, stigma, and psychosocial impact across social and healthcare settings.

Methods

A cross-sectional observational study was conducted using a structured, pilot-tested survey to assess discrimination against MSM in media, family, socio-occupational, and healthcare environments.

Results

Among 115 MSM surveyed, 81.7% observed discriminatory comments in media, while discrimination was noted in workplaces (41.7%), by family/friends (45.2%), cohabitants (15.7%), and healthcare (34.8%). Stigma significantly impacted healthcare-seeking behavior, with 33% avoiding medical care due to fear of discrimination. Psychologically, 50.4% reported low mood/anxiety, and 72.7% of those frequently fearing Mpox also experienced these symptoms. The outbreak led 71.3% to alter sexual behavior, primarily reducing encounters (60%). Fear of Mpox was strongly associated with behavioral changes (p < 0.001).

Conclusion

The Mpox outbreak has exacerbated stigma toward MSM, highlighting an urgent need for intervention. Authorities, media, and community leaders must disseminate accurate information and implement psychological support programs to mitigate stigma and its detrimental effects on MSM.

From pox to protection: understanding Monkeypox pathophysiology and immune resilience

The Monkeypox virus (MPXV), which causes Monkeypox (Mpox) is an invasive ailment with global implications. MPXV, categorized within the Orthopoxvirus genus, exhibits diverse clades with varying fatality rates. Initially discovered in monkeys and later in humans, the disease predominantly affects regions across West and Central Africa. Clinical manifestations encompass a spectrum from mild flu-like symptoms to severe eruptions. This article aims to give the scientific community a comprehensive overview of Mpox Pathophysiology and delve into the intricate landscape of host immune responses against MPXV infection. It offers crucial insights into the virus's Pathophysiology, spanning its entry, replication, dissemination, and elicited host responses. The immune reaction to Mpox involves innate immunity, B-cell immunity, and T-cell immunity. Moreover, this review underscores the immunological response and resistance mechanisms against MPXV. It also highlights imperative research areas warranting prioritization to devise more efficacious treatments for controlling viral propagation within healthcare systems. In addition, it gives us a look into possible futures that could help the progress of immunotherapies and cutting-edge biotechnological solutions for protecting against MPXV.

Early Diagnosis and Monitoring of Adaptive Immune Response in a Cohort of Mild Mpox Patients During the 2022 Wave

Our study wanted to describe the kinetics of serological and adaptive immune responses in mpox patients.

METHODS

Fourteen patients with laboratory-confirmed mpox were tested at different time points after the symptom onset. An immunofluorescence assay was performed to evaluate the seroconversion kinetics of specific IgA, IgM, and IgG. Moreover, the characterization of the adaptive immunological profile of T- and B-cells was performed.

RESULTS

The antibody kinetics revealed the faster and more effective seroconversion of specific IgA than IgM. Moreover, we detected an increase in Active memory B cells and CD8+ cells in the early phases of infection, and a reduction in CD4+ T-cells in the mpox patients with respect to the controls and found the presence of higher levels of Treg cells in the HIV+ patients in the early phase of infection.

CONCLUSION

Our data highlight the relevance of specific IgA testing early after the symptom onset, suggesting a possible role as a marker in early diagnosis, especially in close contact subjects. Furthermore, the different maturation states of effector cells in HIV+ patients, together with high Treg levels, may lead us to better understand the role of MPXV-HIV co-infection and identify potential cellular markers to monitor the excessive immune activation involved in mpox disease progression.

The Mpox outbreak is a public health emergency of international concern: Implications for mental health and global preparedness

BACKGROUND

The Mpox, a zoonotic viral disease that has historically affected Central and West Africa, has been declared a Public Health Emergency of International Concern by the World Health Organization. Rapid transmission and recent dissemination in Africa may imply significant challenges to global health, including mental health.

METHODS

We reviewed the mental health implications of the Mpox outbreak according to the published literature. We also discussed the psychological effects of the global spreading of this infection and public health preparedness strategies. Key areas of intervention may include the epidemiological surveillance, vaccine development, and mental health strategies.

COMMENTS

The Mpox outbreak calls for a robust global preparedness to address potential health emergencies. Strengthening epidemiological surveillance, ensuring equitable vaccine distribution, and building resilient public health infrastructure are crucial. Additionally, addressing mental health consequences may require immediate, intermediate, and long-term strategies, including telepsychiatry, stress management training, and the integration of mental health into primary care.

