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Importance: A global outbreak of clade IIb Monkeypox virus (MPXV) infections spread rapidly across at least 118 countries resulting in a Public Health Emergency of International Concern (PHEIC) from July 2022 to May 2023. This outbreak affected more than 99 000 persons worldwide and caused more than 33 000 infections and 60 deaths in the US. In 2024, there have been approximately 200 new infections per month in the US. On August 14, 2024, the World Health Organization declared mpox a PHEIC for a second time due to a rapid increase in infections with clade I MPXV in Central Africa., Observations: Mpox is primarily acquired through direct skin to skin contact with MPXV. With clade IIb MPXV, infections are most commonly associated with sexual activity among individuals who are gay, bisexual, and other men who have sex with men. After a median incubation period of 7 to 10 days, prodromal symptoms include fever (62%-72%), lymphadenopathy (56%-86%), myalgias (31%-55%), malaise (23%-57%), and headache (25%-55%). Skin lesions progress through 4 well-defined stages (macules, papules, vesicles, and pustules) over 2 to 4 weeks. Clade IIb MPXV is typically a self-limited illness with a low mortality rate (<0.2% in the US); however, severe illness and death may occur in immunocompromised individuals, especially those with advanced HIV (CD4 count <200 cells/μL). Mpox should be suspected in patients with potential exposure to MPXV who have skin lesions, and the diagnosis is confirmed with polymerase chain reaction testing of lesions. Management is supportive and focuses on skin care and symptom relief with analgesics. While no antiviral treatments are currently approved for mpox by the US Food and Drug Administration, several therapeutics, such as tecovirimat, brincidofovir, and vaccinia immune globulin intravenous, are available through expanded access programs or clinical trials. Vaccination with the 2-dose Modified Vaccinia Ankara-Bavarian Nordic vaccine is recommended for high-incidence populations and has an efficacy of 66% to 86%., Conclusions and Relevance: Mpox is a viral infection transmitted primarily through close skin to skin contact that typically causes a self-resolving illness but can result in severe illness and death in immunocompromised individuals. First-line therapy is supportive care, although patients with severe mpox infection may be treated with advanced therapeutics. Mpox vaccination is effective and, if available, should be offered to individuals at risk of exposure to mpox.

