Mpox infection: A state-of-the-art overview of epidemiological, molecular, and clinical aspects following the 2024 public health emergency
Shayan Zamani, Elahe Noroozi, Alireza Hasanzadeh, Erfan Zamani, John Trinidad, Alireza Firooz
Abstract
Mpox, caused by the monkeypox virus (MPXV), re-emerged as a significant global health issue in 2024, resulting in the declaration of a second Public Health Emergency of International Concern (PHEIC). The emergence of Clade Ib in Central Africa, particularly affecting children and immunocompromised individuals, and the ongoing global spread of Clade IIb have raised concerns about increased transmissibility and virulence, potentially driven by accelerated APOBEC3-mediated viral mutations. Novel vaccination strategies include the licensed JYNNEOS and Japan's LC16 KMB, as well as promising mRNA vaccine candidates currently in clinical trials. Although antiviral therapies, such as tecovirimat, cidofovir, and brincidofovir, remain effective, resistance is emerging among immunocompromised patients. Enhanced diagnostics, including WHO-approved rapid molecular tests, along with preventive strategies such as zoonotic risk reduction and equitable vaccine distribution, are critical. Continued genomic monitoring, enhanced global surveillance and interdisciplinary collaboration are essential to prevent future outbreaks and strengthen global preparedness.