Mpox Virus as a Global Public Health Emergency: A Scoping Review

The monkeypox (Mpox) virus has emerged as a global public health emergency of international concern recently. The virus that was endemic in West and Central Africa has now been reported with chains of global transmission to several countries. A scoping review was carried out from the relevant literature available from PubMed, Scopus and Web of Science. This comprehensive analysis describes the virus epidemiology, pathogenesis, clinical manifestations, complications including secondary bacterial infections, diagnosis, treatment and vaccination. The article underscores the significance of key viral and immune mediators of infection and discusses updated recommendations on therapeutic strategies and vaccination.

Dynamics of Mpox in an HIV endemic community: A mathematical modelling approach

During the 2022 monkeypox (Mpox) outbreak in non-endemic countries, sexual transmission was identified as the dominant mode of transmission, and particularly affected the community of men who have sex with men (MSM). This community experienced the highest incidence of Mpox cases, exacerbating the public health burden they already face due to the disproportionate impact of HIV. Given the simultaneous spread of HIV and Mpox within the MSM community, it is crucial to understand how these diseases interact. Specifically, since HIV is endemic within this population, understanding its influence on the spread and control of Mpox is essential. In this study, we analyze a mechanistic mathematical model of Mpox to explore the potential impact of HIV on the dynamics of Mpox within the MSM community. The model considered in this work incorporates the transmission dynamics of the two diseases, including antiretroviral therapy (ART) for HIV. We assumed that HIV was already endemic in the population at the onset of the Mpox outbreak. Through our analysis, we derived the Mpox invasion reproduction number within an HIV-endemic setting and established the existence and local asymptotic stability of the Mpox-free equilibrium under these conditions. Furthermore, we demonstrated the existence and local asymptotic stability of an Mpox-endemic equilibrium in an HIV-endemic regime. Notably, our findings revealed that the model exhibits a backward bifurcation, a phenomenon that may not have occurred in the absence of HIV within the population. The public health significance of our results is that the presence of HIV in the MSM community could hinder efforts to control Mpox, allowing the disease to become endemic even when its invasion reproduction number is below one. Additionally, we found that Mpox might be more challenging to control in scenarios where HIV increases susceptibility to Mpox. Finally, consistent with previous studies, our analysis confirms that reducing sexual contact can be effective for controlling the spread of Mpox within the MSM community.

Monkeypox: a re-emergent virus with global health implications - a comprehensive review

Monkeypox virus (MPXV) is an enclosed, double-stranded DNA virus from the Orthopoxvirus genus, which also contains variola, vaccinia, and cowpox. MPXV, which was once confined to West and Central Africa, has recently had a rebound, spreading beyond its original range since 2017. The virus is distinguished by its unique morphology, which includes an oval or brick-shaped structure and a complex lipid and protein makeup. The current multi-country outbreak designated a public health emergency in 2022, has highlighted MPXV's shifting epidemiology and ability to spread rapidly over the globe. 'No one is safe until everyone is safe' is a slogan we often heard during the COVID-19 pandemic, which is now also required for the growing global and regional mpox outbreaks. The epidemic is divided into two clades: Clade I and Clade II, which have distinct pathogenic characteristics. Diagnostic approaches have developed with advances in molecular techniques, yet problems persist in resource-constrained situations. This overview summarizes the virus's history, epidemiology, morphology, and clinical characteristics, offering insights into its recent comeback and current global response efforts.

Development and Validation of LAMP Assays for Distinguishing MPXV Clades with Fluorescent and Colorimetric Readouts