This review examines key events, challenges, and responses to the mpox public health emergency following the Africa CDC's declaration of a Public Health Emergency of Continental Concern on August 13, 2024. In response to the crisis, over 3.6 million vaccine doses and more than $150 million in funding have been mobilized globally, with contributions from the United States, European Union, and Japan. However, challenges persist, particularly in the Democratic Republic of Congo, where a humanitarian crisis in Kinshasa has complicated mpox diagnostics and treatment. In response, the Africa CDC has deployed its One Continental Incident Management Support team, with a focus on decentralizing diagnostics and enhancing sample movement through additional PCR equipment, funded by the Pandemic Fund and USAID. To reinforce laboratory diagnostics, surveillance, and case management, the Africa CDC has adopted a comprehensive "One Team, One Plan, One Budget, One M&E" approach and has deployed 72 epidemiologists to improve data integration. Collaborative efforts with WHO, GAVI, and UNICEF aim to expedite vaccine distribution, with a target of 10 million doses by 2025, alongside enhanced vaccine safety monitoring., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: The extent to which infections may have been undetected in an epicenter of the 2022 mpox outbreak is unknown., Methods: A serosurvey (July and August 2022) assessed the seroprevalence and correlates of mpox infection among a diverse sample of asymptomatic patients with no prior mpox diagnoses and no known histories of smallpox or mpox vaccination. We present seropositivity stratified by participant characteristics collected via survey., Results: Two-thirds of 419 participants were cismen (281 of 419), of whom 59.1% (166 of 281) reported sex with men (MSM). The sample also included 109 ciswomen and 28 transgender/gender nonconforming/nonbinary individuals. Overall seroprevalence was 6.4% (95% confidence interval [CI], 4.1%-8.8%); 3.7% among ciswomen (95% CI, 1.0%-9.1%), 7.0% among cismen with only ciswomen partners (95% CI, 2.0%-11.9%), and 7.8% among MSM (95% CI, 3.7%-11.9%). There was little variation in seroprevalence by race/ethnicity, age group, HIV status, or number of recent sex partners. No participants who reported close contact with mpox cases were seropositive. Among participants without recent mpox-like symptoms, 6.3% were seropositive (95% CI, 3.6%-9.0%)., Conclusions: Approximately 1 in 15 vaccine-naive people in our study had antibodies to mpox during the height of the NYC outbreak, indicating the presence of asymptomatic infections that could contribute to ongoing transmission., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Monkeypox virus clade I is endemic in several central African countries and characterised by an increase in disease severity and mortality. Since October, 2023, a large-scale mpox outbreak has emerged in DR Congo, and in March, 2024, the first individuals with mpox were reported outside the endemic areas in Republic of the Congo. We aimed to provide insight into the epidemic by sequencing samples obtained from individuals with mpox in Republic of the Congo., Methods: In this cross-sectional, descriptive study, samples were collected from individuals with suspected mpox between Jan 15 and April 8, 2024, in Brazzaville, Pointe-Noire, Likouala, Cuvette-Centrale, and Plateaux (Republic of the Congo). Blood samples, skin or oropharyngeal swabs, or skin crusts were obtained for molecular diagnosis via real-time PCR. Monkeypox virus sequences were obtained and analysed using newly established nanopore sequencing methodology and bioinformatic pipeline. The sequences obtained were aligned and used to construct a maximum likelihood phylogenetic tree using IG-TREE., Findings: 61 samples were collected from individuals with suspected mpox, 31 of which were positive for monkeypox virus and were included in our analysis (four positive samples were excluded due to unavailability of epidemiological data or insufficient biological material). Individuals who tested positive for monkeypox virus were from Cuvette-Centrale (19 [61%] of 31), Likouala (eight [26%]), and Pointe-Noire (four [13%]). 20 (65%) were male and 11 (35%) were female. Phylogenetic analysis of sequences showed two major clusters within clade Ia. One cluster was made up of four sequences from this study clustering with two monkeypox virus sequences from the current DR Congo outbreak, three older sequences from Central African Republic sequenced between 2017 and 2018, and seven sequences from DR Congo sequenced in 2006-07 and 2022. The second cluster was made up of 16 sequences from this study clustering with sequences from the current DR Congo outbreak. In addition, sequences from Republic of the Congo show multiple phylogenetic positioning suggesting the occurrence of multiple co-circulating strains in the human population., Interpretation: Our findings suggest that multiple monkeypox virus strains are co-circulating in the human population, highlighting the need for implementation of expanded mpox surveillance, especially in countries bordering DR Congo and Republic of the Congo, in combination with control measures focused on containing the current outbreaks in these countries to prevent escalation into a larger-scale epidemic., Funding: Intramural Research Program of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Published by Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Monkeypox (MPX) is a zoonotic viral disease caused by the monkeypox virus (MPXV), which belongs to the Orthopoxvirus genus. The main clinical features of MPX are fever, rash, and lymphadenopathy. It is usually a self-limited disease and can resolve within a few weeks in most cases. MPXV is now becoming a global concern. The world health organization declared the outbreak of MPX in 2022 a global health emergency. In this article, we focus on the mucocutaneous manifestations and differential diagnosis of MPX., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

