Mpox emergence, epidemiology, biology, clinical features and control

Mpox, a zoonotic orthopoxvirus disease, has transitioned from a rare infection confined to African rainforests to a global public health threat. Originally identified in laboratory monkeys in 1958, the first human case was documented in 1970 in the Democratic Republic of Congo. Following the declaration of smallpox eradication in 1980 and the subsequent cessation of smallpox vaccination, mpox cases persisted at low levels before surging, ultimately leading to the declaration of two Public Health Emergencies of International Concern by the WHO in 2022 and 2024, and the Africa CDC declaration of mpox as a Public Health Emergency of Continental Security in August 2024. Monkeypox virus comprises two major clades: clade I (formerly the Central African clade) subdivided into Ia and emerging Ib variants, and clade II (formerly the West African clade) also subdivided into IIa and the globally circulating IIb subclade. Recent outbreaks demonstrate enhanced human-to-human transmission, particularly through sexual networks, challenging traditional epidemiological patterns. Clinical presentation varies by clade and transmission route, ranging from classical centrifugal rash with high lesion counts to localized anogenital lesions. This Review outlines the emergency, epidemiology, biology, transmission dynamics, risk factors, clinical characteristics, and prevention and control strategies of mpox, and identifies future priorities for addressing this ongoing global issue.