Human monkeypox (Mpox) is a zoonotic disease caused by the Monkeypox virus (MPXV). As of 14 August 2024, the World Health Organization (WHO) has declared it a global health emergency. For Mpox, this was the second public health emergency of global significance in the past two years. MPXV belongs to the Poxviridae family and is phylogenetically and epidemically divided into two clades: the Congo Basin (Clade-I) and the West African (Clade-II) clades. Clade-I has been associated with more severe disease progression and higher mortality compared to Clade-II, and thus the differentiation between clades can play an important role in predicting disease prognosis. The LAMP technique has the advantages of not requiring thermal cycling and achieving higher amplification in a shorter time compared to qPCR. Different types of LAMP assays were developed in this study to benefit from these advantages. We report the development of LAMP-1 and LAMP-2 assays using the LAMP method to detect MPXV Clade-I and Clade-II, respectively. The LAMP-1 assay includes both fluorescence and visible colorimetric readout tests developed with sensitivities of 103 and 107 copies, respectively. For the LAMP-2 assay, a probe-based test utilizing the Novel R-Duplex DARQ probe was developed, offering fluorescence detection at a sensitivity of 103 copies. As a result, we successfully developed three highly specific molecular diagnostic tests that distinctly differentiate between MPXV clades, delivering essential tools for the precise diagnosis and effective control of Mpox.

Epidemiology, Pathogenesis, and Treatment Options of Monkeypox: A Narrative Review

Recently, human mpox (monkeypox) has emerged as a global outbreak. This debilitating disease is the result of a zoonotic infection and often entails multiorgan involvement. The knowledge of pathophysiology and treatment options is evolving. This review aims to summarise the pathophysiology and current treatment options of mpox. Prevention and vaccination strategies are out of the scope of this review. We performed a literature review to achieve this objective. Mpox is a zoonotic infection caused by the monkeypox virus, a double-stranded DNA virus. The virus, with debilitating complications, affects multiorgan functions, including skin and other systems. The available treatments for this widespread infection are limited. Only a few antivirals have been sanctioned and approved by the regulatory authorities. We have summarised the efficacy and safety of the three antiviral agents, namely, cidofovir (CDV), brincidofovir (BDV), and tecovirimat. The available limited evidence points towards promising efficacy and tolerability of tecovirimat.

Clade Ib: a new emerging threat in the Mpox outbreak

Monkeypox, a zoonotic virus in the Orthopoxvirus genus, has drawn global attention for its impact on public health. In the current Mpox outbreak, a novel clade, Ib, has emerged as a significant and potentially fatal threat. This review examines the dynamics of MPXV transmission, person-to-person spread, and infection mechanisms, highlighting key risk factors. We explore the clinical features of Mpox, focusing on symptomology, illness duration, and the distinguishing characteristics of clade Ib compared to other clades. A critical analysis addresses diagnostic techniques and emphasizes the need for robust surveillance, particularly for clade Ib detection. We review recent prevention and treatment strategies, including antiviral drugs and vaccines, with a focus on clade Ib containment. The conclusion underscores the urgency of global collaboration to prevent and prepare for emerging threats like clade Ib and identifies crucial research paths and knowledge gaps. This review offers a comprehensive overview of clade Ib, covering its emergence, genetic traits, epidemiological impact, transmission patterns, clinical features, the role of Artificial Intelligence (AI) in outbreak management, detection challenges, and implications for public health response.

Exploring the genomic basis of Mpox virus-host transmission and pathogenesis

Mpox disease, caused by the monkeypox virus (MPXV), was recently classified as a public health emergency of international concern due to its high lethality and pandemic potential. MPXV is a zoonotic disease that emerged and is primarily spread by small rodents. Historically, it was considered mainly zoonotic and not likely to sustain human-to-human transmission. However, the worldwide outbreak of Clade IIb MPXV from 2020 to 2022 and ongoing Clade I MPXV epidemics in the Democratic Republic of the Congo and surrounding areas are a warning that human-adapted MPXVs will continually arise. Understanding the viral genetic determinants of host range, pathogenesis, and immune evasion is imperative for developing control strategies and predicting the future of Mpox. Here, we delve into the MPXV genome to detail genes involved in host immune evasion strategies for this zoonotic rodent-borne and human-circulating virus. We compare MPXV gene content to related Orthopoxviruses, which have narrow host ranges, to identify potential genes involved in species-specific pathogenesis and host tropism. In addition, we cover the key virulence factor differences that distinguish the MPXV clade lineages. Finally, we dissect how genomic reduction of Orthopoxviruses, through various molecular mechanisms, is contributing to the generation of novel MPXV lineages with increased human adaptation. This review aims to highlight gene content that defines the MPXV species, MPXV clades, and novel MPXV lineages that have culminated in this virus being elevated to a public health emergency of national concern.