The 2022-2024 outbreak of MPOX is an important worldwide public health issue that has triggered significant concerns in the scientific community. MPOX is caused by monkeypox virus (MPXV) belonging to the Poxviridae family. The study of MPXV presents a multifaceted challenge due to the diverse viral formThis study was supported by ISIDORe consortium and Agencia Estatal de Investigación.s produced by this pathogen. Notably the intracellular mature viruses (MVs) primarily contribute to localized lesions and host-to-host transmission, while the extracellular enveloped viruses (EVs) are associated with systemic infection. Clinically, MPOX manifests as a vesiculopustular rash that initially emerges on the face and trunk, subsequently spreading throughout the body, with heightened severity observed in immunocompromised individuals. Results obtained in this manuscript indicate that the 2022 outbreak MPXV has a significantly slower viral cycle compared with previous Clade II strains, with WRAIR 7-61 being more intermediate and USA 2003 producing highest viral titers. Additionally, proteomic and phospho-proteomic analysis displays differences in protein expression between these three strains. These findings highlight key differences between the current Lineage B.1 MPXV and previous strains. Further studies will be undertaken to demonstrate if these differences are important for the apparent increased human-to-human transmission mechanisms observed in the Clade IIb MPXV outbreak., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Introduction: Monkeypox (mpox) is an illness caused by the MPX virus and endemic to certain African countries. Historically, sporadic outbreaks have occurred in some non-endemic areas. In 2022, a new variant emerged, clade IIb, causing a global outbreak sustained within sexual networks among men who have sex with men (MSM). To our knowledge, this is the first multi-country study examining mpox epidemiology and clinical features of the 2022-2023 outbreak caused by clade IIb across the Eastern Mediterranean Region (EMR)., Methods: We analyzed datasets of anonymous mpox case-based reports submitted to the World Health Organization (WHO) from May 2022 to December 2023 in the EMR to describe the cumulative incidence, demographics, transmission routes, and clinical outcomes., Results: By the end of 2022, 95 case reports were submitted to the WHO. The first case of mpox was reported in the United Arab Emirates on May 24, 2022. The highest number of cases were reported from Lebanon (27 confirmed cases). Most cases in the EMR were adult males (92 %), 60 % identifying as MSM, and 10 % living with HIV. Most reported symptoms were rash (95.4 %) and fever (69.6 %). No intensive care unit admissions or deaths were reported., Conclusion: In this study we investigated the epidemiology, clinical presentation, and outcomes of the mpox outbreak related to clade IIb in the EMR. We raise concerns about the accuracy and completeness of the data, given that the number of cases reported to the WHO from EMR countries appears to be significantly lower than the number of cases documented within the region. This discrepancy could impact the reliability of the reported figures and the region's response strategies. Despite these challenges, collaborative efforts across EMR countries have laid the groundwork for effective outbreak response, underscoring the importance of ongoing regional cooperation to enhance future preparedness strategies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

We used cross-sectional data from 226 patients with monkeypox virus to investigate the association between anatomic exposure site and lesion development. Penile, anorectal, and oral exposures predicted lesion presence at correlating anatomic sites. Exposure site also predicted the first lesion site of the penis and anus.

We studied a community cluster of 25 mpox cases in Vietnam caused by emerging monkeypox virus sublineage C.1 and imported into Vietnam through 2 independent events; 1 major cluster carried a novel APOBEC3-like mutation. Three patients died; all had advanced HIV co-infection. Viral evolution and its potential consequences should be closely monitored.

Background: Up until recently, monkeypox (mpox) was considered to be a rare zoonotic infection restricted to Central and West Africa. However, in July 2022, the World Health Organization declared mpox to be a public health emergency of international concern, after there were several outbreaks in non-endemic countries. This study assessed the information channels used by individuals accessing the "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" of Istituto Superiore di Sanità (National Institute of Health in Italy) with regard to mpox. We also evaluated their awareness, and knowledge about mpox focusing on transmission and prevention., Methods: This is a cross-sectional study conducted on "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" users, between January and April 2023. The target population was helpline users who were older than 18 years of age, and were phoning the service for the first time (i.e. who have not phoned in the last 12 months). Participants were interviewed using a questionnaire containing 19 questions filled by the interviewer. Collected data were analysed through descriptive statistics, and significance testing., Results: From January to April 2023, "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse" received 2,389 phone calls, 216 of which participated in this study. Most of these were male (85.2%; n=186), single (79.2%; n=171) and in employment (72.2%; n=156). Awareness about mpox was high (71.3%; n=154), with the central and south/islands regional areas having the highest percentage of participants who heard about the virus (84.3%; n=43 vs 72.4%; n=42; p=0.078). Television was the most frequently mentioned source of information about mpox by participants (63%; n=97; p<0.001). This medium was also the most preferred source of information about mpox (39%; n=60; p=0.109). The majority of participants stated that they did not know what mpox is (67.6%; n=146), and less than half knew that it is preventable (42.4%; n=89). Of those who stated that mpox is a preventable illness, less than half knew about the existence of a vaccine (44.9%; n=40; p<0.001)., Conclusions: This study provides insights into the awareness, knowledge, prevention tools and information channels of individuals who contacted the "Telefono Verde AIDS e Infezioni Sessualmente Trasmesse". Useful indications for defining future information campaigns were obtained.

