Re-emergence of monkeypox: Changing epidemiology, clinical manifestations, and preventive strategies

Monkeypox (MPX), a zoonotic disease caused by an orthopoxvirus, results in a smallpox-like disease in humans. The Democratic Republic of the Congo (DRC) reported the first human cases of MPX in 1970. Before 2000, outbreaks of MPX were regularly reported in Africa Apart from the outbreaks in Congo (2007–2011) and Nigeria (2017–2018), the current outbreak includes mostly men who identified themselves as gay, bisexual or other men who have sex with men. Along with the COVID-19 pandemic, the recent rise in the number of MPX cases reported from non-endemic nations has sounded global concerns and warnings. The current outbreak of MPX in Western countries seems to be a milder disease with reported mortality only of 0.04%. However, according to the World Health Organization, rates of MPX deaths have been between 3% and 6% in recent years, and have reached 11% in the past. This review examines the existing scientific understanding of the disease and highlights the key difference from the classic description of MPX to that of the current epidemic and to provide insight into its changing epidemiology and clinical manifestations.