Navigating monkeypox: identifying risks and implementing solutions

Monkeypox is a zoonotic disease caused by the orthopox virus, a double-stranded DNA virus that belongs the Poxviridae virus family. It is known to infect both animals (especially monkeys and rodents) and humans and causes a rash similar to smallpox. Humans can become infected with monkeypox virus (MPXV) when they get in close contact with infected animals (zoonotic transmission) or other infected people (human-human transmission) through their body fluids such as mucus, saliva, or even skin sores. Frequently observed symptoms of this disease include fever, headaches, muscle aches, and a rash that initially looks like a tiny bump before becoming a lump that is filled with fluid. Monkeypox symptoms also include an incubation period of 5-21 days, divided into prodromal and eruption phases. Several contributing factors, such as smallpox vaccine discontinuation, widespread intake of infected animal products as a source of protein, and high population density, amongst others, have been linked to an increase in the frequency of monkeypox outbreaks. The best course of action for diagnosing individuals who may be suffering from active monkeypox is to collect a sample of skin from the lesion and perform PCR molecular testing. Monkeypox does not presently have a specific therapy; however, supportive care can assist in managing symptoms, such as medication to lower body temperature and pain. Three major orthopoxvirus vaccines have been approved to serve as a preventive measure against monkeypox: LC16, JYNNEOS, and ACAM2000. The discovery that the monkeypox outbreak is communicable both among humans and within a population has sparked new public health worries on the possibility of the outbreak of another viral pandemic. Research and studies are still being conducted to gain a deeper understanding of this zoonotic viral disease. This review is therefore focused on deciphering monkeypox, its etiology, pathogenesis, transmission, risk factors, and control.

Bioinformatic identification of monkeypox virus phylogenetic gene trees that are representative of its whole-genome phylogenetic tree

Phylogenetic analysis based on whole-genome sequences is the gold standard for monkeypox virus (MPXV) phylogeny. However, genomic epidemiology capability and capacity are lacking or limited in resource poor countries of sub-Saharan Africa. Therefore, these make real-time genome surveillance of MPXV virtually impossible. We hypothesized that phylogenetic analysis based on single, conserved genes will produce phylogenetic tree topology consistent with MPXV whole-genome phylogeny, thus serving as a reliable proxy to phylogenomic analysis. In this study, we analyzed 62 conserved MPXV genes and showed that Bayesian phylogenetic analysis based on five genes (OPG 066/E4L, OPG068/E6R, OPG079/I3L, OPG145/A18R, and OPG150/A23R) generated phylogenetic trees with 72.2-96.3% topology similarity index to the reference phylogenomic tree topology. Our results showed that phylogenetic analysis of the identified five genes singly or in combination can serve as surrogate for whole-genome phylogenetic analysis, and thus obviates the need for whole-genome sequencing and phylogenomic analysis in regions where genomic epidemiology competence and capacity are lacking or unavailable. This study is relevant to evolution and genome surveillance of MPXV in resource limited countries.

Monkeypox (Mpox): Diagnosis and Emerging Challenges

Monkeypox (Mpox) has once again been designated a Public Health Emergency of International Concern (PHEIC) as of August, 2024. The severity of the disease is underscored by its significant mortality rate, and unfortunately, there are no targeted therapeutics currently available for this viral infection. Management relies on preventive measures and the use of existing smallpox vaccines due to their genetic similarity to the Mpox virus. Diagnosing a disease is a critical aspect of managing any health condition, and for a highly contagious viral infection like Mpox, it is essential to employ a specific and sensitive diagnostic approach. The lack of adequate diagnostic facilities in laboratories poses a significant challenge, hindering accurate diagnoses and the identification of underlying etiologies, particularly in low-resource settings. Current serology-based diagnostic tests lack specificity for the Mpox virus, leading to cross-reactivity with other orthopoxviruses. With the emergence of new viral variants, molecular and genomic diagnostic methods are far more reliable for accurately confirming Mpox infections. This review focuses on current diagnostic methods approved worldwide and the future challenges that need to be addressed to effectively control and mitigate the spread of Mpox.