Background: With the widespread outbreak of monkeypox, it is crucial to enhance awareness and understanding of the disease, especially among high-risk individuals. This study aimed to investigate the knowledge levels of individuals seeking preexposure vaccination in Taiwan., Methods: This descriptive cross-sectional questionnaire survey was conducted online, and included a nationwide sample of high-risk adults receiving preexposure vaccination. The questionnaire comprised 30 items with six aspects and explanatory variables. A multivariate logistic regression model was used to identify the factors that influenced participants' knowledge of human monkeypox., Results: Among 2,604 participants, 97.3 % were male, 76.4 % identified as homosexual, and 24.4 % had a history of HIV infection. Approximately half of the participants displayed inadequate knowledge of human monkeypox, with weaker performance in diagnosis and treatment aspects. Using a multivariate logistic model, we found that those with a medical background or higher education level had a better understanding after adjustment for potential confounding factors. Among those with an educational level of college or below, men who had sex with men (MSM) without HIV displayed significantly lower knowledge levels (OR: 0.68; 95 % CI 0.51-0.91)., Conclusions: The existence of a knowledge gap within subgroups of MSM highlights the necessity for targeted educational interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

According to the WHO, more than 90,000 cases of mpox have been reported since the 2022 worldwide outbreak, which resulted in 167 deaths, while a new outbreak in Africa since 2023 has resulted in over 18,000 cases and 617 deaths. Mpox is a zoonosis caused by the monkeypox virus, a double-stranded DNA virus belonging to the Orthopoxvirus genus, which causes smallpox-like illness. Until 2022, cases were predominately located in West and Central Africa, with only sporadic cases and outbreaks reported in other parts of the world. During the 2022 outbreak, the primary mode of transmission was sexual contact among men who have sex with men. The changing epidemiology of mpox resulted in new disease phenotypes and populations at risk, disproportionally affecting people who live with HIV. Commonly presenting as a mild, self-limiting illness, mpox can cause severe and protracted disease in people with HIV with a CD4 count < 200 cell/mm 3 . The global emergence of mpox that followed and intersected with COVID-19 mobilized the scientific community and healthcare stakeholders to provide accurate diagnostics, preventive vaccines and treatment to those most affected. Despite existing gaps, this rapid response helped to contain the outbreak, but challenges remain as new variants emerge. Preparedness and readiness to respond to the next outbreak is crucial in order to minimize the impact to the most vulnerable.

The antiviral drug tecovirimat* has been used extensively to treat U.S. mpox cases since the start of a global outbreak in 2022. Mutations in the mpox viral protein target (F13 or VP37) that occur during treatment can result in resistance to tecovirimat † (1,2). CDC and public health partners have conducted genetic surveillance of monkeypox virus (MPXV) for F13 mutations through sequencing and monitoring of public databases. MPXV F13 mutations associated with resistance have been reported since 2022, typically among severely immunocompromised mpox patients who required prolonged courses of tecovirimat (3-5). A majority of patients with infections caused by MPXV with resistant mutations had a history of tecovirimat treatment; however, spread of tecovirimat-resistant MPXV was reported in California during late 2022 to early 2023 among persons with no previous tecovirimat treatment (3). This report describes a second, unrelated cluster of tecovirimat-resistant MPXV among 18 persons with no previous history of tecovirimat treatment in multiple states., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Todd G. Smith reports that SIGA Technologies, the owner of TPOXX, provided the drug used in the study under a material transfer agreement. Nicole M. Green reports serving as president of the Southern California Society for Microbiology. Daisy McGrath reports support from the Oak Ridge Institute for Science and Education. Meilan Bielby reports unpaid membership on the Association of Public Health Laboratories (APHL) Infectious Disease and Public Health Preparedness committees. Danielle Haydel reports institutional support from APHL to attend the APHL conference. No other potential conflicts of interest were disclosed.