Monkeypox 2024 outbreak: Fifty essential questions and answers

As the world still vividly recalls the previous monkeypox (mpox) outbreak that impacted over 120 countries worldwide with more than 99,000 cases in 2022, we are now facing a second wave of infections from the monkeypox virus (MPXV), characterized by an exponential increase in cases. The current 2024 outbreak has already recorded more than 20,000 cases in Africa, marking a dramatic escalation compared to previous outbreaks. The predominance of the newly identified clade Ib variant, first detected in the Democratic Republic of the Congo (DRC) and now identified across multiple African nations and beyond, underscores its enhanced transmissibility and potential for international spread, evidenced by cases in Sweden and Thailand. The World Health Organization (WHO) declared on August 14, 2024, the current mpox outbreak a Public Health Emergency of International Concern (PHEIC), calling for heightened global public health measures. The ongoing pattern of unusual, frequent, and extensive outbreaks of mpox with potential global implications poses significant questions. This review addresses, in the format of 50 questions and answers, the 2024 mpox outbreak, detailing its characteristics, epidemiological data, and impact compared to previous outbreaks. It comprehensively explores critical questions related to MPXV virological characteristics, immunological response, clinical manifestations, epidemiology, diagnostics, and available treatments. The review also documents the significant and evolving challenges posed by the current mpox outbreak, highlighting its scale, spread, and public health response.

Evaluating the Binding Potential and Stability of Drug-like Compounds with the Monkeypox Virus VP39 Protein Using Molecular Dynamics Simulations and Free Energy Analysis

Background/Objectives: Monkeypox is a re-emerging viral disease with features of infectiously transmitted zoonoses. It is now considered a public health priority because of its rising incidence and transmission from person to person. Monkeypox virus (MPXV) VP39 protein is identified as an essential protein for replication of the virus, and therefore, it is a potential target for antiviral drugs. Methods: This work analyzes the binding affinities and the differential conformational stability of three target compounds and one control compound with the VP39 protein through multiple computational methods. Results: The re-docking analysis revealed that the compounds had high binding affinities towards the target protein; among these compounds, compounds 1 and 2 showed the highest binding energies in the virtual screening, and thus, these were considered as the most active inhibitor candidates. Intermolecular interaction analysis revealed distinct binding mechanisms. While compound 1 had very strong hydrogen bonds and hydrophobic interactions, compound 2 had numerous water-mediated interactions, and compound 3 had only ionic and hydrophobic contacts. In molecular dynamic simulations, compounds 1 and 2 showed that the protein-ligand complexes had a stable conformation, with protein RMSD values around 2 Å for both compounds. In contrast, compound 3 was slightly flexible, and the control compound was more flexible. MM/GBSA analysis again supported these results, which gave the binding free energies that were also supportive for these compounds. Conclusions: Notably, all the selected compounds, especially compounds 1 and 2, demonstrate high binding affinity. Therefore, these compounds can be further tested as antiviral agents against monkeypox treatment.

Identification of potential antigenic proteins and epitopes for the development of a monkeypox virus vaccine: an in silico approach

Virus assembly, budding, or surface proteins play important roles such as viral attachment to cells, fusion, and entry into cells. The present study aimed to identify potential antigenic proteins and epitopes that could be used to develop a vaccine or diagnostic assay against the Monkeypox virus (MPXV) which may cause a potential epidemic. To do this, 39 MPXV proteins (including assembly, budding, and surface proteins) were analyzed using an in silico approach. Of these 39 proteins, the F5L virus protein was found to be the best vaccine candidate due to its signal peptide properties, negative GRAVY value, low transmembrane helix content, moderate aliphatic index, large molecular weight, long-estimated half-life, beta wrap motifs, and being stable, soluble, and containing non-allergic features. Moreover, the F5L protein exhibited alpha-helical secondary structures, making it a potential "structural antigen" recognized by antibodies. The other viral protein candidates were A9 and A43, but A9 lacked beta wrap motifs, while A43 had a positive GRAVY value and was insoluble. These two proteins were not as suitable candidates as the F5L protein. The KRVNISLTCL epitope from the F5L protein demonstrated the highest antigen score (2.4684) for MHC-I, while the GRFGYVPYVGYKCI epitope from the A9 protein exhibited the highest antigenicity (1.754) for MHC-II. Both epitopes met the criteria for high antigenicity, non-toxicity, solubility, non-allergenicity, and the presence of cleavage sites. Molecular docking and dynamics (MD) simulations further validated their potential, revealing stable and energetically favorable interactions with MHC molecules. The immunogenicity assessment showed that GRFGYVPYVGYKCI could strongly induce immune responses through both IFN-γ and IL-4 pathways, suggesting its capacity to provoke a balanced Th1 and Th2 response. In contrast, KRVNISLTCL exhibited limited immunostimulatory potential. Overall, these findings lay the groundwork for future vaccine development, indicating that F5L, particularly the GRFGYVPYVGYKCI epitope, may serve as an effective candidate for peptide-based vaccine design against MPXV.