Competing Interests: IA reports funding from the European Union under grant agreement no 101046314 and the UK National Institute for Health and Care Research (NIHR) under grant NF-SI-0616–10037. The views and opinions expressed in this Comment are however those of the authors only and do not necessarily reflect those of the European Union or NIHR; neither the European Union nor NIHR the granting authority can be held responsible for them. JL, CK, and OS declare no competing interests.

Monkeypox is an emerging zoonotic viral disease caused by the Monkeypox virus, traditionally confined to central and west Africa, which has recently spread to other regions worldwide, making it a global health concern...

We aimed to estimate the secondary attack rate of mpox among UK household contacts and determine factors associated with transmission to inform public health management of contacts, during the global outbreak in 2022. Information was collected via NHS and public health services and included age, gender, place of residence, setting, and type of contact. Aggregate information was summarized for the UK. Record level data was combined for England, Wales and Northern Ireland, and multivariable logistic regression was used to determine factors associated with transmission. The secondary attack rate among UK household mpox contacts was 4% (60/1 526). Sexual contact with the index case was associated with a 11-fold increase in adjusted odds of becoming a case in England, Wales, and Northern Ireland (95% CI 5.5-22, p < 0.001). Household contacts outside of London had increased odds compared to London residents (adjusted OR 2.9, 95%CI 1.6-5.4, p < 0.001), while female contacts had reduced odds of becoming a case (aOR: 0.41, 95% CI: 0.15-0.95). We found a low overall secondary attack rate among household mpox contacts with strong evidence of increased transmission risk associated with sexual contact. This evidence will inform the risk assessment of contacts and support prioritization of those with close intimate contact for follow up.

We analysed mpox cases in Burundi from July to September 2024, following the introduction of Clade Ib virus. Of 607 samples from the whole population of suspected cases, 154 were PCR-positive, of whom 85 were children under 15 years, with a higher proportion of female children testing positive. Geographical analysis demonstrates case concentration in Bujumbura Mairie (91/154). Age- and sex-specific interventions, as well as community engagement, are important for outbreak containment, as are targeted public health strategies in Burundi.

We describe cases with monkeypox virus (MPXV) Clade Ib in Burundi from their first detection in July until 20 August 2024. Testing 442 people with vesicular lesions confirmed 170 cases (98 male; 72 female), 82 (48%) being < 15 years old. Differential diagnosis of the first 30 individuals testing MPXV negative revealed chickenpox in 20. Cases occurred in 26 of 49 Burundi health districts, but mostly in Bujumbura Nord (88/170; 67%). Case-derived MPXV genetic sequences from Burundi and South-Kivu (Democratic Republic of the Congo), clustered together in phylogenetic analysis.

In response to the increasing number of mpox cases caused by monkeypox virus (MPXV) clade I in the African continent and the first reported travel-related clade Ib case of mpox in EU/EEA, the European Centre for Disease Prevention and Control surveyed national capability for detection and characterisation of MPXV in the EU/EEA. The results showed high level of capability for case confirmation by PCR, alongside molecular typing methods for identification of MPXV clades and/or clade I subclades within the EU/EEA.

We used published data from outbreak investigations of monkeypox virus clade I in the Democratic Republic of the Congo to estimate the distributions of critical epidemiological parameters. We estimated a mean incubation period of 9.9 days (95% credible interval [CrI] 8.5-11.5 days) and a mean generation time of 17.2 days (95% CrI 14.1-20.9 days) or 11.3 days (95% CrI 9.4-14.0 days), depending on the considered dataset. Presymptomatic transmission was limited. Those estimates suggest generally slower transmission dynamics in clade I than in clade IIb. The time-varying reproduction number for clade I in the Democratic Republic of the Congo was estimated to be below the epidemic threshold in the first half of 2024. However, in the South Kivu Province, where the newly identified subclade Ib has been associated with sustained human-to-human transmission, we estimated an effective reproduction number above the epidemic threshold (95% CrI 0.96-1.27).

We linked 4 mpox cases in South Ubangi, Democratic Republic of the Congo, to transboundary transmission from Central African Republic. Viral genome sequencing demonstrated that the monkeypox virus sequences belonged to distinct clusters of subclade Ia. This finding demonstrates the borderless nature of mpox and highlights the need for vigilant regional surveillance.