Development of a multiplex real-time PCR for the simultaneous detection of monkeypox virus clades I, II, and goatpox virus

Introduction

Monkeypox virus (MPXV) hosts are of multiple species, with a risk of cross-species transmission. This phenomenon poses a threat to unreported affected domestic animals and increases the risk to human public health. Clinical diagnostics continue to face challenges regarding specificity among poxviruses. The need for a rapid and precise assay to differentiate between MPXV clades I and II, as well as goatpox virus (GTPV) is essential for enhancing our capacity for disease prevention, control, and epidemiological investigation.

Methods

To address this need, we have successfully developed a multiplex real-time PCR assay targeting MPXV D14L gene for clade I, MPXV D18L gene for clade II, and GTPV RPO30 gene, which can simultaneously detect MPXV clades I and II as well as GTPV.

Results

The developed assay demonstrated high sensitivity, with limits of detection at 207.83 copies/reaction for MPXV clade I, 252.07 copies/reaction for MPXV clade II, and 208.72 copies/reaction for GTPV. Importantly, there was no cross-reactivity with other non-pox viruses which infect goats. The assay exhibited excellent repeatability, with coefficients of variation (CV%) for intra-assay and inter-assay ranging from 0.17% to 0.89% and 0.58% to 1.09%, respectively.

Discussion

This assay can serve as a vital resource to safeguard against the MPXV epidemic posing a threat to the life safety of goats, to mitigate potential risks to the sheep farming industry, and to prevent the transmission of MPXV to humans through sheep, which could act as a potential transmission vector for infection.

Mpox Resurgence: A Multifaceted Analysis for Global Preparedness

This study provides an in-depth analysis of mpox, encompassing its history, characteristics, epidemiology, diagnostics, treatment options, and the ongoing evolution of the virus and its transmission dynamics. Mpox, though once successfully eradicated, has re-emerged with new modes of transmission and a broader host range. Genomic analyses have revealed the virus's adaptability, posing challenges for diagnostics and vaccine efficacy. The epidemiology has shifted from sporadic zoonotic transmission in rural Africa to a significant presence in urban areas, particularly impacting high-risk populations. Advancements in diagnostics and therapeutics offer hope, but challenges persist. This work underscores the critical need for enhanced surveillance, vaccination strategies, and continued research to bolster global health systems and preparedness for future outbreaks.

Monkeypox (Mpox) vs. Innate immune responses: Insights into evasion mechanisms and potential therapeutic strategies

Orthopoxviruses, a group of zoonotic viral infections, have emerged as a significant health emergency and global concern, particularly exemplified by the re-emergence of monkeypox (Mpox). Effectively addressing these viral infections necessitates a comprehensive understanding of the intricate interplay between the viruses and the host's immune response. In this review, we aim to elucidate the multifaceted aspects of innate immunity in the context of orthopoxviruses, with a specific focus on monkeypox virus (MPXV). We provide an in-depth analysis of the roles of key innate immune cells, including natural killer (NK) cells, dendritic cells (DCs), and granulocytes, in the host defense against MPXV. Furthermore, we explore the interferon (IFN) response, highlighting the involvement of toll-like receptors (TLRs) and cytosolic DNA/RNA sensors in detecting and responding to the viral presence. This review also examines the complement system's contribution to the immune response and provides a detailed analysis of the immune evasion strategies employed by MPXV to evade host defenses. Additionally, we discuss current prevention and treatment strategies for Mpox, including pre-exposure (PrEP) and post-exposure (PoEP) prophylaxis, supportive treatments, antivirals, and vaccinia immune globulin (VIG).