Monkeypox virus (MPXV) is zoonotic and capable of infecting many mammal species. However, whether common companion animals are susceptible to MPXV infection is unclear. During July 2022-March 2023, we collected animal and environmental swab samples within homes of confirmed human mpox case-patients and tested for MPXV and human DNA by PCR. We also used ELISA for orthopoxvirus antibody detection. Overall, 12% (22/191) of animal and 25% (14/56) of environmental swab samples from 4 households, including samples from 4 dogs and 1 cat, were positive for MPXV DNA, but we did not detect viable MPXV or orthopoxvirus antibodies. Among MPXV PCR-positive swab samples, 82% from animals and 93% from environment amplified human DNA with a statistically significant correlation in observed cycle threshold values. Our findings demonstrate likely DNA contamination from the human mpox cases. Despite the high likelihood for exposure, we found no indications that companion animals were infected with MPXV.

Competing Interests: DLW was supported by Balvi Filantropic Fund, Barry Satz and Ronald Satz Memorial Fund and Chulalongkorn University (Second Century Fund- C2F Postdoctoral Fellowship), University of Western Australia (Overseas Research Experience Fellowship) and Yamagata Prefectural Central Hospital, Yamagata, Japan (Clinical Residency Fellowship). CM was supported by the Centre of Excellence in Mathematics, Ministry of Higher Education, Science, Research and Innovation, Thailand, Center of Excellence on Medical Biotechnology, and Thailand Center of Excellence in Physics. AKi is a Rothwell Family Fellow. The funder(s) had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. All other authors declare no competing interests. The data supporting the findings of this study are available within this paper and its additional information. All genome sequences and associated metadata in this study are published in GISAID's EpiCoV database under the mpox category (accession numbers are given in the appendix). The institutional review board at Yamagata Prefectural Central Hospital, Yamagata, Japan, waived ethical approval for this work as it determined that our project is exempt under the type of environmental surveillance study. We, the authors of this paper, embrace inclusive, diverse, and equitable conduct of research. Our team comprises individuals who self-identify as underrepresented ethnic minorities, gender minorities, members of the LGBTQIA+ community, and individuals living with disabilities. We actively promote gender balance in our reference list while maintaining scientific relevance. We thank all the volunteers, entertainment venue staff, and sanitary workers who kindly supported the sample collection. Also, thanks to the United States Centers for Disease Control and Prevention (CDC) Thailand for technical support and the previous Chargé d'Affaires of the United States of America to Thailand (U.S. Embassy & Consulate in Thailand) for facilitating collaboration with the CDC and Armed Forces Research Institute of Medical Sciences. We also thank the LGBTQIA+ community in Indonesia, Madagascar, Myanmar, Thailand, Papua New Guinea, Mozambique, Pakistan, Viet Nam, Sri Lanka, India, Philippines, Cambodia, Laos, Timor-Leste, Nepal, Maldives for generously supporting sample collection, TEDxChiangMai team for facilitating a platform for collaboration, and marginalised, vulnerable indigenous communities in Indonesia, Madagascar, Myanmar, Thailand, Papua New Guinea, Mozambique, Pakistan, Viet Nam, Sri Lanka, India, the Philippines, Cambodia, Laos, Timor-Leste, Nepal, and the Maldives for supporting sample collection. Special thanks to Nuttawut Kietchaiyakorn for helping with the illustrations. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps.

Mpox (formerly known as monkeypox) was declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization on 23rd July 2022, however cases of the disease have been detected in Nigeria since the 1970s and more recently since it began spreading in more urban areas of the country from 2017 onward. Nigeria has a strong track record of epidemic preparedness and response, spearheaded by the Nigeria Centre for Disease Control. Despite being somewhat separate architectures on paper, epidemic response (in particular, integrated disease surveillance and response) relies on a foundation of primary health care, which is inadequately funded not only in Nigeria, but globally. Situating mpox response within this wider landscape, we draw on ethnographic research from September 2022-March 2023 in southwestern Nigeria on lived experiences of mpox and mpox response, focusing on the perspectives of frontline health workers and community-based suspected or confirmed mpox cases. We aimed to understand how prioritization and resource constraints shape mpox response at a local level, including effects on the everyday work of frontline health workers in public health and clinical care who are left to "make do." We analyze their experiences interfacing with two intersecting infrastructures, community-based surveillance and primary health care. Health workers' improvisation and "repair work," which we detail, enables the surveillance system to function in some capacity. However, health workers must regularly contend with competing priorities and routine care that may be sidelined during an outbreak or epidemic. We argue that this reveals the limitations of a global health security agenda as it materializes at a local level and the need for strengthening primary health care for longer-term sustainability., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: We declare no competing interests.

Competing Interests: We declare no competing interests. This Correspondence received funding from the National Natural Science Foundation (72334004, 72122001, 71934002).

Outbreaks of monkeypox (mpox) have historically resulted from zoonotic spillover of clade I monkeypox virus (MPXV) in Central Africa and clade II MPXV in West Africa. In 2022, subclade IIb caused a global epidemic linked to transmission through sexual contact. Here we describe the epidemiological and genomic features of an mpox outbreak in a mining region in eastern Democratic Republic of the Congo, caused by clade I MPXV. Surveillance data collected between September 2023 and January 2024 identified 241 suspected cases. Genomic analysis demonstrates a distinct clade I lineage divergent from previously circulating strains in the Democratic Republic of the Congo. Of the 108 polymerase chain reaction-confirmed mpox cases, the median age of individuals was 22 years, 51.9% were female and 29% were sex workers, suggesting a potential role for sexual transmission. The predominance of APOBEC3-type mutations and the estimated emergence time around mid-September 2023 imply recent sustained human-to-human transmission., (© 2024. The Author(s).)

Monkeypox virus (mpox) has currently affected multiple countries around the globe. This study aims to analyze how the virus spread globally. The study uses entropy-driven bioinformatics in five directions to analyze the 60 full-length complete genomes of mpox. We analyzed the topological entropy distribution of the genomes, principal component analysis (PCA), the dissimilarity matrix, entropy-driven phylogenetics, and genome clustering. The topological entropy distribution showed genome positional entropy. We found five clusters of the mpox genomes through the two PCA, while the three PCA elucidated the clustering events in 3D space. The clustering of genomes was further confirmed through the dissimilarity matrix and phylogenetic analysis which showed the bigger size of Cluster 1 and size similarity between Clusters 2 and 4 as well as Clusters 3 and 5. It corroborated with the phylogenetics of the genomes, where Cluster 1 showed clear segregation from the other four clusters. Finally, the study concluded that the spreading of the mpox is likely to have originated from African countries to the rest of the non-African countries. Overall, the spreading and distribution of the mpox will shed light on its evolution and pathogenicity of the mpox and help to adopt preventive measures to stop the spreading of the virus., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Competing Interests: We declare no competing interests.

Background: Since May 7 2022, mpox has been endemic in many countries which has attracted the attention of health authorities in various countries and made control decisions, in which vaccination is the mainstream strategy. However, the shortage of vaccine doses and the reduction of protective efficacy have led to unresolved issues such as vaccine allocation decisions and evaluation of transmission scale., Methods: We developed an epidemiological model to describe the prevalence of the mpox virus in New York City and calibrated the model to match surveillance data from May 19 to November 3, 2022. Finally, we adjusted the model to simulate and compare several scenarios of non-vaccination and pre-pandemic vaccination., Results: Relative to the status quo, if vaccination is not carried out, the number of new infections increases to about 385%, and the transmission time will be extended to about 350%, while if vaccinated before the epidemic, the number of new infections decreases to 94.2-96%., Conclusions: The mpox outbreak in New York City may be linked to the Pride event. However, with current vaccine coverage, there will be no more large-scale outbreaks of mpox, even if there is another similar activity. For areas with limited vaccines, priority is given to high-risk groups in the age group [34-45] years as soon as possible., (© 2024. The Author(s).)