Neurological Implications of Poxvirus Infections: Pathogenesis, Neurotropism, and Clinical Manifestations

Poxviridae is a diverse family of double-stranded DNA viruses, historically significant for diseases like smallpox caused by variola virus (VARV). These viruses exhibit unique cytoplasmic replication strategies, large genomes encoding numerous proteins, and the ability to cause severe cutaneous and systemic diseases. Recent attention has focused on their neurotropic potential, including mechanisms of CNS invasion, immune-mediated damage, and clinical manifestations such as encephalitis and myelitis. This review synthesises current knowledge on poxvirus neurotropism, highlighting pathophysiological mechanisms and clinical implications.

The Feasibility of Elimination of Monkeypox Virus in Nigeria: A Systematic Review

Monkeypox is a zoonotic virus with an increasing incidence in Nigeria, posing significant public health challenges. The virus, related to smallpox, primarily spreads through direct contact with infected animals or humans and has been noted for its potential for wider transmission due to changing ecological and social dynamics. This research aims to evaluate the feasibility of eliminating monkeypox in Nigeria through integrated approaches involving vaccination, public health strategies, and ecological management. Additionally, it seeks to propose a unified public health strategy, incorporating One Health principles, to achieve the elimination of monkeypox in Nigeria. A review of the feasibility of eliminating the monkeypox virus in Nigeria was conducted using databases like Science Direct, Cochrane, PubMed, and Medline. The search was guided by the methodologies and reporting guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The initial search yielded 89 publications, but the number of articles that required examination was reduced after applying selected keywords and evaluating abstracts. We deemed 32 articles relevant to the subject after applying inclusion and exclusion criteria. The findings are analyzed, highlighting their limitations and strengths and discussing practical implications, knowledge gaps, and recommendations for future research. This study provides evidence supporting the feasibility of the elimination of the monkeypox virus in Nigeria. Strategic recommendations for a sustainable public health approach to eliminating monkeypox emphasize preventive measures, community engagement, and ecological preservation. This study will provide critical insights into the feasibility of eliminating monkeypox in Nigeria, offering a model that can be adapted for other regions facing similar challenges. The integration of health, ecological, and community-focused strategies is expected to contribute significantly to global efforts to control and potentially eradicate monkeypox. This research could serve as a foundational study for public health authorities in Nigeria and internationally, informing policy and operational decisions to control and eliminate monkeypox as a public health threat. The monkeypox virus reemerges in Nigeria, increasing mortality rates. Awareness programs should be conducted on its danger, transmission mode, and potential human transmission. Public education on the lack of treatment and vaccines is crucial. Meat inspection laws should be enforced to ensure safe animal consumption.

Expression analysis and mapping of Viral-Host Protein interactions of Poxviridae suggests a lead candidate molecule targeting Mpox

BACKGROUND

Monkeypox (Mpox) is an important human pathogen without etiological treatment. A viral-host interactome study may advance our understanding of molecular pathogenesis and lead to the discovery of suitable therapeutic targets.

METHODS

GEO Expression datasets characterizing mRNA profile changes in different host responses to poxviruses were analyzed for shared pathway identification, and then, the Protein-protein interaction (PPI) maps were built. The viral gene expression datasets of Monkeypox virus (MPXV) and Vaccinia virus (VACV) were used to identify the significant viral genes and further investigated for their binding to the library of targeting molecules.

RESULTS

Infection with MPXV interferes with various cellular pathways, including interleukin and MAPK signaling. While most host differentially expressed genes (DEGs) are predominantly downregulated upon infection, marked enrichments in histone modifiers and immune-related genes were observed. PPI analysis revealed a set of novel virus-specific protein interactions for the genes in the above functional clusters. The viral DEGs exhibited variable expression patterns in three studied cell types: primary human monocytes, primary human fibroblast, and HeLa, resulting in 118 commonly deregulated proteins. Poxvirus proteins C6R derived protein K7 and K7R of MPXV and VACV were prioritized as targets for potential therapeutic interventions based on their histone-regulating and immunosuppressive properties. In the computational docking and Molecular Dynamics (MD) experiments, these proteins were shown to bind the candidate small molecule S3I-201, which was further prioritized for lead development.

RESULTS

MPXV circumvents cellular antiviral defenses by engaging histone modification and immune evasion strategies. C6R-derived protein K7 binding candidate molecule S3I-201 is a priority promising candidate for treating Mpox.