Mpox, caused by the Monkeypox virus (MPXV), has emerged as a significant global public health concern, particularly affecting vulnerable populations. The recent outbreak in the Democratic Republic of the Congo (DRC) is the largest recorded, driven by the highly virulent clade 1 strain. Transmission has shifted from animal contact to primarily sexual contact among Key Populations (KPs) such as Sex Workers (SW) and Men who have Sex with Men (MSM). In Zanzibar, where HIV prevalence is significantly higher among Key Populations, People Living with Human Immunodeficiency Virus (PLHIV) are at increased risk of Mpox infection due to socioeconomic challenges and immunosuppression. Despite no reported cases in Zanzibar, the spread of Mpox in non-endemic areas highlights the need for proactive measures. Leveraging Zanzibar's strengthened public health infrastructure, key strategies include tailored awareness campaigns, improved vaccine access through existing COVID-19 vaccination models, healthcare infrastructure enhancement, and mental health support. These targeted actions aim to protect Zanzibar's most vulnerable populations and bolster preparedness against Mpox, emphasizing the importance of resource-appropriate interventions to mitigate potential outbreaks., (© 2024. The Author(s).)

Monkeypox virus (MPXV) is the zoonotic agent responsible for mpox, an often-self-limiting pox-like disease. Since May 2022, an outbreak characterized by increased human-to-human transmission was detected outside the endemic regions. Whole genome sequencing (WGS) has been successfully used to keep track of viral evolution during outbreaks or for surveillance of multiple pathogens of public health significance. Current WGS protocols for MPXV are either based on metagenomic sequencing or tiled-PCR amplification. The latter allows multiplexing due to the efficient enrichment of the viral DNA, however, mutations or the presence of different clades can negatively influence genome coverage yield. Here, we present the establishment of a novel isothermal WGS method for MPXV based on Phi29 DNA polymerase-based multiple displacement amplification (MDA) properties making use of only 6 primers. This approach yielded from 88% up to 100% genome coverage using either alkaline denatured extracted DNA or clinical material as starting material, with the highest coverage generated by clinical material. We demonstrate that this novel isothermal WGS protocol is suitable for monitoring viral evolution during MPXV outbreaks and surveillance in any conventional laboratory setting., (© 2024. The Author(s).)

Objective: The World Health Organization declared the current monkeypox outbreak a public health emergency of international concern (PHEIC) on July 23, 2022, as it has posed a great threat to human health. This bibliometric analysis aimed to explore the current research hotspots focused on monkeypox., Methods: A systematic search of the Web of Science Core Collection database was conducted for published articles on monkeypox from database inception to February 23, 2023. VOSviewer software was used for analysis and visualization of research results., Results: A total of 1646 publications on monkeypox virus were included for bibliometric analysis. Results showed that (1) the number of publications about monkeypox virus increased significantly in 2022, (2) smallpox and monkeypox virus were popular research keywords, (3) the United States has made the most significant contribution to the study of monkeypox virus, (4) Journal of Virology was the most active journal in publishing articles about monkeypox, and (5) research themes mainly included the body's reaction after monkeypox infection, epidemiology, diagnosis, and pathological mechanisms., Conclusions: Future research should focus on early sensitive diagnostic measures of monkeypox and the development of vaccines based on the characteristics of the virus. Study findings also provided key areas for public health experts to focus on and collaborate with policymakers.

Human monkeypox virus infection (mpox) is a reemerging viral zoonotic disease that has been occurring outside of locations where it has been endemic in Africa. To understand the shifting epidemiology of this disease and respond accordingly, increased clinical skill and professional capabilities are essential. However, there are no studies assessing the knowledge of healthcare professionals in Ethiopia on mpox. Hence, this paper aimed to assess knowledge of the infection and associated factors among healthcare providers in Addis Ababa, Ethiopia, specifically knowledge of diagnosis and treatment of mpox, from November 14, 2022 to November 25, 2022. A facility-based cross-sectional study design was used. Knowledge was assessed using a structured questionnaire, and a 70% Bloom's cutoff point was used to classify the scores. A pretest was conducted in a similar setting before data collection. Frequencies, percentages, and bivariate and multivariate logistic regression analyses were used. The majority of participants, 128 (64.6% with 95% CI), scored below 70% on knowledge questions. Professionals with experience of 5 years or less had better knowledge than those who had worked longer (adjusted odds ratio: 0.301; 95% CI: 0.149-0.609; P = 0.000). Knowledge of mpox among healthcare providers in Addis Ababa was poor across sociodemographic and professional variables. Thus, education on mpox among healthcare providers in Ethiopia is critical in preparing the workforce and limiting potential damage to the country.